Another Reality Jolt for Cigarette Smoker : Switching to Pipes or Cigars in the Interest of Better Health Is a Delusion, Study Shows

Another dream of cigarette addicts is in the process of going up in smoke. This time, it’s the delusion that a cigarette user can switch to smoking cigars or a pipe to cut down on the health dangers of tobacco.

And for nonsmokers who have found the odor of cigarette smoke repulsive but the sweet aroma of certain blends of pipe tobacco smoke attractive, there is another jolt into reality: So-called side-stream smoke--that which is exhaled or not inhaled by the smoker, in the first place--is more noxious when it comes from pipe tobaccos than when the origin is cigarettes.

Widespread Attention

Ironically, though the absence of any safety advantage for cigar and pipe smokers as opposed to cigarette users has been the subject of a growing body of evidence for nearly a decade, it has apparently taken a new study published by researchers in Minnesota last week to attract widespread public attention to the scientific reality.

“We got all the press, but it’s the kind of thing that confirms evidence gathered by a lot of other people,” said Terry Pechacek of the division of epidemiology of the University of Minnesota School of Public Health.

The new study comes on the heels of persistent attempts of pipe and cigar promoters to convince the public that even some physicians believe switching provides a safer alternative to cigarettes for smokers who believe they can’t quit.

306 Smokers Studied

What Pechacek’s group found, in a study of the smoking habits of 306 male smokers in seven cities in the upper Midwest, was that smokers who have switched from cigarettes to pipes or cigars find ways to continue to inhale the smoke, no matter what. The kinds of tobacco used in cigars and pipes are cured differently than those used in cigarettes, he said, with pipe-cigar tobaccos producing greater concentrations of cancerous tars and dangerous carbon monoxide gas than those used in cigarettes.

Even for a pipe or cigar smoker who has never used cigarettes, smoking four cigars or four pipefuls a day or more inflicts the equivalent damage to the heart and lungs of at least a half pack of cigarettes, Pechacek said.

“Heavy (cigar and pipe) smokers should be advised to reduce consumption or quit smoking,” the Minnesota team warned in a report published in last week’s issue of the Journal of the American Medical Assn. “Cigarette smokers contemplating switching to (cigars or pipes) should be advised that they are likely to inhale . . . and may not reduce their risk.

“Hence, quitting completely is the best and safest strategy.”

The new report came as essentially the latest installment in a series of studies that have raised doubts about the comparative safety of pipes and cigars as opposed to cigarettes. In a paper published earlier this year, researchers at the National Cancer Institute found, for instance, that cigar and pipe smokers have an elevated risk of contracting bladder cancer.

In the past, the only significant controversy in the field has been over the question of the extent to which pipe and cigar smokers actually inhale, with some studies finding the amounts minimal and others finding them high.

The Minnesota research, Pechacek said, tried to ascertain smoke absorption by a new method--the measurement of levels in the blood of a chemical called serum thiocyanate, which occurs in the body as a byproduct of tobacco exposure. The researchers monitored serum thiocyanate levels in the bloodstreams of pipe and cigar smokers who had used cigarettes previously and those who had not.

Other Ways to Inhale

The former cigarette smokers recorded significantly higher measurements of the chemical marker, the Minnesota team found. The values recorded in the 306 smokers were compared with more than 2,200 others who were either exclusively nonsmokers or exclusively cigarette users.

What the findings indicate, Pechacek said, is that former cigarette smokers who have switched to pipes and cigars continue to find ways--perhaps unconsciously--to inhale large amounts of smoke. In a telephone interview, Pechacek said the former cigarette smokers apparently accomplish this by taking in a puff of smoke and then exhaling almost all of it immediately.

But they retain a small amount of smoke in their mouths and then inhale a fresh puff, with the fresh smoke mixing with the more noxious smoke that has remained from the previous puff. Some of that continuous series of mixings of old and new smoke is drawn back into the lungs, Pechacek said.

“Pipe and cigar smoke actually has higher levels or carcinogens and is actually more dangerous (than cigarette smoke) because it is more irritating to the mucous lining” of the throat and respiratory system, he said. “Cigarette smoke is easier to inhale.”

Differences in the two smokes are accounted for, he said, by the use in cigarette tobaccos of a process called flue curing in which the leaves are dried artificially in a way Pechacek likened to curing a ham. Cigar and pipe tobaccos, on the other hand, are dried naturally, ending up higher in nicotine. The result, Pechacek said, is that cigar and pipe tobacco ends up with comparative carcinogen concentrations equivalent to a far larger equivalent number of cigarettes, he said.

Sidestream Smoke

The higher concentrations mean that the potentially cancerous contents of pipe and cigar smoke can act in the mouths of even users who do not inhale any of the smoke.

He added that the comparative exposure risk of the two tobacco types also means that sidestream smoke--that which exists in room air, for instance, where pipes or cigars are being smoked--is just as bad as the same type of smoke residue from cigarettes and should be avoided just as assiduously.

Sidestream smoke has also been known by an analogous term: passive smoking.

“Both pipe and cigar sidestream smoke is more dangerous than cigarette smoke,” Pechacek said.

Dr. Anne L. Davis, a researcher at the New York University School of Medicine and a former president of the American Thoracic Society, agreed that the dangers of pipe and cigar smoking are real and should not be minimized. She also said it is her impression that, among smokers, the belief persists that, despite the scientific reality, cigars and pipes are, somehow, less dangerous.

Last year, Davis was the principal author of an American Lung Assn. study of the effects of self-help smoking cessation programs.

She said such programs have not emphasized pipe and cigar smoking cessation because their major thrust has been to try to persuade people to stop using cigarettes--because cigarettes account for far more of the tobacco market than their two major competitors.

In recent years, consumption of all such products has been on the decline. According to the U.S. Surgeon General’s Office, cigarette production in the U.S. dropped from 634 billion cigarettes in 1982 to 595 billion estimated for this year. Pipe tobacco dropped from 33.7 million pounds to 27.5 million pounds and cigar production fell from 3.7 billion cigars in 1982 to 3.1 billion estimated for this year.