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Shortly after ASH asked its members in its newsletter to write to U.S. Surgeon General Satcher to ask him to back ASH's petition for cigarette-like warnings on cigars, the Surgeon General has responded.

Not only did he and the Department of Health and Human Services urge such warnings; their urging are backed up by two major reports from the HHS Inspector General.

Below, side by side, are a press report of this new action and a reprint from the January-February 1999 ASH Smoking and Health Review which presented the case for such warnings and asked readers to write to Surgeon General Satcher.

Following is a copy of a press release from HHS describing the action, and links to the two major new reports.

YOU CAN HELP. PLEASE WRITE TO THE FTC, 6TH ST. & PENNS. AVE. NW, WASH D.C. 20580, AND TELL THEM YOU SUPPORT ASH'S PETITION FOR HEALTH WARNINGS ON CIGARS.

YOU CAN ALSO HELP BY WRITING TO YOUR TWO U.S. SENATORS AND ONE U.S. REPRESENTATIVE IN THE HOUSE OF REPRESENTATIVES, AND ASK THEM TO WRITE TO THE FTC IN SUPPORT OF HEALTH WARNINGS ON CIGARS.
 

The Department of Health and Human Services today issued a pair of reports by the HHS Inspector General warning about cigar use among teenagers and recommending mandatory warning labels similar to those on cigarettes and other tobacco products.

“These reports add to our department’s growing understanding of the dangers of cigar smoking,” said HHS Secretary Donna E. Shalala. “The new information in these studies will help us with our ongoing efforts to reduce teenage smoking and youth access to tobacco products of all kinds, and I am pleased that the Surgeon General has agreed to review the issues these reports raise.”

The Office of the Inspector General (OIG) study on “Patterns of Use and Perception of Risk” included 18 focus groups involving a mix of 227 young cigar users and non-users of different socioeconomic backgrounds from urban and suburban areas across the country. Thirteen of the focus groups comprised high school students, four involved junior high students, and one was made up of college students. The purpose of the focus groups was to explore patterns of cigar use among the participants and their peers. Specific questions focused on initiation, frequency, and variations of use, as well as the motivations and influences to use cigars.

The study found that 19 percent of the teenagers who participated in the focus groups admitted to having smoked a cigar in the past 30 days, and half of the smokers said they expect to be cigar users five years into the future. They further reported widespread cigar use and experimentation among their peers and disclosed that some teens create modified cigars called “blunts” by removing some or all of the core tobacco of a cigar and replacing it with marijuana.

“These findings are of profound concern and require our immediate action to inform the public about the health risks associated with cigar smoking,” said HHS Inspector General June Gibbs Brown. “There is a great need for additional research on cigars, including prevalence, patterns of use, health effects, the addictive potential of cigars as well as the practice of blunting.”

“There is no safe form of tobacco,” said Surgeon General Dr. David Satcher. “We should require the same sort of warning labels on cigars that we already require on packages of cigarettes and spit tobacco. The absence of such a warning on cigars could lead consumers to erroneously conclude that cigars do not carry health risks.”

Although sale of cigars to minors is illegal in all 50 states, the OIG report on “Federal and State Enforcement and Regulation” showed that state level enforcement is uneven and is generally given a lower priority than enforcement of unlawful cigarette and spit tobacco sales. Half the states, according to the study, are unaware of the ease with which minors can purchase cigars, the degree to which the use of cigars by minors is a problem, and the health risks caused by cigar smoking. In addition, the OIG recommended that the government develop a public awareness campaign about the health effects of cigars.

The studies were requested by the Office on Smoking and Health at the Centers for Disease Control and Prevention (CDC), as part of Secretary Shalala’s campaign to reduce the use of tobacco by minors. The request was triggered, in part, by new information showing surprisingly high use of cigars by minors and new scientific evidence from the National Cancer Institute that cigar use can cause cancers of the lungs, larynx, oral cavity and esophagus. Those results were contained in a NCI monograph, “Cigars: Health Effects and Trends,” released in April 1998.

HHS has only recently begun to survey cigar use among young people, and the surveys have used different methodologies. Both CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) added questions about youth cigar use to their annual surveys for the first time in 1997. SAMSHA’s National Household Survey on Drug Abuse, a written survey conducted in households, estimated that 5 percent of teenagers smoke cigars. CDC’s Youth Risk Behavior survey, conducted in schools, estimated that 22 percent of youths have smoked a cigar in the past 30 days. These agencies have agreed that additional research will be required to better understand patterns of cigar use among young people.

In the focus groups conducted by the OIG, higher percentages of both male and female participants said they have smoked a cigar, with the highest use reported among urban teens. Fifty four percent of the focus group participants had smoked a cigar sometime in their life, and of that number, two-thirds had done so in the past year, and more than one-third within the past 30 days. Of the 82 teens who had smoked a cigar in the past year, 60 percent also reported smoking cigarettes, while 16 percent reported having used spit tobacco products.

While most teens are first exposed to tobacco is through cigarettes, 22 percent of 159 focus group participants surveyed by the OIG, tried cigars first, again suggesting that more research is needed to determine whether cigars are attracting a new group of users who would otherwise not have used tobacco products.

Forty percent of the focus group participants reported that cigar use was increasing in popularity and use among their peers. About half of both suburban and urban participants said they expect to be using cigars in the next five years, despite general awareness of the health risks associated with smoking. The teens said that smoking cigars is more socially acceptable among teens and adults than smoking cigarettes or using spit tobacco. Moreover, they easily recalled a wide assortment of television shows, movies, and famous celebrities associated with cigar smoking.

Focus group participants said teens generally buy cigars at gas stations or convenience stores, typically smoke them at parties, frequently while drinking alcohol, and prefer manufactured cigars, to premium cigars, because of the ease of purchase, low cost, sweetened flavors and pleasant aromas. They further reported that many of their peers use cigars as “blunts” for smoking marijuana, especially in urban schools. While the practice is common at weekend parties, urban teens reported that blunting often occurs everyday. The report went on to say that cigars used as blunts for smoking marijuana are popular with teens because they reportedly result in a better high, improve the flavor of marijuana, and burn more slowly than cigarette paper.

The OIG report suggests that the ready availability of cigars to minors, and the increased popularity of cigars among teens, is partly due to the fact that cigars have not faced the same degree of regulation and oversight as other tobacco products. For example, the OIG report notes that no federal laws require cigar manufacturers to report their ingredients, and, aside from little cigars, they are not subject to television and radio advertising restrictions.

The only federal oversight for cigars is through a provision of the Public Health Service Act known as the Synar Amendment that requires states to conduct yearly, random, unannounced inspections of vendors to measure tobacco sales to minors.

To read and/or download these two major reports,  Click Here

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