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The toxicants generated by combustion of tobacco include oxidizing chemicals, carcinogens (such as nitrosamines and polycyclic hydrocarbons), carbonyls (such as acrolein, formaldehyde, and acetaldehyde), carbon monoxide (CO), metals, and particulates. Mechanisms of tobacco smoke toxicity and biomarkers of toxicant exposure are applicable to understanding the potential harms of premium cigars.

Chapters 2 and 3 address inhalation and frequency of use for large cigars.

The health risks of little cigars and cigarillos, which are commonly inhaled and may be smoked more frequently, may be expected to be similar to those of cigarette smoking.

The extent of inhalation and the frequency and duration of use are major factors in determining whether tobacco smoking will cause disease. When tobacco is burned, the generated toxicants are generally similar across tobacco types. These include increased overall mortality, cardiovascular disease (CVD), chronic obstructive lung disease, cancer, susceptibility to respiratory infection, adverse reproductive outcomes, and other diseases ( HHS, 2004, 2010, 2014). Cigarette smoking is the most common form of combusted tobacco use, and its health effects are well established. The potential adverse health effects of “premium” 1 cigars need to be viewed in the context of harms of combusted tobacco smoking broadly.

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