Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Chapter 5 Annex
Health Effects Evidence Tables
These tables provide descriptive and methodological information on the studies cited in Chapter 5 that studied primary cigar smokers for all-cause mortality, cardiovascular disease, lung cancer and respiratory illness, oral health and head/neck cancer, and other cancers. The findings and results are discussed in the chapter proper (see Chapter 5 reference list for full citations).
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
TABLE 5A-1 All-Cause Mortality
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Study Period (e.g., Enrollment And FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Chang et al., 2015 PMID: 25907101 | Seven studies contained primary cigar smoking: Best (1966), with 196 cigar smoker deaths, Kahn (1966), with 1,532 deaths, Cole (1974), with 33 deaths, Castensen (1987), with 131 deaths, Lange (1992), with 511 deaths, Ben-Shlomo (1994), with 141 deaths, and Shanks (1998) with 5,216 deaths | Systematic review Study Period: Studies published before 2014 were included. Studies were conducted in different periods but fell within 1951–2000. |
All-cause and cause-specific mortality associated with cigar use | All studies adjusted for age | Primary cigar smoking associated with all-cause mortality based on two studies for primary cigar smoking. Among significant mortality ratios, the estimates were 1.1–1.8. | Current cigar use. Cigar type unspecified and varied by study. | Intensity (cigars per day), inhalation (none, slight, moderate-deep), and duration (less than or greater than 25 years) |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Christensen et al., 2018 PMID: 29459935 | N = 3,537 exclusive cigar smokers with 427 deaths from all-cause mortality | Prospective cohort Study Period: Participants were identified in 1985, 1992, 1995, 1998, 2000, 2001, 2003, 2006, and 2010 and followed to 2011 |
All-cause and cause-specific mortality risk | Adjusted for age, sex, race/ethnicity, education, and survey year | Increased all-cause mortality among current primary cigar smokers compared to never-tobacco users (HR: 1.20; 95% CI: 1.03–1.38); this risk was attenuated among former primary cigar smokers (HR: 1.11; 95% CI: 0.99–1.25). | Current or former use of any cigar (little cigar, cigarillos, large cigar) | Intensity (daily versus nondaily use) |
| Inoue-Choi et al., 2019 PMID: 31321380 | N = 165,335 adults; 1,595 exclusive cigar users | Prospective cohort Study Period: Participants were identified in 1991, 1992, 1998, 2000, 2005, and 2010 and followed to 2015 |
All-cause and cause-specific mortality | Adjusted for sex, education level, race or ethnicity, and survey year (1991, 1992, 1998, 2000, 2005, and 2010) | Increased risk of mortality among current primary cigar smokers, though findings not statistically significant (HR: 1.22; 95% CI: 0.93–1.60). Daily but not nondaily cigar smoking was associated with significantly increased risk of all-cause mortality among current primary cigar smokers. Risk of mortality associated with current primary cigar smoking was lower than observed for cigarettes; it increased significantly with more frequent cigar smoking (daily versus nondaily). | Former, current, current daily, current nondaily, nondaily, previous-daily users of any cigar | Daily versus nondaily users; number of days smoked last 30 days |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Study Period (e.g., Enrollment And FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Rodu and Plurphanswat, 2021 PMID: 33413424 | N = 14,657 deaths, 176 exclusive cigar user deaths | Pooled analysis from the Integrated Public Use Micro-data Series for NHIS surveys Study Period: Participants were identified in 1987, 1991, 1992, 1998, 2000, 2005, and 2010 and followed to 2015 |
Mortality associated with cigar use | Age, race/ethnicity, marital status, educational attainment, family income, region of residence, and survey year | Increased risk of mortality among current primary cigar smokers, not statistically significant (IRR: 1.02; 95% CI: 0.86–1.23) | Never cigar smokers defined as never smoked at least 50 cigars in their lifetime. Current cigar smokers had smoked at least 50 cigars and smoked every day or some days at the time of the survey. Former cigar smokers had smoked at least 50 cigars but did not | Lack of information about frequency and duration of consumption for current smokers and the number of years since quitting for former smokers. Study partially accounted for these deficiencies by distinguishing between exclusive cigar smokers and those with a cigarette smoking history. |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| smoke at the time of the survey. Cigar type not specified. | |||||||
| Thomson et al., 2020 PMID: 32446350 | N = 109,395, 2,535 primary cigar smokers (Cuba) | Prospective study Study Period: 1996–2002 to 2017 |
Cause-specific mortality | Age (in 5-year groups of age at risk, 30–69 years), sex, education completed, province, alcohol consumption, and BMI | Compared to never-smokers, primary cigar smoking was associated with increased all-cause mortality (IRR: 1.27; 95% CI: 1.11–1.46). | Ever cigar smokers | Cigars smoked per day in the past month |
NOTE: BMI = body mass index; CI = confidence interval; HR = hazard ratio; IRR = incidence rate ratio; NHIS = National Health Interview Survey.
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
TABLE 5A-2 Cardiovascular Disease
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (e.g., Enrollment and Follow-Up Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Chang et al., 2015 PMID: 25907101 | Seven studies contained primary cigar smoking: Best (1966), with 196 cigar smoker deaths, Kahn (1966), with 1,532 deaths, Cole (1974), with 33 deaths, Castensen (1987), with 131 deaths, Lange (1992), with 511 deaths, Ben-Shlomo (1994), with 141 deaths, and Shanks (1998) with 5,216 deaths | Systematic review Study Period: Studies published before 2014 were included. Studies conducted during different periods but fell within 1954–2000. |
All-cause and cause-specific mortality associated with cigar use, including coronary heart disease and aortic aneurysm | All studies adjusted for age | Slight and generally nonsignificant increased risk in cigar-only smokers, with the exception of CPS-II study, in which smokers 30–74 years who inhaled moderately deeply or had smoked for 25 or more years had a significant HR of approximately 1.4 | Current cigar use. Cigar type unspecified and varied by study. | Intensity (cigars per day), inhalation (none, slight, moderate-deep), and duration (less than or greater than 25 years) |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Christensen et al., 2018 PMID: 29459935 | N = 3,537 exclusive cigar use, with 2,398 former users and 608 current nondaily and 531 daily. Seventy-two CVD deaths in former cigar users, 53 in current. | Prospective cohort Study Period: Participants were identified in 1985, 1992, 1995, 1998, 2000, 2001, 2003, 2006, and 2010 and followed to 2011 |
Identified cause of death based on ICD-10 codes, including circulatory, cardiovascular, and cerebrovascular causes | Adjusted for age, sex, race/ethnicity, education, and survey year | Age-adjusted risk of circulatory death was significantly increased in former (HR: 1.50; 1.23–1.82) and current (HR: 1.42; 1.12–1.81) cigar smokers compared to never-tobacco users—effects became nonsignificant in multivariable analysis controlling for sex, race and ethnicity, education, and survey year. Age-adjusted risk of CVD death was significantly increased in former (HR: 1.56; 1.25–1.94) but not current (HR: 1.24; 0.94–1.62) cigar smokers, with no significant risk after multivariable analysis. No significant increased risk was found for cerebrovascular disease (small number of deaths). The number of deaths was too low to make a robust analysis of daily versus nondaily use. | Current or former use of any cigar (little cigar, cigarillos, large cigar) | Intensity (daily versus nondaily use) |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (e.g., Enrollment and Follow-Up Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Iribarren et al., 1999 PMID: 10362820 | N = 17,774 men 30–85 years old, followed for 25 years; 1,546 male current cigar users (never smoked cigarettes) | Prospective cohort Kaiser Health system in California; Baseline 1964–1973 with 25-year follow-up |
CVD, both nonfatal and fatal, was determined from hospital discharge diagnoses | Age adjusted for all study outcomes; Covariates included in multivariate analyses of the incidence of cancer, CVD, and COPD were the following: age, race, BMI, history of diabetes mellitus, current alcohol consumption, recent or past occupational exposure, as compared with no exposure. Multivariate analyses of cardiovascular outcomes also | Cigar smoking was associated with a significantly increased risk of coronary heart disease compared to never smokers (RR: 1.27; 1.12–1.45). Risk estimates for cigar smoking and ischemic stroke, hemorrhagic stroke, and peripheral arterial disease were nonsignificant (case numbers were relatively small). Compared to never-smokers, cigar smokers who smoked fewer than five per day had a lower RR for coronary heart disease (1.20; 1.03–1.40) compared to those who smoked five or more (1.56; 1.21–2.01). | No data were available on type of cigar, but it was estimated that 21% smoked large cigars. The study could not distinguish occasional versus daily cigar smokers. | None |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| included educational attainment), systolic blood pressure, and total serum cholesterol level (but not occupational exposure). | |||||||
| Jacobs et al., 1999 PMID: 10665889 | N = 121,278 men, 2,508 deaths | Prospective cohort Study Period: 1982 to 1991 |
Death from coronary heart disease | Adjusted for age, race, marital status, education, alcohol use, BMI, exercise level, self-reported hypertension, environmental tobacco smoke exposure at home, fat intake, vegetable and citrus fruit intake, and use of aspirin, multivitamin, vitamin C, E, and A supplements | 1) Multivariable analysis: rate ratio for coronary heart disease mortality: 1.30 (95% CI: 1.05–1.62) for current cigar smokers aged 30–74 but not significantly increased for those 75+. 2) Analysis by amount smoked found a significant increase in mortality for 2+ cigars per day but no increase for 1 cigar per day. 3) Analysis by duration found an increase in mortality for those who had smoked for 25 or more years but not for less than 25 years. 4) The mortality risk was also higher in those who reported inhaling versus those who did not. |
Current cigar smokers had never smoked cigarettes, and the majority smoked at least daily. Cigar type not specified. | Statistical power was limited so duration, frequency, and inhalation patterns could not be measured precisely. |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (e.g., Enrollment and Follow-Up Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Inoue-Choi et al., 2019 PMID: 31321380 | N = 165,335 adults; 1,595 exclusive cigar users | Prospective cohort Study Period: Participants were enrolled in 1991, 1992, 1998, 2000, 2005, and 2010 and followed to 2015 |
All-cause and cause-specific mortality, including coronary heart disease | Adjusted for sex, education level (<high school, high school, some college or associated degree, college, graduate or professional school, and missing), race or ethnicity (non-Hispanic white, non-Hispanic Black, Hispanic, non-Hispanic other, and missing), and survey year (1991, 1992, 1998, 2000, 2005, and 2010) | Risk of coronary heart disease mortality was strongly associated with daily cigar smokers (HR: 1.32; 0.69–2.30) but not for nondaily cigar smokers (HR: 1.21; 0.57–2.56) compared to never smokers. For cerebrovascular disease death, neither daily nor nondaily cigar use was associated with increased risk compared to never-tobacco users. (The study had a small number of deaths in this category.) | Former, current, current daily, current nondaily, nondaily, previous-daily users of any cigar | Daily versus nondaily users; number of days smoked last 30 days |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Rostron et al., 2019 PMID: 30815336 | Approximately 30,000 respondents each year | Cross-Sectional Study Period: 2000, 2005, 2010, and 2015 |
Angina, coronary heart disease, heart attack, other heart disease, or stroke | Adjusted for sex, age, race/ethnicity, education, alcohol use, and BMI | 1) Current primary cigar smoking was not associated with an increased risk of heart attack or stroke. 2) However, former primary cigar smoking was associated with an increased risk of heart conditions (aPR: 1.33; 95% CI: 1.03–1.72) and stroke (aPR: 2.42; 95% CI: 1.57–3.75) compared to never smokers. |
Current smoker defined as every day or some days. Former defined as having smoked at least 50 cigars but currently not smoking at all. Never use defined as having smoked <50 cigars. Type of cigar not specified. | None. Timing of cessation also was not assessed. |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (e.g., Enrollment and Follow-Up Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Wald and Watt, 1997 PMID: 9224127 | N = 21,520 men | Prospective cohort Study period: Recruited 1975–1982; follow-up period was 11–18 years |
Risk of dying from lung cancer, ischemic heart disease, obstructive lung disease | Adjusted for age at entry of the study | 1) Carboxyhemoglobin levels: secondary cigar smokers had higher levels than primary smokers (1.0% versus 0.9%), with both being much lower than that of cigarette smokers (4.6%). Some cigar smokers who reported moderate to deep inhalation and had carboxyhemoglobin levels similar to those seen in cigarette smokers. 2) Ischemic heart disease mortality data were presented only for combined cigar and pipe smokers. Primary cigar/pipe users |
Compared primary to secondary cigar smokers (those who had switched to cigars from cigarettes). Cigar tobacco consumption defined as one small cigar containing 2 g and one large cigar containing 5 g. Type of cigar was not reported. | None |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| had no higher mortality than lifelong nonsmokers, while secondary cigar/pipe users had a slight but not significant increase in mortality risk (1.29; 95% CI: 0.88–1.99). Current cigarette smokers’ relative mortality compared to never-smokers was 2.27 (95% CI: 1.81–2.84). |
NOTE: aPR = adjusted prevalence ratio; BMI = body mass index; CI = confidence interval; CPS-II = Cancer Prevention Study II; CVD = cardiovascular disease; g = gram; HR = hazard ratio; RR = relative risk.
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
TABLE 5A-3 Lung Cancer and Other Respiratory Illness
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (e.g., Enrollment and Follow-Up Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Boffetta et al., 1999 PMID: 10218507 | N = 120 (43 cases and 77 controls) | Pooled case control Study Period: Studies were conducted between 1988 and 1994 |
Lung cancer | Adjusted for age and by center where study took place | 1) Adjusted OR for smoking cigars and cigarillos only: 9.0 (95% CI: 5.8–14.1). 2) There was a significant trend for duration of tobacco use (p = .0003), average consumption of tobacco in grams per day (p = .01), and cumulative consumption, which combines average consumption and duration of use (p < .0001). 3) Significant trend for age at start (p = .002); those who started before age 19 had an OR of 17.0 (95% CI: 8.6–33.4), and those who started after age 26 had an OR of 3.4 (95% CI: 1.5–8.0). 4) Possible greater effect among inhalers: OR 28.1 (95% CI: 45.7–22.4). An effect was also suggested for inhalation of cigar and cigarillo smoke. |
Smokers (exclusive and poly) of cigars and/or cigarillos | Intensity (consumption of tobacco in grams per day), inhalation, duration (0.1–13.0, 13.1–26.0, 26.1–39.0, ≥39.1), age at start of tobacco use |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Inoue-Choi et al., 2019 PMID: 31321380 | N = 165,335 adults; 1,595 exclusive cigar users | Prospective cohort Study Period: Participants were enrolled in 1991, 1992, 1998, 2000, 2005, and 2010 and followed to 2015 |
Lung cancer | Adjusted for sex, education level (<high school, high school, some college or associated degree, college, graduate or professional school, and missing), race or ethnicity (non-Hispanic white, non-Hispanic Black, Hispanic, non-Hispanic other, and missing), and survey year (1991, 1992, 1998, 2000, 2005, and 2010) | 1) Adjusted HR for lung cancer for former cigar smokers: 0.28 (95% CI: 0.04–2.03), 2) 1.87 (95% CI: 0.53–6.55 for current cigar smokers, 3) 1.50 (95% CI: 0.22–10.09) for current daily cigar smokers, and 4) 2.10 (95% CI: 0.43–10.20) for current nondaily cigar smokers. |
Former, current, current daily, and current nondaily users of any cigar | Daily versus nondaily users; number of days smoked last 30 days |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (e.g., Enrollment and Follow-Up Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Lee et al., 2012 PMID: 22943444 | Fifteen effects from studies were pooled | Meta-analysis Study Period: Papers published before 1999 were included |
Lung cancer | Results were entered with greatest number of potential confounders for which results were available | 1) Random-effects relative risk of lung cancer for ever smoking cigars: 2.95 (95% CI: 1.91–4.56), and 2) Current cigar smoking: 4.67 (95% CI: 3.49–6.25), 3) Ex-smokers: 2.85 (95% CI: 1.45–5.61). |
Ever, current, and former use of any cigar | None |
| McCormack et al., 2010 PMID: 20162568 | N = 1,451 exclusive cigar users with 22 lung cancer cases | Prospective cohort Study Period: 1991–1998 to 2003–2006 |
Lung cancer | Adjusted for BMI, alcohol history, and educational level, stratified by country | 1) For lung cancer, the adjusted HR among current exclusive cigar smokers was significant at 3.9 and 2.4 (95% CI: 0.7–8.2) among every cigar smokers. 2) Lung cancer combined with upper aerodigestive tract and bladder cancers were assessed by inhalation, duration, cigars per week, and cigar size. For more information, see the entry for this study in the other cancers section. |
Exclusive cigar and pipe smoking and in combination with cigarettes | Inhalation, duration, cigars per week, cigar size |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (e.g., Enrollment and Follow-Up Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Jimenez-Ruiz et al., 2002 PMID: 12435319 | N = 37 cigar smokers (4 cases of COPD, hemoptosis, and coughing) | Cross-sectional Study Period: October 1996–April 1997 |
Other respiratory illnesses: COPD and respiratory symptoms | Not adjusted. Reported percentages solely. | 1) 10.8% of exclusive cigar smokers have COPD, 10.8% have hemoptosis, and 10.8% reported a chronic cough. 2) 71.4% of cigar smokers reported never inhaling. |
Exclusive current smoker of any cigar | Inhalation |
| Schneller et al., 2020 PMID: 33320256 | N = 266 (44 cases wheezing ever, 25 cases wheezing in past 12 months, and 25 cases wheezing after exercise) | Cross-sectional Study Period: October 2015–October 2016 |
Other respiratory illnesses: wheezing symptoms | Adjusted for age, gender, race/ethnicity, BMI, insurance, asthma, and secondhand smoke exposure | 1) For cigar users who never smoked, the adjusted OR for indicating “ever had wheezing or whistling in chest at any time in the past” was 0.90 (95% CI: 0.51–1.58), 2) For indicating “in the past 12 months, had wheezing or whistling in the chest” was 0.80 (95% CI: 0.38–1.69), and 3) For indicating “in the past 12 months, chest has sounded wheezy during or after exercize” was 1.02 (95% CI: 0.56–1.86). |
Current, exclusive cigar users were those who had ever smoked a cigar (traditional cigars, cigarillos, or filtered cigars), had smoked at least one cigar product fairly regularly, smoked every day or some days at Wave 3 | None |
NOTE: BMI = body mass index; CI = confidence interval; COPD = chronic obstructive pulmonary disease; HR = hazard ratio; OR = odds ratio.
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
TABLE 5A-4 Oral Health and Head/Neck Cancer
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Iribarren et al., 1999 PMID: 10362820 | N = 17,774; 1,546 exclusive current cigar smokers | Prospective cohort study Study Period: 1971–1996 |
Cancers of UADT (oropharynx, nose, larynx, and esophagus) | Age, race, BMI, diabetes status, alcohol consumption, occupational exposure to hazardous chemicals or substances | 1) Cancer of the oropharynx: Current exclusive cigar smoking: age-adjusted rate: 2.0 per 10,000 person-years (adjusted RR: 2.61; 95% CI: 1.18–5.76). 2) UADT cancer: Current exclusive cigar smoking: age-adjusted rate: 2.4 per 10,000 person-years (adjusted RR: 2.02; 95% CI: 1.01–4.06). |
Never smoked cigarettes and did not currently smoke a pipe; cigar type not specified | Did not assess duration of cigar smoking; unable to separate occasional cigar smokers (those who smoked a few each month) or sporadic cigar smokers (those who smoked a few each year) from others in the study group |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Malhotra et al., 2017 PMID: 28972007 | N = 6,622 cigar smokers across five studies | Pooled analysis of five prospective cohort studies from the NCI Cohort Consortium Study Period: Five studies with different enrollment dates (and median duration of follow-up): 1986 (17.3), 1990–1994 (18.6), 2000–2002 (9.9), 1995–1996 (15.5), 1993–2001 (12.5) |
Cancers of head and neck | Adjusted for age at enrollment, BMI, race/ethnicity, SES, race/ethnicity, alcohol use, family history of cancer | Subgroup analysis that included the two cohort studies with the most detailed data on frequency and duration of tobacco use, exclusive cigar smokers with no history of cigarette smoking had an elevated risk of head and neck cancer (HR: 2.59; 95% CI: 1.21–5.58) | Ever and exclusive use of any cigar | None |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| McCormack et al., 2010 PMID: 20162568 | N = 1,451 exclusive cigar users, 33 for UADT, and 620 all tobacco-related cancers | Prospective cohort Study Period: 1991–1998 to 2003–2006 |
Cancers of UADT (lip, oral cavity, tonsil, oropharynx, esophagus) | Adjusted for BMI, alcohol history, and educational level, stratified by country | 1) Men who ever exclusively smoked cigars had an elevated HR relative to those who never smoked (HR: 4.0; 95% CI: 1.7–9.4). 2) Men who had quit cigarette smoking and became current cigar smokers had an HR for UADT cancer (8.2; 95% CI: 4.1–16.7) that was comparable to that observed for exclusive cigarette smokers (8.9, 95% CI: 3.1–6.6). |
Exclusive cigar and pipe smoking, and in combination with cigarettes | Inhalation, duration, cigars per week, cigar size |
| Shapiro et al., 2000 PMID: 10675383 | N = 137,555, 7,888 current and 7,868 former cigar smokers | Prospective cohort Study Period: 1982 to 1994 |
Mortality from oral cavity/pharynx | Age, alcohol use, and use of snuff or chewing tobacco | 1) Mortality IRR for cancers of the oral cavity or pharynx: 4.0 (95% CI: 1.5–10.3) among current cigar smokers and 2.4 (95% CI: 0.8–7.3) among former cigar smokers. 2) The IRR estimates were |
Ever cigar smokers | Intensity (cigars/day), inhalation (data were too sparse for detailed analysis by number of cigars per day), duration (< 25 years or ≥ 25 years) |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| higher among men who reported inhalation of cigar smoke (IRR: 6.5; 95% CI: 1.4–29.2) than those who did not (IRR: 3.3; 95% CI: 0.9–11.0). | |||||||
| Wyss et al., 2013 PMID: 23817919 | N = 13,935 cases, 18,691 controls; N = 171 every cigar smokers (155 controls) | Pooled data from 13 case-control studies Study Period: within range of 1981–2007 |
Cancers of head and neck (included oral cavity, pharynx, or larynx; excluded lip, salivary glands, nasopharynx, or esophagus) | Sex, age, race, educational level, frequency of alcohol use, and duration of pipe smoking | 1) Among persons who had never smoked cigarettes, those who had ever used cigars were at elevated risk of head and neck cancer compared with those who never used cigars (OR: 2.54; 95% CI: 1.93–3.34). Among cigar smokers who never smoked cigarettes, the odds of head and neck cancer significantly increased with the number of cigars per day, duration of cigar use, and cumulative cigar-years (P for trend <.0001 for all three). 2) In site-specific analysis among persons who never smoked cigarettes, cigar use was associated with increase odds of cancer of the oropharynx (OR: 2.31; 95% CI: 1.54–3.45) and all other sites. |
Ever cigar smokers, unspecified cigar type. | Cigar-years were calculated by multiplying the frequency and duration of smoking cigars. Levels of frequency, duration, and cumulative use of tobacco were categorized according to previous INHANCE Consortium reports. |
NOTE: BMI = body mass index; CI = confidence interval; HR = hazard ratio; INHANCE = International Head and Neck Cancer Epidemiology; IRR = incidence rate ratio; NCI = National Cancer Institute; OR = odds ratio; RR = relative risk; SES = socioeconomic status; UADT = upper aerodigestive tract.
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
TABLE 5A-5 Periodontal Disease
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and Follow-Up Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Krall et al., 1999 PMID: 9919032 | N = 690 (50 cigar smokers) | Prospective cohort Study Period: 1968 to 1991 |
Radiographic alveolar bone loss ≥40% | Age, education, number of teeth at baseline, percentage of alveolar sites with moderate to severe bone loss at baseline, percentage of sites with moderate to severe pocket depth at baseline | 1) Cigar smokers had higher percentage of mesial and distal alveolar sites with bone loss progression than nonsmokers (16% versus 8%, p < .05). 2) Adjusted RR of tooth loss for cigar smokers was 1.3 (95% CI: 1.2–1.5) relative to nonsmokers. |
Exclusive cigar smokers during follow-up period; cigar type unspecified | None |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Vora and Chaffee, 2019 PMID: 30922519 | N = 32,223 unweighted (1.1% of weighted sample were current established cigar smokers) | Cross-sectional Study Period: September 2013–De-cember 2014 |
Self-reported gingival disease diagnosis and treatment for it | Age, sex, race/ethnicity, education, income, employment, history of diabetes | 1) Adjusted OR of gingival disease was 1.9 (95% CI: 1.4–2.7) relative to tobacco never users. 2) Adjusted OR of gingival disease treatment was 1.5 (95% CI 1.2–2.0) relative to tobacco never users. |
Current use defined as using only one product “fairly regularly”: “everyday” or “some days.” Cigar types included traditional and filtered cigars and cigarillos, (results combined) | None |
NOTE: CI = confidence interval; OR = odds ratio; RR = relative risk.
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
TABLE 5A-6 Other Cancers
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Alguacil and Silverman, 2004 PMID: 14744733 | N = 46 (9 cases and 37 controls) | Case control Study Period: August 1986–April 1989 |
Pancreatic cancer risk | Adjusted by race, gender, geographic site, and cigar smoking, smokeless tobacco, and age | Adjusted OR for cigar-only smokers was 1.9 (95% CI: 0.8–4.3). | Regular cigar use of any cigar | None |
| Andreoti et al., 2017 PMID: 28035020 | N = 433 cigar users with 76 cases of total cancers, 24 cases of smoking-related cancers, 10 cases of gastrointestinal cancer, and 9 cases of urinary cancer. N = 44 cigarillo users with 5 cases of total cancers. | Prospective cohort Study Period: 1993–1997 to 2010–2011. |
Total cancer and tobacco-related cancer incidence. Tobacco-related cancers analyzed were bladder, colon, cervix, esophagus, kidney, larynx, lip, liver, lung, myeloid | Adjusted for age, gender, race, state of residence, education, and alcohol use | 1) For cigar use, the adjusted HR was 1.51 (95% CI: 1.20–1.90) for total cancers, 2) 1.87 (95% CI: 1.24–2.82) for smoking-related cancers, and 3) 2.50 (95% CI: 1.27–4.93) for urinary cancer. 4) Other associations were not significant (gastrointestinal) or not available. 5) For cigarillos, only the total cancers adjusted HR was available: 1.44 (95% CI: 0.60–3.48), which is not significant. |
Ever cigar and cigarillo use | None |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| leukemia, nasal and sinus, oral cavity, pancreas, pharynx, rectum, stomach, tongue, ureter, and uterus | |||||||
| Bracci and Holly, 2005 PMID: 15953976 | N = 9 patients, 15 controls | Case control Study Period: 1988–1995 |
NHL incidence, overall and by histology | Adjusted for age | 1) The age-adjusted OR for NHL was 1.3 (95% CI: 0.54–3.0). 2) For follicular NHL, OR was 2.8 (95% CI: 1.1–7.2). 3) For diffuse large cell, OR was 0.42 (95% CI: 0.05–3.2). |
Ever use of any cigar | None |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Chang et al., 2015 PMID: 25907101 | Two studies contained primary cigar smoking: Shanks (1998) with 19 cigar smoker deaths and Shapiro (2000) with 9 cigar smoker deaths | Systematic review Study Period: Studies published before 2014 were included. Shanks (1998): 1959–1960 to 1972 and Shapiro (2000): 1982–1994 |
Mortality from esophageal cancer and BC | All studies adjusted for age |
Esophageal: 1) The adjusted IRR for cigar-only smokers in Shanks (1998) was 3.6 (95% CI: 2.17–5.62), and the HR in Shapiro (2000) was 1.8 (95% CI: 0.90–3.70). 2) In Shanks (1998), the IRR was 2.28 (95% CI: 0.74–5.33) for 1–2 cigars per day, 3.93 (95% CI: 1.43–8.55) for 3–4 cigars per day, and 5.19 (95% CI: 2.23–10.22) for 5 or greater cigars per day, which is suggestive of a dose response. 3) In Shapiro (2000), the HR was 1.8 (95% CI: 0.60–5.00) for 1–2 cigars per day and 1.9 (95% CI: 0.80–4.90) for 3+ cigars per day. |
Current cigar use; cigar type was unspecified and varied by study. | Intensity (cigars per day), inhalation (none, slight, moderate-deep), and duration (less than or greater than 25 years) |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
|
4) In Shanks (1998), the IRR was 3.4 (95% CI: 1.90–5.61) for no inhalation, 1.9 (95% CI: 0.02–10.58) for slight inhalation, and 14.84 (95% CI: 2.98–43.37) for moderate-deep inhalation. 5) In Shapiro (2000), the HR was 1.6 (95% CI: 0.70–4.10) for no inhalation and 1.0 (95% CI: 0.10–7.20) for inhalation. 6) In Shapiro (2000), the HR for smoking cigars for shorter than 25 years was 0.9 (95% CI: 0.10–6.40) and 2.2 (95% CI: 1.00–4.70) for 25 years or longer. 7) Evidence indicates that cigars affect mortality from esophageal cancer and that an increased number of cigars per day is associated with increased mortality. Mortality ratios for BC were 0.94–1.9 for current cigar smoking. |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Christensen et al., 2018 PMID: 29459935 | N = 3,537 exclusive cigar with 32 deaths from tobacco-related cancers | Prospective cohort Study Period: Participants were identified in 1985, 1992, 1995, 1998, 2000, 2001, 2003, 2006, and 2010 and followed to 2011 |
Tobacco-related cancers (bladder, esophagus, larynx, lung, oral cavity, and pancreas) | Adjusted for age, sex, race/ethnicity, education, and survey year | 1) The adjusted HR for current cigar smokers was 1.61 (95% CI: 1.11–2.32) for risk of dying from tobacco-related cancers and 3.26 (95% CI: 1.86–5.71). 2) Among daily cigar users, mortality risks from tobacco-related cancer (HR: 1.80; 95% CI: 1.20–2.69), lung cancer (HR: 4.18; 95% CI: 2.34–7.46), and COPD (HR: 3.29; 95% CI: 1.33–8.17) were elevated and statistically significant. For nondaily use, these associations were not significant. |
Current or former use of any cigar (little cigar, cigarillos, large cigar) | Intensity (daily versus nondaily use) |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Cumberbatch et al., 2016 PMID: 26149669 | Outcomes for 51,404 BC cases and 64,602 controls were included in the meta-analysis. | Meta-analysis Study Period: included 83 studies on BC between 1987 and August 2013 in Europe, America, Asia, and Oceania |
Impact of tobacco exposure on BC incidence and mortality; renal cell cancer (not reported here, as no primary cigar smokers in the study) | If multiple RRs or ORs were presented in the original the authors extracted the estimates from the maximally adjusted model to reduce the risk of possible unmeasured confounding | BC incidence increased among cigar smokers compared to never smokers (RR: 1.62; 95% CI: 1.18–2.22). Relative to other tobacco products, the risk of incident BC was similar for pipe smokers (RR: 1.49; 95% CI: 1.18–1.88) but lower than the risk for cigarette smokers (RR: 3.37; 95% CI: 3.01–3.78). Cigar smoking also had a nonsignificant higher risk of death from BC, but authors noted that BC mortality was less extensively reported in the literature. | Not specified | None |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Inoue-Choi et al., 2019 PMID: 31321380 | N = 165,335 adults; 1,595 exclusive cigar users | Prospective cohort Study Period: Participants were identified in 1991, 1992, 1998, 2000, 2005, and 2010 and followed to 2015 |
BC mortality | Adjusted for sex, education level, race or ethnicity, and survey year (1991, 1992, 1998, 2000, 2005, and 2010) | Compared to never-tobacco users, HRs for BC mortality were 5.68 (95% CI: 0.74–43.69) for current exclusive cigar smokers, 4.65 (2.65–8.17) for current exclusive cigarette smokers, and 6.90 (1.06–45.14) for current exclusive smokeless tobacco use. | Former, current, current daily, current nondaily, nondaily, previous-daily users of any cigar | Daily versus nondaily users; number of days smoked last 30 days |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Malhotra et al., 2017 PMID: 28972007 | N = 6,622 cigar smokers across five studies | Pooled analysis of five prospective cohort studies from the NCI Cohort Consortium Study Period: Five studies with different enrollment dates (and median duration of follow-up): 1986 (17.3), 1990–1994 (18.6), 2000–2002 (9.9), 1995–1996 (15.5), 1993–2001 (12.5) |
Incidence of smoking-related cancers, such as head and neck, esophagus, lung, stomach, liver, pancreas, kidney, and bladder | Adjusted for age at enrollment, BMI, race/ethnicity, SES, race/ethnicity, alcohol use, family history of cancer | 1) The adjusted HR for ever cigar use was 1.47 (95% CI: 1.34–1.61) for smoking-related cancers (head and neck, esoph agus, lung, stomach, pancreas, liver, kidney, bladder, and colorectal) and 1.07 (95% CI: 1.02–1.16) for all cancers. No other significant associations existed except for lung cancer. 2) For exclusive cigar use, the risk of gastric cancer was 1.96 (95% CI: 0.99–3.88) and of all cancers was 1.41 (95% CI: 1.04–1.91). Esophageal Cancer The adjusted HR for ever cigar use was 1.01 (95% CI: 0.56–1.84). The adjusted HR for exclusive cigar use was 1.39 (95% CI: 0.35–5.47). BC Compared to never smokers, HRs for incidence of BC were 1.14 (95% CI: 0.88–1.48) for ever cigar smokers only and 1.40 (95% CI: 1.07–1.84) for ever pipe smokers only. |
Ever and exclusive use of any cigar (exclusive cigar use was defined as 100% of lifetime tobacco consumption coming from cigar use). | None |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| McCormack et al., 2010 PMID: 20162568 | N = 1,451 exclusive cigar users with 22 lung cancer cases, 33 upper aerodigestive tract (UADT), 81 bladder, 29 liver, 77 stomach, 51 pancreas, 63 kidney, 264 colorectal cancers, and 620 all tobacco-related cancers | Prospective cohort Study Period: Recruitment between 1991 and 1998, and participants were followed until 2003–2006 depending on country |
Incidence of lung, UADT, bladder, liver, stomach, pancreas, kidney, colorectal cancers, and all tobacco-related cancers (lung, UADT, bladder, liver, stomach, pancreas, kidney and colorectal) | Adjusted for BMI, alcohol history, and educational level, stratified by country | 1) Compared to never-smokers, HR of cancers of lung, UADT, and bladder combined was 2.2 (95% CI: 1.3–3.8) for exclusive cigar smokers. The study found no significant associations for overall current cigar smoking and esophagus, pancreas, and BC mortality risk. 2) For combined lung, UADT, and bladder cancers, cigar size and duration of smoking trend were assessed and not significant (although the trend was close to significant with duration). 3) Those with light/deep inhalation had higher HR than those who did not inhale (7.5 versus 1.8). There did appear to be somewhat |
Exclusive cigar and pipe smoking, and in combination with cigarettes | Inhalation, duration, cigars per week, cigar size |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| of a pattern for cigars per week: 14+ cigars had an HR of 4.1, while smoking fewer than 7 had an HR of 2.0. | |||||||
| Pitard et al., 2001 PMID: 11519763 | N = 50 “pure” cigar smokers only smokers with 122 controls | Pooled Analysis (6 case-control studies from Denmark, France, Germany, and Spain) Study Period: Reviewed studies were published between 1980 and 1996 |
BC risk | Adjusted for age, center, and occupational exposure | The OR for BC was 2.3 (95% CI: 1.6–3.5) for primary cigar smoking, 1.9 (95% CI: 1.2–3.1) for primary pipe smoking, and 3.5 (95% CI: 2.9–4.2) for primary cigarette smoking compared to never-smokers. | Not specified | Duration of smoking and time since quitting (for ex-smokers) was ascertained in all studies. Average daily consumption was ascertained in two studies. Analysis of daily tobacco consumption was restricted to two studies. |
Suggested Citation:"Chapter 5 Annex: Health Effects Evidence Tables." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
| Reference | Sample Size (Number of Exclusive Cigar Users in Study) | Study Design and Period (E.g., Enrollment and FollowUp Years) | Operationally Defined Outcomes | Confounders or Adjusted Factors | Results | Cigar Use Definition | Other Cigar Use Characteristics: Inhalation, Duration, Intensity |
|---|---|---|---|---|---|---|---|
| Shapiro et al., 2000 PMID: 10675383 | N = 7,848 former cigar smokers with 30 deaths from pancreatic cancer and 10 deaths from BC. N = 7,866 current cigar smoker with 28 deaths from pancreatic cancer and 6 deaths from BC | Prospective cohort Study Period: 1982–1994 |
Mortality from lung, oral cavity/pharynx, larynx, esophagus, pancreas, and bladder | Adjusted by age, alcohol use, and use of snuff or chewing tobacco | 1) For former cigar smokers, the adjusted HR of pancreatic cancer was 1.1 (95% CI: 0.7–1.6) and BC was 1.3 (95% CI: 0.7–2.5). 2) For current cigar smokers, the adjusted HR of pancreatic cancer was 1.3 (95% CI: 0.9–1.9) and BC was 1.0 (95% CI: 0.4–2.3). 3) Adjusted HRs were higher for cigar users reporting inhalation than those reporting no inhalation. The adjusted HR for pancreatic cancer was 2.7 (95% CI: 1.5–4.8), and BC was 3.6 (95% CI: 1.3–9.9). 4) Data were insufficient to assess intensity or duration for BC. A slight trend for cigars per day and duration may exist. |
Ever | Intensity (cigars/day), inhalation, duration (less than 25 years or greater than or equal to 25 years) |
NOTE: BC = bladder cancer; BMI = body mass index; CI = confidence interval; COPD = chronic obstructive pulmonary disease; HR = hazard ratio; IRR = incidence rate ratio; NCI = National Cancer Institute; NHL = non-Hodgkin lymphoma; OR = odds ratio; RR = relative risk; SES = socioeconomic status; UADT = upper aerodigestive tract.
