Black and Milds are genuinely harmful, and in some ways more so than cigarettes. Despite a common perception that cigarillos are a lighter or safer alternative, they deliver higher levels of carbon monoxide, contain significantly more cancer-causing compounds per gram of tobacco, and carry enough nicotine to create dependence. The packaging and flavor options may make them feel casual, but the health risks are serious.
More Carbon Monoxide Than Cigarettes
A National Institutes of Health study comparing Black and Milds directly to conventional cigarettes found that smoking a single Black and Mild produced a significantly higher spike in carbon monoxide levels in the blood than smoking a cigarette. Carbon monoxide reduces the amount of oxygen your blood can carry, which strains your heart and lungs over time. Both products raised heart rate, but the carbon monoxide exposure from the cigarillo was measurably worse.
The same study found that cigarettes delivered a larger nicotine hit per session. That might sound like a point in Black and Milds’ favor, but it’s misleading. The nicotine delivery from a cigarillo is still high enough to initiate and sustain addiction. And the trade-off is greater exposure to carbon monoxide and the toxic byproducts of combustion, which drive cardiovascular and respiratory disease.
Higher Concentrations of Cancer-Causing Chemicals
Cigar tobacco, including the type used in Black and Milds, goes through an air-curing and fermentation process that cigarette tobacco does not. This process dramatically increases the levels of tobacco-specific nitrosamines, which are among the most potent carcinogens found in any tobacco product. Lab analysis of 23 cigarillo brands found that, on average, cigarillos contain roughly five times more of one key nitrosamine (NNN) and seven times more of another (NNK) compared to commercial cigarettes, gram for gram.
These aren’t obscure chemicals. NNN and NNK are directly linked to cancers of the mouth, throat, esophagus, and lungs. The fermentation that gives cigar tobacco its distinct flavor is the same process that concentrates these carcinogens to levels far beyond what’s found in cigarette tobacco.
Cancer Risk Is Not Theoretical
Large studies tracking cigar smokers over time have found stark increases in cancer mortality. Primary cigar smokers face roughly 4 to 8 times the risk of dying from oral cancer compared to nonsmokers, depending on the study. Esophageal cancer risk increases by roughly 2 to 5 times. The most dramatic finding involves laryngeal cancer (cancer of the voice box), where cigar smokers face approximately 10 times the mortality risk of nonsmokers. That number has been consistent across multiple large studies spanning decades.
All three cancer types show a clear dose-response pattern. The more cigarillos you smoke per day, the deeper you inhale, and the longer you’ve been smoking, the higher the risk climbs. There’s no safe threshold below which the risk disappears.
Most People Inhale, Even If They Think They Don’t
One of the most persistent ideas about cigarillos is that you’re only supposed to puff, not inhale, and that this somehow protects your lungs. Research tells a different story. A study measuring nicotine absorption and carbon monoxide levels in cigarillo smokers found that the timing and pattern of nicotine uptake strongly suggested the smoke was being inhaled into the lungs, not just held in the mouth. The carbon monoxide spikes confirmed it: the smoke was reaching deep into the respiratory tract.
This is especially true for people who also smoke cigarettes. Dual users tend to smoke cigarillos the same way they smoke cigarettes, pulling smoke into their lungs with each drag. Even among people who genuinely try to avoid inhaling, some smoke inevitably reaches the lungs. And the chemicals that don’t get inhaled still make direct contact with the lining of your mouth, throat, and esophagus, which is exactly where cigar-related cancers tend to develop.
Nicotine and Dependence
A single Black and Mild contains between 10 and 12 milligrams of nicotine per gram of tobacco, depending on the variety. For context, a cigarette typically contains about 1 to 2 milligrams of deliverable nicotine total. A Black and Mild holds considerably more tobacco than a single cigarette, which means the total nicotine available in one cigarillo is substantial.
The National Cancer Institute has noted that while cigar smokers may develop dependence at lower rates than cigarette smokers overall, this is partly because many cigar smokers use the product infrequently. For people who smoke Black and Milds daily or near-daily, there is every reason to expect nicotine tolerance and physical dependence to develop. The pattern of regular use matters more than the product label. If you’re reaching for one every day, the addiction potential is real.
The “Freaking” Practice Makes Things Worse
A common practice among Black and Mild smokers involves removing the inner paper lining from the cigarillo, a process called “freaking” or “hyping.” The belief is that this removes some of the harshness or harmful material. In reality, removing the binder paper does nothing to reduce the carcinogens baked into the tobacco itself through fermentation. The nitrosamines, carbon monoxide, and tar are properties of the tobacco and its combustion, not the inner wrapper. This ritual gives a false sense of harm reduction while changing nothing meaningful about exposure.
Flavoring and Appeal
Black and Milds come in flavors like wine, apple, cream, and cherry. These flavors make the smoke smoother and easier to tolerate, which lowers the barrier to regular use, particularly among younger smokers. The FDA has proposed banning all characterizing flavors in cigars (other than tobacco) specifically because flavored products drive youth experimentation and progression to regular use. That proposal has not been finalized, and the products remain widely available. If it does take effect, enforcement would target manufacturers and retailers, not individual consumers.
The flavoring also masks the irritation that might otherwise signal how much toxic material you’re breathing in. A harsher product might naturally limit how much you smoke or how deeply you inhale. Flavored cigarillos remove that built-in warning signal.
How They Compare to Cigarettes Overall
Black and Milds are not a safer alternative to cigarettes. They deliver more carbon monoxide per session, contain far higher concentrations of key carcinogens, and expose users to the same categories of disease: lung cancer, oral cancer, esophageal cancer, laryngeal cancer, heart disease, and chronic respiratory illness. The main difference is cultural perception. Cigarettes are widely understood to be deadly. Cigarillos occupy a gray zone in many people’s minds, seen as occasional or recreational, but the tobacco inside them is, by measurable chemistry, more concentrated in the compounds that cause the most harm.
Smoking one Black and Mild on a rare occasion carries less cumulative risk than a pack-a-day cigarette habit, simply because total exposure matters. But comparing product to product, puff to puff, the cigarillo is not the lighter option many people assume it to be.