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¹ Note that when the terms “cigar(s)” or “cigars in general” are used in this report, they refer to all cigar types (filtered cigars, little cigars, cigarillos, and large/traditional cigars [which include premium cigars]). When discussing a specific cigar type, the type is noted in text.

² Note that quotations are used at the first occurrence of the term “premium” in each chapter, as there is no formally agreed upon definition of what constitutes a premium cigar, and different entities might use this term differently. See Chapter 1 for more information.

and Reducing Tobacco Use, synthesized data to demonstrate a causal relationship between tobacco advertising and promotion and increased use (NCI, 2008). Surgeon General reports on tobacco have underscored that “advertising and promotional activities by the tobacco companies cause the onset and continuation of smoking among adolescents and young adults” (HHS, 2012, 2014). The committee found no evidence to suggest that the effects of advertising and promotion of premium cigars would differ from that of other tobacco products. This chapter summarizes and identifies the unique literature related to premium cigars and cigars in general, which builds on the conclusions in Monographs 9 and 19.

Cigar use, including of premium cigars, began to increase in 1993 when promotional activities increased (NCI, 1998). Prior to 1993, cigar smoking had declined by 66 percent, a trend that began in the mid-1960s (NCI, 1998). However, as the promotion and sales of large cigars expanded, cigar use grew rapidly between 1993 and 1997, with premium consumption increasing by nearly 50 percent (NCI, 1998). Consolidated Cigar, General Cigar, and Swisher International were major premium cigar companies whose media spending increased during this period (NCI, 1998). Premium cigars (as a percentage of total cigar consumption) decreased from 4.1 percent in 1999 to 2.2 percent in 2012 (Maxwell, 2006, 2013), and has remained relatively constant through 2020 (see Table 3-1 in Chapter 3). Given this sharp reversal, NCI initiated a monograph to explore various aspects of cigar use, including marketing (NCI, 2008).

decreasing exposure among targeted populations and the deceptive or misleading nature of marketing (NCI, 2008).

Regulations

Federal regulations aim to restrict tobacco marketing. For example, the Master Settlement Agreement and the Tobacco Control Act³ of 2009 prohibit tobacco marketing in traditional media (e.g., television, radio), billboards, transit stations, and events (e.g., sporting events, concerts) (FDA, 2020; National Association of Attorneys General, n.d.). Despite these restrictions, the cigarette and smokeless tobacco industry spends billions of dollars each year on marketing (FTC, 2021). Premium cigars (along with other tobacco products, such as nonpremium cigars, hookah, pipe tobacco, and electronic cigarettes [e-cigarettes]) are not included in these provisions of the agreement or the act. The most recent federal data on marketing expenditures of cigars, including premium cigars, document a nearly 300 percent increase ($1.1 million to $4 million) between 1994 and 1996 (NCI, 1998).

FDA has authority under the Tobacco Control Act to regulate certain types of marketing content for premium cigars (FDA, 2020, 2021); its rules for premium cigars include prohibiting

1. The sale of tobacco products to minors;
2. The sale and distribution of tobacco products with unsubstantiated modified risk tobacco product (MRTP)⁴ health claims or false or misleading claims on labeling or advertising;
3. The use of modified risk descriptors (e.g., “light,” “low,” and “mild”), unless authorized by FDA; and
4. The distribution of free samples of tobacco products.

FDA also requires health warnings to be displayed on packaging and advertisements of cigarettes, smokeless tobacco, and e-cigarettes (FDA, 2016). However, on September 11, 2020, the United States District Court ruled that premium cigars, as well as other cigar products and pipe tobacco, should be excluded from this rule (FDA, 2020). Scientific evidence is ample to suggest that a health warning is warranted on any tobacco product because no level of tobacco consumption is safe (Ham

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³ Public Law 111–31.

⁴ “Modified risk tobacco products (MRTPs) are tobacco products that are sold or distributed for use to reduce harm or the risk of tobacco-related disease associated with commercially marketed tobacco products” (FDA, 2018).

mond, 2011; HHS, 2020). Despite this scientific evidence, the court ruled to exclude cigars and pipe tobacco, including premium cigars, from this rule.

Presence of Marketing

Monograph 9 (NCI, 1998) reported that only a small number of cigar companies engaged in conventional advertising. Despite limited measurement of cigar advertisements, media advertisement expenditures of cigar brands, which included premium brands, such as Macanudo, Davidoff, and H-Upmann, rapidly increased between 1994 and 1996 (NCI, 1998). However, since that time (NCI, 1998), data on premium cigars’ marketing practices have been limited.

Since tobacco marketing strongly influences perceptions and use behaviors (HHS, 2001, 2014; Lovato et al., 2011; NCI, 2008), the committee reviewed the literature on premium cigar marketing, specifically summarizing articles that were not included in Monograph 9, and conducted primary data collection to elucidate the marketing practices of these companies.

The committee could not identify recent published data on how much premium cigar companies spend on marketing.

Marketing in Print Media

Premium cigars have been presented to the public through promotional and marketing activities in print media, which includes direct mailers, magazines, and newspapers. Premium cigars are widely promoted in print and, in recent years, digital cigar lifestyle magazines (e.g., Cigar Aficionado, Cigar Journal, Cigar Snob) devoted to promoting them. After Cigar Aficionado began, other magazines were launched, including Smoke in 1996 by tobacco trade publisher Lockwood (NCI, 1998, p. 206) and Cigar Snob, a bimonthly publication that claims to bring “a fresh approach to the old, stuffy take on cigars with stunning photography, impactful editorial, and honest, easy to read cigar ratings” (Cigar Snob Magazine, n.d.). Other lifestyle magazines also include premium cigar advertising. One study examined selling propositions of print tobacco ads between 2012 and 2013 in consumer magazines, local magazines, Sunday magazines, and magazines targeting Latino/Latina/Hispanic readers: out of 1,122 tobacco ads, 87 were for premium cigars (Shen et al., 2017).

Premium Cigar Companies’ Print and Electronic Media Advertising

Given the limited amount of published data on the use of print media, including direct-to-consumer (DTC) advertisements and direct mail to

promote premium cigar use, the committee obtained data⁵ from Mintel Comperemedia (Mintel) to assess premium cigar advertising expenditures from print advertising, direct mail, and e-mail received by a national panel of consumers between June 2018 and September 2021. Mintel tracks all three advertising channels in the United States using a nationally representative sample of panelists comprising 67,000 households and an additional e-mail panel of about 1,300 households who forward paper mail and e-mails to Mintel on a weekly basis (Ganz et al., 2016). Although Mintel does not capture premium cigar advertisements as their own category, the Mintel database was searched for premium cigar brand names as identified in Corey et al. (2018).

The Mintel data consist of advertisement image and associated meta-data, which includes (1) company name; (2) the month/year in which the ad was received; (3) estimated dollar amount spent on the ad (direct mail only); and (4) estimated direct mail volume (direct mail only).

Mintel data provided to the committee had two separate paid ad spreads (see Figure 4-1) from a single premium cigar brand in a free in-flight magazine of a major U.S. airline. These ads featured themes of history, culture, and family, and the rate spent for them was $159,000 and $53,100, respectively.

One premium cigar brand, Drew Estate, had several e-mail ads (see Figure 4-2) that promoted an in-person entertainment event/festival to celebrate its 25th anniversary and “The Rebirth of Cigars Movement,” promoting branded items, new cigars, and live music featuring rock and hip-hop. These ads used graffiti images with a logo of the Manhattan Bridge and pictures of musical artists who would be featured at the festival; these DJs and musicians gained popularity from the 1990s through mid-2000s. Some of these e-mail ads featured only the brand logo with an image and a description of DJs and musicians without the mention of any premium cigar products. These promotional efforts that highlighted DJs and musicians were part of a larger tobacco industry movement to use music to appeal to consumers. This same strategy was used for menthol cigarettes and the Kool Mix Campaigns and Newport music festivals.

The committee did not identify any premium cigar advertising in direct mail but did observe that cigarillo brands (i.e., Black & Mild, Swisher Sweets, Night Owl, and Havana Honey Cigars) and little cigar brands (i.e., Talon) used direct mail (Rutgers Center for Tobacco Studies,

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⁵ Available in the project’s public access file and upon request from the National Academies Public Access Records Office at PARO@nas.edu. This is the committee’s analysis of Mintel data; it does not represent the views or opinions of Mintel.

n.d.) with strategies including coupons,⁶ discounts, rewards and free gifts for purchasing, sweepstakes entry, invitation to visit the brand website or their social media accounts, and links to visit their website for non-cigar-related topics (e.g., a new episode of a reality show featuring a new singer, recipes, concerts).

DTC advertisement is a common source of tobacco advertising and has been used widely by the cigarette and smokeless tobacco industries (FTC, 2021). The Mintel data suggest that cigarillo and little cigar brands are using direct mail with multiple discount strategies, as well as nontobacco-related events and promotional items, to a variety of populations across the majority of U.S. states. With higher price points associated with premium cigars, these may be marketed in other venues not obtained

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⁶ Coupons were not identified in the Mintel data, but this does not imply that they do not exist for premium cigars.

through DTC advertisements. For example, they are advertised in inflight magazines, which are often associated with luxury and travel.

However, third-party retailers are also using DTC to market premium cigar products. An example is Thompson Cigar,⁷ which started out as a mail-order cigar company in 1915 (it was sold to Scandinavia Tobacco Group in 2018) and continues to sell premium cigars through mail catalogues, e-mails, and its website (Danielson, 2019). When the Mintel database was searched for terms (including “premium,” “small batch,” “limited edition,” “limited refill,” “hand rolled,” “reserve,” and “long leaf”) related to how premium cigars could be used in DTC ads, third-party retailers were found that primarily sell premium cigars using e-mail coupons, catalogs, and subscription services (e.g., “get five premium cigars each month”). The e-mails featured coupons (e.g., $10 off, free lighter/wallet with purchase, time-limited sales) for premium cigars, and some e-mail ads advertised a specific brand. The ads described premium cigars as “highly rated,” from a “renowned” brand, and “exclusive” cigars, alluding to a higher class of product.

Although premium cigar brands are generally not using DTC ads, evidence suggests that they are using similar marketing strategies as other cigar brands, such as e-mails to promote non-cigar-specific themes that appeal to young people—music festivals, urban lifestyle, and hip-hop and rock music. Additional evidence indicates that third-party retailers that primarily sell premium cigars are using DTC to market these products using discount strategies similar to those used by the nonpremium cigar industry, and also alluding to premium cigars as a higher-class product.

Summary and Conclusion

To assess premium cigar marketing, the committee conducted primary data collection, given the extremely limited literature, to reach its conclusions. It examined:

1. Data obtained from Mintel Comperemedia, which collects DTC advertisements using mail and e-mail sent to a national panel of consumers, as well as print advertising (June 2018 and September 2021);
2. Content from cigar lifestyle magazines (i.e., Cigar Aficionado, Cigar Journal, and Cigar Snob) published in 2021; and
3. Content from social media platforms and company-owned websites of premium cigar brands.

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⁷ See https://www.thompsoncigar.com (accessed November 12, 2021).

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⁸ The codebook used (developed by the committee based on published analyses) and results from this review are available in the project’s public access file and upon request from the National Academies Public Access Records Office at PARO@nas.edu.

(3) enjoyable social activity, (4) luxury, (5) product quality, (6) success, (7) masculinity, (8) sex appeal, (9) taste, and (10) other substance (i.e., alcohol, cannabis).

Article Analysis

Nineteen (68 percent) of the 28 articles sampled had content related to premium cigars, including ratings and reviews; pairing of cigars with alcohol; interviews with celebrities and people in the cigar industry to discuss topics related to cigars; cigar history and information (e.g., about Premium Cigar Association [PCA]); and a gift guide (e.g., featuring cigar products, such as accessories). One article featured rankings of cigar-related Twitter accounts that had the most followers by cigar-related organizations, radio stations, companies, and retailers. Nine (32 percent) of the articles that included non-cigar-related topics had travel guides and reviews of vehicles, alcohol, and coffee. See Table 4-1 for the themes in the articles.

TABLE 4-1 Themes from Cigar Lifestyle Magazine Articles Sampled (n = 28)

SOURCE: Commissioned magazine analysis (data available in the project’s public access file and upon request from the National Academies Public Access Records Office at PARO@nas.edu).

TABLE 4-2 Demographics of Celebrities (n = 18) Featured in Cigar Lifestyle Magazine Articles Sampled

SOURCE: Commissioned magazine analysis (data available in the project’s public access file and upon request from the National Academies Public Access Records Office at PARO@nas.edu).

the Whisky Advocate special edition. The content featured on the covers included five (56 percent) interviews, four (44 percent) photo shoots (e.g., scantily dressed young female models posing on a beach or a pool with cigars), three (33 percent) travel tips, two (22 percent) cigar reviews, one (11 percent) alcohol-related content, and 35 percent “other” articles (e.g., social media rankings of cigar-related Twitter accounts, editorials related to premium cigars/industry).

Seven of the nine covers (78 percent) included the image of a celebrity; one magazine had two. The celebrities were models/social media influencers, sports figures, and actors; four (50 percent) were male and four (50 percent) were female, representing diverse age ranges: three (38 percent) 18–30, three (38 percent) 31–50, one (13 percent) 51–65, and one (13 percent) 65 or older. Six (75 percent) of the celebrities were coded as white, one (13 percent) as Black, and one (13 percent) as other (Indian/British).

such as Instagram (Allem et al., 2017; Richardson et al., 2014) and Twitter (Kostygina et al., 2016).

Navarro et al. (2020) examined whether cigar brands were using social media influencers to market cigar products on the brands’ Instagram accounts from 2017 to 2018. The brands were identified from the top 20 leading cigar brands from Nielsen Scantrack data that tracks sales from total U.S. convenience stores and outlets (cigar brands from Nielsen data: n = 11) and Euromonitor’s list of 2017 U.S. market leaders based on retail volume (additional cigar brands from the Euromonitor list: n = 13). They included all types of cigars, including premium. Seven of the 24 leading cigar brands had an official Instagram account, with at least one influencer in the 20 Instagram posts examined; two were premium⁹ cigar brands.

Another study examined whether leading tobacco brands (i.e., cigar, e-cigarette, cigarette, hookah, and smokeless tobacco) had a social media account in 2018 (O’Brien et al., 2020). The authors identified 112 leading brand names of all tobacco products using Nielsen Scantrack data, Euromonitor, and Population Assessment of Tobacco and Health (PATH) study data (only for hookah). For each brand, the authors searched whether an official account exists on Instagram, Facebook, Twitter, YouTube, Pinterest, and Tumblr. Eight were premium and 16 were nonpremium¹⁰ cigars. Specific conclusions regarding premium cigars cannot be drawn because the data analysts grouped all brands together. This study observed that leading cigar brands (as well as e-cigarette and hookah brands) had at least two social media platforms, with Facebook, Instagram, and Twitter being the most common.

As the Internet and technology rapidly evolve to engage and entertain their users, tobacco companies that market using these sources will also likely evolve, so studies will need to keep up with these changing trends. For example, mobile phone apps could be one way to market premium cigars. In 2012, one study examined the presence of pro-tobacco apps by searching the keywords “smoke,” “cigarette,” “cigar,” “smoking,” and “tobacco” on the Apple App Store and Android Market and found 107 apps. Apps relevant to cigars included one that showed where to buy tobacco products, including cigars (the authors did not differentiate cigar type); one for a premium cigar users advocacy group (Cigar Rights of America); and a “Cigar Smoker” app (the authors did not differentiate cigar type, but the example images included premium cigars), which provided information about cigar news, reviews, and deals, as well as options for users to share their own photos of their cigars on social media (BinDhim et al., 2014).

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⁹ As determined by the committee (see Chapter 1 and Appendix E).

¹⁰ As determined by the committee (see Chapter 1 and Appendix E).

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¹¹ The search included the premium brands identified in the committee-commissioned papers (see Appendix F).

¹² The codebook used (developed by the committee based on published analyses) and results from this review are available in the project’s public access file and upon request from the National Academies Public Access Records Office at PARO@nas.edu.

tion period was captured. Metadata for the social media sites were also captured, including the number of followers (or subscribers for YouTube), likes, comments, and/or views. In addition, the committee documented the presence of a smartphone app for each brand and the number of downloads. Finally, following the methodology used by Shen et al. (2017) and Escobedo et al. (2018), the committee documented the presence of selling propositions in the online content of each premium cigar brand:

• Sociability: content that promotes fun, hip, cool, contests, and adventures;
• Innovation: content that promotes simple to use, technology, convenience, and price;
• Party lifestyle: content that may include smoke/vapor, nightlife, celebrities, music, party, and holiday;
• Celebrity endorsement and the industry in which the celebrity is a part of (e.g., music, art, sports);
• Music content and the genre of music (e.g., pop, hip-hop or rap, dance or electronic, alternative, R&B rock, or other genres);
• Taste: content that implies smooth taste and/or satisfaction;
• Harm reduction: content that implies that premium cigars are safe or less harmful to use than others or are an alternative to quitting smoking;
• Quality: content that implies that the product is of high quality, historic, or longer lasting;
• Masculinity: content that feature themes, activities, and settings stereotypically considered masculine, such as the outdoors, and activities, such as manual labor or hunting;
• Femininity: content that includes encouraging female use of premium cigars, such as hashtags like #girlswhosmoke or #girlssmoketoo; and
• Sex appeal, including images or content that shows a “beautiful, glamorous, sophisticated, handsome, or cool-looking individual using tobacco.”

A descriptive analysis was conducted to assess the online presence of each premium cigar brand and capture the most common selling propositions.

Of the sample of 60 cigar brands initially identified as premium, 8 were sub-brands of 5 brands and 5 were not found in online searches, resulting in 47 brands searched (see Table 4-4). Thirty-six premium (77 percent) had an official website, and 31 (66 percent) had a Facebook page. Each brand had an average of 21,341 “likes” and an average of 22,225 followers on its Facebook page. Thirty-one premium (66 percent) had

Instagram accounts, with an average of 842 posts and 34,210 followers. Nearly half (n = 28; 46.7 percent) had a Twitter account with an average of 12,727 account followers and 5,189 tweets. More than one-fifth (n = 11; 23 percent) had a YouTube page, with an average of 4,767 subscribers and 363,391 channel views. Eight (17 percent) of the 47 premium cigar brands used other online platforms: four (8 percent) had content on the Cigar World social media platform, three (6 percent) had LinkedIn accounts, and one (2 percent) had a Pinterest account.

Summary and Conclusion

The committee’s analysis of the online presence of premium cigar brands identified that 77 percent of the brands examined had an official website, 66 percent had a Facebook account, 66 percent had an Instagram account, 57 percent had a Twitter account, and 23 percent had a YouTube account (see Table 4-4). The presence and use of social media to promote premium cigars is not currently captured by existing tracking methods of marketing expenditures. These findings led the committee to conclude that there is conclusive evidence that premium cigar companies have online and social media presences not captured by traditional methods of tracking marketing expenditures.

TABLE 4-4 Online Presence of Premium Cigar Brands (n = 47)

SOURCE: Committee social media commissioned analysis (data available in the project’s public access file and upon request from the National Academies Public Access Records Office at PARO@nas.edu).

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¹³ Nonbranded marketing refers to general promotion of premium cigars overall as a product type.

both align with research that examined tobacco product advertising content (NCI, 2008; Shen et al., 2017). For this review, selling propositions are considered a component of cigar advertising promotions.

This section begins with a summary of articles that examined the general/overall advertising promotions. Next, it describes the unique selling propositions. Articles that examined premium cigar products are described first in each section. Given the absence of published literature focused exclusively on premium cigars, the literature search and subsequent article review were broadened to include those that described cigar products but did not specify type (such as premium, nonpremium, cigarillo, little filtered cigar). Next, the advertising promotions and selling propositions for non-large-cigar products, including cigarillos and little filtered cigars, are described. While the main goal is to describe findings for premium cigars, this section highlights the similarities in advertising promotions and selling propositions between premium cigars and nonlarge cigars.

Advertising Promotions for Premium Cigars and/or Brands

The committee found three articles that exclusively assessed the advertising promotions and selling propositions of premium cigars and/or premium brands: a Tobacco Industry Ad-Watch (Falit, 1997) and two scientific studies (DeSantis and Morgan, 2003; Wenger et al., 2001a). The articles were published between 1997 and 2003, during a greater than 50 percent increase in cigar sales and consumption (Department of Agriculture, 1997; Wenger et al., 2001a). The rise in cigar sales during the late 1990s was due, almost exclusively, to the sale of large cigars (Department of Agriculture, 1997; Wenger et al., 2001a). The stated goal of each article was to understand the role of advertising in increasing cigar sales and consumption. Additionally, the three articles analyzed content from prominent cigar magazines, such as Cigar Aficionado. In 1995, it was the most popular lifestyle magazine in the United States, with a readership of more than 400,000 per issue (DeSantis and Morgan, 2003; NCI, 1998). Falit (1997) cited studies that described the growing popularity of cigar products and increased advertising to 20-, 30-, and 40-year-olds as well as promotion to older adults. Despite this popularity among younger and middle-aged adults, Falit noted an initial delayed public health response to advertisements targeting 20–40-year-olds because they were not specifically targeting children.

Selling Propositions for Premium Cigars and/or Brands

“Luxury, success, and prestige.”

Falit’s (1997) Ad-Watch in the Tobacco Control journal describes the advertisements of cigars and their accom-

panying products (i.e., humidors, holders, lighters) in magazine publications, such as Cigar Aficionado and Smoke, and newspapers that were “geared towards older, more affluent adults” (p. 240). Older celebrities, including Hollywood movie stars, such as George Burns and those who have “achieved success and earned the right to smoke a cigar” (p. 240), were prominently featured in Cigar Aficionado and Smoke holding cigars or smoking them. The Ad-Watch also describes cigars as popular props in several major motion pictures during the late 1990s, notably an advertising campaign for the premium brand Macanudo. It featured “two men—one older and one younger—who shared cigars as a common interest and symbol of maturity and success” (p. 241).

Wenger et al. (2001a) conducted a content analysis of content in Cigar Aficionado (1992–1998) and another cigar lifestyle magazine, Smoke (1996–1998) to identify their role in the elevated premium cigar sales and consumption rates in the late 1990s. Overall, approximately 40 percent of the combined articles were focused on cigars. Of these articles, 92 percent portrayed premium cigars positively, highlighting them as “pleasurable, relaxing, and part of a successful lifestyle” (p. 282). Celebrities and influential public figures, including politicians, actors, musicians, and painters, were featured in 34 percent of the articles. Although Wenger et al. mentioned that sometimes the celebrities were “mentioned in passing” (p. 282), usually the articles featured a celebrity who described their favorable views on cigars or the role of cigars as a part of their lifestyle. Premium cigar events were featured in 12 percent of the articles and included social events, such as cigar smoking, eating gourmet meals and dinners (i.e., Cigar Aficionado’s “Big Smoke” dinners), drinking “premium” alcohol, and the openings of cigar bars, lounges, and shops in the United States and other countries. The authors concluded that aligning cigar use with celebrities and influential public figures and promoting them at “exclusive” social events normalized and promoted cigar use as a part of a successful lifestyle.

Findings from Wenger et al. (2001a) indicate that approximately 40 percent of these articles advertised premium cigar smoking as a part of a successful, sophisticated lifestyle, which was promoted as a desirable “identity.” Additionally, 60 percent of the non-cigar-focused articles in Cigar Aficionado and 57 percent in Smoke “covered luxury topics such as art, sports, music, fashion, gambling, jewelry, collectibles, and leisure” (p. 280) that are consistent with a successful and desirable lifestyle. The inclusion of elegant content may indicate to the publications’ readers that premium cigars are a part of a luxurious lifestyle.

“Cigar benefits outweigh health effects.”

Cigars during the late 1990s were “not commonly believed to have the same health effects as ciga-

rettes” and “the health effects of cigar smoking have not been researched nearly as much as those of cigarette smoking” (Falit, 1997, p. 241). Evidence presented in the Falit Ad-Watch indicates that premium cigar advertising promotions downplayed the health dangers of cigar smoking compared to cigarette use and supported the perception that cigars were a safe substitute. The Ad-Watch also notes that “with George Burns as the cigar’s most popular ‘poster child,’ the health dangers of cigar smoking are subtly undercut” (p. 241).

DeSantis and Morgan (2003) conducted a content analysis of 41 Cigar Aficionado magazine issues published from 1992 to 2000 to analyze their “pro-smoking messages” (p. 460). DeSantis and Morgan noted that the magazine promoted “premium cigars (i.e., hand-rolled, expensive, and imported)” and included a quote from Cigar Aficionado that indicated that the sales and consumption of premium cigars were attributed to their publication (p. 458). From 1992 to 2000, 380 pro-premium cigar-smoking arguments were found, and 9.4 pro-premium-cigar arguments were present per issue (e.g., cigars are not cigarettes, life is dangerous, and health benefits arguments).

The “cigars are not cigarettes” argument was the most recurring theme and asserted that cigars were a safer alternative. This argument was based on the “significant differences in [cigar] product and process” and asserted that (1) cigarettes are addictive, whereas cigars are not because they are used infrequently; (2) cigarettes are inhaled, and cigars are not, thus they do not pose health risks to the lungs; (3) cigarettes are impure, but cigars are not because they contain “all-natural ingredients” (p. 466). Also, the cigar-making process purifies the products; and (4) cigarettes are consumed in mass quantities, whereas cigars are smoked “in moderation” (p. 467) and not as a daily habit. The “life is dangerous” argument asserted that cigar use is not as dangerous and/or risky as other behaviors, such as reckless driving, alcohol consumption, and breathing polluted air. The “health benefits” argument asserted that cigar smoking offers many health benefits, including stress reduction, decreasing the risk of several major health problems.

Advertising Promotions for Cigar Brands

In response to the lack of articles on advertising promotion and selling propositions for premium cigars, the committee broadened its search to include cigar products in general (i.e., not specifying premium, nonpremium, cigarillo, or little filtered cigar but instead using the broader term “cigar”).

Two articles described the advertising promotions for “cigar” products. Wenger et al. (2001a) conducted a content analysis of 790 cigar--

focused newspaper and magazine articles published in the five largest U.S. newspapers by circulation between 1987 and 1997 but did not specify the cigar type. The authors coded for the primary focus (e.g., cigar business, events, trends) of the articles, image of cigars (positive: enjoyable, profitable, relaxing; negative: harmful, unpleasant), the tobacco industry portrayal (positive: profitable; negative: harmful; neutral: neither); and the presence of celebrities and public figures. Cigar businesses (39 percent of content) and events (19 percent) were the most prominent focus areas. The report did not describe the types of cigar business or events. The authors also noted that both cigars (62 percent) and the tobacco industry (78 percent) were portrayed positively in the majority of the articles. Celebrities and other public figures were quoted or described in 42 percent of the articles, with 87 percent having favorable attitudes toward cigars. The authors also coded for the presence of health effects, which is described in the relevant section.

Feit (2001) examined 70 cigar images in a sample of women’s magazines published between 1992 and 1998 but did not specify the product type. The images were coded for image type (advertisements versus non-advertisements), the product advertised with or without an image, the presence of product with/without actors (e.g., individuals or cartoon characters), and sex of the smoker. The percentage of female compared to male cigar smokers steadily increased, with 25 percent of cigar images showing them in 1992 and 64 percent in 1998. These data indicated that the presence and portrayal of female cigar smokers increased significantly over the 7 years. The smokers included celebrities, such as actors and athletes.

Selling Propositions

“Cigar benefits outweigh health effects.”

Three articles specifically examined and/or described the health effects noted or discussed in the cigar articles or advertising content. In a Tobacco Control Ad-Watch piece, Falit (1997) described the targeted marketing of cigars to adults aged 65+. Notably, older celebrities who appeared healthy, such as George Burns, were thought to “subtly undercut” any health dangers (Falit, 1997) (p. 241). Additionally, the awareness of health consequences of cigarette smoking, along with perceptions that cigars are less harmful (Falit, 1997) are speculated to have contributed to adult cigarette smokers’ switch to cigars (Falit, 1997; Gerlach et al., 1997; NCI, 1998).

Wenger et al.’s (2001b) content analysis of Cigar Aficionado and Smoke examined the presence of environmental tobacco smoke (ETS) or scientific research and the health effects of premium cigars. Although health effects were not explicitly defined, the authors described and provided scientific

citations that reported the increased risk of cancer, heart, and pulmonary disease among cigar smokers (p. 279). Only 1 percent (n = 4) of the 353 articles focused primarily on health effects. The central theme of these four articles, all published in Cigar Aficionado, was that the purported benefits (e.g., pleasure, relaxation) outweighed the potential adverse health effects. Scientific research on cigar use was mentioned in 2 percent of the articles, and the majority of the evidence was described as “weak” and “flawed.” ETS was mentioned in the context of smoking restrictions that denied “… smokers’ rights” (p. 282), and the articles noted that scientific evidence on ETS health risks was considered “weak” or “contradictory” (p. 282). Finally, social events, including benefits to raise money for various health charities, were described. The authors purport that advertising these events markets the cigar industry as “socially responsible and supportive of good health while trivializing public health concerns about tobacco use” (p. 283).

Wenger et al. (2001a) coded for health risks (i.e., whether risks were mentioned, types of health effects mentioned, whether or how cigars were compared with cigarettes) in the advertisements. Of the 790 articles reviewed, health effects were the primary focus in 4 percent (35) but mentioned in 21 percent (169). Half (50 percent) of the articles portrayed cigars positively and minimized their health effects. Only 24 percent (41 of the 169) showed the health effects negatively. Fourteen percent of the articles compared the health effects to cigarette use, describing it as less harmful because cigars are consumed differently (i.e., without inhalation) and infrequently and contain fewer chemicals. These articles emphasized cigars being more socially acceptable than cigarettes, implying that they are part of a lifestyle.

“Cigars are a premium product.”

Shen et al. (2017) examined the unique selling propositions in 171 print tobacco ads collected between August 2012 and August 2013 from the consumer, Sunday, local, and Hispanic-targeted magazines (p. 4). Of those, 22 ads were for “cigar” products. The type of product was not specified, and the term “cigar” was not defined. Overall, the authors found that cigars were being promoted in the advertisements as a “premium product.” The advertisements often promoted cigar use for special occasions and indicated that the products were often used by “sophisticated people” (pp. 7 and 17).

Advertising Promotions and Selling Propositions for Non-Large-Cigar Products

While the peer-reviewed article described next focuses on non-large-cigar products, such as cigarillos with brands like Black & Mild and

Swisher Sweets, the advertising promotions and selling propositions for these products were similar to those reported in peer-reviewed articles examining premium cigar content. Rosario and Harris (2020) examined the messaging strategies of tobacco advertisements within an African American community, including for nonlarge cigars and their variation by tobacco product type. The advertisements were collected from 24 retail stores located in census tracts with greater than 70 percent African Americans in Greensboro, North Carolina. Of the 165 ads examined, 33 (20 percent) featured nonlarge cigars. Misdirection of attention messages, which consisted of images and text that redirected consumers’ focus from health risks toward positive product attributes, commonly appeared in the nonlarge-cigar ads, with 67 percent of ad content using this messaging strategy. Phrases such as “limited release,” “enjoy,” and “hand-rolled” were found, with these phrases used to potentially redirect focus from health facts to positive attributes and feelings. The second most common message strategy was reassurance, which sought to convince consumers that tobacco product use is safe despite its health risks. Of the ads, 18.2 percent contained content that was classified as reassurance. Phrases such as “The natural choice…,” “Like sweets? Go natural,” and “Natural leaf cigarillo” were used to convince consumers that non-large-cigar use is safe.

Similar to what has been documented for nonlarge cigars, premium cigar advertising content has also sought to shift consumers’ focus from health risks to positive product attributes, including using premium cigars as an essential component of a successful or luxurious lifestyle. The content in Cigar Aficionado and Smoke reduces consumers’ ambivalence about the health risks by including older celebrities who appear healthy.

Summary and Conclusion

The committee’s review of the literature found three studies published between 1997 and 2003 that specifically examined advertising content of premium cigar brands. Overall, these studies indicate that these were advertised and promoted as an integral component of a successful, luxurious lifestyle, used at “swanky” social events and by those influential celebrities and individuals. The articles noted that this “identity” was promoted in cigar lifestyle magazines, such as Cigar Aficionado and Smoke. Moreover, some content downplayed the health dangers of premium cigars compared to cigarettes and supported the perception of a safe substitution. Findings from the committee’s systematic literature review and environmental scan of premium cigar content online suggest that the most pronounced selling propositions were that the benefits of cigar use outweighed their adverse health effects and that cigars are a premium or quality product.

across 54,554 stock keeping units (SKUs).¹⁴ The average number of cigar SKUs per retailer was 10,911, highlighting the diversity of products offered. The majority of these orders (3.6 million) included premium cigars: 125,314,590 sold across 51,123 SKUs. The average number of cigars per order was 34.6, at an average price of $3.00 per; the average amount per order was $61.26.¹⁵ Premium cigar sales from these five online retailers in 2017 totaled $376.6 million. The majority of premium cigars sold in 2017 were not in sampler packs that include more than one type of cigar (87 percent). Data provided by some of the retailers for other years (2014–2018) also show that most premium cigar orders are for boxes of five or more cigars (95 percent) without single cigars or multipacks (2–4 cigars); greater than 60 percent of orders included only one or two brands.¹⁶ Online cigar sales also exhibit seasonality, with the lowest purchases in January and February and peak purchasing during the summer months.¹⁷ Using the TTB data for large cigars, Class H (see Table 3-1), as the denominator (380,000,000 sticks consumed in 2017), these data suggest that approximately 33 percent of premium cigars were purchased online in 2017. Survey data do not currently capture online purchasing behavior in premium cigar users. PATH only asks about where cigars are usually purchased for those who purchase in stores.

Data from these online retailers across 2014–2018 also allowed for exploration of demographics of premium cigar purchasers through age verification and geocoding of 80 percent of purchaser addresses to census tracts. Based on age verification for 83 percent of these orders, the mean age was 55.3; more than half (54 percent) of purchasers were over the age of 55, and approximately one-third (34 percent) were 35–54.¹⁸ The median household income in the census tracts of online premium cigar purchasers ($65,573) was higher than the U.S. median household income ($57,617); 15 percent of them live in a census tract with a median household income above $100,000, compared with 10 percent in the U.S. population overall.¹⁹ Greater than 20 percent of them live in census tracts where greater than 50 percent of the population aged 25 and older has

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¹⁴ This paper was prepared for the Cigar Association of America, Inc., Cigar Rights of America, and the International Premium Cigar and Pipe Retailers Association by Richard P. Voith and Peter Angelides at Econsult Solutions, Inc. The full report is available in the project public access file and by request from the National Academies Public Access Records Office at PARO@nas.edu.

¹⁵ Ibid.

¹⁶ Ibid.

¹⁷ Ibid.

¹⁸ Ibid.

¹⁹ Ibid.

a bachelor degree compared with 15 percent in the U.S. population.²⁰ Limitations of this study include that it was limited to sales from large, online retailers; customer demographics are based on census tract data, not actual customer demographics; and no unique customer identification numbers were included, so individuals cannot be tracked across vendors to ensure unique customers across retailers (Voith, 2021).

Summary and Conclusion

Based on the committee’s examination of cigar sales data from TTB and Nielsen, published and commissioned analyses from PATH (see Appendix D), and data submitted by the Cigar Association of America on major online cigar retailer transactions in 2017, the committee concludes:

Conclusion 4-5: There is strongly suggestive evidence from survey data that consumers of premium cigars who buy in person typically purchase their cigars from cigar bars or smoke/tobacco specialty shops or outlet stores, whereas nonpremium large traditional cigar users typically purchase their cigars at convenience stores/gas stations. A lower proportion of premium cigar users buy their cigars in person than nonpremium large traditional cigar users. Data from online cigar retailers show that a large proportion of premium cigar sales occur online, though this is not directly captured in current surveys of cigar users.

Premium Cigar Retailer Density

An exploratory analysis commissioned by the committee (Kong, 2022) mapped U.S. retailers registered with PCA to better understand the distribution of brick-and-mortar retail venues throughout the country. To be included in these analyses, retailers had to (1) be located in the United States, (2) have a valid address, and (3) currently be open upon review of the address.²¹ PCA provided the committee with a retailer-level dataset that included current members in 2019–2021, with all physical brick-and-mortar retailers with necessary state tobacco licensing and where the majority of sales were for premium cigars or pipe tobacco; retailer types, such as convenience stores, hookah/head shops, and vape stores, were excluded. The original dataset included 1,316 unique retailers. However, upon review of the address fields and states, 25 retailers were removed, leaving 1,291. All premium cigar retailers were spatially joined to their respective census tract and corresponding sociodemographic data to

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²⁰ Ibid.

²¹ Not every address was reviewed.

explore the density of premium cigar retailers and the characteristics of census tracts in which they were present. Figure 4-3 shows the distribution of premium cigar retailers across the United States.

Table 4-6 shows the total count and density of PCA retailer members by state. All states except two (North Dakota and Vermont) had premium cigar retailers, ranging from 1 in West Virginia to 220 in Florida. The density per 1,000 residents of outlets in states with at least 1 retailer ranged from 0.96 in Iowa to 25.1 in Delaware. Examination of data at the census tract level found that premium cigar retailers were present in a small proportion (1.7 percent) of tracts, with a median density of 0.0 retailers per 1,000 people and a maximum density of 8.2. Census tracts with a higher percentage of non-Hispanic white residents had greater odds of having at least one (versus no) retailer (odds ratio [OR]: 1.06; 95 percent confidence interval [CI]: 1.03–1.09). In contrast, tracts with a higher percent of Black (OR: 0.92; 95 percent CI: 0.88–0.96) and Hispanic/Latino/Latina (OR: 0.90;

NOTE: Supplemental materials available in the project’s public access file and upon request from the National Academies Public Access Records Office at PARO@nas.edu.

SOURCE: Kong, 2022.

95 percent CI: 0.84–0.96) residents had lower odds of having at least one retailer. Findings from these analyses support that while the majority of census tracts do not have a retailer, density varies widely at the state level.

Summary Finding

Based on the committee’s (1) review of the literature on cigar sales; (2) analysis of data on consumer purchasing behavior; and (3) analysis of data on premium cigar retailers, it finds:

Finding 4-2: Large cigar retail outlets include smoke shops/tobacco specialty or outlet stores, convenience stores (Corey et al., 2018),

pharmacies, and Internet vendors. Premium cigar users report purchasing their cigars primarily in cigar bars and smoke shops/tobacco specialty or outlet stores. Data from online retailers suggest that a large proportion of premium cigar sales occur online, but this is not currently captured in national surveys of cigar users. Data provided to the committee show that all but two U.S. states have a physical premium cigar retailer and the density of premium cigar retailers varies by state, with some states having a significantly higher density of shops than others; there are no data on the location or sale of premium cigars in cigar bars. Based on an exploratory analysis, premium cigar retailers are more likely to be present in census tracts with a higher percentage of white residents; premium cigar purchasers are more likely to reside in census tracts with higher median income and education compared to the general population.

AWARENESS, KNOWLEDGE, AND BELIEFS

Consumers’ uptake of the use of tobacco products occurs through a series of steps, from initial awareness, to knowledge of the product and its features, to formulating beliefs, such as perceived risks, to trial and sustained use (Rees et al., 2009). Consumers’ awareness, knowledge, and beliefs can be influenced by factors characterized elsewhere in this chapter and this report, such as advertising and marketing, point-of-sale availability, and product characteristics (see Chapter 2) (Rees et al., 2009). Beliefs such as risk perceptions (i.e., people’s thoughts and feelings about risks) are central to numerous health behavior theories and have been the focus of decades of tobacco research (Kaufman et al., 2020a,b; Slovic, 2001). Risk perceptions are also often the targets of interventions to prevent and reduce tobacco use (Kaufman et al., 2020b), such as required health warning labels on tobacco packaging/marketing and mass media campaigns designed to raise awareness about the risks. This section reviews the evidence on consumers’ awareness of premium cigars, knowledge, risk perceptions, and other perceptions, such as perceived benefits and reasons for use, and on how beliefs such as risk perceptions relate to patterns of use of premium cigars and other forms of tobacco.

Awareness

Researchers have examined awareness of tobacco products, including various types of cigars, in U.S. adults and youth. These studies use data from population-based surveys, such as PATH, or other population-based data sources.

cigars, cigarillos, or cigars, including by sex and age. The results suggest adult cigarette users are likely to misclassify cigar products.

Dickinson et al. (2016) report data from focus groups conducted in five U.S. cities in 2014. Adults who used cigars, cigarillos, and little cigars were included. Participants were shown pictures of cigar products and asked how they identify them. Overall, use of brand names was common. Participants were most likely to identify the picture of a large/traditional cigar as a “cigar”: however, they also used brand names (e.g., Cohiba), and some referred to large/traditional cigars as “blunts.” Little cigars, tipped cigarillos, and untipped cigarillos were predominantly identified by brand names and also as “blunts.” Little filtered cigars were most consistently misidentified as cigarettes, and many participants did not consider little filtered cigars, tipped cigarillos, and untipped cigarillos to be cigars. Finally, participants were asked whether they considered cigar users to be “smokers.” Most preferred the term “cigar smoker,” and others indicated that they would only use the label if they smoked several times a week or daily. Participants reported little cigars and cigarillos to be more common daily use products and large/traditional cigars as something for leisure time or special occasions. They were less likely to view large/traditional cigar users as “smokers.” Participants had mixed responses on whether inhaling the smoke means someone is a smoker and the connotations of the term (e.g., negative connotations associated with cigarette smoking).

Youth

Yerger et al. (2001) report data from focus groups conducted with Black/African American youth on understanding of cigar products and cigar use. The groups included cigar users and nonusers (the types of cigars used by participants were not specified), but results are reported for all participants combined. The findings indicate that youth had three distinct ways of referring to cigars, describing larger, premium-type cigars as “cigars”; however, participants rarely used these, viewing them as primarily used by older, wealthier people. Other types of cigars were predominantly referred to by brand, such as “Black & Milds.” “Blunt” was used solely for cigars used for smoking cannabis. The participants were a small, nongeneralizable sample, but the results suggest that the youth studied associate products that likely include premium cigars with older, adult smokers.

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²² Traditional cigars were defined as “contain[ing] tightly rolled tobacco that is wrapped in a tobacco leaf. Some common brands of cigars include Macanudo, Romeo y Julieta, and Arturo Fuente, but there are many others” (Fong et al., 2019).

risks by cigar type among U.S. adults. Information including brand and other characteristics (such as price) was used to categorize smokers’ usual brand as filtered cigar, cigarillo, or traditional cigar, which was further categorized as premium or nonpremium. Overall, comparable proportions of premium cigar, nonpremium cigar, cigarillo, and filtered cigar smokers indicated that cigars may be less harmful than cigarettes (see Table 4-10).

These estimates differed by cigarette smoking status. Across the four cigar products, the proportion of cigarette smokers indicating that cigars may be less harmful was the lowest for current and higher among former and never-cigarette smokers (see Table 4-11).

Analyses of Waves 2–5 of the PATH data commissioned for this report (see Appendix D) indicate some variability from year to year. For example, the proportion of premium cigar smokers indicating that cigars may be less harmful than cigarettes was 32.1 percent at Wave 2, 25.2 percent at Wave 3, 16.5 percent at Wave 4, and 36.9 percent at Wave 5 (Jeon and Mok, 2022). The variability may be attributable in part to methodological issues, such as attrition, in subsequent waves; it may also reflect the timing of survey completion, given potential seasonality in cigar use.

Wackowski and Delnevo (2016) assessed tobacco use behavior (cigarette smoking; menthol cigarette use; past 30-day use of cigars, smokeless tobacco, and waterpipe; and ever use of e-cigarettes) and perceived harm of cigars, e-cigarettes, waterpipe, snuff, dip, chew, snus, and menthol cigarettes relative to cigarettes in U.S. young adults. The measures excluded filtered little cigars but included large cigars and cigarillos. Young adults were more likely to indicate that e-cigarettes (57.8 percent) and waterpipe (24.5 percent) were less risky than they were to indicate that cigars

(13.9 percent), menthol cigarettes (2.5 percent), and traditional smokeless tobacco (7.1 percent) were. They were also more likely to indicate that cigars are less risky than cigarettes compared to traditional smokeless tobacco, snus, and menthol cigarettes. In adjusted models, men were more likely than women, Black and Hispanic young adults were less likely than white young adults, and those with more than high school education were more likely to perceive cigars to be less risky than cigarettes.

Smith et al. (2007) report data from a sample of college students assessing perceived risks relative to cigarettes (less harmful, as harmful/more harmful) for nicotine patch, nicotine gum, nicotine water, nicotine lollipop, nicotine inhaler, ultra-light cigarettes, waterpipe, light cigarettes, cigarillos, cigars, and smokeless tobacco along with demographic and tobacco-related predictors of perceived risks. Overall, 80.4 percent of participants perceived a nicotine patch to be less harmful, 75.9 percent for nicotine gum, and 47.1 percent for a nicotine inhaler. Overall, 40.4 percent of participants perceived ultra-light cigarettes were less harmful, 37.0 percent for a waterpipe, 35.2 percent for light cigarettes, 17.4 percent for cigarillos, and 16.9 percent for cigars. Although perceptions of some nicotine and tobacco products assessed varied by demographic and tobacco-related characteristics, there were no differences based on these variables for perceptions of cigars.

In a second paper, Smith-Simone et al. (2008) reported psychosocial profiles, including perceived risks, associated with cigarette smoking, waterpipe tobacco use, and cigar smoking. In multivariable models, lower perceived likelihood of sickness from cigar smoking was associated with ever and current (past 30 day) cigar smoking, and lower perceived likelihood of addiction was associated with current cigar smoking. Although different perception items were associated with use of cigarettes and waterpipe, the general patterns were consistent across these three products (i.e., lower perceived risks, higher likelihood of use).

Groups of adults

Campbell et al. (2019) surveyed adult patients enrolled in addiction treatment centers on demographics, tobacco use, and perceived risks; 77 percent were cigarette smokers, 8.3 percent were cigar smokers, 15.3 percent were little filtered cigar/cigarillo users, 11.4 percent were smokeless tobacco users, and 26.3 percent were e-cigarette users. Perceived risks were measured using a third-person scenario in which participants were asked to estimate the risks (0–100 percent chance) of lung cancer, having trouble breathing, and having a heart attack from cigarette smoking, and cigar, little filtered cigar/cigarillo, smokeless tobacco, and e-cigarette. Responses were averaged by product to create an overall score. Average perceived risks were 61.8 for cigarettes, 58.8 for cigars, 58.4 for little filtered cigars/cigarillos, 41.6 for smokeless tobacco, and 40.0

for e-cigarettes. Health risk perceptions were only associated with current e-cigarette use (higher perceived risk, lower odds of use) in analyses adjusting for demographics and treatment program type.

Youth

Strong et al. (2019b) measured risk perceptions as “How much do you think people harm themselves when they use [product]?” For some products, two other items measured “How long do you think someone has to use [product] before it harms their health?” and “Is using [product] less harmful, about the same, or more harmful than smoking cigarettes?” Another question assessed perceived addictiveness as “How likely is someone to become addicted to [product]?”

In this analysis, all cigar types were combined. Harm perceptions were combined into a composite index, with higher scores (range 1–3) reflecting greater perceived harm. Overall scores were highest for cigarettes (mean 2.79), followed by pipe tobacco (mean 2.50), smokeless tobacco (mean 2.49), cigars (mean 2.47), waterpipe (mean 2.22), and e-cigarettes (mean 1.95). Statistically, compared with smokeless tobacco, youth perceived cigars, waterpipe, and e-cigarettes as significantly less harmful. For cigars, perceived harm was associated with age and race and ethnicity: older youth (14–15, 16–17) perceived lower harm than younger (12–13) youth, and Black youth perceived lower harm than non-Hispanic white, Hispanic, and other non-Hispanic youth. For perceived addictiveness (score range 1–5; higher is more addictive), scores were highest for smokeless tobacco (mean 4.33), followed by cigarettes (mean 4.09), pipe tobacco (mean 4.07), cigars (mean 3.99), waterpipe (mean 3.99), and e-cigarettes (mean 3.60). Perceived addictiveness of cigars was lower among youth who were older (14–15 and 16–17 versus 12–13) and male and female respondents.

Strong et al. (2019b) also analyzed perceived harm and addictiveness relative to youth susceptibility to using each product and tobacco use behavior. For cigars, compared with never-users, those who were susceptible, those who had ever tried but had not used cigars in the past 30 days and those who had used cigars in the past 30 days endorsed significantly lower perceived harm and perceived addictiveness. Moreover, compared with never-users, those who had smoked cigarettes only, smoked cigarettes and used one or more other tobacco product, or used noncigarette combustible tobacco reported significantly lower perceived harm of cigars. Compared with never-tobacco users, all youth tobacco user groups reported significantly lower perceived addictiveness of cigars. Despite some variability, these associations were relatively consistent across perceived harm and addictiveness of tobacco products examined (i.e., susceptible youth and youth tobacco users tend to perceive tobacco products as less harmful and addictive).

are more likely to perceive lower harms associated with cigar smoking. Among youth, generally perceived risks of cigars are comparable to other combustible tobacco products (e.g., cigarettes, waterpipe) and smokeless tobacco and higher than e-cigarettes. Some evidence indicates that risk perceptions of cigars vary by youth sociodemographic characteristics, including age (lower among older youth) and race and ethnicity (lower among racial and ethnic minority youth), but these data are limited. Among youth, current tobacco users tend to perceive lower risks of cigars than nonusers, a pattern consistent with most other tobacco products (i.e., lower perceived harm of tobacco products is associated with a higher likelihood of use). Overall, however, these findings should be interpreted with respect to measurement limitations of the evidence reviewed, as most of the available data are not specific to premium cigars.

Perceived Benefits and Reasons

No studies investigated perceived benefits of premium cigar smoking. Some studies have examined similar constructs, such as reasons for use, and are described below.

Adults

Corey et al. (2018) reported data from PATH Wave 1 on reasons for use by cigar type among U.S. adults; the findings are summarized in Table 4-13. Overall, premium cigar users were less likely than other cigar users to indicate that they choose premium cigars because they are affordable, come in flavors that they like, are promoted by people in the media or public figures, are an alternative to quitting tobacco altogether, feel like a regular cigarette, and are a way to cut down cigarette smoking. Premium cigar users were more likely to indicate that they smoke them when they socialize. For the data stratified by cigarette smoking status, many point estimates could not be provided for premium cigar users due to small sample sizes. Thus, these stratified analyses do not provide additional meaningful insights as to reasons for use of premium cigars by cigarette smoking groups beyond the overall numbers summarized.

Analyses of Waves 2–5 of the PATH study data commissioned for this report (see Appendix D) indicate that the reasons for smoking premium cigars were relatively stable over time. For example, at Wave 2, the most commonly reported reason was socializing (76.1 percent of premium cigar smokers), followed by flavors (38.9 percent), and affordability (26.6 percent). In analyses of data for Waves 3–5, however, not all data were collected/available for reasons for use (e.g., smoking while socializing was not available for analyses) (Jeon and Mok, 2022).

DeSantis (2002) conducted an ethnographic study of patrons of a cigar shop to understand their reasons for continued cigar smoking, despite

known health risks, with more than 600 hours of fieldwork to collect information on behaviors and conversations from 1997 to 2000. From the description, this setting appears to be one where premium cigars are sold and consumed, but this is not explicit in the paper. The analysis included coding and synthesis of transcripts from individual interviews and group interactions and showed that cigar shop patrons supported six common pro-cigar arguments:

1. Smoking cigars in moderation reduces health harms, and patrons adapted their definition of moderation to their own user patterns (i.e., cognitive dissonance);

2. Cigar smoking has potential health benefits, such as stress reduction;
3. Cigars are not cigarettes, cigarettes are full of chemicals, the quantity smoked is more, and smokers inhale them;
4. Research on health effects of cigars is flawed and inconsistent over time;
5. Other hazards are far more likely to cause harm than cigar smoking (e.g., pollution, car accidents); and
6. Following the death of a fellow cigar shop patron, that other causes were the primary contributors to his heart attack.

Groups of adults

Campbell et al. (2019) surveyed adult patients enrolled in a network of addiction treatment centers on demographics, tobacco use, and reasons for use; 77 percent were cigarette smokers, 8.3 percent were past 30-day cigar smokers, 15.3 percent were past 30-day little filtered cigar/cigarillo smokers, 11.4 percent were past 30-day smokeless tobacco users, and 26.3 percent were past 30-day e-cigarette users. Cigar (33.3 percent) and little filtered cigar/cigarillo users (25.1 percent) were more likely to indicate that they use these products because they enjoy the taste/flavor than smokeless tobacco (15.3 percent) and e-cigarette users (10.5 percent). Cigar users were less likely than users of all other products assessed to indicate they choose the product when they cannot smoke cigarettes (10.4 percent, versus 17.1 percent for little filtered cigars/cigarillos, 48.1 percent for smokeless, and 25.0 percent for e-cigarettes). In total, 7.3 percent of cigar users indicated that they smoked cigars to reduce health risks, compared with 5.1 percent for little filtered cigars/cigarillos, 6.9 percent for smokeless tobacco, and 11.2 percent for e-cigarettes. Cigar smokers were least likely to indicate that they smoke cigars to reduce/quit smoking cigarettes (8.3 percent, versus 9.1 percent for little filtered cigars/cigarillos, 11.5 percent for smokeless tobacco, and 29.3 percent for e-cigarettes). Greater than 40 percent of cigar and little filtered cigar/cigarillo users indicated “other” reasons (not specified) for using these products, higher proportions than smokeless tobacco (18.3 percent) and e-cigarette users (24.0 percent).

Smith-Simone et al. (2008) reported psychosocial profiles, including perceived social acceptability, associated with cigarette smoking, waterpipe tobacco use, and cigar smoking in a convenience sample of college students (n = 411). In multivariable models, only the perception that cigar smoking looks cool among peers was associated with current (past 30-day) cigar smoking. Despite different perceived benefits items associated with use of cigarettes and waterpipe, the general patterns were consistent across these three products (greater perceived social benefit is

associated with product use). The authors also report on an overall perceived product attractiveness score, an index of perceived social benefits, and social acceptability: cigars and waterpipes were perceived to be more attractive socially than cigarette smoking.

Youth

Tucker et al. (2020) report data from a survey of youth experiencing homelessness in Los Angeles County, California. They assessed cigarette smoking and past 30-day use of other tobacco (natural cigarettes, e-cigarettes, little cigars/cigarillos, and cigars). Among tobacco users, the assessed reasons for use included that “you can use it in places where cigarette smoking is not allowed,” “I like socializing while using it,” “it tastes good,” “it smells good,” “you get more nicotine for the cost,” and “it gives you a good buzz.” These are reported descriptively for users of each product but not compared statistically. Notably, e-cigarette, little cigar/cigarillo, and cigar users were more likely to support these products because of the taste (74.2 percent e-cigarettes, 61.9 percent little cigars/cigarillos, 65.8 percent cigars) and smell (67.3 percent e-cigarettes, 57.2 percent little cigar/cigarillos, 56.8 percent cigars) than cigarette (50.3 percent taste, 36.6 percent smell) and natural cigarette (50.3 percent taste, 36.6 percent smell) users. E-cigarette users (72.3 percent) were more likely than little cigar/cigarillo (26.0 percent) and cigar users (24.0 percent) to indicate using e-cigarettes in places where cigarette smoking is not permitted.

Summary of Perceived Benefits and Other Perceptions of Premium Cigars

Research is limited on perceived benefits and reasons for using premium cigars. Only one study assessed reasons for use in a representative sample of U.S. adults using PATH data (Corey et al., 2018). The findings indicate adult premium cigar users are more likely than those who use other types of cigars to indicate socializing as a reason for use, and they are less likely to indicate smoking premium cigars for reasons related to cigarette smoking, such as smoking them in places where cigarette smoking is not allowed or to cut down cigarette smoking.

Other ethnographic (DeSantis, 2002) and observational research on groups of adults (Campbell et al., 2019; Smith-Simone et al., 2008) used convenience samples, so the generalizability of findings is more limited. The only study assessing perceived benefits or reasons for using cigars among youth was Tucker et al. (2020); although the measures used likely capture use behavior and reasons for using premium cigars, they were not specific to those, and it is unlikely that cigar use in this study reflected premium cigars.

0.96–1.94). The association between lower perceived harm of traditional cigars and subsequent use was also modified by sex, age, and race and ethnicity. Generally, the association was stronger among women, older adults (ages 55+), and those who identified as Hispanic/Latino. It was not modified by sexual orientation, income, or education.

For all products assessed except pipe tobacco, the prevalence of having decreased harm perceptions from Wave 1 to Wave 2 was highest among those who transitioned from nonuse to use (Elton-Marshall et al., 2020). For traditional cigars, among those transitioning from nonuse at Wave 1 to use at Wave 2, 20.2 percent had decreased harm perceptions. In comparison, 14.8 percent of those who were nonusers at both waves, 13.8 percent of those who transitioned from users at Wave 1 to nonusers at Wave 2, and 13.7 percent of those who were users at both waves decreased harm perceptions. These findings are consistent with the observed phenomenon of cognitive dissonance: some users tend to shift their risk perceptions to rationalize their own behavior.

Youth

Strong et al. (2019a) analyzed prospective data from U.S. youth aged 12–17 from PATH Wave 1 to Wave 2. The authors examined whether perceived harm and addictiveness of tobacco products changed over time, whether perceived harm and addictiveness at Wave 1 predicted initiation at Wave 2, and whether trying the product between Wave 1 and Wave 2 predicted decrease in perceived harm and addictiveness at Wave 2. They did not perform longitudinal analyses of change in perceptions for cigar products because the questions changed from Wave 1 to Wave 2. Questions captured absolute harm (how much does [product] harm your health?), how long someone needs to use [product] to harm their health, and perceived harm relative to cigarettes. Items were combined to reflect a score of 1–3, with higher values indicating greater perceived harm. Perceived addictiveness was measured with a single item and coded to a three-level variable for comparability.

The absolute percentages of youth indicating “high” perceived harm are shown in a figure, and point estimates are not provided. However, visual inspection indicates most youth report high perceived harm of cigars, a greater proportion than for waterpipe and e-cigarettes, and comparable proportions to cigarettes and smokeless tobacco. The proportion of youth reporting low perceived harm of cigars was greater among older youth (16–17) and non-Hispanic Black youth, although statistical differences were not reported. At Wave 1, the majority of youth reported high perceived addictiveness of cigars, and, similar to perceived harm, the proportion reporting low perceived addictiveness was higher among older

youth (16–17) and non-Hispanic Black youth. The authors also report that perceived addictiveness of cigars increased from Wave 1 to Wave 2 in nearly all demographic groups, but they do not present associated data.

For nearly all tobacco products assessed, the probability of initiation from Wave 1 to Wave 2 was highest among those with low or medium perceived harm at Wave 1, followed by those who had high perceived harm, who were unsure, or who had not heard of the product. The median effect size across products for the association between low perceived harm and initiation was OR: 4.71. For perceived addictiveness, the probability of initiation from Wave 1 to Wave 2 was highest among those with low or medium perceived addictiveness at Wave 1, followed by those with high perceived addictiveness, those who were unsure, and those who had not heard of the product. The median effect size across products for the association between low perceived addictiveness and initiation was OR: 4.82. For traditional cigars, these results suggest that lower perceived harm and addictiveness among youth is associated with higher odds of subsequent initiation, a pattern that was consistent across the tobacco products examined.

Parker et al. (2018) analyzed the associations between perceived product-specific harms, perceived harm relative to cigarettes, and tobacco use initiation among youth from Wave 1 to Wave 2. This analysis is similar to Strong et al. (2019b), but risk perception measures were not combined in an index. Specific group analyses are not reported, but models are adjusted for age, sex, race, region, parental education, ever alcohol use, and ever-tobacco use at Wave 1.

For absolute harm perceptions of cigars, compared to those who reported a lot of harm, those who reported no or a little harm at Wave 1 were significantly more likely to initiate use at Wave 2 (OR: 2.6). Those who reported some harm had an increased odds of initiation as well, but the difference was not statistically significant (OR: 1.3). For e-cigarettes, pipes, waterpipe, and smokeless tobacco, youth who reported no or a little harm at Wave 1 had higher odds of initiation at Wave 2. Adjusted models examining the association between perceived harm relative to cigarettes at Wave 1 and initiation at Wave 2 showed similar patterns.

Youth who perceived cigars to be less harmful than cigarettes at Wave 1 were more likely to initiate cigar smoking at Wave 2 (OR: 1.5) compared with those who perceived cigars to be more harmful. This pattern was consistent for perceived relative harm of e-cigarettes, waterpipe, and smokeless tobacco but not for pipe tobacco. Overall, these data indicate that for most noncigarette tobacco products assessed, perceived lower absolute harm and perceived lower harm than cigarette smoking is associated with an increased likelihood of initiation among youth.

and qualitative data, but most studies do not specifically examine premium cigar use.

Conclusion 4-7: There is strongly suggestive evidence that the U.S. population perceives cigar products overall to be harmful and addictive. However, there is no research that examines the knowledge of the specific health effects of premium cigars.

Perceptions and Patterns of Use

In the committee’s review, research analyzing prospective population-based data from PATH demonstrated that lower perceived risks (lower perceived health harm, addictiveness) of cigars is associated with subsequent use among U.S. adults and initiation of use among U.S. youth. These studies did not differentiate premium cigars from other cigar products.

Conclusion 4-8: There is strongly suggestive evidence from prospective studies that lower perceived harm and addictiveness of cigars in general is associated with cigar use behavior, including current use in adults and initiation in youth.

CONCLUDING OBSERVATIONS

Marketing and promotion are designed to increase the sales of tobacco products and increase consumer demand. Relative to other tobacco products, the committee found limited published data specific to the marketing and sales and consumers’ awareness, knowledge, and perceptions of premium cigars. As a result, primary data collection was needed to understand their marketing and promotion practices. Thus, the committee conducted primary content analyses of magazines; examined direct print and e-mail marketing; conducted secondary analysis of existing surveys; conducted an environmental scan of marketing on social media; examined online marketing; collected data on retail marketing; and conducted literature reviews. Based on the available research and the committee’s efforts, key insights can be drawn.

Consistent with research on the “premiumization” of other tobacco products, it is clear that premium cigars are marketed as a quality product with benefits that outweigh their potential risks. Marketing occurs through channels that are unique to premium cigars, such as lifestyle magazines and festivals, and through channels that are common to other tobacco products, such as DTC and online marketing. Premium cigar marketing uses strategies to increase product appeal by emphasizing

premium cigars as part of a successful, luxurious lifestyle, use at upscale social events, and appealing to influential celebrities and individuals. Sales of premium cigars are also distinct from other forms of tobacco—consumers most often purchase them from cigar bars and tobacco specialty shops versus convenience stores and other retail locations. Online premium cigar sales are prevalent, though not captured in national surveys of cigar users. Finally, despite limited direct evidence on consumers’ awareness, knowledge, and perceived benefits of using premium cigars, consistent with research on other tobacco products there is evidence that lower perceived risks of cigar products in general promote initiation and current use of cigars. See Box 4-2 for key research and measurement gaps.