Mortality Risks for US Cigarette, Cigar, and Pipe Users | Lifestyle Behaviors | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population

Educational Objective
To investigate the mortality risks associated with current and former use of cigars, pipes, and cigarettes.
1 Credit CME
Key Points

Question  What is the association of cigar, pipe, and cigarette use with mortality risk in the US population?

Findings  In this nationally representative longitudinal cohort study of 357 420 participants comparing exclusive cigar, pipe, and cigarette use with mortality risk, a statistically significantly elevated risk of tobacco-related cancer mortality among exclusive current and former cigarette smokers, current cigar smokers, and current pipe smokers, as well as a statistically significantly elevated risk of mortality from most examined causes of death among both current daily and nondaily cigarette smokers, were demonstrated.

Meaning  Use of cigar, pipe, and cigarettes each confers mortality risks.

Abstract

Importance  Tobacco products have changed in recent years. Contemporary mortality risk estimates of combustible tobacco product use are needed.

Objective  To investigate the mortality risks associated with current and former use of cigars, pipes, and cigarettes.

Design, Setting, and Participants  The National Longitudinal Mortality Study is a longitudinal population-based, nationally representative health survey with mortality follow-up that includes demographic and other information from the Current Population Survey, tobacco product use information from the Tobacco Use Supplement, and mortality data from the National Death Index. In this study, participants provided tobacco use information at baseline in surveys starting from 1985 and were followed for mortality through the end of 2011. The study includes 357 420 participants who reported exclusively using cigar, pipes, or cigarettes or reported never using any type of tobacco product.

Exposures  Current or former exclusive use of any cigar (little cigar, cigarillos, large cigar), traditional pipe, or cigarette and never tobacco use. Information on current daily and nondaily use was also collected. Estimates adjusted for age, sex, race/ethnicity, education, and survey year.

Main Outcomes and Measures  All-cause and cause-specific mortality as identified as the primary cause of death from death certificate information.

Results  Of the 357 420 persons included in the analysis, the majority of current and former cigar and pipe smokers were male (79.3%-98.0%), and smokers were more evenly divided by sex (46% of current daily smokers were male). There were 51 150 recorded deaths during follow-up. Exclusive current cigarette smokers (hazard ratio [HR], 1.98; 95% CI, 1.93-2.02) and exclusive current cigar smokers (HR, 1.20; 95% CI, 1.03-1.38) had higher all-cause mortality risks than never tobacco users. Exclusive current cigarette smokers (HR, 4.06; 95% CI, 3.84-4.29), exclusive current cigar smokers (HR, 1.61; 95% CI, 1.11-2.32), and exclusive current pipe smokers (HR, 1.58; 95% CI, 1.05-2.38) had an elevated risk of dying from a tobacco-related cancer (including bladder, esophagus, larynx, lung, oral cavity, and pancreas). Among current nondaily cigarette users, statistically significant associations were observed with deaths from lung cancer (HR, 6.24; 95% CI, 5.17-7.54), oral cancer (HR, 4.62; 95% CI, 1.84-11.58), circulatory death (HR, 1.43; 95% CI, 1.30-1.57), cardiovascular death (HR, 1.24; 95% CI, 1.11-1.39), cerebrovascular death (stroke) (HR, 1.39; 95% CI, 1.12-1.74), and chronic obstructive pulmonary disease (HR, 7.66; 95% CI, 6.09-9.64) as well as for daily smokers.

Conclusions and Relevance  This study provides further evidence that exclusive use of cigar, pipes, and cigarettes each confers significant mortality risks.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: December 20, 2017.

Corresponding Author: Carol H. Christensen, PhD, MPH, Office of Science, Center for Tobacco Products, Food and Drug Administration, 10903 New Hampshire Ave, Bldg 71, Room G335, Silver Spring, MD 20993 (carol.christensen@fda.hhs.gov).

Published Online: February 19, 2018. doi:10.1001/jamainternmed.2017.8625

Author Contributions: Drs Christensen and Ms Cosgrove had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Christensen, Rostron, Altekruse, Apelberg, Inoue-Choi, Freedman.

Acquisition, analysis, or interpretation of data: Christensen, Rostron, Cosgrove, Altekruse, Hartman, Gibson, Inoue-Choi, Freedman.

Drafting of the manuscript: Christensen, Rostron, Cosgrove, Altekruse, Gibson, Inoue-Choi, Freedman.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Christensen, Rostron, Cosgrove, Gibson, Inoue-Choi, Freedman.

Obtained funding: Altekruse.

Administrative, technical, or material support: Christensen, Cosgrove, Altekruse, Inoue-Choi, Freedman.

Study supervision: Apelberg, Freedman.

Conflict of Interest Disclosures: None reported.

Census Bureau Disclaimer: This article is released to inform interested parties of research and to encourage discussion. Any views expressed on statistical, methodologic, technical, or operational issues are those of the authors and not necessarily those of the US Census Bureau, Food and Drug Administration (FDA), and National Institutes of Health (NIH).

Disclaimer: This publication represents the views of the authors and does not represent FDA/Center for Tobacco Products nor NIH/National Cancer Institute position or policy.

References
1.
Thun  MJ, Carter  BD, Feskanich  D,  et al.  50-Year trends in smoking-related mortality in the United States.  N Engl J Med. 2013;368(4):351-364.PubMedGoogle ScholarCrossref
2.
Jha  P, Ramasundarahettige  C, Landsman  V,  et al.  21st-century hazards of smoking and benefits of cessation in the United States.  N Engl J Med. 2013;368(4):341-350.PubMedGoogle ScholarCrossref
3.
US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014. Washington, DC: US Dept of Health and Human Services; 2014.
4.
Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration. 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015.
5.
Hu  SS, Neff  L, Agaku  IT,  et al.  Tobacco product use among adults—United States, 2013-2014.  MMWR Morb Mortal Wkly Rep. 2016;65(27):685-691.PubMedGoogle ScholarCrossref
6.
Wang  TW, Kenemer  B, Tynan  MA, Singh  T, King  B.  Consumption of combustible and smokeless tobacco - United States, 2000-2015.  MMWR Morb Mortal Wkly Rep. 2016;65(48):1357-1363.PubMedGoogle ScholarCrossref
7.
National Cancer Institute, ed.  Cigars: Health Effects and Trends: Smoking and Tobacco Control Monograph. Vol 9.  Bethesda, MD: National Cancer Institute; 1998.
8.
Nonnemaker  J, Rostron  B, Hall  P, MacMonegle  A, Apelberg  B.  Mortality and economic costs from regular cigar use in the United States, 2010.  Am J Public Health. 2014;104(9):e86-e91.PubMedGoogle ScholarCrossref
9.
Chang  CM, Corey  CG, Rostron  BL, Apelberg  BJ.  Systematic review of cigar smoking and all cause and smoking related mortality.  BMC Public Health. 2015;15:390.PubMedGoogle ScholarCrossref
10.
Henley  SJ, Thun  MJ, Chao  A, Calle  EE.  Association between exclusive pipe smoking and mortality from cancer and other diseases.  J Natl Cancer Inst. 2004;96(11):853-861.PubMedGoogle ScholarCrossref
11.
Nelson  DE, Davis  RM, Chrismon  JH, Giovino  GA.  Pipe smoking in the United States, 1965-1991: prevalence and attributable mortality.  Prev Med. 1996;25(2):91-99.PubMedGoogle ScholarCrossref
12.
Johnson  J. National Longitudinal Mortality Survey Files and Technical Systems Reference Manual. Suitland, MD: Census Department; 2014.
13.
Shapiro  JA, Jacobs  EJ, Thun  MJ.  Cigar smoking in men and risk of death from tobacco-related cancers.  J Natl Cancer Inst. 2000;92(4):333-337.PubMedGoogle ScholarCrossref
14.
Caraballo  RS, Giovino  GA, Pechacek  TF, Mowery  PD.  Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: Third National Health and Nutrition Examination Survey, 1988-1994.  Am J Epidemiol. 2001;153(8):807-814.PubMedGoogle ScholarCrossref
15.
Soulakova  JN, Bright  BC, Crockett  LJ.  On consistency of self- and proxy-reported regular smoking initiation age.  J Subst Abus Alcohol. 2013;1(1):1001.PubMedGoogle Scholar
16.
Thun  MJ, Apicella  LF, Henley  SJ.  Smoking vs other risk factors as the cause of smoking-attributable deaths: confounding in the courtroom.  JAMA. 2000;284(6):706-712.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close