Safe tobacco? Nice try, but no cigar.

Persons looking for a hip alternative to cigarettes have increasingly reached for cigars. Despite a 3 percent decline in U.S. cigarette use between 1990 and 1996, cigar sales have jumped nearly 50 percent since 1993.

Cigar smoking's increasing popularity follows some heavy promotion by tobacco companies. Moreover, notes epidemiologist Carlos Iribarren of the Kaiser Permanente Medical Care Program in Oakland, Calif., many people consider stogies a relatively safe alternative to cigarettes. His new data indicate that this is a dangerous misconception.

Iribarren's team studied 17,774 men who entered the health plan 25 years earlier. Of these, 1,546 men reported smoking cigars and no other tobacco products. Some 17 percent of that number smoked more than five cigars a day.

The Kaiser team recorded hospitalizations or deaths from heart disease through 1995, and cancer diagnoses through 1996.

In the June 10 NEW ENGLAND JOURNAL OF MEDICINE, the researchers report that regular cigar smoking, independent of any other risk factor, increased a man's risk of coronary heart disease by about 30 percent. Cigar use boosted by roughly 40 percent the likelihood that a man would develop chronic obstructive pulmonary disease, which includes some cases of chronic bronchitis and emphysema. This study, which updates preliminary observations reported at a meeting last year (SN: 3/28/98, p. 204), becomes the first to tie regular stogie use with coronary heart disease. Regular use, Iribarren emphasizes, is not "a cigar now and then."

Cigar smoking also roughly doubled the chance that a man would develop cancer in the mouth, throat, esophagus, or lungs. The Kaiser team also detected hints of synergism between cigars and heavy alcohol consumption among the few throat- and mouth-cancer victims.

"It is critical that cigars not be construed as a safe or a less costly alternative to cigarettes," argues Surgeon General David Satcher in an accompanying editorial. Indeed, to discourage use, he now advocates taxing cigars at the same rate as cigarettes. Cigar labels, he says, should carry health warnings comparable to those on cigarettes.