Health Effects of Pipe Smoke

Curious George smoking a pipe

$ means behind a pay wall.  F means full text available at link.

Mortality in relation to smoking: 50 years’ observations on male British doctors (doi: 10.1136/bmj.38142.554479.AE)

Only cigarette smoke tracked.

During the 19th century much tobacco was smoked in pipes or as cigars and little was smoked as cigarettes, but during the first few decades of the 20th century the consumption of manufactured cigarettes increased greatly.

Analysis of a Historical Cohort of Chinese Tin Miners with Arsenic, Radon, Cigarette Smoke, and Pipe Smoke Exposures Using the Biologically Based Two-Stage Clonal Expansion Model

Smoking a bamboo water pipe or a Chinese long-stem pipe appears to confer less risk than cigarette use, given equivalent tobacco consumption.

Cigar, Pipe, and Cigarette Smoking as Risk Factors for Periodontal Disease and Tooth Loss (doi:10.1902/jop.2000.71.12.1874)

Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7%) compared to former cigarette smokers (20.2%), and non-smokers (13.1%). The estimated prevalence of moderate and severe periodontitis in current or former cigar/pipe smokers was 17.6%. A similar pattern was seen for other periodontal measurements […]

Current smokers: smoke daily. Former heavy smokers: smoked daily for 10 or more years and quit. Non-smokers: had smoked less than 10 years or never.

Pipe smokers similar to former cigarette smokers for tooth health, less than current cigarette smokers.

Mortality in relation to cigarette and pipe smoking: 16 years’ observation of 25,000 Swedish men (doi:10.1136/jech.41.2.166)

From summary: “Pipe smokers showed similar risk levels to cigarette smokers.”

From table 2, relative death rates, all causes: cigarette 1.45, pipe 1.29, cigar 1.39.  This may be caused by the fact that “** The mean grams oftobacco smoked perday in 1963, standardised for age and residence, was estimated to be 10.7 in cigarette smokers, 8.4 in pipe smokers, and 13.5 in cigar smokers.”  Pipe smokers smoked less tobacco.

From table 2, relative death rates, suicide, accidents, and violence: 1.7, 0.9, 2.5.  Pipe smokers less likely to die of these causes than non-smokers.  Cigar smokers live dangerously.  But may not be statistically significant.

The pipe smoker death rate may be higher here, because in this group (Swedes) pipe smokers tend to inhale as frequently as cigarette smokers:

The relative risks for several smoking related diseases, including lung cancer, have been reported to be lower in cigar and pipe smokers than in cigarette smokers.2-6 These results were mostly obtained in studies performed in the United Kingdom and United States, where the proportion of inhalers is substantially higher among cigarette smokers than among smokers of cigars or pipes.20 21 In the present study we found similar risks of lung cancer in cigarette, pipe, and cigar smokers, controlling for amount of tobacco consumed, age when started smoking, and urban/rural residence. The similar proportion of inhalers among Swedish cigarette and pipe smokers may partly explain our results. No information was available on inhalation patterns in Swedish cigar smokers.

Summary of a Canadian Study of Smoking and Health

Mortality ratio: cigarettes only 1.54, pipe only 1.05.

May be worth looking into more, this is just a short summary of the study.

Mortality in relation to smoking: 20 years’ observations on male British doctors

Same people as 50 year study above.

From table VI, annual death rates per 100 000 men, all causes: non-smokers 1418, pipe or cigar only 1540, pipe or cigar and cigarettes previously 1600, cigarettes only 2456. (1600 corrected from 1000).

So, non-smoker 1.0, pipe/cigar 1.09, cigarettes 1.73.

It is evident from table IV that the excess overall mortality among smokers was due principally to an excess among men who had smoked cigarettes. Those who smoked only pipes or cigars experienced mortality rates which, with few exceptions, were similar to, or only slightly above, those of men who did not smoke at all. Substantial differences between pipe and cigar smokers and non-smokers were observed only for the eight conditions closely associated with smoking and for myocardial degeneration, which, it has already been noted was more closely related to smoking among men aged 65 years and over than was ischaemic heart disease. The numbers of deaths attributed to these conditions in pipe and cigar smokers were small and significant excesses over the rates for non-smokers were observed only for lung cancer, chronic bronchitis and emphysema, pulmonary heart disease, non-syphilitic aortic aneurysm, and myocardial degeneration.

Worth looking into more.  Note reduced Parkinsonism death rate in smokers (eg. in table XII).

Added 2015-01-27

After reviewing more studies (mostly skimming the conclusions), there seem to be a few general, uncontested “rules”:

  • Inhaling is more unhealthy than not inhaling: this appears in some studies as a difference in mortality between cigarette smokers and pipe or cigar smokers.  However, in some populations pipe smokers inhale at a similar rate as the cigarette smokers (Swedes in particular), and so they don’t show the cigarette/pipe distinction.  When a distinction is made (very often or usually it isn’t), non-inhalers died less/later than inhalers.  When no distinction is made, some studies find increased mortality among pipe smokers.  Mouth or gum diseases seem to be not affected by inhalation or not.
  • Smoking more frequently is more unhealthy: some studies find a linear relationship between amount smoked and mortality increase.  Low frequency of pipe use, and a correspondingly lower or nonexistant increase in mortality, seems to be classified as five (Higgins ITT, Mahan CM, Wynder EL: Lung cancer among cigar and pipe smokers, Preventive Med, 1988;Page 5 of 13 17(1):116-128.) or up to four (“Pipe and Cigar Smoking”, The Report of an Expert Group Appointed by Action on Smoking and Health, Practitioner, 1973; 210:645-652) pipefuls.

Added 2015-06-13

To read:

Added 2015-08-24

Brief history of the studies and politics that resulted in the current consensus that smoking cigarettes causes lung cancer and cardiovascular diseases.