Cigars expose your body to many of the same toxins and carcinogens found in cigarettes, and in some cases deliver them in higher concentrations. The widespread perception that cigars are a safer or more refined form of tobacco is not supported by the research. From your mouth and lungs to your heart and skin, cigar smoke causes measurable damage, and the degree of that damage depends on how often you smoke, whether you inhale, and what type of cigar you choose.
How Cigar Smoke Gets Into Your System
One of the key differences between cigar and cigarette smoke is chemistry, not safety. Cigar smoke is more alkaline, with a pH around 8.5 compared to about 5.3 for cigarette smoke. That higher pH means more of the nicotine in cigar smoke exists in a form that passes easily through the lining of your mouth, even without inhaling into your lungs.1Nature. Absorption of Nicotine in Cigarette and Cigar Smoke through the Oral Mucosa This is why many cigar smokers absorb significant amounts of nicotine just by holding the smoke in their mouths. It also means the tissues of the mouth, tongue, and throat are in direct, prolonged contact with concentrated toxicants.
When researchers measure cotinine, a nicotine byproduct that shows up in blood and urine, daily cigar smokers show levels that are lower than daily cigarette smokers but still dramatically higher than nonsmokers. More telling is NNAL, a biomarker tied to a potent tobacco-specific carcinogen. Daily cigar smokers have NNAL levels roughly comparable to daily cigarette smokers, which undercuts the idea that cigars expose you to meaningfully less cancer-causing chemistry.2Cancer Epidemiology, Biomarkers & Prevention. Biomarkers of Exposure among U.S. Cigar Smokers: An Analysis of 1999–2012 National Health and Nutrition Examination Survey (NHANES) Data Even nondaily cigar smokers had NNAL levels many times higher than people who don’t use tobacco at all.
Oral Cancer and Gum Disease
The mouth takes the hardest hit. Because cigar smoke sits in the oral cavity rather than being pulled deep into the lungs, the tissues there absorb an outsized share of the exposure. A systematic review of large cohort studies found that current cigar smokers had oral cancer mortality rates four to nearly eight times higher than nonsmokers.3PubMed Central. Systematic review of cigar smoking and all cause and smoking related mortality That risk climbed with more cigars per day, longer duration of use, and deeper inhalation. Critically, even cigar smokers who reported no inhalation at all still had a roughly sevenfold higher risk of dying from oral cancer compared to nonsmokers.
Beyond cancer, cigars damage the supporting structures of the teeth. Research on cigar and pipe smokers found that about 18% had moderate to severe periodontal disease, and they averaged four missing teeth.4PubMed. Cigar, pipe, and cigarette smoking as risk factors for periodontal disease and tooth loss Cigar smokers also had more gum recession and attachment loss compared to nonsmokers, meaning the gum tissue was pulling away from the teeth and the bone supporting them was eroding. One slightly counterintuitive finding: smokers actually had less gingival bleeding than nonsmokers, which does not mean healthier gums. Nicotine constricts blood vessels, masking the bleeding that would normally signal disease. So a cigar smoker’s gums can look deceptively calm while serious damage progresses underneath.
Cancer Risk Beyond the Mouth
Cigar smoking is linked to elevated cancer risk across multiple organs, not just those directly bathed in smoke. A large study of men found that current cigar smokers, compared to never-smokers, had a fivefold higher risk of dying from lung cancer, a fourfold higher risk of dying from cancers of the oral cavity and throat, and a tenfold higher risk of dying from laryngeal cancer.5JNCI: Journal of the National Cancer Institute. Cigar Smoking in Men and Risk of Death From Tobacco-Related Cancers Risk of esophageal cancer death was also elevated, though that finding was less statistically certain.
Lung cancer risk among cigar-only smokers rises sharply with both the number of cigars smoked and, especially, how deeply the smoke is inhaled. One study noted that differences in lung cancer risk between cigar, pipe, and cigarette smokers were strongly tied to inhalation habits rather than the product itself.6PubMed. Lung cancer risk with cigar and pipe use When cigar smokers do inhale deeply, their lung cancer risk approaches that of cigarette smokers. When they do not, it remains elevated but substantially lower.
Organs further from the smoke’s immediate path are not spared. A pooled European analysis found that exclusive cigar smokers had roughly two and a half times the risk of bladder cancer compared to nonsmokers.7PubMed. Cigar, pipe, and cigarette smoking and bladder cancer risk in European men And a large international consortium analysis found that cigar-only smokers had a pancreatic cancer risk on par with cigarette-only smokers, with the risk climbing at higher daily consumption.8PubMed Central. Cigar and pipe smoking, smokeless tobacco use and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (PanC4) Bladder and pancreatic cancers develop because tobacco carcinogens enter the bloodstream, get processed by the body, and are concentrated in organs like the bladder during excretion or affect the pancreas through systemic exposure.
What Happens to Your Heart and Arteries
Cigar smoking raises the risk of coronary heart disease. A large study published in the New England Journal of Medicine found that cigar smokers had about a 27% higher risk of coronary heart disease compared to nonsmokers.9PubMed. Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men That is a smaller increase than what cigarette smoking produces, but it is not trivial, and it compounds over years of regular use.
The effects on blood vessels are immediate and measurable. A study that tracked arterial stiffness before, during, and after cigar smoking found that just one cigar increased pulse wave velocity and augmentation index, both indicators that arteries have become stiffer and less elastic. These changes appeared within minutes of lighting up and persisted for at least two hours.10PubMed. Cigar smoking has an acute detrimental effect on arterial stiffness Blood pressure also rose during the same period. Stiffer arteries mean the heart has to work harder to pump blood, and over time that contributes to hypertension, heart enlargement, and increased stroke risk.
Lung Function and Airflow Obstruction
Even among people who say they do not inhale, cigar smoking is associated with reduced lung function. A cross-sectional analysis found that cumulative cigar-years were associated with a decline in the ratio of how much air you can force out of your lungs in one second relative to total lung capacity, a standard measure of airflow obstruction. Cigar and pipe smokers who had never smoked cigarettes still had more than double the odds of airflow obstruction compared to people with no smoking history.11PubMed Central. The association of pipe and cigar use with cotinine levels, lung function, and airflow obstruction: a cross-sectional study Those who had also smoked cigarettes at some point fared even worse. This suggests that even without deliberate inhalation, enough smoke reaches the lower airways to cause cumulative damage over years of use.
Overall Mortality
The bottom-line number that combines all these individual risks is all-cause mortality. A study using nationally representative U.S. data found that exclusive current cigar smokers had a 20% higher risk of death from any cause compared to people who had never used tobacco.12JAMA Internal Medicine. Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population That is well below the nearly doubled mortality risk seen in current cigarette smokers in the same analysis. But a 20% increase is not negligible. It translates into real years of life lost across a population, and it underscores that regular cigar use is not a harmless pastime.
Another analysis found that current cigarette smokers, regardless of whether they also used cigars, had the highest mortality hazard ratios, ranging from roughly 2.2 to 2.6. Former cigarette smokers who had switched to cigars generally showed excess mortality too, with hazard ratios between about 1.2 and 1.6.13PubMed Central. Mortality among male cigar and cigarette smokers in the USA The pattern is clear: cigar use carries real risk, but combining it with cigarette smoking, or switching from cigarettes to cigars without quitting, amplifies the danger considerably.
The “I Don’t Inhale” Problem
Many cigar smokers believe that not inhaling protects them from serious harm. The oral cancer data already described shows why that assumption is wrong for the mouth and throat. But there is another layer to the problem: many cigar smokers do inhale, whether they realize it or not, and former cigarette smokers who switch to cigars are especially likely to do so.
A prospective study found that pipe and cigar smokers who had previously been cigarette smokers had higher carboxyhaemoglobin levels than cigar and pipe smokers who had never touched cigarettes, even though both groups smoked the same amount of tobacco per day. The higher carboxyhaemoglobin indicates deeper or more frequent inhalation.14PubMed Central. Prospective study of effect of switching from cigarettes to pipes or cigars on mortality from three smoking related diseases Separate population-based analyses confirmed the same pattern using serum thiocyanate, another marker of smoke exposure: former cigarette smokers who switched to cigars or pipes showed higher exposure levels and reported inhaling into the chest more often.15PubMed Central. Does switching from cigarettes to pipes or cigars reduce tobacco smoke exposure?16JAMA. Smoke Exposure in Pipe and Cigar Smokers: Serum Thiocyanate Measures
The takeaway for former cigarette smokers is blunt: switching to cigars does not reset your habits. Your body has learned to inhale, and you are likely still pulling smoke deeper into your lungs than someone who picked up cigars without a cigarette history. The result is higher toxicant exposure and a less favorable risk profile than the “casual cigar smoker” image would suggest.
Not All Cigars Are the Same
The word “cigar” covers a huge range of products, and the health effects vary accordingly. A large premium cigar smoked once a month delivers a very different exposure than a flavored little cigar smoked daily. The differences are not just about size and frequency; the chemical makeup of the smoke itself changes.
Little cigars, which resemble cigarettes in shape and are often sold with filters, produce mainstream smoke containing three to five times more tobacco-specific nitrosamines (NNK and NNN, two of the most potent carcinogens in tobacco) compared to commercial cigarettes.17PubMed. Tobacco-Specific Nitrosamines in the Tobacco and Mainstream Smoke of Commercial Little Cigars That is a counterintuitive finding given their visual similarity to cigarettes, but cigar tobacco is fermented differently and wrapped in tobacco leaf rather than paper, which changes the combustion chemistry.
When researchers had people smoke both cigarillos and little cigars under real-world conditions (not machine smoking), they found wide variation in behavior. Total puff volume ranged enormously depending on the person and the product. Cigarillos generally produced more total toxicants than little cigars or cigarettes, but when adjusted for the weight of tobacco burned, little cigars delivered more nitrosamines per gram.18PubMed. Cigarillo and Little Cigar Mainstream Smoke Constituents from Replicated Human Smoking Smoking topography also differed dramatically across cigar types: cigarillo smokers took significantly more puffs and spent more time smoking than little cigar smokers, while large cigar smokers had greater puff velocity.19PubMed Central. Dual Use of Cigarettes, Little Cigars, Cigarillos, and Large Cigars: Smoking Topography and Toxicant Exposure The practical implication is that you cannot assume a cigarillo or little cigar is “lighter” than a cigarette. The opposite may be true for some toxicants.
What Cigar Smoke Does to the Air Around You
Cigar smoke is not just a problem for the person holding it. Cigars produce higher concentrations of toxic and carcinogenic compounds than cigarettes, and because they burn for much longer and produce more sidestream smoke (the smoke that drifts off the lit end), they are a major source of indoor air pollution.20JAMA. Health Risks Associated With Cigar Smoking
Laser spectrometric analysis of cigarillo secondhand smoke found that particulate matter concentrations ranged from roughly 2,800 to nearly 6,700 micrograms per cubic meter for the fine particles most relevant to health. The vast majority of particles, between 70% and 90% depending on the brand, were in the smallest size fraction (PM1), which penetrates deepest into the lungs of anyone nearby.21PLOS ONE. High particulate matter burden by cigarillos: A laser spectrometric analysis of second-hand smoke of common brands with and without filter Filter-tipped cigarillos produced somewhat less particulate matter than unfiltered ones, but the reductions were modest and not always statistically significant. If you smoke a cigar indoors, everyone in that room is breathing substantial quantities of fine particulate matter and carbon monoxide whether they want to or not.
Skin Aging and Wound Healing
Tobacco smoke accelerates skin aging through several mechanisms. It impairs collagen production, the protein that keeps skin firm. At the same time, it increases levels of enzymes that break down collagen and elastic fibers, and it triggers the production of abnormal elastin material. Reactive oxygen species from tobacco smoke add further damage. The combined result is premature wrinkling, sagging, and changes in skin texture.22Journal of Dermatological Science. Tobacco smoke causes premature skin aging Tobacco smoke is also associated with impaired wound healing, psoriasis, hair loss, and elevated risk of squamous cell carcinoma and melanoma. Most of this research has focused on cigarette smoking, but the mechanisms are driven by compounds present in all tobacco smoke, cigar smoke included. Nicotine-driven vasoconstriction, which reduces blood flow to the skin, operates regardless of how the nicotine was delivered.
The Perception Gap
A persistent mismatch exists between how risky cigars actually are and how risky people think they are. Survey data from young adults found that about 14% rated cigars as less risky than cigarettes, while roughly a quarter thought cigars were more risky. That leaves a large share of people who see them as roughly equivalent, and a meaningful minority who consider them safer.23PubMed Central. Young Adults’ Risk Perceptions of Various Tobacco Products Relative to Cigarettes: Results From the National Young Adult Health Survey The “less risky” perception was actually more common for cigars than for smokeless tobacco, which is notable because combustible products generally carry higher health risks than non-combustible ones.
Qualitative research with young adult smokers revealed some of the reasoning behind these perceptions. Participants described flavored little cigars and cigarillos as “healthier” and “less addictive” than cigarettes, sometimes explicitly because of the flavoring or because the products felt more “natural.”24Nicotine & Tobacco Research. The Most Natural Tobacco Used: A Qualitative Investigation of Young Adult Smokers’ Risk Perceptions of Flavored Little Cigars and Cigarillos The same study found that many young adults use little cigars primarily as a vehicle for smoking marijuana, which further muddies the risk calculus because people may not think of themselves as “cigar smokers” even while regularly exposing their mouths and lungs to burning cigar tobacco. The flavor, the packaging, and the cultural framing all work to make cigars feel like a different category from cigarettes. The chemistry of the smoke, and the body’s response to it, says otherwise.
Metabolic Effects and Diabetes Risk
There is some evidence that cigar use may affect metabolic health, though the picture is less clear-cut than for cancer or heart disease. A study from the Multi-Ethnic Study of Atherosclerosis found that former cigar users had higher fasting glucose and insulin resistance markers compared to both current and never users. In unadjusted analysis, former cigar users had about 74% higher risk of developing type 2 diabetes over roughly a decade of follow-up. However, once the researchers controlled for body weight, blood pressure, cholesterol, physical activity, and diet, the association between cigar use and incident diabetes was no longer statistically significant.25PLOS ONE. Tobacco Use, Insulin Resistance, and Risk of Type 2 Diabetes: Results from the Multi-Ethnic Study of Atherosclerosis That does not mean cigars are metabolically harmless; it means the relationship is entangled with other lifestyle factors that tend to cluster together in the same people. The honest assessment is that cigar smoking probably does not help your metabolic health, but the independent contribution is hard to isolate from everything else going on.