Tobacco substitutes


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When quitting smoking many people feel the need
for help in the form of a tobacco substitute. There are a wide variety of
different products billed as alternatives to smoking that are supposedly healthier.
The main additive in cigarettes that makes them so addictive is
nicotine. Hence most of the products that aim to replace smoking are nicotine
replacements such as nicotine gum, inhalers, patches and medications.
Other products are sold as smokeless tobacco such as snuff and hookah or as better because they are low yield cigarettes.  Not all of these smoking substitutes are
healthy or even better than cigarettes. 

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Tobacco substitutes

  1. 1. EducationHealth TopicsTobacco substitutes
  2. 2. 1OverviewWhen quitting smoking many people feel the needfor help in the form of a tobacco substitute. Thereare a wide variety ofdifferent products billed as alternatives to smokingthat are supposedly healthier.
  3. 3. 2OverviewThe main additive in cigarettes that makes themso addictive isnicotine. Hence most of the products that aim toreplace smoking are nicotinereplacements such as nicotine gum, inhalers,patches and medications.
  4. 4. 3OverviewOther products are sold as smokeless tobacco suchas snuff and hookah or as better because they arelow yield cigarettes. Not all of these smokingsubstitutes arehealthy or even better than cigarettes.
  5. 5. 4Chewing tobacco and SnuffThe two main types of smokeless tobacco in theUnited States are chewing tobacco and snuff.Smokeless tobacco is not a safe alternative tosmoking cigarettes.Smokeless tobacco use can cause cancer, oralhealth problems, and nicotine addiction.
  6. 6. 5Chewing tobacco and SnuffChewing TobaccoChewing tobacco comes in theform of loose leaf, plug, or twist.
  7. 7. 6Chewing tobacco and SnuffFormDescriptionUseMarket Share(2009)**Percentage of U.S. market for smokelesstobacco productsLoose leafCured tobacco stripstypically sweetened and packaged in foilpouchesPiece taken from pouch and placedbetween cheek and gums22.2%PlugCured tobaccoleaves pressed together into a cake or "plug" formand wrapped in a tobacco leafPiece taken frompouch and placed between cheek andgums0.6%Twist (or roll)Cured tobacco leaves(often flavored) twisted together to resemble
  8. 8. 7Chewing tobacco and SnuffFormDescriptionUseMarket Share(2009)**Percentage of U.S. market for smokelesstobacco productsMoistCured and fermentedtobacco processed into fine particles and oftenpackaged in round cansPinch or "dip" is placedbetween cheek or lip and gums75.3%DryFire-curedtobacco processed into a powderPinch of powderis taken orally or inhaled through thenostrils1.4%SachetsMoist snuff packaged in ready-to-use pouches that resemble small tea bagsSachetis placed between cheek or teeth and gumsData
  9. 9. 8Chewing tobacco and SnuffHealth EffectsCancerSmokeless tobacco contains28 cancer-causing agents (carcinogens).Smokeless tobacco is a known cause of humancancer; it increases the risk of developing cancer ofthe oral cavity.
  10. 10. 9Chewing tobacco and SnuffOral HealthSmokeless tobacco is also stronglyassociated with leukoplakia—a precancerouslesion of the soft tissue in the mouth that consistsof a white patch or plaque that cannot be scrapedoff.Smokeless tobacco is associated with recession ofthe gums, gum disease, and tooth decay.
  11. 11. 10Chewing tobacco and SnuffReproductive HealthSmokeless tobacco use duringpregnancy increases the risks for preeclampsia(i.e., a condition that may include high bloodpressure, fluid retention, and swelling), prematurebirth, and low birth weight.Smokeless tobacco use by men causes reducedsperm count and abnormal sperm cells.
  12. 12. 11Chewing tobacco and SnuffNicotine AddictionSmokeless tobacco use can leadto nicotine addiction and dependence.Adolescents who use smokeless tobacco are morelikely to become cigarette smokers.Smokeless tobacco is not a safe substitute forsmoking cigarettes.
  13. 13. 12Chewing tobacco and SnuffSmokeless Tobacco Use in the UnitedStatesPercentage of Adults Who Were CurrentSmokeless Tobacco Users in 200983.5% all adults (aged 18 years and older)7.0% men0.3% women1.0% African Americans
  14. 14. 13Chewing tobacco and Snuff5.7% American Indian/Alaska Natives*0.5% Asian Americans1.1% Hispanics4.5% whites*2008 estimate; 2009 estimate not available
  15. 15. 14Chewing tobacco and SnuffPercentage of High School Students who wereCurrent Smokeless Tobacco Users in 200996.1% all high school students11.0% males1.5% females1.8% African Americans
  16. 16. 15Chewing tobacco and Snuff1.5% Asians4.6% Hispanics7.5% whitesPercentage of Middle Students who were CurrentSmokeless Tobacco Users in 200992.6% all middle school students
  17. 17. 16Chewing tobacco and Snuff4.1% males1.2% females1.7% African Americans2.0% Asians3.4% Hispanics2.8% whites
  18. 18. 17Chewing tobacco and SnuffNOTE: "Current" user is defined as using smokelesstobacco products on 1 or more of the 30 dayspreceding the survey.Tobacco Industry InformationThe five largesttobacco manufacturers have spent record amountsof money on smokeless tobacco advertising andpromotions:1$547.9 million in 2008
  19. 19. 18Chewing tobacco and Snuff$411.3 million in 2007$354.1 million in 2006The two leading smokeless tobacco brands forusers aged 12 years or older are—Skoal® (with 25% of the market share) and
  20. 20. 19Chewing tobacco and SnuffCopenhagen® (with 24% of the market share).
  21. 21. 20Hookah-- Hookahs—sometimes called water pipes—areused to smoke specially made tobacco that isavailable in a variety of flavors (e.g., apple, mint,cherry, chocolate, coconut, licorice, cappuccino,and watermelon)-- Hookah smoking is typically practiced in groups,with the same mouthpiece passed from person toperson.
  22. 22. 21Hookah-- Hookahs originated in ancient Persia and Indiaand have been used extensively for centuries.1,2,3Today, hookah cafés are gaining popularity aroundthe globe, including Britain, France, Russia, theMiddle East, and the United States.1 An estimated300 hookah cafés operated in the United States in2006, and the numbers continue to grow.1 Inrecent years, there has been a increase in hookahuse around the world, most notably among youth.
  23. 23. 22Hookah-- Hookah is known by a number of differentnames, including narghile, argileh, shisha, hubble-bubble, and goza.-- Hookahs vary in size, shape, and composition.-- A typical modern hookah comprises a head (withholes in the bottom), a metal body, a water bowl,and a flexible hose with a mouthpiece.
  24. 24. 23Hookah**Compared with Cigarettes**While many hookah smokers may consider thispractice less harmful than smoking cigarettes,hookah smoking carries many of the same healthrisks as cigarettes.-- Water pipe smoking delivers the addictive drugnicotine and is at least as toxic as cigarette smoke.
  25. 25. 24Hookah**Compared with Cigarettes**-- Due to the mode of smoking—includingfrequency of puffing, depth of inhalation, andlength of the smoking session—hookah smokersmay absorb higher concentrations of the toxinsfound in cigarette smoke.-- A typical 1-hour-long hookah smoking sessioninvolves inhaling 100–200 times the volume ofsmoke inhaled from a single cigarette.
  26. 26. 25Hookah**Compared with Cigarettes**-- Hookah smokers are at risk for the same kinds ofdiseases as are caused by cigarette smoking,including oral cancer, lung cancer, stomach cancer,cancer of the esophagus, reduced lung function,and decreased fertility.**Hookah smoking is NOT a safe alternative tosmoking cigarettes.**
  27. 27. 26Hookah**Health Effects Hookah Smoke and Cancer**-- The charcoal used to heat tobacco in the hookahincreases the health risks by producing high levelsof carbon monoxide, metals, and cancer-causingchemicals.
  28. 28. 27Hookah**Health Effects Hookah Smoke and Cancer**-- Even after it has passed through water, thesmoke produced by a hookah contains high levelsof toxic compounds, including carbon monoxide,heavy metals, and cancer-causing chemicals.-- Hookah tobacco and smoke contain numeroustoxic substances known to cause lung, bladder, andoral cancers.
  29. 29. 28Hookah**Health Effects Hookah Smoke and Cancer**-- Irritation from exposure to tobacco juicesincreases the risk of developing oral cancers. Theirritation by tobacco juice products is likely to begreater among hookah smokers than among pipeor cigar smokers because hookah smoking istypically practiced (with or without inhalation)more often and for longer periods of time.**Other Health Effects of Hookah Smoke**
  30. 30. 29Hookah**Health Effects Hookah Smoke and Cancer**-- Hookah tobacco and smoke contain numeroustoxic substances known to cause clogged arteriesand heart disease.-- Infectious diseases may be transmitted bysharing a hookah.
  31. 31. 30Hookah**Health Effects Hookah Smoke and Cancer**-- Babies born to women who smoked one or morewater pipes a day during pregnancy have lowerbirth weights (were at least 3½ ounces less) thanbabies born to nonsmokers and are at an increasedrisk for respiratory diseases.**Hookahs and Secondhand Smoke**
  32. 32. 31Hookah**Health Effects Hookah Smoke and Cancer**-- Secondhand smoke from hookahs poses aserious risk for nonsmokers, particularly because itcontains smoke not only from the tobacco but alsofrom the heat source (e.g., charcoal) used in thehookah.
  33. 33. 32Low yield cigarettesAfter the landmark 1964 Surgeon Generals Reporton the health consequences of smoking, cigarettemanufacturers began heavily marketing cigaretteslabeled "light," "low," and "mild" (or similardescriptors). Cigarettes with "light/low/mild"labels delivered less tar or nicotine in standardizedmachine measurements. They were often referredto as "potentially reduced-exposure products," andadvertisements implied that they were safer thanregular or "full-flavor" cigarettes.
  34. 34. 33Low yield cigarettesHowever, due to passage of the Family SmokingPrevention and Tobacco Control Act,manufacturers are now prohibited frommanufacturing for sale or distribution any tobaccoproducts for which the label, labeling, oradvertising contains the descriptors "light," "low,"or "mild" or any similar descriptors.
  35. 35. 34Low yield cigarettesThere is no strong scientific evidence that low-yieldcigarettes are less harmful than regularcigarettes. Smoking cessation is the only waysmokers can avoid the health risks of smoking (seeCDCs Smoking Cessation fact sheet for moreinformation).Cigarette DesignLow-yield cigarettes were definedby measuring tar on standardized smokingmachines.
  36. 36. 35Low yield cigarettesCigarette brands that yield approximately 1–6 mgof tar were historically called "ultra light."Those with approximately 6–15 mg of tar werecalled "light."Brands yielding more than 15 mg of tar were called"regular" or "full flavor."
  37. 37. 36Low yield cigarettesThe following cigarette design changes over thepast decades affected the tar and nicotinemeasurements:Addition of different size and density filtersVentilation holes in the cigarettes to bring in airand dilute the smoke measured
  38. 38. 37Low yield cigarettesChemical additives in the paper and/or tobaccoTobacco (i.e., using different types, blends, andcuring methods)Changes in cigarette design have not madecigarettes safe.
  39. 39. 38Low yield cigarettesNo strong scientific evidence exists indicating thatchanges in cigarette design have resulted in adecrease in the diseases caused by smokingcigarettes.Compensatory SmokingMost smokers are addictedto nicotine, and, consequently, compensate whensmoking low-yield cigarettes in order to take inmore nicotine than estimated by a smokingmachine.
  40. 40. 39Low yield cigarettesMany smokers block the ventilation holes, thusinhaling more tar and nicotine than measured bymachines.Many smokers inhale longer, harder, and morefrequently when smoking low-yield cigarettes toget more nicotine.
  41. 41. 40Low yield cigarettesSmokers may get as much or more tar and nicotinefrom cigarettes with low-yield ratings as fromregular cigarettes because of the ways theycompensate when smoking them.Smokers Who Use Low-Yield CigarettesUse of low-tar products increases dramatically as age,education level, and income level increase.
  42. 42. 41Low yield cigarettesUse of low-yield cigarettes is higher among womenthan men.Many smokers consider smoking low-yieldcigarettes, menthol cigarettes, or additive-freecigarettes to be safer than smoking regularcigarettes, even though no strong scientificevidence exists to substantiate these beliefs.
  43. 43. 42Low yield cigarettesMany smokers may have switched to low-yieldbrands instead of quitting; smokers may be misledby the implied promise of reduced toxicityunderlying the marketing of such brands.Health Risks of SmokingExisting research does notsupport recommending that smokers switch tolow-yield cigarettes.
  44. 44. 43Low yield cigarettesNo strong scientific evidence exists indicating thatchanges in cigarette design have resulted in adecrease in the diseases caused by cigarettes.
  45. 45. 44Nicotine ReplacementThis medication guide was created to provide youwith a general understanding of the currentmedications used by smokers who are trying toquit. Please note that this guide may not includeevery medication available. All of thesemedications have been shown to be useful forhelping smokers quit. There is no one medicationthat works best for all smokers. Always read theinstructions on the package carefully and talk withyour doctor or pharmacist if you have questions.The dosing information bel
  46. 46. 45Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**These medications are called "first-line" becausemany smokers use these when they first try toquit. If the first-line medications don’t work, theymight try a "second-line" medication instead.
  47. 47. 46Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**Nicotine replacement therapy (NRT) helps smokersquit by reducing their craving sensations. Thesecraving sensations happen when the body goesthrough withdrawal from the nicotine in tobacco.NRT products provide controlled amounts ofnicotine. Individuals reduce their use of NRTproducts over time, allowing their bodies togradually adjust to increasingly lower nicotinelevels.Nicotine Patches-Over-the-Counter
  48. 48. 47Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**The nicotine patch is placed on the skin andsupplies a small and steady amount of nicotine tothe body. Nicotine patches contain varied amountsof nicotine (21 mg, 14 mg, or 7 mg, for example)and the user reduces the dose over time.Nicotine Gum- Over-the-Counter
  49. 49. 48Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**Nicotine gum is chewed to release nicotine that isabsorbed through tissue inside the mouth. Theuser chews the gum until it produces a tinglingfeeling, then places (parks) it between the cheekand gum tissue. Nicotine gums have variedamounts of nicotine (typically 2 mg or 4 mg) toallow users to reduce the amount of nicotine intheir bodies.Nicotine Lozenges- Over-the-Counter
  50. 50. 49Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**Nicotine lozenges look like hard candy and areplaced in the mouth to dissolve slowly. Thenicotine lozenge (typically a 2 mg or 4 mg dose ofnicotine) releases nicotine as it slowly dissolves inthe mouth.Nicotine Inhaler- Prescription
  51. 51. 50Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**A nicotine inhaler is a cartridge attached to amouthpiece. Inhaling through the mouthpiecedelivers a specific amount of nicotine to the user.Nicotine Nasal Spray- Prescription
  52. 52. 51Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**Nicotine nasal spray is a pump bottle containingnicotine, which is inserted into the nose andsprayed. Nicotine nasal spray can be used for fastcraving control, especially for heavy smokers.**First-Line Medications: Other**Bupropion- Prescription
  53. 53. 52Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**Bupropion, also known as Zyban®, helps to reducenicotine withdrawal symptoms and the urge tosmoke. Bupropion can be used safely with nicotinereplacement products.Varenicline Prescription
  54. 54. 53Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**Varenicline, also known as Chantix®, is aprescription medication that eases nicotinewithdrawal symptoms and blocks the effects ofnicotine from cigarettes if the user starts smokingagain.**Second-Line Medications**Nortriptyline- Prescription
  55. 55. 54Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**Nortriptyline, also known as Aventyl®, is generallyprescribed to treat depression; howevernortriptyline has been prescribed to assist withsmoking cessation when the first-line medicationsdo not work. The use of nortriptyline for smokingcessation has not been approved by the Food andDrug Administration (FDA).Clonidine- Prescription
  56. 56. 55Nicotine Replacement**First-Line Medications: Nicotine ReplacementTherapy (NRT)**Clonidine, also known as Catapres®, is generallyprescribed to treat high blood pressure; howeverclonidine may reduce tobacco withdrawalsymptoms when first-line medications do notwork. The use of clonidine for smoking cessationhas not been approved by the FDA.