In age-adjusted analyses with people who had never smoked as the comparison group, the relative risk of suicide was 1.4 among former smokers, 2.6 for light smokers, and 4.5 among heavier smokers. Characteristics controlled for included age, marital status, body mass index, physical activity, alcohol intake, coffee consumption and history of cancer. The authors found that the smoking-suicide connection is not entirely due to the greater tendency among smokers to be unmarried, sedentary, heavy drinkers or to develop cancer. Although purchase of tobacco by minors is illegal, only about 25 percent of internet sites marketing cigars prohibit purchase by minors, and almost 30 percent of them include elements with potential youth appeal. Of the 141 sites examined, only 3.5 percent display health warnings.
Sites use cartoons, music, moving images and sportswear tie-ins.
One site features a cartoon clown from a popular TV show smoking a cigar. A Synar-like enforcement program for the Internet could be one option. The American Journal of Public Health is the monthly Journal of the American Public Health Association, the oldest and largest organization of public health professionals in the world and the foremost publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health.