- Smoking Pipe Tobacco: Exposure and Health
- Is Smoking Pipe Tobacco Safe?
- What are the Effects of Smoking Pipe Tobacco Around Others?
- The Bottom Line
- Is Any Type of Tobacco Product Safe?
- Regular (combustible) cigarettes
- Light, hand-rolled, natural, or herbal cigarettes
- Menthol cigarettes
- Cigars and little cigars
- Electronic or e-cigarettes (vaping devices)
- Clove cigarettes (kreteks)
- Bidis (flavored cigarettes)
- Hookahs (water pipes)
Smoking Pipe Tobacco: Exposure and Health
Silvana Barbosa, National Center for Health Research
Smoking pipe tobacco has been around for centuries. Pipe smoking typically consists of loose leaf tobacco that is fire-cured and burned in a traditional smoking pipe with a bowl and mouthpiece.
Although pipe smoking has dwindled over the years, the proportion of regular users varies by state and ranges from 3% to 13%.1 More surprising, 1.
4% of high school students nationwide currently smoke a pipe.2
Is Smoking Pipe Tobacco Safe?
While it is often assumed to be safer than smoking cigarettes, smoking pipe tobacco is still very harmful to the health of the user. cigarettes, pipe tobacco contains nicotine and is therefore addictive. In addition, nicotine has a harmful impact on adolescent brain development.
This is especially worrisome because 90% of smokers started using tobacco before the age of 18. For pregnant women, nicotine harms the fetal brain and increases the risk of stillbirth and preterm birth.
Other harmful effects of nicotine include increased risk for forming a blood clot, lightheadedness, changes in heart rate, and nausea.3
Pipe tobacco contains toxic chemicals that increase the risk for some cancers. A study conducted by the prestigious American Association for Cancer Research found that people who smoke pipe tobacco are more ly to develop cancer of the head and neck, liver, and lung.
This risk was higher for people who smoked more often, had smoked for more years, or who inhaled more deeply. Even if users do not inhale, they are still exposed to toxic chemicals in the tobacco smoke released by the pipe. The only way to reduce the risk of these cancers is to quit smoking.
Cancer risk decreases over the years following quitting. 4
According to the National Cancer Institute, the U.S. government’s major research institute on cancer, there is no safe form of tobacco, and all forms of tobacco are harmful and addictive.5
What are the Effects of Smoking Pipe Tobacco Around Others?
Smoking pipe tobacco is not only harmful to the health of the user, but it is also a serious health risk to anyone exposed to its smoke. Secondhand smoke is classified as a known human carcinogen because it contains many of the harmful chemicals that are in the smoke directly inhaled by smokers.
Children exposed to secondhand smoke have an increased risk of sudden infant death syndrome, ear infections, respiratory infections, and far more frequent and severe asthma attacks.
Adults exposed to secondhand smoke have increased risk of heart disease, stroke, lung cancer, and reduced fertility.
Pregnant women are especially susceptible to the harms of secondhand smoke, because it can cause pregnancy complications such as low birth weights and preterm birth.
Since 1964, approximately 2.5 million nonsmokers have died from health problems caused by exposure to secondhand smoke. Opening windows and using air filters does not protect others from inhaling secondhand smoke. The only way to protect nonsmokers from secondhand smoke is for smokers to stop smoking.6
There are also numerous health hazards associated with exposure to thirdhand smoke. Thirdhand smoke is residue from tobacco smoke that stays on surfaces and objects, clothing, bedding, and furniture. The tobacco residue may remain on surfaces and objects for several months.
Children are most susceptible to thirdhand smoke. Children breathe faster and inhale more than adults, have greater hand-to-mouth contact, and absorb more chemicals through their skin. Exposed children are more ly to have coughing fits associated with mucus production.
Research also suggests that thirdhand smoke causes genetic damage that can increase the risk of developing cancer in the future. For example, studies in mice found increased risk for lung cancer and liver damage from thirdhand smoke.7 To learn more about thirdhand smoke, please see here.
The Bottom Line
cigarettes, smoking pipe tobacco is not safe. Pipe tobacco contains many of the harmful chemicals found in cigarettes, including nicotine and toxic chemicals known to cause cancer. Smoking pipe tobacco is addictive, and users have an increased risk of head and neck, liver, and lung cancers.
Smoking pipe tobacco also jeopardizes the health of those around you. Secondhand smoke causes cancer and is especially harmful to pregnant women and children.
Recent studies are discovering the harms of thirdhand smoke. Children face greater health risks than adults because the exposure is proportionally greater.
The only way prevent harm from tobacco smoke is for the smoker to quit smoking.
For information on quitting smoking, see here.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
1. Centers for Disease Control and Prevention. (2018). State-Specific Prevalence of Tobacco Product Use Among Adults – United States 2014-2015. Morbidity and Mortality Weekly Report 67(3): 97-102 https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a3-H.pdf
2. Food and Drug Administration. (2018). Pipe Tobacco. Retrieved from https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm482580.htm. Accessed on April 25, 2019.
3. Bahl, Rajiv. (2018). From E-Cigs to Tobacco: Here’s How Nicotine Affects the Body. Retrieved from https://www.healthline.com/health-news/heres-how-nicotine-affects-the-body#5. Accessed on April 25, 2019
4. Malhotra, Jyoti, Borron, Claire, Freedman, Neal D., Abnet, Christian C., van den Brandt, Piet A., White, Emily, Milne, Roger L., Giles, Graham G., and Boffetta, Paolo. (2017). Association between Cigar or Pipe Smoking and Cancer Risk in Men: A Pooled Analysis of Five Cohort Studies. American Association for Cancer Research 10(12): 704-709 http://cancerpreventionresearch.aacrjournals.org/content/10/12/704
5. National Cancer Institute (2017). Harms of Cigarette Smoking and Health Benefits of Quitting. Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet#q5. Accessed April 25, 2019
6. Centers for Disease Control and Prevention. (2018). Secondhand Smoke Facts. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm#what. Accessed April 25, 2019.
7. Drehmer, Jeremy E., Walters, Bethany Hipple, Nabi-Burza, Emara and Winickoff, Jonathan P. (2017). Guidance for the Clinical Management of Thirdhand Smoke Exposure in the Child Health Care Setting. Journal of Clinical Outcomes Management 24(12): 551-559 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716630/
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, 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, people who have always smoked 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 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.
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 cigarettes. They come in flavors 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 cigarettes than cigars, inhaling and smoking every day. They look 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 people who smoke cigarettes inhale, but most people who smoke larger cigars 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 people 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.
People who smoke regular cigars are 4 to 10 times more ly to die from cancers of the mouth, throat, larynx, and esophagus than people who don't smoke cigars. 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. 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 chromosomal 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.
other flavored cigarettes, kreteks are used mostly by younger people. 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. People who smoke regular kreteks have up to 20 times the risk for abnormal lung function (blocked airways or poor oxygen uptake) compared with people who don't smoke.
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. People who smoke bidis have much higher risks of heart attacks, emphysema, chronic bronchitis, and cancer than those who don't smoke bidis.
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 them 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 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 ly that a person's overall 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.