Up in Smoke: The Truth About Cigarette Alternatives

It’s no secret smoking is bad for your health. It increases the risk of heart attack, stroke and cancer (lung and otherwise) — and it’s the single largest cause of preventable death in the United States. And while cigarette smoking is slowly but steadily declining, many people are turning to e-cigarettes, chewing tobacco, hookah and crafty cigarette imitators called cigarillos to fill the gap.

Trouble is, unlike the medications approved by the U.S. Food and Drug Administration (FDA) for smoking cessation, all of these cigarette alternatives may carry serious risks, explains Amanda L. Holm, MPH, project manager for Henry Ford’s Tobacco Treatment Services. It’s a mistake to use them to help quit cigarettes in place of medications that are proven safe and effective — or when quitting cold turkey is an option. (And they’re not risk-free on their own, either.)

So, before you pick up yet another bad habit, here’s what you need to know about trendy cigarette alternatives:

• E-cigarettes. These battery-operated devices use vapor instead of smoke to deliver nicotine and flavorings. And while they’ve been around for nearly a decade, researchers are still studying their long-term effects. Each of the hundreds of brands on the market may use different formulas and have questionable quality control. In fact, regardless of what the label states, there’s no telling how much (if any) nicotine a product contains. “The FDA started a process to regulate them, but that won’t have any effects on the marketplace for 1-3 years,” says Holm. “Right now, the e-cigarette industry is still like the wild west." The fine print: The flavors used in e-cigarettes have been approved by the FDA to be added to foods, but that doesn’t mean they’re safe to breathe into your lungs. What’s more, the vials of candy-flavored nicotine juice can be enticing but deadly for little kids and pets, says Holm.
• Hookah. Hookah is a water pipe used to smoke flavored and sweetened tobacco. The water doesn’t filter out the bad stuff; it just cools the smoke. That allows you to inhale more deeply, which could be more harmful. Proponents may say hookah is safer than cigarettes, but according to Holm, there can be a great deal of tobacco in the apparatus. A 1-2 hour hookah session is the equivalent of several packs of cigarettes. Smoke it all yourself and you’ve just inhaled 5 packs. Share it with a group and you could contract communicable diseases from the pipe. The fine print: Sellers may claim their hookah contains only herbal ingredients, but that doesn’t mean it’s tobacco-free. Most hookah tobacco contains the same toxic chemicals (and addictive nicotine) that make cigarettes so harmful.
• Spit tobacco. For decades, spit tobacco (chewing tobacco, smokeless tobacco or snuff) has been a popular pastime among American baseball players. These days, you don’t see as many ballplayers with brown gobs in their cheeks, but plenty of people still use spit tobacco. Also called chew, dip, and chaw among other names, this product comes in two forms: snuff (for dipping) and chewing tobacco (for chewing). In either case, the nicotine-laced grains sit in your mouth where you suck on the juices, spitting as necessary to ditch the saliva that builds up. “The risk profile is different from that of cigarettes, but the problems it can cause are equally concerning,” says Holm. In addition to short-term issues like bad breath and stained teeth, chewing tobacco causes mouth sores, cracked and bleeding lips, and gum disease, and dramatically increases the risk of heart disease and cancer, particularly oral, throat, and stomach cancer. The fine print: Spit tobacco has higher concentrations of nicotine, making it even more addictive than cigarettes.
• Cigarillos. While cigar use isn’t necessarily on the upswing, smokers who want an inexpensive hit of nicotine may turn to cigarillos, or little cigars. These products look like and function cigarettes, but they’re wrapped in brown paper instead of white. Perhaps most important, they’re not subject to the same taxes as cigarettes, making them a tempting alternative to smokers more concerned about the cost of their habit. The fine print: Cigarillos are as dangerous as cigarettes. They just cost less.

Your best bet: Commit to quit. Decide on a date to go without cigarettes or alternatives. The Great American Smokeout is November 17, and there’s no better time to stop smoking (or chewing) than when you have a community of people all feeling empowered to ditch tobacco products. If you don’t feel ready on that day, pick another date that feels right to be your first step towards a tobacco-free life.

Then, get your ducks in a row. Inform your friends and family about your decision, ask for their support, and start planning strategies to manage a life free of tobacco. Track your smoking habits, taking note of the times when you smoke and the emotions that come up, then determine what you can do in place of smoking to fill up that space, suggests Holm.

For example, do you typically smoke after breakfast? Brush your teeth instead. Are you used to smoking during social situations? Occupy your hands with a fruity drink. Rely on chain smoking to get through your evening commute? Take a different route and chew gum.

The key, says Holm, is identifying strategies that fit into your daily routine. And don’t be afraid to ask for help. The FDA has approved a number of medications, both with and without nicotine, to help smokers quit.

Amanda L. Holm, MPH, is the immediate past chair of Tobacco-Free Michigan and project manager for Tobacco Treatment Services for the Henry Ford Center for Health Promotion and Disease Prevention.