Skip Ribbon Commands
Skip to main content
Health Issues
Text Size
Facebook Twitter Google + Pinterest

Alternative Forms of Tobacco are Dangerous

In a world where the tobacco industry is constantly adjusting their strategies to get new users hooked, it can be hard for parents to keep up with all of the dangerous forms of tobacco available. Tobacco companies market their products in several forms, and while some may look harmless, all have the potential to cause health problems.

In addition to combustible cigarettes, there are many other forms that parents should be aware of.

Other Forms of Smoking

  • E-cigarettes: E-cigarettes are a type of electronic smoking device. Some people do not view using an e-cigarette as smoking, and instead call it "vaping." E-cigarettes are available in a wide variety of youth-friendly flavors, and can be refilled with liquid. This liquid often contains nicotine- a highly addictive chemical. Young children have been poisoned from these liquid nicotine containers, and one child died from liquid nicotine. E-cigarettes are very popular with youth. A recent Centers for Disease Control and Prevention (CDC) survey showed that e-cigarettes are the tobacco product teens use the most—even more than cigarettes.
  • Cigars: Cigars are large, tightly-rolled, fermented bundles of dried tobacco that are smoked. Cigars may also be called cigarillos, and come in several sizes. Depending on the size of the cigar, there is an average of 5 milligrams (mg) of nicotine in each, compared to an average of 1.5mg in cigarettes. Cigars are sold in a variety of flavors, and can be purchased in low numbers, which make them both cheap and popular with youth.
  • Hookah: Hookahs, or waterpipes, are a more socially-oriented form of tobacco use. Tobacco is heated, filtered by water, and then inhaled through a hose to a mouthpiece. The hose is then passed to the next person in the group, and they then inhale the smoke. Hookah use can lead to several types of cancers, as well as heart and lung diseases. In addition, because multiple people are sharing a mouthpiece, there is also a risk of hepatitis, herpes, and tuberculosis. Hookah bars and lounges are gaining popularity as a way for people to socialize and embrace multiculturalism while smoking. These lounges are especially popular with younger populations like college students and teens. 
  • Bidis: A bidi is a hand rolled, leaf-wrapped cigarette. Bidis can be tied with a string at one or both ends. A bidi can be flavored with child-friendly flavors like chocolate or cherry. The amount of nicotine in bidi smoke is 3-5 times higher than the amount of nicotine in cigarette smoke. Several research studies have found that many of the same health problems associated with cigarettes can be common with bidi use.
  • Kreteks: Also known as cloves, or clove cigarettes, kreteks contain a rolled mixture of tobacco, cloves, and other additives. As with bidis, kretek use can cause some of the same health problems that cigarette smoking causes such as difficulty breathing, coughing up blood, and other lung problems.

Forms of Smokeless Tobacco

Many people falsely believe that because there is no smoke, there is no danger. This is not true. Smokeless tobacco still contains many dangerous chemicals and ingredients that can cause harm to the body. In addition, some forms are easier to disguise use, as there is no tell-tale smoke. This may make it easier for children to use tobacco products.

  • Chewing tobacco: Also known as spit tobacco, or chew, chewing tobacco is made of strips of shredded tobacco leaves in various forms. The most common form is loose-leaf, which means the strips of tobacco are sweetened and packaged in a foil pouch. Chewing tobacco can also appear in plug form, where the tobacco is pressed together into a small, cake-like form and wrapped in a tobacco leaf, or twist form, where the tobacco is twisted to resemble a rope. In each form, the user takes a piece from the package, and places it in their mouth, between their gums and cheek. Chewing tobacco users are at risk for gum loss, cancers, stained teeth, and oral sores.
  • Snuff: Snuff is also referred to as pinch, or dip, and is a finely-ground form of tobacco that can be either dry or moist. Dry snuff is often a powder-like consistency, and can be inhaled through the nostrils, taken orally, or placed between the gums and cheek, as is common to do with moist snuff.
  • Snus: Snus is moist snuff that originated in Sweden. Snus is dispensed in packets, or sachets (like miniature tea bags), and placed between the gums and cheek. Snus contains between 3-10mg of nicotine (compared to about 1.5mg in cigarettes), depending on the portion size, and is marketed as a safer alternative to smoking for scenarios when smoking is prohibited. Snus is also designed so that there is no need to spit the product juices out, as is the case with other forms of smokeless tobacco, and this may make the product more attractive to teens. Snus contains many of the same dangers as other smokeless forms of tobacco, despite intense marketing as a safer alternative to cigarettes.
  • Pellets and other candy-like forms of tobacco: Several tobacco companies have created dissolvable tobacco in the form of sticks, strips, or orbs. The orbs resemble tic tac candies in appearance, and the sticks resemble toothpicks, while the strips resemble thin films that can be placed in the mouth, similar to mint breath strip films. These are all forms of smokeless tobacco that still deliver anywhere from 0.6-3mg of nicotine per unit, compared to 1.5mg in cigarettes. The amount of nicotine in some of these brands may seem small compared to other tobacco forms, but because the product is easily concealed, it may be highly appealing towards underage users, who may use the product more often, causing dependence.  There is also significant concern for accidental overdose by youth that may not recognize these products as tobacco.  A child putting several orbs in their mouth at the same time, thinking they are candy, could consume a dangerous amount of nicotine at once. 

Many of these forms of tobacco are available in flavors and are easier to get than cigarettes. The American Academy of Pediatrics recommends that flavors be banned from all tobacco products, that the legal age of purchase for tobacco products be raised to 21, and that tobacco product prices be increased so that it is harder for teens to get these products.

Some of these forms are commonly found in social settings, and it is important to have conversations with your children about abstaining from tobacco use, and resisting peer pressure.

Additional Resources:



Last Updated
American Academy of Pediatrics (Copyright © 2015)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Facebook Twitter Google + Pinterest