Individuals who smoke more than four cigars a day are exposed to an increased amount of smoke, the equivalent of ten cigarettes a day. This is because the average smoker takes seven minutes to smoke a cigarette while most cigars take from 60 to 90 minutes. Mainstream smoke from cigars has more nicotine, benzene, hydrogen cyanide, lead nitrogen oxides, ammonia, carbon monoxide and other compounds than cigarettes. For years, it was thought that because many cigar smokers do not inhale, they were exempt from the potential harm caused by the exposure. However, an increased awareness of the ill effects of ETS has shown that cigar smokers who do not inhale are still at risk.
Risk is dose-related with individuals smoking four or more cigars at greatest risk.
There is also thought to be a synergistic relationship between cigar smoking and alcohol consumption that leads to a greater risk of oropharyngeal cancers and cancers of the upper aerodigestive tract. According to one study, individuals who have trouble quitting cigarettes, but still hope to improve their health by switching to cigars, will experience a 46 percent lower risk than if they had continued with cigarettes. However, they have a 68 percent higher risk of dying from lung cancer, ischemic heart disease, or chronic obstructive lung disease than those who have never smoked. More research is needed to ascertain the potential harm caused by pipe smoking. Marijuana, which is associated more closely with drug usage than traditional tobacco smoking, has been shown to increase a person's risk of heart attack by nearly fivefold in the first hour after smoking it.