Monograph 9: Cigars: Health Effects and Trends
Acknowledgments
Cigars: Health Effects and Trends was developed under the editorial direction of Donald R. Shopland, Coordinator, Smoking and Tobacco Control Program (STCP), National Cancer Institute, Bethesda, Maryland.
The Senior Scientific Editor for this monograph was David M. Burns, M.D., Professor of Medicine, School of Medicine, University of California San Diego, San Diego, California. The Consulting Scientific Editors were Dietrich Hoffmann, Ph.D., Associate Director, American Health Foundation, Valhalla, New York and K. Michael Cummings, Ph.D., M.P.H., Senior Research Scientist, Roswell Park Cancer Institute, Buffalo, New York. The Managing Editor for this monograph was Richard H. Amacher, Project Director, KBM Group Inc., Silver Spring, Maryland.
The editors and STCP staff members gratefully acknowledge the many researchers and authors who made this monograph possible. Attributions for each chapter are as follows:
Chapter 1.
Cigar Smoking: Overview and
Current State of the Science
David M. Burns, M.D.
Professor of Medicine
School of Medicine
University of California San Diego
San Diego, CA
Chapter 2.
Trends in Cigar Consumption and Smoking Prevalence
Karen K. Gerlach, Ph.D., M.P.H.
Epidemiologist
Office on Smoking and Health
Centers for Disease Control and Prevention
Atlanta, GA
K. Michael Cummings, Ph.D., M.P.H.
Senior Research Scientist
Department of Cancer Control and Epidemiology
Roswell Park Cancer Institute
Buffalo, NY
Andrew Hyland, M.A.
Data Analyst
Department of Cancer Control and Epidemiology
Roswell Park Cancer Institute
Buffalo, NY
Elizabeth A. Gilpin, M.S.
Senior Statistician
Cancer Prevention and Control
University of California San Diego
La Jolla, CA
Michael D. Johnson, Ph.D.
Chief
Data Analysis and Evaluation Unit
California Department of Health Services
Tobacco Control Section
Sacramento, CA
John P. Pierce, Ph.D.
Professor and Associate Director
Cancer Prevention and Control
Sam M. Walton Professor for Cancer Research
University of California San Diego
La Jolla, CA
Chapter 3.
Chemistry and Toxicology
Dietrich Hoffmann, Ph.D.
Associate Director
American Health Foundation
Valhalla, NY
Ilse Hoffmann, B.S.
Research Coordinator
American Health Foundation
Valhalla, NY
Chapter 4.
Disease Consequences of Cigar Smoking
Thomas G. Shanks, M.P.H., M.S.
Principal Statistician
University of California San Diego
San Diego, CA
David M. Burns, M.D.
Professor of Medicine
School of Medicine
University of California San Diego
San Diego, CA
Chapter 5.
Indoor Air Pollution from Cigar Smoke
James L. Repace, M.S.
Repace Associates
Bowie, MD
U.S. EPA Office of Radiation and Indoor Air (Retired)
Wayne R. Ott, Ph.D.
Visiting Scholar
Department of Statistics
Consulting Professor
Department of Civil and Environmental Engineering
Stanford University
Stanford, CA
Neil Klepeis, M.S.
School of Public Health
Environmental Health Sciences
University of California, Berkeley
Berkeley, CA
Chapter 6.
Pharmacology and Abuse Potential of Cigars
Reginald V. Fant, Ph.D.
Pinney Associates, Inc.
Bethesda, MD
Jack E. Henningfield, Ph.D.
Vice President
Research and Health Policy
Pinney Associates, Inc.
Bethesda, MD
Associate Professor
Department of Psychiatry and Behavioral Sciences
Johns Hopkins University
School of Medicine
Baltimore, MD
Chapter 7.
Marketing and Promotion of Cigars
John Slade, M.D.
Professor of Clinical Medicine
University of Medicine and Dentistry of New Jersey
Robert Wood Johnson Medical School
Saint Peter's Medical Center
New Brunswick, NJ
Chapter 8.
Policies Regulating Cigars
Gregory N. Connolly, D.M.D., M.P.H.
Director of the Massachusetts Tobacco Control Program
Massachusetts Department of Public Health
Boston, MA
We gratefully acknowledge the following distinguished scientists, researchers, and others, both in and outside Government, who contributed critical reviews or assisted in other ways:
Anthony Alberg, Ph.D., M.P.H.
Assistant Scientist
Johns Hopkins University
Baltimore, MD
Dileep G. Bal, M.D.
Chief
Cancer Control Branch
California Department of Health Services
Sacramento, CA
Steve Bayard, Ph.D.
Director
Office of Risk Assessment
Health Standards Program
OSHA, Department of Labor
Washington, DC
Neal L. Benowitz, M.D.
Professor of Medicine
Chief
Division of Clinical Pharmacology and Experimental Therapeutics
University of California San Francisco
San Francisco, CA
Lois Biener, Ph.D.
Senior Research Fellow
Center for Survey Research
University of Massachusetts Boston
Boston, MA
Michele Bloch, M.D., Ph.D.
Chair
Tobacco Control and Prevention Subcommittee
American Medical Women's Association
Alexandria, VA
Tom Capehart, M.S.
Agricultural Economist
Economic Research Service
United States Department of Agriculture
Washington, DC
Sir Richard Doll, F.R.S., F.R.C.P.
Emeritus Professor of Medicine
Radeliffe Infirmary
University of Oxford
Oxford
United Kingdom
Michael Eriksen, Sc.D.
Director
Office on Smoking and Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Atlanta, GA
Lawrence Garfinkel, M.A.
Consultant
American Cancer Society
New York, NY
Ellen Gritz, Ph.D.
Professor and Chair of the Department of Behavioral Science
University of Texas
MD Anderson Cancer Center
Houston, TX
S. Katharine Hammond, Ph.D., CIH
Associate Professor of Environmental Health Sciences
School of Public Health
University of California
Berkeley, CA
Thomas P. Houston, M.D.
Director
Department of Preventative Medicine and Environmental Health
American Medical Association
Chicago, IL
John Hughes, M.D.
Professor
Department of Psychiatry
Ira Allen School
University of Vermont
Burlington, VT
Murray J. Kaiserman, Ph.D.
Acting Director
Office of Tobacco Control
Health Protection Branch
Ottawa, Ontario
CANADA
C. Everett Koop, M.D.
Bethesda, MD
U. S. Surgeon General (1981-1989)
Claude Lenfant, M.D.
Director
National Heart, Lung, and Blood Institute
National Institutes of Health
Bethesda, MD
Alan I. Leshner, Ph.D.
Director
National Institute on Drug Abuse
National Institutes of Health
Rockville, MD
John L. Pauly, Ph.D.
Cancer Research Scientist V
Department of Molecular Immunology
Roswell Park Cancer Institute
Buffalo, New York
John Pinney, B.A.
President
Pinney Associates, Inc.
Bethesda, MD
Richard W. Pollay, Ph.D., M.B.A.
Professor of Marketing
Faculty of Commerce
University of British Columbia
Vancouver, British Columbia
CANADA
Bill Rickert, Ph.D.
President
Labstat Incorporated
Kitchener, Ontario
Associate Professor
Department of Statistics
University of Waterloo
Waterloo, Ontario
CANADA
Nancy A. Rigotti, M.D.
Director
Tobacco Research and Treatment Center
General Internal Medicine Unit
Massachusetts General Hospital
Boston, MA
Jonathan M. Samet, M.D., M.S.
Professor and Chairman
Department of Epidemiology
School of Hygiene and Public Health
Johns Hopkins University
Baltimore, MD
Jesse L. Steinfeld, M.D.
San Diego, CA
U. S. Surgeon General (1969-1973)
Michael J. Thun, M.D.
Vice President
Epidemiology and Surveillance Research
American Cancer Society
Atlanta, GA
Kenneth E. Warner, Ph.D.
Richard D. Remington Collegiate
Professor of Public Health
Department of Health Management and Policy
School of Public Health
The University of Michigan
Ann Arbor, MI
Jeffrey Wasserman, Ph.D.
Consultant
The RAND Corporation
Santa Monica, CA
Judith Wilkenfeld, J.D.
Special Advisor to the Commissioner
Food and Drug Administration
Rockville, MD
Ernst L. Wynder, M.D.
President
American Health Foundation
New York, NY
Mitchell R. Zeller, J.D.
Associate Commissioner
Food and Drug Administration
Rockville, MD
Finally, the editors and STCP staff members would also like to acknowledge the contributions of the following individuals who provided technical and editorial assistance in the preparation of this monograph. We would particularly like to acknowledge the staff of Business Images, Vienna, Virginia, especially Allen Côté, Marleen Flegel, and Ken Snow for their invaluable assistance during the final production phase of the monograph.
KBM Group, Inc., Silver Spring, MD
Shelia Russell McCullers, M.S., Information Coordinator/Assistant Managing Editor
Thomas H. Gough, B.A., Technical Editor
Barbara A. Hatfield, A.A.,Copy Editor/Research Assistant
Keith W. Stanger, A.A., Graphics Designer
Heidi Volf, B.A., Copy Editor/Research Assistant
Carleen H. Wallington, M.S., Copy Editor/Research Assistant
Tobacco Control Policies Project, University of California San Diego, San Diego, CA
Christy M. Anderson, B.S., Statistician
Maureen Arnn, B.S., Project Assistant
Robert W. Davingnon, M.S., Production Editor
Victoria L. Dirac, B.A., Project Assistant
Kathryn B. Gower, B.A., Statistical Assistant
Jacqueline M. Major, M.S., Statistician
Melissa L. Sage, B.A., Project Assistant
Jerry W. Vaughn, B.S., Programmer/Analyst
Kristina M. Webb, Project Assistant
How This Monograph Was Prepared
This volume is the ninth in the series of Smoking and Tobacco Control monographs published by the National Cancer Institute (NCI) since their inception in 1991. One of the major reasons for establishing the monograph series was to provide a mechanism for the rapid, systematic, and timely dissemination of information important to the research and public health communities about emerging issues in smoking and tobacco use control. While the focus of the monographs has primarily centered on topics related to public health interventions, this volume is somewhat of a departure in that it is the first comprehensive examination of what we know about current trends in cigar use and resultant health implications.
CIGARS: Health Effects and Trends, is being published, in part, because of the growing and sustained interest in cigars as reflected by the countless inquiries received over the past two years about the topic by NCI's Office of Cancer Communications.
Prior to 1994, smoking of cigars had declined by 60 percent in the United States, a downward trend which started in the mid-1960's. Surveys conducted from the mid-1950's through the early 1990's confirmed that cigar smoking was declining. The public health community assumed, incorrectly it now appears, that cigar smoking would continue to decline in popularity and did not warrant further investigation. But starting in the early 1990's, the downward trend in cigar use began to reverse; and between 1993 and 1997, cigar consumption increased almost 50 percent with consumption of large, premium cigars increasing nearly 250 percent.
Public interest, spurred by new magazines devoted entirely to cigars and cigar smoking, and the social environment that cigar smoking purportedly involves, was enough to rapidly increase the consumption of cigars. Unfortunately, the public has been led to believe that cigar smoking is far less of a threat to an individual's health than cigarette smoking simply because it is a cigar. The present monograph is an attempt to dispel this misconception and put the risks of cigar smoking into their proper context.
The Smoking Tobacco and Control Program (STCP) staff continually monitors the consumption of all forms of tobacco products, and consequently, the recent interest and increased consumption of cigars was considered important enough to the nation's health to prepare a health oriented publication regarding cigar smoking.
Once the decision was made by the STCP Coordinator to look into the matter of cigar smoking, a broad outline was developed showing the major chapters or topics to be covered in the monograph. A three-person scientific editorial team was established, consisting of the Senior Scientific Editor, David M. Burns, Professor of Medicine, University of California San Diego, California, and two Consulting Scientific Editors, Dietrich Hoffmann, Associate Director, American Health Foundation, Valhalla, New York, and K. Michael Cummings, Senior Research Scientist, Roswell Park Cancer Institute, Buffalo, New York. After a more detailed outline was developed, potential authors were identified and contacted to determine their willingness to write individual chapters or sections of the monograph.
A one-day meeting was convened in the Washington, D.C. area in February 1997 involving the entire monograph team. Each lead author presented an overview of his/her assignment, including how they proposed approaching their particular chapter, potential sources to be used, the need for primary or secondary data analysis, and gaps or overlaps in coverage. Discussions and recommendations followed each presentation.
Peer Review
Preliminary draft chapters were delivered to the NCI approximately 4 months following the initial meeting in Washington. The senior scientific editor, in consultation with the other science editors, reviewed all chapter drafts for scientific and technical content and advised authors if revisions were needed. All chapter drafts were distributed to two or more outside experts knowledgeable in the subject area of the chapter. All review comments received were considered and a new iteration of the monograph was generated. The revised version of the entire monograph was sent to a select list of 12 senior level reviewers as well as to a number of Public Health Service agency heads, for review and comments. All comments received from this review cycle were also integrated and a third version of the volume was generated. A total of 30 outside experts participated in the peer review.
CIGARS: Health Effects and Trends was the work of dozens of individuals, and is organized into 8 chapters:
Chapter 1: Cigar smoking: Overview and current state of the science.
Chapter 2: Trends in cigar consumption and smoking prevalence.
Chapter 3: Chemistry and toxicology.
Chapter 4: Disease consequences of cigar smoking.
Chapter 5: Indoor air pollution from cigar smoke.
Chapter 6: Pharmacology and abuse potential of cigars.
Chapter 7: Marketing and promotion of cigars.
Chapter 8: Policies regulating cigars.
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