Is smokeless tobacco safe?

DEAR DOCTOR K:

Is smokeless tobacco safer than cigarettes? What about other non-cigarette tobacco products?

DEAR READER:

It’s tempting to think so, but there is no safe way to use tobacco. Any level of tobacco, in any form, increases your risk of heart attack, stroke, emphysema, chronic bronchitis, pneumonia, lung cancer and other cancers.

Don’t fool yourself into thinking that any tobacco products are safe to use.

Chewing tobacco. Tobacco can cause cancer and other health problems even when it is chewed rather than inhaled. It may be somewhat safer than regular tobacco, but it’s still dangerous for your health. Chewing tobacco increases the risk of cancer of the cheek and gums by about 50 times.

Snuff. The same goes for snuff, finely ground tobacco that’s either inhaled or tucked next to the gum.

Cigars. Since cigar smokers usually smoke less often than cigarette smokers, they may think their habit is a safe one. That’s a mistake. Cigar tobacco contains more nitrate than cigarette tobacco. The smoke it produces contains more toxins of various types (particularly nitrosamines and carbon monoxide) that raise cancer and heart risks.

It’s true that cigar smokers don’t inhale as deeply as cigarette smokers, and probably have a lower risk of lung cancer. But they are at considerably higher risk for all tobacco-related diseases than non-smokers.

Pipes. When I was young, I was a pipe smoker for a few months. I thought it added to my self-image as a contemplative intellectual. I probably would have been a pipe smoker for more than a few months if I could have figured out how to keep the darn thing lighted. Smoking one pipe of tobacco typically took me a couple of matchbooks.

Because you didn’t inhale as deeply as with cigarettes, people thought pipe smoking was safer than the ravages of cigarettes. In fact, it’s like cigar smoking: maybe a little safer than cigarettes (except for mouth and throat cancer), but much riskier than not smoking.

Water pipe (hookah) smoking is widely perceived to be less harmful and less addictive than smoking cigarettes or other forms of tobacco. In fact, my colleagues here at Harvard who study tobacco use say that hookahs are becoming more popular among young tobacco users. But they are as addictive as cigarettes — and perhaps even more harmful. When people smoke a water pipe, they often smoke for long periods of time. Each session can last half an hour or more. This long duration means more exposure to nicotine and other toxins.

Electronic cigarettes, or e-cigarettes, are battery-powered devices that were developed to gradually get people off cigarettes. They vaporize a solution of nicotine dissolved in water and propylene glycol, a fluid that helps nicotine dissolve. While they’re often advertised as free of cancer-causing substances, the Food and Drug Administration is not convinced. Ads claim they help people stop smoking, but there is no evidence yet to back this up.

In short, there is no safe form of tobacco.