January 15, 2009

Cigar Use among Young Adults Aged 18 to 25

Cigar use increases the risk of many health problems, including several types of cancer.¹ In fact, regular cigar smokers have 4 to 10 times the risk of dying from oral, esophageal, or laryngeal cancer than nonsmokers. Nicotine dependence may occur even among cigar smokers who do not inhale because nicotine is absorbed through the lining of the mouth. It is important to gain a better understanding of the epidemiology and correlates of cigar smoking in order to increase the public's awareness of the risks and improve the effectiveness and targeting of prevention and intervention programs on cigar use. The National Survey on Drug Use and Health (NSDUH) collects information that can contribute to this effort.

This issue of The NSDUH Report examines past month cigar use among young adults aged 18 to 25, the age group with the highest rates of past month cigar use.² The first section presents information on trends in cigar smoking from 2002 to 2007. The remaining sections use 2007 data to examine cigar use by demographic and geographic characteristics, and the prevalence of use of other types of tobacco among cigar users.

More young adults used cigars in the past month in 2007 (11.8 percent) than in 2002 (11.0 percent), although the prevalence rate peaked in 2004 at 12.7 percent (Figure 1). Overall trends in past month cigar use were primarily driven by trends among males, who were generally 3 times as likely as females to have smoked cigars. In 2002, 16.8 percent of males used cigars compared to 19.7 percent in 2004 and 18.4 percent in 2007. Among females, rates remained relatively stable between 2002 and 2007, ranging from 5.1 to 5.8 percent.

Figure 1. Percentages of Young Adults Aged 18 to 25 Using Cigars in the Past Month, by Gender: 2002 to 2007

In 2007, rates of past month cigar use varied by race/ethnicity and age group. The highest rate was found among young adults reporting two or more races (16.9 percent), followed by whites (13.4 percent), blacks or African Americans (11.2 percent), Hispanics or Latinos (8.3 percent), and Asians (4.4 percent) (Figure 2). Rates of past month cigar use generally declined with age among young adults; for example, the rate was 14.5 percent for those aged 18 or 19 compared with 8.5 percent for those aged 24 or 25 (Figure 3).

Figure 2. Percentages of Young Adults Aged 18 to 25 Using Cigars in the Past Month, by Race/Ethnicity**: 2007

Figure 3. Percentages of Young Adults Aged 18 to 25 Using Cigars in the Past Month, by Detailed Age Groups: 2007

Rates also varied by geographic characteristics. Young adults living in non-metropolitan counties were more likely than those living in large or small metropolitan counties to have used cigars in the past month (13.5 percent vs. 11.4 and 11.8 percent). The rate of past month cigar use was higher among young adults living in the Midwest and the South (13.8 and 12.0 percent) than their counterparts living in the West and the Northeast (10.9 and 10.4 percent).

Nearly two thirds (65.9 percent) of past month cigar smokers also used cigarettes, 15.3 percent also used smokeless tobacco, and 5.8 percent also used pipe tobacco (Figure 4). Female and male past month cigar users had similar rates of past month cigarette use; however, males were more likely than females to have also used smokeless tobacco (18.6 vs. 3.0 percent) and pipe tobacco (6.4 vs. 3.5 percent).

Figure 4. Percentages of Past Month Use of Other Tobacco Products among Past Month Cigar Smokers Aged 18 to 25, by Gender: 2007

Cigar smoking continues to be a serious public health problem. In 2007, approximately 12 percent of young adults smoked cigars in the past month, with some subgroups having particularly high rates—most notably males, with a rate of almost 1 in 5. Most young adult cigar smokers (two thirds) also used cigarettes. These findings emphasize the importance of targeting prevention and intervention programs, and the importance of addressing both cigar and cigarette use. It is important for young adults to understand—and for prevention and intervention programs to continue to emphasize—that cigar use is not a healthy alternative to cigarette smoking.