Tobacco information

Tobacco

Alternative Tobacco Products

    Bidis

    Kreteks

    Hookahs

    Potentially Reduced Exposure Products (PREPS)

Smokeless Tobacco

Cigars

Tobacco

The Problem

Nicotine is a naturally occurring drug found in tobacco. Nicotine is highly addictive (as addictive as heroin and cocaine). Cigarette smoke contains over 4,000 chemicals, including over 60 carcinogens,¹ such as Ammonia (used as a cleaning agent), Formaldehyde (used in embalming), and Acetone (used as a paint thinner).²

• Almost 60 million Americans age 12 or older smoke cigarettes.³
• Approximately 440,000 people in the U.S. die each year from smoking related-illnesses.⁴
• Approximately 50% of all of the smokers who continue to smoke will die from a smoking-related illness.⁵
• Cigarette smoking shortens smoker's lives
  • On average, men who smoke shorten their lives by 13.2 years, and female smokers lose 14.5 years.⁵
• Smoking is responsible for one of every five deaths¹ making it more lethal than AIDS, accidents, homicides, suicides, illegal drugs, and fire combined.⁶ Specifically, smoking is responsible for:
• At least 30% of all cancer deaths⁵
• Almost 90% of all lung cancer deaths⁶
• Tobacco use results in an annual cost of more than $167 billion ($75 billion in direct medical costs & $92 billion in lost productivity).⁴

Good News: No matter how long a smoker has smoked, a smoker will live longer if he or she quits today!

• Smokers who quit prior to the age of 35 avoid 90% of the health risks associated with tobacco use.
• Even smokers who quit when they are older can significantly reduce their risk of early death.

Helpful Links

• CDC Smoking and Tobacco Page: Contains a wide variety of tobacco information and resources for individuals, children and adolescents, as well as researchers and scientists. 

• National Cancer Institute Smoking and Cancer Page: Provides a variety of tobacco information, including quitting resources, clinical trials information, tobacco research, etc.

• The Tobacco Technical Assistance Consortium (TTAC): The goal of this resource is to assist organizations in building and developing highly effective tobacco control programs.

Alternative Tobacco productS

BIDIS (flavored cigarettes)

Bidis (pronounced "bee-dees") are thin, hand-rolled, filter-less cigarettes, consisting of flavored or unflavored tobacco wrapped in a tendu or temburini leaf (plants indigenous to India and Southeast Asian countries), and may be tied with a colored string at either end. Bidis are popular because they come in a wide variety of flavors (e.g., vanilla, strawberry, mango) and due to their size, resemble marijuana cigarettes. Bidis may be perceived as less harmful or more natural than conventional cigarettes. However, bidi smoke contains higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States. Also, due to the nature of the leaf wrapper, smokers must puff bidis with greater frequency than conventional cigarettes.^1,2  Indian research studies indicate that bidi smokers are at greater risk for developing oral, lung, stomach, and esophagus cancer, as well as coronary heart disease, acute myocardial infarction, and chronic bronchitis than non-smokers.^2,3,4

Photo derived from www.bullybeef.co.uk/beedies.htm

While prevalence rates of adult bidi smoking in the U.S. are not known, 2% of middle school students and 3% of high school students are current bidi smokers, with bidi smoking being more common among males than females.⁵

KRETEKS (Clove Cigarettes)

Kretek is the Indonesian name for a clove cigarette. Most clove cigarettes are imported from Indonesia and are similar to American cigarettes in many ways. Clove cigarettes contain a mixture of shredded clove buds and tobacco, which produces a distinct, pungent smell. Clove cigarette smoke contains more nicotine, tar, and carbon monoxide than conventional cigarettes.⁶ Clove smokers are at greater risk for acquiring an acute lung injury, as well as developing abnormal lung functioning than non-smokers.^7,8

Photo derived from: http://en.wikipedia.org/wiki/Kretek

Rates of adult kretek smoking in the U.S. are not known, but an estimated 2% of middle school students and 3% of high school students are current kretek smokers, with kretek smoking being more common among males than females.⁵

HOOKAHS (Water Pipes)

Hookah (narghile, water-pipe) smoking is a common form of tobacco use in countries such as China, India, Pakistan, and many countries in the Middle East. Recently, the phenomenon has spread in the United States and Europe with the growth of Eastern and Arab cultures. Hookahs vary widely in shape and size, but the basic design includes: a head, consisting of a ceramic bowl with a conical cap; a metal body which is attached to a glass bottle partially filled with water; and a flexible tube with a mouthpiece affixed to the neck of the bottle. The tobacco (shisha, maassel, tumbâk, jurâk; moist, shredded tobacco mixed with sweeteners such as honey, molasses, and fruit) is placed in the head of the hookah with a heating apparatus (usually charcoal). Combustion begins in the head, where the smoke then passes through the water in the body of the pipe where it is cooled and diluted before traveling through the hose where the smoker inhales it.

Photo derived from: http://www.hooka-hookah.com/

While the risks of waterpipe smoking are not as well known as the risks of cigarette smoking, a growing body of research is beginning to indicate these risks. Many waterpipe smokers falsely believe that hookah smoke is less harmful that cigarette smoke.  This false belief leads many individuals to initiate tobacco use with waterpipe smoking.  Hookah smokers often inhale the equivalent amount of smoke of one pack of cigarettes in a 30-60 minute smoking session. Many smokers believe that the water in the hookah will filter out any harmful toxins, making it safer to smoke than cigarettes. While the water filtration in a hookah does reduce some toxins, it does not reduce the level of tar inhaled in the smoke, which contains the most carcinogens. Hookah smokers may be at greater risk for harm from smoking than cigarette smokers, as waterpipe smokers are exposed to greater overall amounts of nicotine, carbon monoxide, and other toxins. ⁹

In addition, because of several factors, such as the low burning temperature of the tobacco and the air pressure required to inhale the smoke, waterpipe smokers often inhale much deeper, allowing the smoke to more deeply penetrate the lungs. Other health concerns of waterpipe smoking include the spread of infections diseases, such as tuberculosis, aspergillus, and heliobacter, which can be spread through the sharing of the pipe or in the uncontrolled process by which the tobacco is made. ⁹

POTENTIALLY REDUCED EXPOSURE PRODUCTS (PREPs)

What are PREPs?

The best way to reduce the harm caused by smoking is to quit. While the adverse effects of smoking are well documented, not all smokers are ready to quit. In the past several years, tobacco companies have recognized this growing market and have introduced several potentially reduced exposure products (PREPs). PREPs are tobacco-based products that claim to reduce the exposure to and harm from the toxins found in tobacco.¹⁰

Some of these products are nicotine delivery devices that are lit the same way as a cigarette, but heat rather than burn (e.g. Eclipse, Accord), which (in theory) reduces the number of toxic combustion products. Others claim to achieve reduced levels of toxins through different tobacco curing or fermentation processes, or by adding chemicals (such as palladium) to the tobacco leaves (examples of cigarettes include OMNI and Advance cigarettes). Still others claim to contain reduced nicotine levels by using genetically engineered tobacco leaves (e.g. Quest). Lastly, there are several oral non-combustible tobacco products (either, hard, tobacco lozenges, or "cigaletts", e.g. Ariva and Stonewall, or tobacco packets, e.g. Revel and Exalt) being marketed as tobacco alternatives to smoking, but not cessation products.

Are PREPs less harmful?

While quitting smoking is the surest way to reduce risk for disease from tobacco, several caveats should be noted when discussing PREPs. While the companies that market PREPs claim they reduce consumers' exposure to harmful toxins, independent research has not produced evidence to warrant claims that they significantly reduce risk of disease or toxin exposure. Indeed, the way in which PREPs are advertised is confusing to many consumers, leading them to erroneously believe that PREPs are safer or will help them quit smoking, claims which have not been confirmed.¹¹

Click here for an interview with a leading authority, Dr. Dorothy Hatsukami, co-director of the Transdisciplinary Tobacco Use Research Center (TTURC) at the University of Minnesota.

Click here for Dr. Hatsukami's paper entitled "Hope or Hazard?  What Research Tells Us about Potentially Reduced-Exposure Tobacco Products"

References:

1 Watson, C., Polzin, G., Calafat, A., & Ashley, D. (2003).  Determination of tar, nicotine, and carbon monoxide yields in the smoke of bidi cigarettes.  Nicotine & Tobacco Research, 5, 747-753.
2 Rahman, M. & Fukui, T. (2000).  Bidi smoking and health.  Public Health, 114, 123-127.
³ Nayak, K., Gett, S., Sharda, D. & Misra, S. (1989).  Treadmill exercise testing in asymptomatic chronic smokers to detect latent coronary heart disease.  Indian Heart Journal, 41, 62-65.
4 Gupta, P., Murti, P. & Bhonsle, R. (1996).  Epidemiology of cancer by tobacco products and the significance of TSNA.  Critical Reviews in Toxicology, 26, 183-198. 
5 Centers for Disease Control and Prevention (2005).  Tobacco use, access, and exposure of tobacco in media among middle and high school students - United States, 2004.  Morbidity & Mortality Weekly Report, 54 (12), p. 298.
6 Malson, J., Lee, E., Murty, R., Moolchan, E., & Pickworth, W. (2003).  Clove cigarette smoking: Biochemical, physiological, and subjective effects.  Pharmacology, Biochemistry, and Behavior, 73, 739-745. 
7 Mangunnegoro, H. & Sutoyo, D. (1996).  Environmental and occupational lung diseases in Indonesia.  Respirology, 1, 85-93.
⁸ Anonymous.  (1988).  Evaluation of the health hazard of clove cigarettes.  Council on Scientific Affairs.  Journal of the American Medical Association, 260, 3641-3644.
9 Knishkowy, R. & Amitai, Y.  (2005).  Water-pipe (Narghile) smoking:  An emerging health risk behavior.  Pediatrics, 116, e113-e119.
Click here for link to full-text article.
10 Hatsukami, D. K. & Zeller, M. (2004).  Tobacco harm reduction:  The need for research to inform policy.  Retrieved from
 http://www.apa.org/science/psa/sb-hatsukami.html, April 2007.
¹¹ Hamilton, W. L., diStefano-Norton, G., Ouellette, T. K., Rhodes, W. M., Kling, R., & Connolly, G. N. (2004).  Smokers' responses to advertisements for regular and light cigarettes and potential reduced-exposure tobacco products.  Nicotine & Tobacco Research, 6 (Suppl. 3), S353-S362.

Smokeless Tobacco (ST)

Types of Smokeless Tobacco

Oral Snuff

Snuff or ‘dip’ is a finely ground, cured tobacco that can be dry, moist, and finely cut.  Moist snuff is put in a crevice of the mouth between the gum and one’s cheek or lip where it stays as nicotine is absorbed through the mucosal lining of the mouth.¹

Chewing Tobacco

Chew (a.k.a., wad or quid) comes as loose leaf, plug, and twist tobacco.  It is placed in the cheek and chewed to mix the tobacco with saliva.¹

Prevalence of Smokeless Tobacco

Data from the 2005 National Health Interview Survey (NHIS) estimated that 2.3% of adults in the United States use smokeless tobacco.  Among adults, men (4.5%) typically use smokeless tobacco more often than women (0.2%).²

The 1986 Surgeon General’s Report stated that smokeless tobacco poses a significant health risk and is not a safe substitute for cigarettes.³  Despite warnings in the last two decades of the risks, the use of smokeless tobacco continues in the US.¹

Differences between Smoked and Smokeless Tobacco

    Behaviors

It can be more difficult for professionals to identify and help a smokeless tobacco user than a smoker because it can be used constantly (e.g., while working, during physical activity, etc.) and without others noticing, while smoking is obvious and often banned in work places and other public locations.  While spitting smokeless tobacco juice is one act that can identify smokeless tobacco users, some users learn to swallow the juice and even keep the tobacco in their mouth while sleeping.⁵

    Nicotine Uptake

Since nicotine is absorbed through the mucosa of the smokeless tobacco user’s mouth, uptake is affected by both the pH of the tobacco product and the pH of the mouth.⁶  The rate of absorption and action for smokeless tobacco is thus slower than when it enters the body via the lungs when smoked.  This implies that smokeless products may be less physiologically addictive than cigarettes due to the delayed affect. ⁵  However, some smokeless users still report an easier time quitting cigarettes than smokeless tobacco.

Brief Health Care/Opportunistic Interventions

Studies of smokeless tobacco cessation interventions in applied settings have demonstrated promising results for helping smokeless tobacco users quit.  Although all health professionals can help intervene with tobacco use, dental professionals are in a unique position to intervene because of the unique oral symptoms associated with smokeless tobacco use.⁶  Immediate and visible evidence of the negative health effects such as pre-cancerous oral lesions can quickly form in the mouths of smokeless tobacco users.¹  This is dissimilar to the negative health effects observed in smokers, which can often take years to develop and are hidden from the naked eye.  Finding such evidence of smokeless use is an opportunity for the professional to show the client the effects of tobacco use (the client can see the lesions first hand with the aid of a mirror) and to talk to them about quitting.  The client can also see the benefits of quitting, because the non-carcinomous lesions will typically heal within about two weeks following the quit.¹

* Note: It is important that the client’s gums and mouth be tested to ensure he or she does not have cancer or other diseases that cannot be cured simply by stopping smokeless tobacco use.¹

Other health professionals are also able to quickly and efficiently intervene with clients about their smokeless tobacco use.¹  For example, several studies have shown that sports settings are effective for smokeless tobacco interventions.  Studies of smokeless tobacco use in baseball players indicate that the majority of players continue using smokeless tobacco year round.  This is consistent with the fact that many perceived themselves to be addicted and reported other signs of addiction.⁷  Using the Five A’s approach, usually promoted to help clients quit smoking, can be used for smokeless tobacco users.¹

Helping Clients Quit Snuff and Chew

Helping individuals develop a quit plan for quitting snuff and chew is similar to the methods used for helping someone quit cigarettes.  While a wider variety of cessation methods have been shown to be effective for cigarette smoking than for smokeless tobacco use, there are still many options to consider with your clients to help them quit.  Herbert H. Severson, Ph.D. and his colleagues have developed a four-stage model that can be tailored to whatever cessation method you and your clients choose to implement.

Step 1: Getting Ready

• Assess smokeless tobacco use and dependence

• Assess readiness to quit

• Assess reasons for quitting and the individual’s motivation to quit

Step 2: Developing the Quit Plan

If the individual is ready to quit using smokeless tobacco, as a professional, you can help them develop a plan to quit.  Most smokeless tobacco users attempt quitting using the “cold turkey” method, but gradual reduction (e.g., using less and less each day, or mixing ST with non-tobacco products such as mint chew) and nicotine replacement have been used by some.  Steps to quitting cold turkey are described below.¹

Cold Turkey Approach to Quitting Smokeless Tobacco

• Help client set and write down a quit date, preferably within the next two weeks
• Encourage client to seek support from friends and family
• Help client identify and encourage elimination of triggers of ST use, such as spit cups, clothing with smokeless branding, and use of ST while in the car, when drinking, etc.
• Encourage the availability and use of substitutes, such as gum and mint snuff, which is a non-tobacco chew made of mint leaves instead of tobacco
• Suggest that the quitter remain involved in activities that are not triggers for use and educate about using appropriate rewards for success
• Advise the client to drink large amounts of non-alcoholic fluids

After a quit date and approach have been selected, it is helpful for you to occasionally call the client, if possible, to check in with him or her on their progress.  Phone calls have been shown to increase success rates both in the short- and long-term.¹

Nicotine Replacement Therapy (NRT)

A number of studies have examined the effects of nicotine replacement therapy in aiding smokeless tobacco cessation.  Thus far, the evidence in support for recommending NRT in aiding smokeless tobacco cessation has been modest, with the general finding being that NRT does not significantly increase abstinence rates when compared to placebo treatments.^1,5,6  While studies examining the effects of NRT in aiding smokeless tobacco cessation have shown less robust effects than when used for smoking cessation, NRT can be helpful to clients who are highly dependent on nicotine and are likely to suffer severe withdrawal effects.¹  Oral medicinal nicotine products, such as gum and lozenges, can be used to substitute smokeless tobacco products and may be useful in aiding cessation efforts in this way.

In addition to NRT in aiding smokeless tobacco cessation, there has been much interest in other pharmacotherapies, such as buproprion.  The empirical literature has little to say on this topic, although one recent study of the efficacy of buproprion SR indicated that it did not increase abstinence rates among smokeless tobacco users.⁸  While there is still much research to be done in this area, at this time the most effective treatment for smokeless tobacco cessation appears to be behavioral intervention.

Step 3: Putting the Quit Plan into Action

Withdrawal symptoms are common when quitting smokeless tobacco, and are similar to those observed when quitting cigarettes.  Examples include cravings, increased appetite, irritability, and distractability.  To help reduce concerns about withdrawal symptoms, inform the client that symptoms in quitters often decrease quickly in the first weeks.  Having the client track withdrawal symptoms by writing them down and noting changes in severity by rating them on a scale from one to ten can also decrease frustration by increasing recognition that the symptoms are decreasing.  Oral substitutes, as mentioned previously, are anecdotally helpful to some individuals, though empirical validation of their efficacy has not been established.

High-risk situations likely to trigger the client’s desire to use smokeless tobacco should be reviewed with the client.  Additionally, help the client develop plans to deal with such situations without using smokeless tobacco so that the client is better prepared to stay quit.  Severson and colleagues recommend using the Four A’s of smokeless tobacco cessation listed below.¹

The Four A’s

• Avoid: Encourage the client to avoid trigger situations until he or she has more confidence in their ability to stay quit
• Alter: By changing behaviors he or she would typically engage in during that event or situation, it can alter the strength of the trigger
• Alternatives: By using oral substitutes or other alternatives to smokeless tobacco, the client can better stay quit in trigger situations
• Activities: Taking walks or engaging in other physical activities to help distract the client from cravings and thoughts about smokeless tobacco. (If particular activities are triggers for the client, alternative activities should be substituted.)

Step 4: Maintaining Abstinence from Smokeless Tobacco

One risk to the quit plan is the use of cigarettes, which will make the quit attempt more difficult and increase the odds of relapse.  Therefore, it is important that professionals encourage clients to quit all tobacco products, not just one type.¹

Despite the known risk for disease, some professionals suggest that smokeless tobacco is less risky than smoking cigarettes.  It is important for users to know that both types of tobacco products contain carcinogenic chemicals, which may lead to cancer.  However, for smokers who are unwilling to stop using tobacco products completely, these professionals posit that smokeless tobacco products offer a less hazardous nicotine delivery system.  Smokeless tobacco products are not safer than medicinal nicotine products being marketed as smoking cessation aids, but can be considered as one way to reduce the risk for harm from tobacco.  This is largely due to the absence of smoke, which affects not only the user but those around him/her.⁴

Other aids for cessation from smokeless tobacco include brief counseling or psychotherapy, self-help readings or tapes, and relaxation exercises.  Nicotine replacement therapies have also been suggested by some researchers, though medical advice should be sought to determine the appropriate use of these products for each client.¹

1. Severson, H. H. & Hatsukami, D. (1999). Smokeless tobacco cessation. Primary Care: Clinics in Office Practice, 26(3), 529-551.
2. Centers for Disease Control and Prevention (2006). Tobacco use among adults – United States, 2005. Morbidity & Mortality Weekly Report, 55(42), 1145-1148.
3. U.S. Department of Health and Human Services (1986). The health consequences of using smokeless tobacco. A report to the advisory committee to the Surgeon General. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service. NIH Pub. No. 86-2874. Available from: http://profiles.nlm.nih.gov/NN/B/B/F/C/. Accessed: August 2007.
4. Gartner, C. E., Hall, W. D., Vos, T., Bertram, M. Y., Wallace, A. L., & Lim, S. S. (2007) Assessment of Swedish snus for tobacco harm reduction: An epidemiological modeling study. Lancet. 369, 2010-2014.
5. Severson, H. H. (2003). What have we learned from 20 years of research on smokeless tobacco cessation? American Journal of Medical Science, 326(4), 206-211.
6. Hatsukami, D. K., & Severson, H. H. (1999). Oral spit tobacco: Addiction, prevention and treatment. Nicotine & Tobacco Research, 1, 21-44.
7. Severson, H. H., & Klein, K. J. K. (2002). Tobacco use among professional baseball players: 1998 to 2001. Tobacco Control, 14(1), 31-36.
8. Dale, L. C., Ebbert, J. O., Glover, E. D., Croghan, I. T., Schroeder, D. R., Severson, H. H., & Hurt, R. D. (2007). Buproprion SR for the treatment of smokeless tobacco use. Drug and Alcohol Dependence, 90, 56-63.

Cigars

Despite a decline in cigarette smoking in the United States, cigar consumption has been dramatically increasing since 1993. The 2005 U.S. National Health Interview Survey (NHIS) estimated that 2.2% of adults smoke cigars, which is about the same rate as smokeless tobacco use but is far less than the 21% of adults who smoke cigarettes.  There are significant gender differences in cigar use; about 4.3% of men, but only 0.3% of women smoke cigars.¹  Lately, new and more profitable forms of cigar-like nicotine products have gained popularity.  Two types of more modern cigar-like products are little cigars (also known as small cigars) and cigarillos. While these two products are very similar in nature, some distinctions do exist.

 Cigars

• Cigars contain the same toxic and carcinogenic compounds found in cigarettes and are not a safe alternative to cigarettes.¹
• Most cigar smokers do not inhale, as most cigarette smokers do. Therefore, the risk of lung cancer is lower for cigar smokers than cigarette smokers.  Lung cancer risk increases with more frequent cigar smoking and depth of inhalation.²
• Cigar smokers can spend up to an hour smoking a single cigar that can contain as much tobacco as a pack of cigarettes.
• After cigarette smoking, cigar smoking is the second most common form of tobacco use among youth.³
• In 2005, 14 percent of high school students reported current use of cigars (19.2% among boys; 8.7% among girls).
• Among all age groups, cigar use is higher among men than women.⁴

  Little Cigars & Cigarillos

Little cigars and cigarillos differ greatly from regular cigars. They weigh less than cigars and cigarillos², but more importantly, they resemble cigarettes in size, shape, packaging, and filters.⁵  Little cigars are sometimes called "cigarettes in disguise", and unsuccessful attempts have been made to reclassify them as cigarettes. Sales of little cigars quadrupled in the U.S. from 1971 to 1973 in response to the Public Health Cigarette Smoking Act, which banned the broadcast of cigarette advertisements and required stronger health warnings on cigarette packs. Cigars were exempt from the ban, and perhaps more importantly, were taxed at a far lower rate. Sales of little cigars reached an all-time high in 2006, fueled in great part by their taxation loophole. Today, cigars are still taxed far less than cigarettes.  In fact, a pack of little cigars costs less than half as much as a pack of cigarettes in many states.⁶

What are little cigars?

• Little cigars light and burn like cigarettes and users inhale the smoke, unlike with a traditional cigar.
• Little cigars contribute to a multitude of ailments, including cancer and cardiovascular disease.
• The only difference between cigarettes and little cigars is that the paper wrapping of little cigars contains some tobacco; any amount of tobacco in the paper wrapping removes little cigars from the cigarette category.
• Brands of little cigars currently sold in Maryland include Winchester, Dutch Masters, and Captain Black.
• Many small cigars and cigarette-like “little cigars” are produced in different flavors, such as candy, fruit, chocolate and various other tastes, which may especially appeal to children and teenagers.⁷

How much do little cigars cost and where are they available? ⁸

• A package of little cigars sells at retail for approximately $2.00 to $2.50 for the premium brands.
• The tax of little cigars is 15% of the wholesale price of the product, making the tax on a pack of little cigars less than 30¢.
• Comparatively, a pack of cigarettes costs approximately $5.00 to $6.00 for a premium brand, $4.00 or so for a cheap brand.
• Little cigars can be sold individually - sometimes for as little as a quarter a piece!
• The single sales restriction applicable to cigarettes does not apply to little cigars, therefore the packs can be broken down and the sticks can be sold individually.
• Little cigars are sold in the same places as cigarettes - most convenience stores, mom and pop shops, and gas station stores.

Why are legal groups advocating that little cigars be included in the definition of cigarette? ⁸

• Little cigars look like cigarettes, smoke like cigarettes and are harmful like cigarettes.
• The availability of cheap little cigars as a cigarette substitute may cause cigarette smokers who are inclined to quit because of a tax increase to instead smoke little cigars, reducing the fiscal and public health impact of the 2007 tax increase.⁹
• The cheap cost of little cigars makes the product more accessible to young people and those with little disposable income.
• Increasing the tax to make the price of little cigars comparable to that of cigarettes may reduce the risk that would-be quitters will switch from cigarettes to little cigars.

What is a Cigarillo?

Cigarillos are similar to “little cigars” in both size and structure, and the two terms are often used synonymously. A cigarillo (Spanish for "cigarette", pronounced "see-gah-ree-yoh" in Spanish and "see-gah-ree-loh" in English) is a short, narrow cigar.  While cigarettes are wrapped in paper, cigarillos are wrapped in whole-leaf tobacco.  Cigarillos can be found for purchase alone or in packs, and are sometimes made without filters. Unlike a cigarette, the smoke of a cigarillo is not meant to be inhaled, but rather puffed like a cigar.

• Cigarillos are known in Europe as a 'Seven Minute Cigar'. This due to the fact that they can be smoked in seven minutes, making them an alternative for someone who does not have enough time to smoke a full cigar, as well as an alternative to cigarettes.
• Generally, a cigarillo contains about 3 grams of tobacco.
• Comparatively, a cigarette contains less than 1 gram of tobacco¹⁰ and is smaller in length and diameter.
• Cigarillos are often machine made, resulting in a lower price than handmade cigars.
• Cigarillos are often smoked in quantities similar to cigarettes (between 5 and 10 per day)

Helpful Links

• Campaign for Tobacco-Free Kids:  The Rise of Cigars and Cigar-Smoking Harms PDF
  
  
• American Lung Association: Cigar Smoking Fact Sheet
  
  
• Smokers’ Choice: What Explains the Steady Growth of Cigar Use in the U.S.?
  
  

1. National Cancer Institute. (1998). Cigars: Health Effects and Trends. Smoking and Tobacco Control Monograph No. 9. Bethesda, MD: NIH Pub. No. 98–4302.
2. Mariolis, P., Rock, V.J., Asman, K. et al. (2006). Tobacco use among adults—United States, 2005. MMWR Morbidity Mortality Weekly Report, October 27, 2006. 55(42), 1145–1148.
3. U.S. Centers for Disease Control & Prevention. (2006). Youth Risk Behavior Surveillance, United States, 2005. Morbidity and Mortality Weekly Report 55(SS-5), June 9, 2006. Whites (14.9%) and Hispanic high schoolers (14.6%) smoke cigars more than African Americans (10.3%).
4. Baker, F., Ainsworth, S.R., Dye, J.T., et al. (2000). Health Risks Associated with Cigar Smoking. Journal of the American Medical Association, 284(6), 735-740.
5. Connolly, G.N. (1998). Policies regulating cigars. In Shopland, D.R., Burns, D.M., Hoffman, D., Cummings, K.M., Amacher, R.H. (Eds.), Cigars: Health Effects and Trends, Smoking and Tobacco Control Monograph No. 9, National Cancer Institute.
6. Delnevo, C.D. (2006).  Smokers’ choice: what explains the steady growth of cigar use in the U.S.? Public Health Reports 121 (2): 116–9.
7. Boonn, A., Lindblom, E. (2008). The Rise of Cigars and Cigar-Smoking Harms. Campaign for Tobacco-Free Kids.
8. Dachille, K. (2008). Cigar Fact Sheet. Center for Tobacco Regulation.
9. Delnevo, C.D., Hrywna, M. (2007). "A whole 'nother smoke" or a cigarette in disguise: how RJ Reynolds reframed the image of little cigars. American Journal of Public Health, 97 (8): 1368-75. 
10. National Cancer Institute. (200). Questions and Answers About Cigar Smoking and Cancer. Retrieved from http://www.cancer.gov/cancertopics/factsheet/Tobacco/cigars