Cigars carry lower overall mortality risk than cigarettes in large population studies, but “lower risk” and “better for you” are not the same thing. One study of U.S. adults found that exclusive current cigarette smokers had roughly double the all-cause mortality risk of never-users, while exclusive current cigar smokers had about a 20 percent higher risk.1JAMA Internal Medicine. Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population That gap is real, but the reasons behind it have less to do with the tobacco itself and more to do with how, how often, and how deeply people smoke each product.
Why Cigar Smokers Show Lower Risk in the Data
The single biggest factor separating cigar and cigarette health outcomes is inhalation. Cigar smoke is alkaline, which makes it harsh on the lungs but allows nicotine to be absorbed through the lining of the mouth without a deep inhale. Cigarette smoke is more acidic, meaning smokers need to pull it into the lungs to get their nicotine hit.2PubMed. Mouth versus deep airways absorption of nicotine in cigarette smokers Because of that difference, most cigar smokers, especially those who never smoked cigarettes first, tend to puff and hold the smoke in their mouth rather than breathe it deep into their chest. That behavioral difference is enormous: less smoke reaching the lower airways means less direct exposure to the tissues where lung cancer and chronic obstructive pulmonary disease develop.
Frequency also matters. A typical cigarette smoker lights up ten to twenty times a day. Cigar smokers, particularly premium cigar users, tend to smoke less often, sometimes only a few times a week. Premium cigar users are older on average, less likely to smoke daily, and tend to take smaller puffs with less inhalation than people who smoke cigarillos or filtered little cigars.3Nicotine & Tobacco Research. Biomarkers of Toxic Exposure and Oxidative Stress Among U.S. Adult Users of Premium Cigar Versus Other Cigar Subtypes: 2013–2019 So when researchers compare “cigar smokers” and “cigarette smokers” as groups, they are partly comparing people who use tobacco occasionally to people who use it all day long. That built-in difference in dose inflates the apparent safety gap.
What the Mortality Numbers Actually Show
The data consistently show that exclusive cigar smokers die at higher rates than people who never used tobacco. In a large U.S. cohort study, current cigarette smokers had hazard ratios for all-cause mortality between 2.19 and 2.62 compared with never-users, depending on age group. Current and former exclusive cigar smokers had about a 10 percent elevation, though that figure was not statistically significant in that particular analysis.4PubMed Central. Mortality among male cigar and cigarette smokers in the USA A separate analysis of U.S. population data put the hazard ratio for exclusive current cigar smokers at 1.20 compared to never-users, and daily cigar users had higher risks than occasional ones.1JAMA Internal Medicine. Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population
These numbers make cigars look much less dangerous than cigarettes, and at a population level that is true. But there is an important catch: dose and inhalation drive the risk up steeply. A systematic review found strong dose-response trends among primary cigar smokers, meaning the more cigars smoked per day and the deeper the inhalation, the higher the mortality and cancer risks climbed.5PubMed Central. Systematic review of cigar smoking and all cause and smoking related mortality A person who smokes five cigars a day and inhales is in a very different risk category from someone who has one on a weekend without inhaling.
Lung Cancer Risk Is Lower, but Other Cancers Are Not
For lung cancer specifically, cigar smokers face a fraction of the risk that cigarette smokers do. One case-control study found that current cigarette-only smokers had 16 times the lung cancer risk of never-smokers, while cigar-only smokers had about 3 times the risk.6PubMed. Lung cancer among cigar and pipe smokers Another study placed the relative risk at about 5.6 for exclusive cigar use versus 13.3 for exclusive cigarette use.7PubMed. Lung cancer risk associated with cigar and pipe smoking That difference makes intuitive sense given the inhalation patterns described above: if the smoke mostly stays in the mouth and throat, the lungs get less of it.
The mouth and throat, though, get plenty. The systematic review of cigar mortality found that even among primary cigar smokers who reported no inhalation at all, the relative risk of dying from oral, esophageal, and laryngeal cancers was still highly elevated.5PubMed Central. Systematic review of cigar smoking and all cause and smoking related mortality Cigar smoking was also associated with pancreatic cancer and aortic aneurysm. In other words, the same behavior that protects the lungs, holding smoke in the mouth rather than the chest, concentrates carcinogens right where the upper digestive and airway tissues sit. Cancers of the lip, tongue, throat, and esophagus do not require deep inhalation to develop.
Cardiovascular and Respiratory Damage
Heart disease is the leading killer in many countries, and cigars raise that risk too. A large cohort study published in the New England Journal of Medicine found that cigar smokers had a relative risk of 1.27 for coronary heart disease and 1.45 for chronic obstructive pulmonary disease compared to nonsmokers, with evidence of dose-response effects.8PubMed. Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men A more recent cross-cohort analysis extended the picture further: current cigar use was associated with a roughly 25 percent higher risk of stroke, about 32 percent higher risk of atrial fibrillation, and about 29 percent higher risk of heart failure. For exclusive cigar smokers who had never used cigarettes, the stroke risk was even higher, around 53 percent above never-users.9JAMA Network Open. Cigar, Pipe, and Smokeless Tobacco Use and Cardiovascular Outcomes From Cross Cohort Collaboration
Lung function takes a hit as well, even without cigarette-level inhalation. In a cross-sectional study of over 3,500 adults, cigar-years of use were associated with decrements in the ratio of air you can force out in one second to total lung capacity, a standard marker of airflow obstruction. People who smoked cigars had more than double the odds of airflow obstruction compared to people with no smoking history, even among those who had never touched a cigarette.10PubMed Central. The association of pipe and cigar use with cotinine levels, lung function, and airflow obstruction: a cross-sectional study
The Switcher Trap
One of the most common rationalizations is that a cigarette smoker can reduce harm by switching to cigars. The evidence on that is discouraging. Former cigarette smokers who transition to cigars tend to keep inhaling because the habit is deeply ingrained. A study measuring blood markers found that ex-cigarette smokers who took up cigars had carbon monoxide and nicotine levels comparable to what they had when smoking cigarettes, indicating they were inhaling cigar smoke just as deeply.11British Medical Journal. Effect of cigar smoking on carboxyhaemoglobin and plasma nicotine concentrations in primary pipe and cigar smokers and ex-cigarette smokers The authors concluded bluntly that persuading smokers to switch to cigars would have little effect on their health.
A separate study confirmed this pattern: prior cigarette smokers who moved to cigars or pipes had higher toxicant exposure markers than lifelong cigar-only users and reported inhaling into the chest more often.12PubMed Central. Does switching from cigarettes to pipes or cigars reduce tobacco smoke exposure? The population-level safety gap between cigars and cigarettes largely reflects the habits of people who started with cigars and never learned to inhale deeply. The moment you bring cigarette-trained lungs into the picture, the gap narrows dramatically.
Biomarkers Tell a More Complicated Story
If cigars were simply “safer” across the board, you would expect cigar smokers to show lower levels of every toxicant in their blood and urine. That is not what the data show. In the PATH Study, which tracked a large sample of U.S. adults, daily exclusive cigar smokers did have lower urinary nicotine equivalents than daily exclusive cigarette smokers. But for several important cancer-related biomarkers, the two groups were statistically indistinguishable. The metabolite of the potent carcinogen NNK, for instance, was found at similar concentrations in daily cigar smokers and daily cigarette smokers.13PubMed Central. Biomarkers of Exposure Among U.S. Adult Cigar Smokers: Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013–2014) So while cigar smokers take in less total nicotine, their bodies carry comparable loads of at least some of the chemicals that drive cancer.
An earlier NHANES analysis found a similar pattern. Primary cigar smokers, meaning those who smoked cigars as their main tobacco product, had cotinine levels of about 6 ng/mL, far lower than dual users or cigarette smokers. But those same primary cigar smokers had elevated levels of NNAL and blood lead compared to people who used no tobacco at all.14Cancer Epidemiology, Biomarkers & Prevention. Biomarkers of Exposure among U.S. Cigar Smokers: An Analysis of 1999–2012 National Health and Nutrition Examination Survey Data The takeaway is that cigars deliver less total nicotine but still deliver meaningful quantities of carcinogens and heavy metals.
Not All Cigars Are the Same Product
When people picture a cigar, they often imagine a large, hand-rolled premium product smoked leisurely over an hour. But the cigar market also includes cigarillos and filtered little cigars, which are much closer to cigarettes in size, price, and how people smoke them. This matters because the health risks vary substantially across cigar types.
Premium cigar users tend to smoke less frequently, inhale less, and show lower biomarker levels than cigarillo and filtered cigar users.3Nicotine & Tobacco Research. Biomarkers of Toxic Exposure and Oxidative Stress Among U.S. Adult Users of Premium Cigar Versus Other Cigar Subtypes: 2013–2019 In contrast, a study of dual users found that cigarillos and large cigars produced greater exhaled carbon monoxide than little cigars, with some differences persisting even after adjusting for the amount of tobacco burned.15PubMed Central. Dual Use of Cigarettes, Little Cigars, Cigarillos, and Large Cigars: Smoking Topography and Toxicant Exposure The smoke chemistry also differs: cigar tobacco goes through a fermentation process that alters the levels of certain carcinogens compared to cigarette tobacco.16PubMed Central. Tobacco-Specific Nitrosamines in Current Commercial Large Cigars, Cigarillos, and Little Cigars
Lab work on cigarillo smoke, however, found that on a per-milligram-of-nicotine basis, cigarillo smoke was not less toxic than cigarette smoke and in some assays was actually more toxic.17Elsevier / PubMed Central. Mutagenic, cytotoxic, and genotoxic properties of tobacco smoke produced by cigarillos available on the Canadian market If you smoke little cigars or cigarillos the way many people do, essentially as unfiltered cigarettes, the supposed safety advantage of “choosing a cigar” vanishes.
Oral Health Effects
Because cigar smoke bathes the mouth, gums, and teeth for extended periods, the oral health consequences deserve their own attention. A study using national survey data found that current cigarette smokers had the highest rate of moderate-to-severe gum disease at about 26 percent, while cigar and pipe smokers came in at about 18 percent and non-smokers at 13 percent. Cigar and pipe smokers also had about four missing teeth on average, compared to roughly five for current cigarette smokers and fewer than three for non-smokers.18PubMed. Cigar, pipe, and cigarette smoking as risk factors for periodontal disease and tooth loss So cigar smokers land between cigarette smokers and non-smokers, which tracks with the theme of reduced but far-from-zero harm.
Interestingly, when it comes to oral leukoplakia, white patches on the mouth lining that can be precancerous, one older study found that cigar smokers actually had fewer lesions than pipe smokers or mixed smokers.19Oral Surgery, Oral Medicine, Oral Pathology. Influence of tobacco types, amount of tobacco smoked, and dentures on the prevalence of oral leukoplakia That finding should be taken cautiously given its age and that the systematic review still flagged oral cancer as one of the cancers most strongly linked to cigar use regardless of inhalation.
Secondhand Cigar Smoke Indoors
A dimension that rarely comes up in the “cigars versus cigarettes” conversation is what happens to the people around you. Cigars burn longer and produce far more smoke per session than a cigarette. A study modeling the indoor air quality impact of cigar smoke found that cigars release volatile organic compounds at levels one to two orders of magnitude higher than conventional cigarettes.20E3S Web of Conferences. Volatile Emissions of Cigar Smoke and Their Predicted Impact on Indoor Air Quality That means a single cigar smoked in a living room or a poorly ventilated cigar lounge can push formaldehyde and other pollutants to concentrations that dwarf what a cigarette would produce. Whatever your personal risk tolerance, the secondhand exposure you impose on others is considerably worse with a cigar.
How People Perceive the Risk
Public perception on this question is surprisingly mixed. A systematic review of surveys and studies on cigar perceptions found that, collectively, adults tend to view cigar products as roughly similarly harmful to cigarettes.21PubMed Central. Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review But there is a meaningful segment of the population, particularly among little cigar and cigarillo users, who perceive those products as less harmful. Adults who viewed little cigars and cigarillos as less harmful than cigarettes had nearly three times the odds of being current users of those products.22PubMed Central. Little cigars and cigarillos: Affect and perceived relative harm among U.S. adults, 2015 The “cigar” label, it seems, gives some smokers permission to see their habit as more refined or less dangerous, even when the products they are actually using are functionally identical to unfiltered cigarettes in size and use pattern.
What Cigar Smoking Does to How You Smoke
One underappreciated detail is that the physical act of smoking a cigar is quite different from smoking a cigarette, and those differences compound over a session. A topography study found that large cigar smoking involved significantly more puffs, a larger total volume of smoke drawn in, and shorter pauses between puffs compared to cigarette smoking.23Nicotine & Tobacco Research. Large Cigars: Smoking Topography and Toxicant Exposure Even though each individual puff may be shallower, the sheer number of puffs and the extended session time mean the mouth, throat, and nasal passages are exposed to smoke continuously for far longer than a five-minute cigarette break allows. Early research suggested that these behavioral differences are partly driven by the irritant properties of cigar smoke, which naturally discourages deep lung inhalation while encouraging the slower, mouth-focused smoking pattern that cigar culture celebrates.24PubMed. Irritant effects of cigarette and cigar smoke The smoke itself, in effect, trains you to use it in a way that protects the lungs at the cost of the upper airway.