Is Any Type of Tobacco Product Safe?

There is no safe form of tobacco. Staying tobacco free is the best way to protect your health.

Tobacco hurts and kills people. In fact, smoking causes about 1 in 5 deaths in the United States.

There are many forms of tobacco on the market, and people often think some forms are safe and don’t cause health problems. This isn’t true.

Other tobacco products, like e-cigarettes, hookahs, edibles, heat-not-burn cigarettes, and smokeless tobacco, contain some of the same chemicals as regular combustible cigarettes. It's important to know that even though e-cigarettes do not contain tobacco, the Food and Drug Administration (FDA) classifies them as "tobacco products."

Regular (combustible) cigarettes

Regular cigarettes, called combustible cigarettes, contain tobacco, added chemicals, a filter, and a paper covering. People who smoke them expose themselves to over 7,000 chemicals when they inhale the smoke from their cigarettes. People around them are also exposed to the same chemicals through secondhand smoke.

Cigarette smoking accounts for almost all tobacco-related illnesses and deaths in the United States.

Light, hand-rolled, natural, or herbal cigarettes

Some people believe that “light” and “low-tar” cigarettes have lower health risks. But studies have shown that the risk of serious health effects is not lower in light or low-tar cigarettes. Because of this, the FDA has banned use of the terms “light,” “mild,” and “low” in any cigarette sales unless the FDA specifically allows it − and so far, it hasn’t.

Hand-rolled cigarettes are no safer than commercial brands. In fact, life-long smokers of hand-rolled cigarettes have a higher risk of cancers of the larynx (voice box), esophagus (swallowing tube), mouth, and pharynx (throat) when compared with people who smoke machine-made cigarettes.

Some cigarettes are now being sold as “all natural.” They’re marketed as having no chemicals or additives and rolled with 100% cotton filters. There’s no proof they are healthier or safer than other cigarettes, nor is there good reason to think they would be. Smoke from all cigarettes, natural or otherwise, has many chemicals that can cause cancer (carcinogens) and toxins that come from burning the tobacco itself, including tar and carbon monoxide.

Even herbal cigarettes with no tobacco give off tar, particulates, and carbon monoxide and are dangerous to your health.

Menthol cigarettes

Menthol cigarettes are not safer than unflavored cigarettes. In fact, they could be even more dangerous.

Menthol cigarettes tend to be “easier” to smoke – the added menthol produces a cooling sensation in the throat when the smoke is inhaled. It lessens the cough reflex and covers the dry feeling in the throat that smokers often have. People who smoke menthol cigarettes can inhale deeper and hold the smoke in longer. This helps to explain why people who smoke menthol cigarettes and get lung cancer often have their cancers located in certain parts of the lung. It also might be a reason why it is harder for people who smoke menthol cigarettes to quit.

The specific dangers of menthol cigarettes are an active area of research, but they are at least as dangerous as unflavored cigarettes. It's important to note the tobacco industry often targets African Americans for the sale of menthol cigarettes.

Cigars and little cigars

Many people view cigar smoking as more sophisticated and less dangerous than cigarette smoking. Yet one large cigar can contain as much tobacco as an entire pack of cigarettes.

Most cigars are made of a single type of aged, air-cured or dried tobacco that’s fermented in a multi-step process. The fermentation causes chemical and bacterial reactions that change the tobacco. This is what gives cigars a different taste and smell from cigarettes. Cigars come in many sizes:

  • The smallest, known as little cigars or small cigars, are about the size of cigarettes. Other than the fact that they are brown and maybe a little longer, they look like cigarettes. They come in flavors like mint, chocolate, or fruit, and many have filters. They’re often sold in packs of 20. Most people smoke these small cigars exactly the same way as cigarettes.
  • Slightly larger cigars are called cigarillos, blunts, or cheroots. They contain more tobacco than little cigars, and are also often flavored. Studies suggest that some people smoke them more like cigarettes than cigars, inhaling and smoking every day. They look like small versions of traditional cigars, but they can be bought in small packs.
  • True large cigars may contain more than half an ounce of tobacco – as much as a whole pack of cigarettes. It can take from 1 to 2 hours to smoke a traditional large cigar.

Almost all cigarette smokers inhale, but most larger cigar smokers don’t. This could be because cigar smoke tends to irritate the nose, throat, and breathing passages. A new trend among cigar companies is to change the fermenting process to make cigar smoke easier to inhale. The filters on the smaller cigars also help smokers inhale.

There’s a lot of nicotine in cigars

Full size cigars can have as much nicotine as an entire pack of cigarettes.

Cigarettes have an average of about 8 milligrams (mg) of nicotine, but only deliver about 1 to 2 mg of nicotine.

Many popular brands of larger cigars have between 100 and 200 mg, or even as many as 444 mg of nicotine.

No matter the size, cigars are tobacco, and the smoke from them contains the same cancer-causing substances found in cigarette smoke. All cigars are dangerous to your health.

Regular cigar smokers are 4 to 10 times more likely to die from cancers of the mouth, throat, larynx, and esophagus than non-smokers. For those who inhale, cigar smoking appears to be linked to death from cancer of the pancreas and bladder, too.

Smoking more cigars each day or inhaling cigar smoke leads to more exposure and higher health risks. The health risks linked to occasional cigar smoking (less than daily) are less clear. Like cigarettes, cigars give off secondhand smoke, which is also dangerous.

Electronic or e-cigarettes (vaping devices)

Using electronic or e-cigarettes is often called vaping or JUULing. JUUL is a certain very popular brand of e-cigarette. The liquid in these devices is heated and creates an aerosol of tiny particles (sometimes called a "vapor") that is inhaled by users. Although the term “vapor” may make it sound harmless, it is not water vapor. Instead, it's an aerosol that consists of propylene glycol plus flavor ingredients, and it can be harmful. E-cigarette aerosol can also contain nicotine and other substances that are addictive and can cause lung disease, heart disease, and cancer.

It's especially important to know that all JUULs and most other e-cigarettes contains nicotine, the same addictive drug that is in regular cigarettes, cigars, hookah, and other tobacco products.

Because their use is so recent, little is known about the possible harms of long-term e-cigarette use. Studies in lab animals have documented lung damage and some chormosomal abnormalities that may signal a risk for cancer. Because this is such a rapidly evolving field, there is no consensus yet about the harms of vaping. More research is needed over a longer period of time to know what the long-term health effects may be.

There have been reports of severe lung illnesses in some people who vape. Most (but not all) of these cases have been linked to the vaping of off-market cannabis products that contain vitamin E acetate oil. The American Cancer Society is closely watching for new research about the effects of using e-cigarettes and other new tobacco products. Read more in What Do We Know About E-cigarettes?

Clove cigarettes (kreteks)

Clove cigarettes, also called kreteks (KREE-teks), are a tobacco product with the same health risks as cigarettes. Kreteks are imported from Indonesia. They contain tobacco, ground cloves, clove oil, and other additives.

Like other flavored cigarettes, kreteks are used mostly by younger smokers. They are nearly ideal in design as a “trainer cigarette” – giving kids another way to try tobacco and get addicted to nicotine. The false image of these products as clean, natural, and safer than regular cigarettes seems to attract some young people who might otherwise not start smoking. But they are not safer than cigarettes, and researchers are looking into whether the cloves might even cause additional problems.

Kreteks have been linked to lung problems, such as lower oxygen levels, fluid in the lungs, and inflammation. Regular kretek smokers have up to 20 times the risk for abnormal lung function (blocked airways or poor oxygen uptake) compared with non-smokers.

Bidis (flavored cigarettes)

Bidis or “beedies” are thin, flavored cigarettes that originated in India and other Southeast Asian countries. They are hand-rolled in an unprocessed tobacco, tendu, or temburi leaf (plants native to Asia) and may be tied with colorful strings on the ends. They tend to cost less than regular cigarettes and they give the person using them a quick buzz from the high levels of nicotine.

Even though bidis have less tobacco than regular cigarettes, they deliver 3 to 5 times more nicotine than regular cigarettes, as well as other harmful substances, such as tar and carbon monoxide. They are unfiltered. And because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette.

Some people think they are safer and more natural than regular cigarettes. But bidis appear to have all of the same health risks of regular cigarettes, including many types of cancer. Bidi smokers have much higher risks of heart attacks, emphysema, chronic bronchitis, and cancer than non-smokers.

Hookahs (water pipes)

Hookah is also called narghile (NAR-guh-lee) smoking. It started in Asia and the Middle East. A water pipe is used to burn tobacco that has been mixed with flavors such as honey, mint, licorice, molasses, or fruit, and the flavored smoke is inhaled through a long hose. Usually, the tobacco mixture, which is called shisha (SHE-shuh), is heated using charcoal. (The charcoal itself produces carbon monoxide and other toxins.)

Hookah smoking has become popular among younger people in the US as a social event which lets the smokers spend time together and talk as they pass the mouthpiece around.

Newer forms of hookah smoking include steam stones that have been soaked in fluid and are used instead of tobacco and battery powered hookah pens. Both of these create a vapor that’s inhaled. Hookah pens work the same way as electronic or e-cigarettes [see Electronic or e-cigarettes (vaping devices)]. Some sellers advertise that these are purer and healthier alternatives to regular hookahs, but this has not been proven.

Hookahs are marketed as a safe alternative to cigarettes. This claim is false. The water does not filter out the toxins. In fact, hookah smoke has been shown to contain toxins like carbon monoxide, nicotine, tar, and heavy metals, in concentrations that are as high, or even higher, than those in cigarette smoke – it carries many of the same health risks. But because the use of hookahs is generally less frequent than the use of cigarettes, it is likely that a person's overeall exposure to the toxic ingredients is less.

Several types of cancer, including lung cancer, have been linked to hookah smoking. It affects the heart, too, causing coronary artery disease, an increased heart rate, and high blood pressure. Lung damage, carbon monoxide intoxication, chronic bronchitis, emphysema, dental problems, and osteoporosis have also been linked to hookah use. There’s also a risk of passing infections while sharing a hookah.

Hookahs also put out secondhand smoke from both the tobacco and the burning charcoal used as a heat source.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2019-2021. Atlanta, Ga: American Cancer Society; 2019.

Blount BC, Karwowski PG, Shields PG et al. Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. New Eng J Med. 2020;382:697-705.

Breland A, Spindle T, Weaver M, Eissenberg T. Science and electronic cigarettes: Current data, future needs. J Addict Med. 2014; 8(4): 223-233.

Centers for Disease Control and Prevention (CDC). Smoking & Tobacco Use. Bidis and Kreteks. 2018. Accessed at www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/bidis_kreteks/index.htm on November 12, 2020.

Centers for Disease Control and PRevention (CDC). Smoking & Tobacco Use. Cigars. 2020. Accessed at https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/cigars/index.htm on November 12, 2020.

Centers for Disease Control and Prevention (CDC). Smoking & Tobacco Use. Electronic Cigarettes. Accessed at https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm on November 12, 2020.

Centers for Disease Control and Prevention (CDC). Smoking & Tobacco Use. Hookahs. 2020. Accessed at www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm on November 12, 2020.

El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associated with waterpipe smoking. Tob Control. 2015;24 Suppl 1:i31-i43.

Kadhum M, Sweidan A, Jaffery AE, Al-Saadi A, Madden B. A review of the health effects of smoking shisha. Clin Med. 2015;15(3):263-266.

US Food and Drug Administration. Electronic Cigarettes (e-Cigarettes). July 7, 2015. Accessed at www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm on November 12, 2020.

US Food and Drug Administration. Family Smoking Prevention and the Tobacco Control Act. 2020. Accessed at https://www.fda.gov/tobacco-products/rules-regulations-and-guidance/family-smoking-prevention-and-tobacco-control-act-overview on November 12, 2020.

References

American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2019-2021. Atlanta, Ga: American Cancer Society; 2019.

Blount BC, Karwowski PG, Shields PG et al. Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. New Eng J Med. 2020;382:697-705.

Breland A, Spindle T, Weaver M, Eissenberg T. Science and electronic cigarettes: Current data, future needs. J Addict Med. 2014; 8(4): 223-233.

Centers for Disease Control and Prevention (CDC). Smoking & Tobacco Use. Bidis and Kreteks. 2018. Accessed at www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/bidis_kreteks/index.htm on November 12, 2020.

Centers for Disease Control and PRevention (CDC). Smoking & Tobacco Use. Cigars. 2020. Accessed at https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/cigars/index.htm on November 12, 2020.

Centers for Disease Control and Prevention (CDC). Smoking & Tobacco Use. Electronic Cigarettes. Accessed at https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm on November 12, 2020.

Centers for Disease Control and Prevention (CDC). Smoking & Tobacco Use. Hookahs. 2020. Accessed at www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm on November 12, 2020.

El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associated with waterpipe smoking. Tob Control. 2015;24 Suppl 1:i31-i43.

Kadhum M, Sweidan A, Jaffery AE, Al-Saadi A, Madden B. A review of the health effects of smoking shisha. Clin Med. 2015;15(3):263-266.

US Food and Drug Administration. Electronic Cigarettes (e-Cigarettes). July 7, 2015. Accessed at www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm on November 12, 2020.

US Food and Drug Administration. Family Smoking Prevention and the Tobacco Control Act. 2020. Accessed at https://www.fda.gov/tobacco-products/rules-regulations-and-guidance/family-smoking-prevention-and-tobacco-control-act-overview on November 12, 2020.

Last Revised: November 12, 2020

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