Cigars are rolls of tobacco wrapped in a tobacco leaf or paper, often containing as much tobacco as an entire pack of cigarettes. Many users believe that avoiding inhalation shields them from severe health consequences. While not drawing smoke into the lungs alters the risk profile compared to cigarette use, this practice does not eliminate the danger. Harmful substances and addictive nicotine are still absorbed into the body, creating specific and significant health risks.
Nicotine Absorption Through Oral Mucosa
The fundamental difference between cigar and cigarette smoke lies in its acidity, or pH level, which dictates how nicotine is delivered. Cigar smoke is alkaline, meaning it has a higher pH, often ranging between 7.5 and 8.5. This alkaline environment causes the nicotine to exist predominantly in its un-ionized, or freebase, form.
Freebase nicotine is a lipid-soluble molecule that easily passes through the mucus membranes of the mouth, known as the oral mucosa. Even if the smoke is held only in the mouth, nicotine is absorbed directly into the bloodstream through the lining of the cheeks and under the tongue. This delivery bypasses the lungs entirely, providing a systemic dose of the addictive substance.
The nicotine absorbed from a single large cigar can be equivalent to that from several cigarettes, establishing a potent chemical dependency. This absorbed nicotine, along with other toxins, sets the stage for systemic health problems despite the lack of direct lung exposure.
Localized Health Risks to the Mouth and Throat
For individuals who do not inhale, the primary health threats are concentrated in areas that have prolonged contact with the toxic smoke. The smoke is rich in cancer-causing chemicals, such as nitrosamines and polycyclic aromatic hydrocarbons, which continuously wash over the mouth, throat, and upper esophagus. This direct exposure elevates the risk for several types of cancer.
Regular cigar smoking is strongly linked to cancers of the oral cavity, including the lips, tongue, mouth floor, and pharynx. Exposure to carcinogens also increases the risk of esophageal cancer, which occurs when contaminated saliva is swallowed. The risk for these specific head and neck cancers can be comparable to the risks faced by cigarette smokers, regardless of inhalation status.
Localized irritation also causes precancerous lesions such as leukoplakia, which appear as white patches inside the mouth. The smoke’s heat and chemicals contribute to severe periodontal disease, leading to gum recession, bone loss, and eventual tooth loss.
Systemic Impact on the Cardiovascular System
The nicotine absorbed through the oral mucosa quickly enters the bloodstream and causes immediate systemic effects on the heart and circulatory system. Nicotine is a stimulant that triggers the release of stress hormones, causing blood vessels to constrict and the heart to work harder. This increases both heart rate and blood pressure, placing strain on the cardiovascular system.
Regular exposure to nicotine and other smoke components, like carbon monoxide, promotes the development of atherosclerosis, where plaque builds up inside the arteries. This narrowing and hardening of the arteries increases the long-term risk of serious cardiovascular events. Studies link cigar use, even among non-inhalers, to an elevated risk of stroke, atrial fibrillation, and heart failure.
Cigar use is also associated with an increased risk of aortic aneurysms, which is a dangerous bulging in the body’s main artery. The absorbed toxins and nicotine lead to inflammation and damage to the blood vessel lining, contributing to these life-threatening conditions.
Risks Associated with Sidestream and Secondhand Smoke
The smoke that drifts from the lit end of a cigar, known as sidestream smoke, presents a significant risk to anyone nearby. Sidestream smoke is particularly hazardous because it is created by the tobacco burning at a lower temperature than the inhaled smoke and is unfiltered. This incomplete combustion results in a higher concentration of numerous toxins and carcinogens compared to the smoke a user draws in.
Secondhand cigar smoke exposes family members and bystanders to the same chemical cocktail that causes disease in users. Exposure can lead to an increased risk of heart disease and lung cancer in non-smokers. For children, exposure is linked to more frequent respiratory infections, increased risk of ear infections, and the development or exacerbation of asthma.