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Several variables affect outcomes: Inhalation depth: Deep lung inhalation dramatically increases risks compared to keeping smoke in the mouth Cigar type: Large premium cigars differ from cigarillos or little filtered cigars in tobacco content and smoking duration Smoking duration: Years of daily use compound exposure effects Individual health factors: Pre-existing conditions, genetics, and overall lifestyle influence outcomes The National Academies of Sciences document on premium cigars notes that frequency and duration of use are major factors determining whether tobacco smoking causes disease