Authors: Naif Alwithanani

INTRODUCTION

Tobacco has been linked multiple times to many health implications. The relationship between periodontitis and tobacco was thoroughly investigated in this systemic review to evaluate if tobacco specifically smoking impacts the progression of periodontal through impairing vascular and immunity mediators processes.

MATERIALS AND METHODS

The manual and electronic literature searches up to 2020 in the databanks of the EMBASE, MEDLINE, PUBMED, and SCOPUS were conducted. The search terms were "periodontitis," "periodontitis diseases," "smoking," "tobacco use," "tobacco," and "cigarette, pipe, and cigar." The types of studies included were restricted to the original studies and human trials. Analyses of subgroups and meta-regression were used to calculate the heterogeneity.

RESULTS

15 papers total were considered in the review, however only 14 of them provided information that could be used in the meta-analysis. Smoking raises the incidence of periodontitis by 85% according to pooled adjusted risk ratios (risk ratio 1.845, CI (95%) =1.5, 2.2). The results of a meta-regression analysis showed that age, follow-up intervals, periodontal disease, the severity of periodontitis, criteria used to determine periodontal status, and loss to follow-up accounted for 54.2%, 10.7%, 13.5%, and 2.1% of the variation in study results.

CONCLUSION

Smoking has an undesirable impact on periodontal incidence and development. Therefore, when taking the history of the patients at the initial visits the information about the habit of smoking has to be thoroughly noted.

PubMed: 37654319
DOI: 10.4103/jpbs.jpbs_516_22

Review

Authors: Cindy M Chang, Catherine G Corey, Brian L Rostron...

BACKGROUND

Cigars are a growing public health concern, given the changes in cigar use patterns in the US and elsewhere since the 1960s. We conducted a systematic review of published studies on current cigar smoking and all-cause and cause-specific mortality risks to inform potential regulatory approaches and future research that would strengthen the body of evidence.

METHODS

Using 3 different databases and handsearching, we identified epidemiological studies published prior to June 2014 that examined the association between cigar smoking and all-cause mortality and smoking-related mortality. Detailed study characteristics as well as association-level characteristics, including effect estimates and 95% confidence intervals, were abstracted or calculated from each selected study.

RESULTS

A total of 22 studies from 16 different prospective cohorts were identified. Primary cigar smoking (current, exclusive cigar smoking with no history of previous cigarette or pipe smoking) was associated with all cause-mortality, oral cancer, esophageal cancer, pancreatic cancer, laryngeal cancer, lung cancer, coronary heart disease (CHD), and aortic aneurysm. Strong dose trends by cigars per day and inhalation level for primary cigar smoking were observed for oral, esophageal, laryngeal, and lung cancers. Among primary cigar smokers reporting no inhalation, relative mortality risk was still highly elevated for oral, esophageal, and laryngeal cancers.

CONCLUSIONS

In summary, cigar smoking carries many of the same health risks as cigarette smoking. Mortality risks from cigar smoking vary by level of exposure as measured by cigars per day and inhalation level and can be as high as or exceed those of cigarette smoking. The body of evidence would be strengthened by future studies that focus on the health effects of primary cigar smoking and incorporate more contemporary and diverse study populations to better reflect the current patterns of cigar use in the US. Ideally, these studies would also collect detailed information on cigar type, exposure level, and biomarkers of exposure and potential harm.

Topics: Aortic Aneurysm; Coronary Disease; Dose-Response Relationship, Drug; Humans; Lung Neoplasms; Neoplasms; Prospective Studies; Risk; Smoking; Tobacco Products

PubMed: 25907101
DOI: 10.1186/s12889-015-1617-5

Authors: Tameka S Lawler, Stephen B Stanfill, B Rey deCastro...

OBJECTIVE

We examined differences between nicotine concentrations and pH in cigarette and cigar tobacco filler.

METHODS

Nicotine and pH levels for 50 cigarette and 75 cigar brands were measured. Non-mentholated and mentholated cigarette products were included in the analysis along with several cigar types as identified by the manufacturer: large cigars, pipe tobacco cigars, cigarillos, mini cigarillos, and little cigars.

RESULTS

There were significant differences found between pH and nicotine for cigarette and cigar tobacco products. Mean nicotine concentrations in cigarettes (19.2 mg/g) and large cigars (15.4 mg/g) were higher than the other cigars types, especially the pipe tobacco cigars (8.79 mg/g). The mean pH for cigarettes was pH 5.46. Large cigars had the highest mean pH value (pH 6.10) and pipe tobacco cigars had the lowest (pH 5.05).

CONCLUSIONS

Although cigarettes are the most common combustible tobacco product used worldwide, cigar use remains popular. Our research provides a means to investigate the possibility of distinguishing the 2 tobacco product types and offers information on nicotine and pH across a wide range of cigarette and cigar varieties that may be beneficial to help establish tobacco policies and regulations across product types.

PubMed: 28989950
DOI: 10.18001/TRS.3.2(Suppl1).11

Authors: Julia Cen Chen-Sankey, Erin L Mead-Morse, Daisy Le...

INTRODUCTION

Racial/ethnic minorities have a higher prevalence of past 30-day cigar smoking than White, non-Hispanics. Little is known, however, about racial/ethnic differences in advanced cigar-smoking patterns by cigar types. This research explores whether cigar-smoking patterns differ by race/ethnicity and cigar types.

METHODS

This study used a nationally representative sample of adults (aged ≥18 years; N=28,148) from the Wave 3 survey (2015-2016) of the Population Assessment of Tobacco and Health Study for analysis. Cigar-smoking patterns included past 30-day use, daily use, established use, past 12-month blunt use, use within 30 minutes of waking, and the number of cigars used per day. Weighted multivariable regressions were conducted in 2019 to examine the associations between race/ethnicity and cigar-smoking patterns by cigar types (traditional cigars, cigarillos, and filtered cigars), controlling for covariates.

RESULTS

Compared with White, non-Hispanics, Black, non-Hispanics were more likely to smoke cigars in the past 30 days (AOR=2.27, 95% CI=2.03, 2.54) and daily (AOR=2.65, 95% CI=1.89, 3.70), have established cigar smoking (AOR=1.95, 95% CI=1.66, 2.29), and smoke blunts in the past 12 months (AOR=2.30, 95% CI=1.84, 2.88). This pattern was generally consistent across cigar types and was especially pronounced for cigarillos. Compared with White, non-Hispanics, Hispanics were more likely to smoke cigars within 30 minutes of waking (AOR=1.50, 95% CI=1.10, 2.06).

CONCLUSIONS

This study finds that Black, non-Hispanics and Hispanics have more advanced patterns of cigar smoking than White, non-Hispanics. Interventions and policies for minimizing cigar smoking may differentially benefit these populations and reduce disparities.

Topics: Adolescent; Adult; Cigar Smoking; Ethnicity; Humans; Smoking; Tobacco Products; Tobacco Use; United States

PubMed: 33341182
DOI: 10.1016/j.amepre.2020.07.005

Authors: Xu Wang, Yoonsang Kim, Mateusz Borowiecki...

INTRODUCTION

Cigar smoking has increased in recent decades as the cigar product landscape has diversified. This study assessed trends in US cigar sales during 2016-2020.

AIMS AND METHODS

Unit sales and average unit price for cigars were assessed during January 3, 2016-June 13, 2020, overall and by product and flavor type, for the 48 contiguous US states and D.C. Assessed cigar types were large cigars, little cigars, and cigarillos; assessed flavor types were tobacco/unflavored, candy/sweets, fruit, menthol, alcohol, coffee, other flavors, and no flavor stated. A joinpoint regression model was used to assess the magnitude and significance of sales trends.

RESULTS

During January 3, 2016-June 13, 2020, unit sales of cigarillos increased (average monthly percentage change [AMPC] = 0.7%, p < .001), while unit sales of large cigars (AMPC = -0.8%, p < .001) and little cigars decreased (AMPC = -0.2%, p < .001). The average price of cigarillos gradually decreased since mid-August 2017 (AMPC = -0.1%, p < .001), and the average price of little cigars decreased from mid-June 2016 to mid-June 2019 (AMPC = -0.3%, p < .001). In contrast, the average price of large cigars increased during the entire study period (AMPC = 0.6%, p < .001). Irrespective of cigar type, tobacco-flavored/unflavored products were the most commonly sold cigars during the assessed period; however, sales of other flavors varied by cigar type.

CONCLUSIONS

Cigar sales and price vary by type over time in the United States, including sales of cigarillos (94.2% of unit sales) increasing as their prices have decreased in recent years. Public health strategies are warranted to address the full scope of cigar types being used in the United States.

IMPLICATIONS

Surveillance of cigar sales data, including product characteristics, can provide a timely complement to self-reported survey data of cigar use. This study assessed trends in US cigar sales during 2016-2020, including by product and flavor type. The findings indicate that sales of cigarillos, which comprise most cigar sales in the United States during the assessed period, increased as their prices decreased. Sales of certain flavors, such as candy/sweet cigarillos and coffee large cigars, increased significantly. These findings reinforce the importance of evidence-based strategies, including increasing price and restricting flavors, to reduce the affordability and consumption of cigars in the United States.

Topics: Cigar Smoking; Commerce; Flavoring Agents; Humans; Menthol; Tobacco Products; Tobacco Use; United States

PubMed: 34792585
DOI: 10.1093/ntr/ntab238

Authors: Brad Rodu, Nantaporn Plurphanswat

BACKGROUND

Cigars and cigarettes are both smoked, but much less is known about the former's long-term health effects, due to its low prevalence and infrequent collection of cigar information in national surveys.

PURPOSE

We conducted a follow-up mortality study of cigar-smoking men age 40-79 years in National Health Interview Surveys (NHIS).

METHODS

We used pooled NHIS files linked to the National Death Index to obtain follow-up from year of interview to year of death or December 31, 2015. We developed categories of cigarette and cigar smoking that accommodate dual and former use of both products. We used Cox proportional hazards models, adjusted for age, race/ethnicity, marital status, education, income and region to estimate hazard ratios (HRs, 95% confidence intervals, CI) for mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, chronic lower respiratory diseases and two mutually exclusive categories: smoking-related and other diseases.

RESULTS

There were 14,657 deaths from all causes, including 3426 never tobacco users, 3276 exclusive cigarette smokers and 176 exclusive cigar users. The latter had no statistically significant evidence of increased mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, smoking-related diseases or other causes. In contrast, the mortality experience of dual users of cigars and cigarettes and cigar smokers who formerly used cigarettes is similar to exclusive cigarette smokers.

CONCLUSIONS

This study provides evidence that male cigar smokers age 40 + years had elevated mortality risks. However, after accounting for cigarette smoking and other confounding variables, we found significantly increased mortality only among dual and former users of cigarettes.

Topics: Adult; Aged; Cigarette Smoking; Humans; Male; Middle Aged; Proportional Hazards Models; Smokers; Smoking; Tobacco Products; United States

PubMed: 33413424
DOI: 10.1186/s12954-020-00446-4

Authors: R Mulcahy

Topics: Coronary Disease; Humans; Myocardial Infarction; Risk; Smoking

PubMed: 3919865
DOI: 10.1136/bmj.290.6473.951

Authors: Maryam Elhabashy, Lilianna Phan, Kristen R Hamilton-Moseley...

Black young adults have the highest prevalence of cigar smoking in the U.S. Little is known about how this population perceives addiction to cigar smoking, which may influence long-term smoking and cessation outcomes. This study used semi-structured in-depth interviews to understand cravings, triggers, and perceived addiction from cigar smoking among a purposive sample of Black young adult cigar smokers ( 40; 21-29 years). An iterative process was used to develop the codebook, and thematic analysis was used to capture findings based on the products predominantly used: cigarillos, large cigars, or blunts. Results suggest that while participants may share similar types of cravings and triggers (e.g., stress) across the use of these products, predominant blunt smokers reported more unique triggers related to relieving physical discomforts. While most participants reported cigars could be addictive to people in general, only a few perceived that they themselves were addicted. Participants who predominantly smoked cigarillos reported high perceived addiction to cigars, while those who predominantly smoked blunts reported low addiction. Education messages are needed to inform young Black adult cigar smokers about the risks and health symptoms of cigar addiction. These efforts may help increase cigar cessation seeking and reduce cigar addiction-related health consequences and disparities among Black populations.

Topics: Cigar Smoking; Craving; Humans; Smokers; Smoking; Tobacco Products; Young Adult

PubMed: 35682264
DOI: 10.3390/ijerph19116680

Authors: Alexander Persoskie, Erin Keely O'Brien, Elisabeth A Donaldson...

BACKGROUND

Several jurisdictions in the US and abroad limit the minimum number of cigars that can be sold per package. Research has not evaluated whether small packages might result in cigar use initiation, or whether adding cigars to packages might result in purchasers smoking more cigars.

METHODS

Using nationally representative US adult data from Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study, we assessed links between cigar package quantity (number of cigars in the package a person usually buys) and (1) price, and (2) cigar and cigarette use over time, for three cigar types: filtered cigars, cigarillos, and large cigars.

RESULTS

Smaller quantity packages (i.e., packages with fewer cigars) were cheaper per-pack than larger quantity packages but more expensive per-stick for all three cigar types. For filtered cigars, past-year starters tended to buy smaller quantity packages compared to longer-term users (geometric mean = 6.31 vs. 11.75, respectively; b = -.18, 95%CI: -.32, -.04). Also, those who bought smaller quantity packages of filtered cigars tended to smoke fewer cigars over time compared to those who bought larger quantity packages (b = 1.16, 95%CI: 0.45, 1.87). Neither of these associations was observed for cigarillos or large cigars. We also found little evidence that buying larger quantity packages predicted continuing to use cigars or using cigarettes.

CONCLUSIONS

Although we found consistent associations between package quantity and price, we found few associations between package quantity and changes in cigar smoking behaviors over time, particularly for cigarillos and large cigars. Key limitations include our adult-only analyses and inability to determine the package quantity that cigar users initiated with. Future studies could examine whether package quantity plays a causal role in filtered cigar use initiation or consumption rates.

Topics: Adult; Female; Humans; Male; Product Packaging; Smoking; Tobacco Products; United States

PubMed: 31269935
DOI: 10.1186/s12889-019-7205-3