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Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition

Cigarettes and cigars

by Bethany Thivierge, MPH, Michael A. Buratovich, Ph.D.

Category: Substances

Definition: A cigarette is a cylinder of cured and finely cut tobacco wrapped in paper. The paper is ignited and the smoke is inhaled through the mouth into the lungs. A cigar is a larger cylinder of dried and fermented tobacco wrapped in whole-leaf tobacco that is also ignited. Cigar smoke is drawn into the mouth, and nicotine is absorbed through the oral membranes. Because of its alkalinity, cigar smoke irritates inner mucous membranes, and is typically not inhaled.

Status: Legal in the United States and most countries for adults. In some Canadian provinces, the legal age is nineteen years. In Japan, the legal age is twenty years. In Kuwait, the legal age is twenty-one years. In Austria, Belgium, France, and the Netherlands, the legal age is sixteen years.

Classification: Regulated by the U.S. Food and Drug Administration as a nicotine delivery system.

Source: The United States grows about 10 percent of the world’s tobacco and is the fourth largest global producer of tobacco (4.5 percent); the major tobacco-growing countries are China (40 percent), India (8 percent), Brazil (7 percent), and Turkey (4 percent). Two-thirds of the American tobacco crop is grown in the states of Kentucky and North Carolina.

Transmission route: The nicotine in cigarette smoke is absorbed in the lungs and rapidly acts on the brain to activate pleasure centers and stimulate an adrenaline rush. Small amounts of nicotine in the smoke may be absorbed through the mucous membranes of the nose and mouth. The nicotine in cigar smoke is absorbed slowly through the mucous membranes of the mouth because the smoke is too harsh to be inhaled.

History of Use

Tobacco use has a long history in the New World and tobacco cultivation sites in Mexico date to 1400–1000 BCE. Tobacco smoking among Native Americans had important social, ceremonial, and religious significance, and tobacco was also grown for trade.

Smoking tobacco was introduced in Europe in the sixteenth century and in the United States in the seventeenth century. Matches and cigarettes were first commercially produced in the nineteenth century, facilitating the habit of smoking. By 1901, 80 percent of American men smoked at least one cigar a day; that same year, 6 million cigars and 3.5 million cigarettes were sold in the United States.

In 1913, the R. J. Reynolds Tobacco Company introduced Camel cigarettes, and ten years later, Camels were smoked by 45 percent of American smokers. By 1940, the number of cigarette smokers had doubled from that of 1930. The advertising and marketing of tobacco products in the twentieth century especially targeted military personnel and women.

In 1950, the first evidence linking lung cancer and tobacco smoking was published in a British medical journal. In 1965, a U.S. federal law mandated that a warning from the U.S. surgeon general be placed on all packages of cigarettes and all cigarette advertising, stating the risks of smoking tobacco. In 1971, cigarette advertising was banned from television. In 1972, Marlboro cigarettes became the best-selling brand of cigarettes in the world, and it remains the best-selling brand. In 1988, the U.S. surgeon general determined that nicotine, the chief active constituent of tobacco, was an addictive substance. Nine years later, a U.S. federal judge ruled that the U.S. Food and Drug Administration could regulate tobacco as a drug.

Globally, the total number of cigarettes smoked is decreasing. The largest markets for tobacco consumption are populous Asian countries. China, whose people smoke more than 40% of all cigarettes, remains the largest consumer of tobacco products, even though cigarette use in China has begun to decrease. Indonesia is set to increase the number of tobacco smokers by 24 million from 2015 to 2025. Africa and the Eastern Mediterranean show the fastest growth of tobacco use. Nigeria, for example, is set to increase the number of tobacco smokers by seven million from 2015 to 2025.

Worldwide, there are an estimated 1 billion smokers and approximately 6.5 trillion cigarettes are sold, globally, each year. In terms of supply and demand, the tobacco industry makes much of its money off the world’s poorest people, since lower socioeconomic groups tend to smoke more. In 2016, 7.1 million people died from tobacco-related illnesses, including heart disease, stroke, and cancer. For every smoker who dies of a smoking-related disease, twenty others are living with a serious smoking-related disease. On average, men who do not smoke live 13.2 years longer than men who smoke, and women who do not smoke live 14.5 years longer than women who smoke.

The U.S. is the top cigar-consuming country. From 2000 to 2012, cigar consumption increased by 101 percent while cigarette consumption declined by 41 percent. According to data from the 2012 National Youth Tobacco Survey, cigar use is most common among young people; an estimated 12.6 percent of high school students had smoked at least one cigar in the past 30 days. The CDC’s national Adult Tobacco Survey for 2009-2015 showed that cigar smoking prevalence among adults was highest among 18–24 years (15.9 percent).

Effects and Potential Risks

Tobacco smoking usually leads to nicotine addiction. Upon entry into the brain, nicotine binds to receptors that usually bind the neurotransmitter acetylcholine and increases the release of several neurotransmitters, the most important of which is dopamine. Nicotine induces dopamine release in the mesolimbic pathway; in particular, the nucleus accumbens and the ventral tegmental area (VTA) of the midbrain. Dopamine-based activation of the mesolimbic pathway is integral to drug-induced reward and drug addiction. When dopamine levels in the brain drop, the smoker feels depressed and lights the next cigarette or cigar to regain the heightened sense of pleasure and well-being. Nicotine withdrawal symptoms include irritability, depressed mood, restlessness, anxiety, relational problems, difficulty concentrating, increased hunger and eating, insomnia, and tobacco craving.

Tobacco smoking has multiple deleterious health effects. Women who smoke have an increased risk of miscarriage, premature labor, and giving birth to an underweight baby. Tobacco smoke also contains multiple toxins including carbon monoxide, which reduces the blood’s ability to carry oxygen to cells. The harmful health effects of tobacco smoking are cataloged in the table below.

Organ Health effects Eyes Cataracts, blindness (macular degeneration), stinging, excessive tearing and blinking Brain and Psyche Stroke, addiction, altered brain chemistry, anxiety about tobacco Hair Odor and discoloration Nose Cancer of nasal cavities and paranasal sinuses, chronic rhinosinusitis, impaired sense of smell Teeth Discoloration and staining of teeth, periodontal disease, loose teeth, tooth loss, root-surface caries, plaque Mouth and Throat Cancers of the lips, mouth, throat, larynx, and pharynx, sore throat, impaired sense of taste, bad breath Ears Hearing loss, ear infection Lungs Lung, bronchi, and tracheal cancer, chronic obstructive pulmonary disease and emphysema, respiratory infections, shortness of breath, asthma, chronic cough, excessive sputum production Heart Coronary thrombosis (heart attack), atherosclerosis (damage and occlusion of coronary artery) Chest and Abdomen Esophageal cancer, gastric, colon, and pancreatic cancer, abdominal aneurysm, peptic ulcer, possible increased risk of breast cancer Liver Liver cancer Male Reproduction Infertility, loss of sperm motility, low sperm counts, impotence, prostate cancer Female Reproduction Cervical and ovarian cancer, premature ovarian failure, early menopause, reduced fertility, painful menstruation Urinary System Bladder, kidney, and ureter cancer Hands Peripheral circulation disease, poor circulation, resulting in cold fingers Skin Psoriasis, loss of skin tone, wrinkling, premature aging Skeletal System Osteoporosis, hip fracture, susceptibility to back problems, bone marrow cancer, rheumatoid arthritis Wounds and Surgery Impaired wound healing, poor post-surgical recovery, burns from cigarettes and from fires caused by cigarettes Legs and Feet Peripheral vascular disease, cold feet, leg pain and gangrene, deep vein thrombosis Circulatory system Buerger’s disease (inflammation of arteries, veins, and nerves in legs), acute myeloid leukemia Immune system Impaired resistance to infection, possible increased risk of allergies Others Diabetes, sudden death

[i] Adapted from The Tobacco Atlas, p. 24.

Cigar smoking is not a safe alternative to cigarette smoking. Cigar smoking has been credibly linked to an increased risk of gum disease and tooth loss, as well as cancers of the lung, esophagus, tongue, larynx, lips, mouth, and throat. Heavy cigar smoking can also increase the risk for lung diseases and coronary heart disease.

Nonsmokers who breathe environmental, or secondhand cigarette or cigar smoke are also exposed to the toxins and carcinogens contained in it. Children exposed to tobacco smoke suffer from higher incidence of Sudden Infant Death Syndrome, asthma, pneumonia, and middle ear disease. Nonsmoking adults routinely exposed to cigarette smoke show significantly higher incidence of coronary heart disease, lung cancer, nasal irritation, stroke, and, in women, low birth weight. Epidemiological evidence suggests that exposure to secondhand smoke may also increase the risk of chronic obstructive pulmonary disease, asthma, impaired lung function, atherosclerosis, cancer of the nasal sinuses, pharynx, and larynx, and, in women, increased risk of breast cancer and preterm delivery. Exposure to secondhand smoke is highest in Asia.

For Further Information

Bellenir, Karen. (2010). Tobacco information for teens: Health tips about the hazards of using cigarettes, smokeless tobacco, and other nicotine products. Aston, PA: Omnigraphics. A comprehensive, easy-to-read reference book for middle school and high school students.

Boonn, Ann. (2017). The rise of cigars and cigar-smoking harms. Washington, DC: Campaign for Tobacco-Free Kids. Retrieved from https://www.tobaccofreekids.org/assets/factsheets/0333.pdf. A free resource that focuses on the statistics and consequences of cigar smoking among the younger generation.

Carr, Allen. (2010). The easy way to stop smoking: Join the millions who have become non-smokers using Allen Carr’s easy way method. New York: Sterling. This book helps smokers discover the underlying reasons for smoking and discusses how to handle nicotine withdrawal and avoid the temptation to relapse.

Drope, Jeffery, & Schluger, Neil W. (Eds.). (2018). The tobacco atlas (6^th Ed.). Atlanta: The American Cancer Society and Vital Strategies. Retrieved from https://tobaccoatlas.org/. A free resource that graphically catalogues the societal costs of tobacco use.

Jamal, Ahmed, Gentzke, Andrea, Hu, S. Sean, Cullen, Karen A., Apelberg, Benjamin J., Homa, David M., & King, Brian A. (2017). Tobacco use among middle and high school students — United States, 2011–2016. Morbidity and Mortality Weekly Report 66, 597–603. DOI: http://dx.doi.org/10.15585/mmwr.mm6623a1. A summary of the statistics of tobacco use among secondary school students.

Rose, Jed E., Behm, Frédérique M., Drgon, Tomas, Johnson, Catherine, & Uhl, George R. (2010). Personalized smoking cessation: Interactions between nicotine dose, dependence, and quit-success genotype score. Molecular Medicine 16, 247–253. Discussion of a study that found that the reduction of carbon monoxide levels with nicotine replacement therapy increases the likelihood of successful smoking abstinence.

Citation Types

Type

Format

MLA 9th

Thivierge, Bethany, and Michael A. Buratovich. "Cigarettes And Cigars." Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition, edited by Paul Moglia, Salem Press, 2018. Salem Online, online.salempress.com/articleDetails.do?articleName=Addictions2e_0065.

APA 7th

Thivierge, B., & Buratovich, M. A. (2018). Cigarettes and cigars. In P. Moglia (Ed.), Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Salem Press. online.salempress.com.

CMOS 17th

Thivierge, Bethany and Buratovich, Michael A. "Cigarettes And Cigars." Edited by Paul Moglia. Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Hackensack: Salem Press, 2018. Accessed September 13, 2025. online.salempress.com.

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