The smoke is small, but not the risk

The Baltimore Sun

They are small, prevalent and cheap, sometimes flavored and even sold individually. And they have fewer restrictions than cigarettes.

Black & Mild cigars - found at most city convenience shops and drugstores - are smoked by nearly a quarter of 18- to 24-year-old African-Americans in Baltimore, according to a city Health Department report to be released today.

Popular in urban centers across the country and featured in hip-hop music and TV shows, Black & Milds are taxed at a lower rate, carry fewer health warnings on their labels and can be sold as singles.

"I think there's total confusion about what these products really are," said Frances Stillman, co-director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health, which conducted the tobacco use study cited by the Health Department.

"These are not your grandfather's cigars," Stillman said. "They're making them hip and cool, and the price is right and they can get them."

Baltimore health officials and Hopkins researchers believe that many young people are unaware that Black & Milds - which come in flavors such as apple, cream and wine - pose the same health risks as, or potentially more than cigarettes.

Health officials say that Black & Milds are likely inhaled like a cigarette, as opposed to smoked with minimal inhalation like a cigar. They can be smoked, extinguished, then smoked again. And they can be repacked with marijuana or other substances.

The Health Department report cites Hopkins data showing that nearly 24 percent of African-Americans in Baltimore ages 18 to 24 said they smoked a Black & Mild at least once in the past 30 days.

"The statistic that a quarter of young people are smoking them was eye-opening," said Dr. Joshua M. Sharfstein, the city's health commissioner. "If you look around, you realize they're all over the place."

According to the national Centers for Disease Control and Prevention, Black & Mild is the most popular brand of cigars for smokers 12 and older. A video posted on the popular Web site in August, titled "Black & Mild, The Deadly Epidemic," interviews youths in Cleveland about the growing phenomenon.

Here in Baltimore, health officials are trying to call attention to the potential public health concern, hosting a panel Monday at the Youth Opportunity (YO!) Community Center in West Baltimore, featuring public health researchers, young adults and legal experts.

"We're seeing more and more that young people are smoking the little cigars," said Kerry Owings, program manager at the community center, who sees smokers use them as a substitute for cigarettes - or in addition to them.

Manufactured by Pennsylvania-based John Middleton Inc., Black & Mild cigars are filled with pipe tobacco and come in a full and half-size. Individually, they are sold for 50 cents to $1; a pack of five sells for about $3.

The Health Department report says that the little cigars are wrapped in tobacco leaf rather than paper, allowing them to be viewed differently under the law from cigarettes. Last year, a group of attorneys general across the country signed a petition asking the federal government to change its guidelines to clarify what should be labeled a cigar rather than a cigarette.

The company has previously disputed charges that its product is a "little cigar" and shares characteristics with cigarettes. Company representatives did not return a call seeking comment yesterday.

Because they are regulated like cigars rather than cigarettes, Black & Milds are required to prominently display only one of five surgeon general's warnings on packs and in displays. And there are no warnings on individually sold cigars.

But the amount of tobacco in a Black & Mild is more than a cigarette and less than a regular cigar, according to the Health Department. Its report cites cigar risks that include cancer, heart attacks and respiratory diseases. The average cigar smoker loses five years of life by age 40, according to the report.

Jae Kim, who works at the Farado Tobacco Outlet in East Baltimore, pointed to cases of full-size and half-size Black & Milds yesterday, as well as individual ones in flavors. Kim said the cigars - which come with or without a plastic tip - are "fairly popular" among people in their early- to mid-20s.

Down the street, Jessica Thomas, 21, was taking a smoke break from work at Shoe City on Monument Street. She knows plenty of people who regularly smoke Black & Milds. She used to several years ago, but stopped. "They're really strong," she says. "They gave me a real headache."

Thomas isn't sure what the allure of them is, but thinks it could be the price and that they are sold individually. Under Maryland law, cigarettes cannot be sold singly.

Her colleague, Lashawn Neal, 27, says she smokes them five or six times a month, but she smokes cigarettes more often. Black & Milds are especially popular at clubs, she said.

Stillman said the institute was doing a broader study on smoking in the 18- to 24-year-old African-American population in Baltimore when it was alerted to the popularity of Black & Milds. The research group had one person focus on the product, surveying about 187 young adults at the city's two YO! Community Centers.

The overall use of tobacco in the city is much higher than statewide. The study found that close to 60 percent of young adults in the city smoke, compared with slightly more than 20 percent statewide, she said.

"Something's happening in the inner city where you have excessive use of tobacco," she said.

Sharfstein said the Health Department is still gathering information. "We see enough red flags that we want to understand more," he said.

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