CIGAR HABIT POSES MAJOR RISKS

Two a day doubles chances of dying from cancer, other diseases, Kaiser
study says

In one of the first major studies of the health risks of people who smoke
only cigars, a Kaiser Permanente researcher has found that smoking two
stogies a day over a 10-year period doubles the risk of dying of all
cancers and certain circulatory diseases.

The study looked at the causes of death of 225 men from the Bay Area who
had smoked only cigars. The research burns another hole in the theory that
you can puff regularly on cigars and not suffer serious health
consequences. The study comes on the heels of a boom in cigar popularity
nationwide, with sales up 44 percent since hitting a record low of 2.1
billion in 1993 -- partly because cigars are perceived to be a healthier
alternative to cigarette smoking.

While the health risks are lower than smoking cigarettes, they are much
higher than those of people who don't smoke, the study said.

``We're not talking about the occasional users, the guy who smokes a cigar
only on his birthday,'' said the study's lead author, Dr. Carlos Iribarren.
``If you progress to a chronic use, and we know for a fact that nicotine is
very addictive and nicotine gets absorbed in the mouth, there is the
potential for addiction. It opens the gate to bad health behavior.''

The research was presented Thursday at the American Heart Association's
Epidemiology Conference in Santa Fe, N.M.

Dr. Philip Greenland, chairman of the heart association's prevention
committee, said the study is interesting because it looks at one of the
healthiest regular smoking scenarios -- cigar smokers who never smoked
cigarettes.

Less smoke inhaled

Those people have been shown to inhale far less smoke than people who
previously smoked cigarettes. The study bore that out -- 92 percent of the
men reported that they did not inhale their cigar smoke.

``Even though it's looking at the healthier picture of cigar smoking, it's
still showing a health risk,'' said Greenland, chairman of the Department
of Preventive Medicine at Northwestern University. ``It's still showing
that cigar smoking is not a great thing to do.''

Iribarren, an epidemiologist at Kaiser Permanente's Division of Research in
Oakland, found his study participants from the more than 110,000 Kaiser
members in Northern California who completed smoking surveys when they
joined the HMO between 1979 and 1985. He and his research team tracked the
death rates of 225 men between the ages of 30 and 89 and compared the data
with more than 14,200 men who reported never using tobacco.

The study adjusted for other health risk factors such as weight,
cholesterol level, alcohol consumption and blood pressure. Women were not
included because there weren't enough cigar smokers to draw conclusions.

Iribarren said they looked only at causes of death, so there was no data on
mouth and throat cancers -- common in regular cigar smokers, but rarely the
direct cause of death.

For the first time, the study linked cigar smoking with increased risks of
cardiovascular diseases -- double the risk of heart damage from high blood
pressure, deterioration of the heart muscle (known as cardiomyopathy), and
several other circulatory diseases, Iribarren said.

Overall, the study showed cigar smokers died at a 25 percent higher rate
from all causes compared with people who never smoked.

The study also found that cigar smoking, unlike cigarette smoking, doesn't
appear to increase the risk of dying from coronary artery disease, the main
cause of heart attacks. Iribarren and other researchers said that's because
cigarette smokers inhale.

Inhalation, risks linked

``Generally speaking, if you have someone who is a cigar smoker and doesn't
inhale, then their risks tend to be lower for these traditional smoking
diseases,'' said Donald Shopland, head of the Smoking and Tobacco Control
Program at the National Cancer Institute.

The links to cancer have been made before, but the Kaiser study is the
third major one of people who smoke only cigars -- and the first since the
1970s, Iribarren said.

A major reason for that is that cigar smoking fell out of vogue, leading
researchers to stop studying it until recently.

``Obviously cigars have not received the attention that cigarettes have, so
you don't have the same amount of data to be assessed, but there's still
quite a bit out there,'' said Shopland, editor of a volume compiling the
health risks of cigars.

People who smoke cigars after having smoked cigarettes tend to inhale much
more smoke, making their risk factors for cancers and other diseases more
similar to those of cigarette smokers. Those risks are significantly
higher.

For example, studies have shown that men who smoke cigarettes increase
their risk of death from lung cancer by more than 22 times and from
bronchitis and emphysema nearly tenfold.

Still, smoking cigars exposes the body to the carcinogens in the smoke as
it curls off the cigar tip. And harmful substances in the smoke that pauses
in the mouth for a few moments by those who don't inhale still can be
absorbed through the membranes lining the mouth, researchers said.

Cigars also contain much more tobacco than cigarettes. Smaller cigars like
White Owls, have seven to 10 grams of tobacco, Shopland said. Many long,
thick premium cigars have 10 to 20 grams of tobacco.

``The average Marlboro won't have a gram of tobacco,'' he said. ``It's
astounded us that one cigar will have the tobacco equivalent of a pack or
more of cigarettes. So when somebody says they smoke only one cigar a day
or one every other day, that's the equivalent of smoking a pack of
cigarettes a day or a half a pack a day.''

New smokers take note

Greenland said that in looking only at so-called ``pure cigar smokers,'' it
should have resonance with some of the new cigar puffers of the 1990s.

``What's going on out there in the world is there are more people who are
just picking this up. For people like that, that's what this study is
speaking to. People who never smoked before but they are doing this now
because it's cool,'' he said. ``It's a healthier thing to do than
cigarette smoking, but you can't exactly call it healthy.''