A cigar often contains as much tobacco as an entire pack of cigarettes. Even without drawing the smoke into the lungs, cigar use significantly increases the risk of numerous serious diseases and is not a safe alternative to cigarettes. The act of holding the smoke in the mouth and the fundamental chemistry of the cigar itself ensure that toxic substances, including nicotine, are absorbed into the body. The primary difference in how cigars are smoked compared to cigarettes does not eliminate the health threat; it merely shifts the location of the greatest harm.
Nicotine Absorption Through the Mouth
Cigar smoke is uniquely efficient at delivering nicotine into the bloodstream without requiring lung inhalation. This efficiency is tied directly to the smoke’s high alkalinity, which is a result of the air-cured and fermented tobacco used in cigars. The smoke from most cigars has an alkaline pH (often 8.0 or higher), while most cigarette smoke is more acidic (typically around pH 5.5).
This alkaline environment converts nicotine into its un-ionized, or “freebase,” form. Nicotine in this form can easily pass through the mucous membranes lining the mouth, a process called buccal absorption. Simply holding the smoke in the mouth delivers a substantial dose of nicotine directly into the system, quickly leading to dependence and addiction. A single large cigar can contain hundreds of milligrams of nicotine, and even without inhaling, the amount absorbed can be equivalent to the nicotine from multiple cigarettes.
Localized Cancer Risks
Cigar smoke contains many of the same toxic chemicals found in cigarette smoke, including nitrosamines and polycyclic aromatic hydrocarbons, often in higher concentrations. The tar in cigar smoke can be more carcinogenic than cigarette tar, exposing the lips, tongue, cheeks, and throat to these compounds.
Regular cigar smokers who do not inhale have a significantly increased risk of cancers of the oral cavity, including the lips, tongue, and gums. They also face elevated risks for pharyngeal (throat) cancer, laryngeal (voice box) cancer, and esophageal cancer. When saliva containing the smoke’s toxic chemicals is swallowed, it exposes the esophagus to carcinogens. Compared to non-smokers, regular cigar smokers are four to ten times more likely to die from oral, laryngeal, or esophageal cancers.
Systemic and Cardiovascular Damage
Once nicotine and other toxic components are absorbed through the mouth, they enter the bloodstream. This absorption does not require lung inhalation to affect organs far removed from the mouth. Nicotine acts as a stimulant, immediately increasing the heart rate and raising blood pressure.
Beyond nicotine, toxins like carbon monoxide are still produced and absorbed, though generally in lower amounts than with deep inhalation. Carbon monoxide reduces the oxygen-carrying capacity of the blood, which stresses the heart and contributes to the development of atherosclerosis, a hardening and narrowing of the arteries. Regular cigar use is associated with an increased risk of serious cardiovascular events, including stroke, heart failure, and coronary artery disease. While non-inhaling smokers have lower risks of lung disease than those who inhale, the absorption of toxins through the oral mucosa still contributes to significant damage to the body’s circulatory system.
Exposure to Sidestream Smoke
Sidestream smoke is the smoke that emanates directly from the burning end of the cigar, as opposed to mainstream smoke, which is drawn through the tobacco. Because the burning temperature is lower at the tip, sidestream smoke often contains higher concentrations of many specific toxic chemicals and carcinogens, such as ammonia and nitrosamines, than the smoke drawn through the cigar. Due to the large amount of tobacco and the longer burn time, a single cigar can generate a significant volume of sidestream smoke, exposing the smoker and anyone nearby to high levels of harmful particulate matter. The individual smoking the cigar is constantly exposed to this concentrated plume of toxins, which contributes to their overall risk profile regardless of whether they inhale the mainstream smoke.