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

There is no safe form of tobacco.

Tobacco products like e-cigarettes, pipes, cigars, hookahs, heat-not-burn cigarettes, smokeless tobacco, and other products you put in your mouth have some of the same harmful chemicals as regular cigarettes. Because most of these products come from tobacco leaves, the Food and Drug Administration (FDA) considers them "tobacco products."

Tobacco hurts and kills people. More than 480,000 people die each year from tobacco-related diseases. Staying tobacco free is the best way to protect your health and the health of those around you.

Regular (combustible) cigarettes

Regular cigarettes (called combustible cigarettes) have tobacco, added chemicals, a filter, and a paper covering. When you smoke them, you expose yourself to over 7,000 chemicals from inhaling the smoke. People around you are also exposed to the same chemicals through secondhand or thirdhand 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 show that people who smoke these types of cigarettes have the same risk of serious health effects as people who smoke regular cigarettes. Because of this, the FDA has banned use of the terms “light,” “mild,” and “low” for any cigarette product.

Some cigarette makers use other terms for these products. But people who smoke ‘light’ or ‘low-tar’ cigarettes most often smoke more of them to get the nicotine they crave. This outweighs any perceived benefit.

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

Some cigarettes are now being sold as natural, organic, or additive free. These still have tobacco, with the same toxins as other types of cigarettes. They have not been shown to be safer.

Smoke from all cigarettes has many chemicals that can cause cancer (carcinogens). Toxins also come from burning the tobacco itself, including tar and carbon monoxide. Even herbal cigarettes with no tobacco are still dangerous to your health because they give off tar, particulates, and carbon monoxide.

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 people who smoke often have.

Research on menthol cigarettes has shown that:

• Menthol is associated with a more pleasant smoking experience.
• People who start smoking menthol are likely to switch to regular cigarettes.
• Young people who smoke menthol cigarettes are more likely to become addicted to cigarettes.
• People who smoke menthol cigarettes are likely to have a harder time quitting smoking.

Cigars and little cigars

One large cigar can have as much tobacco as an entire pack of cigarettes. And cigar tobacco includes the same harmful chemicals as cigarettes.

Cigars come in many sizes:

Little cigars/small cigars: The smallest cigars are known as little cigars or small cigars. They are about the size as cigarettes. Other than the fact that they are brown and maybe a little longer, they look like cigarettes. They come in flavors like mint, clove, chocolate, or fruit. Many have filters. Most people smoke these small cigars exactly the same way as cigarettes.

Cigarillos/cheroots: Slightly larger cigars are called cigarillos or cheroots. They contain more tobacco than little cigars and may also be flavored. They look like small versions of traditional cigars, but they can be bought in small packs.

True large or premium cigars: A single true large or premium cigar can have more than half an ounce of tobacco. This is as much as a whole pack of cigarettes. It can take from 1 to 2 hours to smoke a traditional large cigar.

Almost everyone who smokes smaller cigars inhales the smoke. But most people who smoke larger cigars just hold the tobacco smoke in their mouths. This could be because cigar smoke tends to irritate the nose, throat, and breathing passages.

This doesn’t make smoking cigars less harmful. The nicotine, carcinogens, and other toxins are absorbed through the lining of the mouth, so smoking them can cause many of the same health problems as smoking cigarettes.

No matter the size, cigars are tobacco. The smoke from them has the same cancer-causing chemicals and other toxins found in cigarette smoke. All cigars are dangerous to your health.

People who smoke cigars are 4 to 10 times more likely to die from cancers of the mouth, throat, larynx, and esophagus than people who don't smoke cigars. The same is likely also true for cancer of the pancreas. For those who inhale, cigar smoking may also increase the risk of cancer of the bladder.

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.

Hookah (water pipes)

Hookah is also called narghile (NAR-guh-lee) smoking. It started in Asia and the Middle East and is popular worldwide as a social activity.

A water pipe is used to burn tobacco that has been mixed with flavors like honey, mint, licorice, molasses, or fruit. The flavored smoke is inhaled through a long hose. Usually, the tobacco mixture, called shisha (SHE-shuh), is heated using charcoal. (The charcoal itself produces carbon monoxide and other toxins.)

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

Hookahs are also marketed as a safe alternative to cigarettes. This claim is false. Hookah smoke has many of the same health risks as cigarette smoke. The water does not filter out the toxins. In fact, hookah smoke has been shown to contain toxins in concentrations that are as high, or even higher, than those in cigarette smoke. These toxins include carbon monoxide, nicotine, heavy metals, and carcinogens.

Several types of cancer including lung, mouth, and esophageal have been linked to hookah smoking. It also affects the heart. It causes 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 because bacteria can live in the hose.

Hookahs put out secondhand smoke from both the tobacco and the burning charcoal used as a heat source. People who go to hookah lounges are exposed to high levels of secondhand smoke and other indoor air pollutants which can cause health problems.  

Electronic or e-cigarettes (vaping devices)

Using electronic or e-cigarettes is often called vaping. 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.

E-cigarette aerosol most often includes nicotine and other substances that are addictive and can cause lung disease, heart disease, and cancer. It also includes propylene glycol, plus flavor ingredients which can be harmful.

While e-cigarettes are still new, health problems are being found in people who use them. Use of e-cigarettes has been linked to nicotine addition, heart and lung problems, and even seizures. More research is needed over a longer period of time to know what the long-term health effects may be.

Cannabis (marijuana)

The effects of cannabis depend on how long you use it. In the short term, cannabis use mostly affects your emotions and mental abilities. But smoking cannabis (or inhaling it as vapor) over a long period of time can have long-term effects on your heart and lungs.

Cannabis smoke and vapor has many of the same chemicals found in tobacco. Also, using cannabis during pregnancy has been linked to low birth weight in babies.   

Clove cigarettes (kreteks) and bidis (flavored cigarettes)

Clove cigarettes, also called kreteks (KREE-teks), and bidis have been banned in the US as a part of the Family Smoking Prevention and Tobacco Control Act of 2009. This act outlawed all flavored cigarettes (except menthol) in an effort to deter kids from trying tobacco.

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