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Other Tobacco Products

Alternative Tobacco Products, Familiar Health Risks

Though cigarettes are by far the most common form of tobacco product used in the United States, it is not the only form. Some additional commonly used tobacco products can pose issues for youth, challenges of quitting, and unique health problems.

The same products and strategies which are used to address cigarette smoking can be used to help with dependence on these alternative tobacco products as well.


Bidis: These are imported from India and consist of hand-rolled tendu leaves containing low-grade tobacco and are tied up with string. Some people mistakenly assume that Bidis are healthier because of their more natural look. In fact, Bidis contain more tar, nicotine and carbon monoxide than the typical cigarette.

Kreteks: Kreteks are commonly referred to as clove cigarettes, which mistakenly conveys the message that they contain only cloves, with no tobacco. In reality, this product contains 60 – 90% tobacco. Kreteks have been shown to produce increases in plasma nicotine, systolic blood pressure, and CO similar to conventional cigarettes. In addition, cloves contain the substance "Eugenol" which is a mild anesthetic. The presence of Eugenol in Kreteks may cause a person to smoke more deeply, thus making them even more of a hazard than cigarettes.

Cigars: Many people think of the big, thick cigars from old movies, but cigars can be quite small, look very much like a cigarette and can come in a variety of flavors. In addition to the appeal of many flavors, cigars have traditionally been taxed at a much lower rate than cigarettes, resulting in much lower consumer prices.

Whether a person inhales or not is partly determined by the size of the cigarette, with little cigars being used much like a regular cigarette. Regardless of whether someone inhales or not, cigar smoke contains the same hazards as cigarette smoke. For instance, smoking just one or two cigars a day doubles the risk for oral and esophageal cancer.

Pipes: Pipes use black (air cured) tobacco which carries a higher risk of esophageal cancer. Even for "non-inhalers" risk of lung cancer is four times that of non-smokers. Four pipe bowls or four premium cigars are roughly equal to smoke exposure of about 10 cigarettes. Mortality rates for those who smoke cigars or pipes is 20 - 40%, higher than that of those who do not smoke. Water pipes, also called Hookahs, Hubble Bubble, Narghile or Shisha have become more popular in very recent years among teens and young adults.

Water Pipes: Tobacco, mixed with a substance such as molasses, is smoldered in the bowl and then drawn through water or other liquid into the person's mouth. Contrary to popular belief, the filtering effect of the liquid does not make water pipe smoking less dangerous. Water pipes sometimes have more than one hose and mouth piece which encourages group sharing. Water pipes are not a healthy alternative to other forms of smoking.

Natural cigarettes: Although these cigarette brands are advertised and heavily promoted as safer because they are additive-free, tobacco itself contains hundreds of different chemicals, many of which can be extremely dangerous when burned and inhaled. They are not a safe alternative.

Chewing tobacco: There are new products, originally from Scandinavia, called "Snus" which due to differences in curing the tobacco, manufacturing and storing have been shown to carry fewer of a particular group of cancer-causing chemicals called "tobacco-specific nitrosamines. However, chewing tobacco contains many other cancer-causing chemicals and it is highly debatable as to whether those who chew tobacco are really any safer than those who smoke it. Also, in addition to the cancer risk, other oral side effects of use of these smokeless products include gingival recession, staining of teeth, loss of taste, bad breath and dental carries. Chewing tobacco clearly contains high levels of nicotine and is highly addictive.

PREPS: This stands for "Potentially Reduced Exposure Products". These are alternative tobacco products put out by various tobacco companies with the explicit or implied claim that they are less harmful than mainstream products. They are also sometimes confused with products such as the nicotine gum, lozenge or inhaler which have been approved to help with smoking cessation. PREPS are not approved for this use and many of the low-risk health claims are unsubstantiated.

For information about alternative tobacco products, visit Campaign For Tobacco-Free Kids Research Center.

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