Cigar smokers are thought to inhale less smoke than cigarette smokers, leading some people to believe they pose fewer health risks than cigarettes.But new research published in the Nov. 7 issue of the journal Cancer, Epidemiology, Biomarkers & Prevention suggests that isn’t so.

In fact, among the analysis of about 25,500 individuals— including smokers and non-smokers— the study authors found that cigar smokers had higher levels of toxic substances in their bodies compared to non-smokers, Medical News Today reported. They also had concentrations of a specific carcinogen at levels comparable with cigarette smokers.

“Cigar smoking exposes users to similar types of harmful and cancer-causing agents as cigarette smoking,” wrote lead researcher Dr. Jiping Chen, an epidemiologist from the Office of Science at the Food and Drug Administration (FDA) Center for Tobacco Products.

According to the National Cancer Institute, part of the National Institutes of Health (NIH), cigar smoking causes oral cavity cancers, as well as cancers of the larynx, esophagus and lung. For every gram of tobacco smoked, there is more cancer-causing tar in cigars than in cigarettes.

However, the institute notes that cigar smokers are at a lower risk of developing smoking-related diseases— like lung cancer and heart disease— than cigarette smokers.  

Because the number of cigar smokers doubled between 2000 and 2011, Dr. Chen’s team decided to explore just how detrimental cigars are to human health.

Study authors used data from the 1999-2012 National Health Nutrition and Examination Survey (NHANES) to check study participants for the presence of five substances that indicate tobacco exposure.

Researchers’ analysis showed that compared with non-smokers, cigar smokers had much higher concentrations of cotinine and cadmium in their blood and 1-butanol (NNAL) in their urine.  

Cotinine is produced after nicotine enters the body, and scientists consider the compound the most reliable measurement of tobacco exposure. Cadmium has been linked to ailments such as kidney disease, inflammation and respiratory diseases, while NNAL is a strong carcinogen, according to Medical News Today.

The concentration of carcinogens increased if the cigar smokers had a history of cigarette smoking— this group had higher cotinine and NNAL concentrations than those who never smoked cigarettes. These findings align with previous research that suggests cigarette smokers are more likely than non-cigarette smokers to deeply inhale cigar smoke.

Researchers also saw that those who smoked cigars on a daily basis had concentrations of NNAL in their urine similar to that of daily cigarette users.

“Our results are consistent with epidemiologic evidence demonstrating cigar smoking as a cause of disease and premature death,” the researchers wrote.