The much-anticipated National Academy of Sciences, Engineering, and Medicine (NASEM) study on premium cigars has been released.
Premium Cigars: Patterns of Use, Marketing, and Health Effects (download here) is a report that was commissioned by the U.S. Food & Drug Administration as part of a federal lawsuit. In August 2020, FDA proposed to a federal court that it should study the issue of premium cigars and their regulation further before requiring premium cigars to go through the product approval process FDA requires from other products like machine-made cigars, e-cigarettes and vaping products, hookah tobacco and others.
NASEM then convened a panel of academics and researchers who studied four main topics:
- Product characteristics
- Patterns of use
- Marketing and perceptions
- Health effects
Per the court ruling, FDA is not bound by the findings of the report, which makes 13 findings, 24 conclusions and nine “priority research recommendations” for the federal government.
The report’s focus is on “premium cigars,” something the authors suggest was challenging because there is no established definition of what is a “premium cigar” and what’s not. (FDA has adopted a definition for the purposes of the aforementioned lawsuit.)
Early in its work, the committee noted the very limited literature available on premium cigars specifically. With no agreed-upon definition of premium cigars, the literature is inconsistent regarding which brands are considered premium, and many publications do not distinguish pre- mium from other large cigars. To guide its work, the committee developed a working definition of premium cigars (see Box S-1 and Chapter 1).
However, the report says that the federal government—through FDA and other agencies—should not only establish a definition but also then study premium cigars specifically:
Recommendation 1: The Food and Drug Administration, in consul- tation with other federal agencies, should develop formal categories and definitions for cigars to be used for research to ensure consistency among studies.
For some, this will be a notable win as it means the report is suggesting that “premium cigars” should be their own class of products, forcing the government to draw a clear line between products like Macanudos and Swisher Sweets. While there’s nothing to be gained by the delineation itself—it changes nothing in regards to current regulations—the separation will be helpful for lobbying FDA, Congress and local governments in regards to treating “premium cigars” differently.
There are some clearer wins for the premium cigar industry. For example, the report says that the health consequences of smoking “premium cigars” are not the same as other types of smoking because of use patterns:
Conclusion 5-5: There is strongly suggestive evidence that health con- sequences of premium cigar smoking overall are likely to be less than those smoking other types of cigars because the majority of premium cigar smokers are nondaily or occasional users and because they are less likely to inhale the smoke.
On the negative side, the report finds that the actual smoke itself is likely to be as dangerous as cigarette smoke. However, the report suggests that there are dangers regarding cigars, but it’s clear the NASEM panel was unable to find clear evidence specifically related to “premium cigars” and as such the report uses terms like “cigar smoke in general.”
Conclusion 2-1: There is conclusive evidence that the addictive, toxic, and carcinogenic constituents of cigar tobacco in general are the same as those present in cigarette tobacco. There is strongly suggestive evidence that constituents of premium cigar tobacco are similar to constituents of other cigars because all tobacco contains nicotine, carcinogenic tobacco- specific nitrosamines, metals, and precursors to toxic and carcinogenic compounds formed during the combustion process.
Conclusion 5-1: There is conclusive evidence that smoke from cigars in general, including premium cigar smoke, contains many hazardous and potentially hazardous constituents, capable of causing cardiovascular dis- ease, lung disease, cancer, and multiple other negative health effects.
Conclusion 2-2: There is conclusive evidence that the toxicants and carcinogens in cigar smoke in general are qualitatively the same as those in cigarette smoke. There is no reason to believe that toxicants and car- cinogens in premium cigar smoke are any different from those in other types of cigars. Additionally, it is likely that the total toxic and carcinogenic constituent yields will increase with the mass of tobacco filler in the cigar.
Conclusion 2-4: There is conclusive evidence that cigar smokers in general are exposed to significant amounts of nicotine and numerous harmful and potentially harmful constituents.
This is a developing story, updates to come.