Smokers lose at least one decade of life expectancy, as compared with those who have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%.

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Background Despite progress in reducing youth smoking, adolescents remain highly susceptible to tobacco use. Of concern is whether youth perceive electronic cigarettes (e-cigarettes) as a preferable alternative to conventional cigarettes. Purpose To describe cigarette harm perception patterns among youth based on the frequency and intensity of cigarette smoking, and examine the relative harm perceptions of conventional versus e-cigarettes, using data from a large, nationally representative sample of U.S. youth. Methods Data from the 2012 National Youth Tobacco Survey (N=24,658) were analyzed in 2013 to identify patterns of cigarette harm perceptions. Multinomial logistic regression was conducted to identify associations between demographic and tobacco use characteristics and cigarette harm perception patterns. Logistic regression was conducted to examine the relationship between cigarette harm perceptions and the perception of e-cigarettes as less harmful than cigarettes for current, ever, and never cigarette smokers. Results The majority of youth (64.2%) perceived the harmfulness of cigarettes as dose-dependent. Approximately one in three students perceived e-cigarettes as less harmful than conventional cigarettes. Regardless of cigarette smoking status, ever users of e-cigarettes and those with “dose-dependent” cigarette harm perceptions consistently were more likely to perceive e-cigarettes as less harmful than conventional cigarettes. Conclusions Many youth perceive tobacco use on a continuum of harm. Youth who perceive gradations in harm—both by frequency and intensity of cigarette use and by type of product—may be particularly susceptible to e-cigarette use.

The majority of e-cigarette users in this study reported less than daily use. Compared with non-daily use, daily use was associated with being a former smoker; however, cross-sectional data limits our ability to establish the temporality or directionality of such associations.

BackgroundCigars are a growing public health concern, given the changes in cigar use patterns in the US and elsewhere since the 1960s. We conducted a systematic review of published studies on current cigar smoking and all-cause and cause-specific mortality risks to inform potential regulatory approaches and future research that would strengthen the body of evidence.MethodsUsing 3 different databases and handsearching, we identified epidemiological studies published prior to June 2014 that examined the association between cigar smoking and all-cause mortality and smoking-related mortality. Detailed study characteristics as well as association-level characteristics, including effect estimates and 95% confidence intervals, were abstracted or calculated from each selected study.ResultsA total of 22 studies from 16 different prospective cohorts were identified. Primary cigar smoking (current, exclusive cigar smoking with no history of previous cigarette or pipe smoking) was associated with all cause-mortality, oral cancer, esophageal cancer, pancreatic cancer, laryngeal cancer, lung cancer, coronary heart disease (CHD), and aortic aneurysm. Strong dose trends by cigars per day and inhalation level for primary cigar smoking were observed for oral, esophageal, laryngeal, and lung cancers. Among primary cigar smokers reporting no inhalation, relative mortality risk was still highly elevated for oral, esophageal, and laryngeal cancers.ConclusionsIn summary, cigar smoking carries many of the same health risks as cigarette smoking. Mortality risks from cigar smoking vary by level of exposure as measured by cigars per day and inhalation level and can be as high as or exceed those of cigarette smoking. The body of evidence would be strengthened by future studies that focus on the health effects of primary cigar smoking and incorporate more contemporary and diverse study populations to better reflect the current patterns of cigar use in the US. Ideally, these studies would also collect detailed information on cigar type, exposure level, and biomarkers of exposure and potential harm.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1617-5) contains supplementary material, which is available to authorized users.

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Despite the diversity of the cigar market place, historically many research studies and tobacco surveillance systems have treated cigars as a single product type. This study describes similarities and differences in the user characteristics, tobacco use patterns, and purchasing behaviors of premium, nonpremium, cigarillo, and filtered cigar smokers. To enhance tobacco regulatory science, sufficient descriptions of the cigar type(s) studied and, where appropriate, differentiation of the particular cigar type(s) studied should be undertaken to improve the interpretation of study findings, understanding of cigar use patterns and related behaviors and future approaches to reducing cigar-attributable morbidity and mortality.

This study suggests that e-cigarette use patterns are highly variable over a 1-year period. This analysis provides the first nationally representative estimates of transitions among US adult e-cigarette users. Future research, including additional waves of the PATH Study, can provide further insight into long-term patterns of e-cigarette use critical to understanding the net population health impact of e-cigarettes in USA.