used by women (for cigarettes as well). A cigar stand is a device used to keep a lit cigar out of an ashtray. Health effects Like other forms of tobacco use, cigar smoking poses a significant health risk depending on dosage: risks are greater for those who smoke more cigars, smoke them longer, or inhale more. A review of 22 studies found that cigar smoking is associated with lung cancer, oral cancer, esophageal cancer, pancreatic cancer, oropharyngeal cancer, laryngeal cancer, coronary heart disease (CHD), and aortic aneurysm. Among cigar smokers who reported that they did not inhale, relative mortality (likelihood of death) risk was still highly elevated for oral, esophageal, and laryngeal cancers. Danger of mortality increases proportionally to use, with smokers of one to two cigars per day showing a 2% increase in death rate, compared to non-smokers. The precise statistical health risks to those who smoke less than daily is not established. The depth of inhalation of cigar smoke into the lungs appears to be an important determinant of lung cancer risk: When cigar smokers don't inhale or smoke few cigars per day, the risks are only slightly above those of never smokers. Risks of lung cancer increase with increasing inhalation and with increasing number of cigars smoked per day, but the effect of inhalation is more powerful than that for number of cigars per day. When 5 or more cigars are smoked per day and there is moderate inhalation, the lung cancer risks of cigar smoking approximate those of a one pack per day cigarette smoker. As the tobacco smoke exposure of the lung in cigar smokers increases to approximate the frequency of smoking and depth of inhalation found in cigarette smokers, the difference in lung cancer risks produced by these two behaviors disappears. Cigar smoking can lead to nicotine addiction and cigarette usage. For those who inhale and smoke several cigars a day, the health risk is similar to cigarette smokers. Cigar smoking can also increase the risk of chronic obstructive pulmonary disease (COPD). So-called "little cigars" are commonly inhaled and likely pose the same health risks as cigarettes, while premium cigars are not commonly inhaled or habitually used. Popularity The prevalence of cigar smoking varies depending on location, historical period, and population surveyed. The United States is the top consuming country by total sales by a considerable margin, followed by Germany and the United Kingdom.