The analysis of Ringel and colleagues,1 who found that youths’ cigar use is sensitive to price, highlights an important but overlooked issue in public health—the use of tobacco products other than cigarettes. However, since 1999 and 2000, when the data used by Ringel et al. were collected, there have been many changes that deserve discussion.

Cigar consumption in the United States increased by more than 28% between 2000 and 2004, whereas cigarette consumption during the same period declined by 10%.2 Groups that historically have not smoked cigars—youths and females—constitute an increasing proportion of new cigar smokers.3 The average state cigarette excise tax has almost doubled, from $0.64 (1999) to $1.17 (2004), raising the average price per pack by $0.814.4 In the last 3 years, 75% of US states increased their cigarette excise taxes (some more than once), whereas far fewer states (30%) increased taxes on noncigarette tobacco products. Nearly all US states have considerably lower taxes on cigars than on cigarettes.5

Price disparities between cigarettes and other tobacco products may encourage youths to experiment with or switch to non-cigarette tobacco products.6 In states with high cigarette excise taxes, a pack of 20 small cigars may cost half as much as a pack of 20 cigarettes.7 In New Jersey, the cigarette excise tax was raised 3 times in as many years (2002–2004), while the tax on other tobacco products was decreased in 2002 from 48% to 30%. Data from the 2004 New Jersey Youth Tobacco Survey revealed both encouraging and alarming trends.8 Current cigarette use declined by 29% among high school students between 2001 (24.5%) and 2004 (17.3%); however, for the first time ever, more high school boys reported currently smoking cigars (17.2%) than cigarettes (15.9%). In addition, 10.4% of high school girls reported smoking cigars.

These findings are both unexpected and worrisome. We should be cautious in declaring a tobacco control success when youths’ initiation of cigarette smoking decreases; it is possible that they may still be initiating use of tobacco in another form. Given the decline in cigarette consumption, the steady growth in cigar consumption, the price inequity between cigars and cigarettes, and the innovative marketing of cigars, the threat to public health posed by cigars is real and deserves attention. To prevent youths from substituting one tobacco product for another, state and federal policy should be to impose equivalent taxes on all tobacco products.

Completion of this work was supported in part by a contract from the New Jersey Department of Health and Senior Services through funding from New Jersey’s cigarette excise tax.


1. Ringel JS, Wasserman J, Andreyeva T. Effects of public policy on adolescents’ cigar use: evidence from the National Youth Tobacco Survey. Am J Public Health. 2005;95:995–998. LinkGoogle Scholar
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Cristine D. Delnevo, PhD, MPH, Jonathan Foulds, PhD, and Mary Hrywna, MPHThe authors are with the School of Public Health, University of Medicine and Dentistry of New Jersey, New Brunswick. “TRADING TOBACCO: ARE YOUTHS CHOOSING CIGARS OVER CIGARETTES?”, American Journal of Public Health 95, no. 12 (December 1, 2005): pp. 2123-2123.

PMID: 16257936