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Tobacco substitutes
- 1.
- 2. 1 Overview When quitting smokingmany 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.
- 3. 2 Overview The main additivein 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.
- 4. 3 Overview Other products aresold 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.
- 5. 4 Chewing tobacco andSnuff The two main types of smokeless tobacco in the United States are chewing tobacco and snuff. Smokeless tobacco is not a safe alternative to smoking cigarettes. Smokeless tobacco use can cause cancer, oral health problems, and nicotine addiction.
- 6. 5 Chewing tobacco andSnuff Chewing TobaccoChewing tobacco comes in the form of loose leaf, plug, or twist.
- 7. 6 Chewing tobacco andSnuff FormDescriptionUseMarket Share (2009)**Percentage of U.S. market for smokeless tobacco productsLoose leafCured tobacco strips typically sweetened and packaged in foil pouchesPiece taken from pouch and placed between cheek and gums22.2%PlugCured tobacco leaves pressed together into a cake or "plug" form and wrapped in a tobacco leafPiece taken from pouch and placed between cheek and gums0.6%Twist (or roll)Cured tobacco leaves (often flavored) twisted together to resemble
- 8. 7 Chewing tobacco andSnuff FormDescriptionUseMarket Share (2009)**Percentage of U.S. market for smokeless tobacco productsMoistCured and fermented tobacco processed into fine particles and often packaged in round cansPinch or "dip" is placed between cheek or lip and gums75.3%DryFire-cured tobacco processed into a powderPinch of powder is taken orally or inhaled through the nostrils1.4%SachetsMoist snuff packaged in ready- to-use pouches that resemble small tea bagsSachet is placed between cheek or teeth and gumsData
- 9. 8 Chewing tobacco andSnuff Health EffectsCancerSmokeless tobacco contains 28 cancer-causing agents (carcinogens). Smokeless tobacco is a known cause of human cancer; it increases the risk of developing cancer of the oral cavity.
- 10. 9 Chewing tobacco andSnuff Oral HealthSmokeless tobacco is also strongly associated with leukoplakia—a precancerous lesion of the soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off. Smokeless tobacco is associated with recession of the gums, gum disease, and tooth decay.
- 11. 10 Chewing tobacco andSnuff Reproductive HealthSmokeless tobacco use during pregnancy increases the risks for preeclampsia (i.e., a condition that may include high blood pressure, fluid retention, and swelling), premature birth, and low birth weight. Smokeless tobacco use by men causes reduced sperm count and abnormal sperm cells.
- 12. 11 Chewing tobacco andSnuff Nicotine AddictionSmokeless tobacco use can lead to nicotine addiction and dependence. Adolescents who use smokeless tobacco are more likely to become cigarette smokers. Smokeless tobacco is not a safe substitute for smoking cigarettes.
- 13. 12 Chewing tobacco andSnuff Smokeless Tobacco Use in the United StatesPercentage of Adults Who Were Current Smokeless Tobacco Users in 20098 3.5% all adults (aged 18 years and older) 7.0% men 0.3% women 1.0% African Americans
- 14. 13 Chewing tobacco andSnuff 5.7% American Indian/Alaska Natives* 0.5% Asian Americans 1.1% Hispanics 4.5% whites *2008 estimate; 2009 estimate not available
- 15. 14 Chewing tobacco andSnuff Percentage of High School Students who were Current Smokeless Tobacco Users in 20099 6.1% all high school students 11.0% males 1.5% females 1.8% African Americans
- 16. 15 Chewing tobacco andSnuff 1.5% Asians 4.6% Hispanics 7.5% whites Percentage of Middle Students who were Current Smokeless Tobacco Users in 20099 2.6% all middle school students
- 17. 16 Chewing tobacco andSnuff 4.1% males 1.2% females 1.7% African Americans 2.0% Asians 3.4% Hispanics 2.8% whites
- 18. 17 Chewing tobacco andSnuff NOTE: "Current" user is defined as using smokeless tobacco products on 1 or more of the 30 days preceding the survey. Tobacco Industry InformationThe five largest tobacco manufacturers have spent record amounts of money on smokeless tobacco advertising and promotions:1 $547.9 million in 2008
- 19. 18 Chewing tobacco andSnuff $411.3 million in 2007 $354.1 million in 2006 The two leading smokeless tobacco brands for users aged 12 years or older are— Skoal® (with 25% of the market share) and
- 20. 19 Chewing tobacco andSnuff Copenhagen® (with 24% of the market share).
- 21. 20 Hookah -- Hookahs—sometimes calledwater pipes—are used to smoke specially made tobacco that is available 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 to person.
- 22. 21 Hookah -- Hookahs originatedin ancient Persia and India and have been used extensively for centuries.1,2,3 Today, hookah cafés are gaining popularity around the globe, including Britain, France, Russia, the Middle East, and the United States.1 An estimated 300 hookah cafés operated in the United States in 2006, and the numbers continue to grow.1 In recent years, there has been a increase in hookah use around the world, most notably among youth.
- 23. 22 Hookah -- Hookah isknown by a number of different names, including narghile, argileh, shisha, hubble- bubble, and goza. -- Hookahs vary in size, shape, and composition. -- A typical modern hookah comprises a head (with holes in the bottom), a metal body, a water bowl, and a flexible hose with a mouthpiece.
- 24. 23 Hookah **Compared with Cigarettes** Whilemany hookah smokers may consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks as cigarettes. -- Water pipe smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke.
- 25. 24 Hookah **Compared with Cigarettes** --Due to the mode of smoking—including frequency of puffing, depth of inhalation, and length of the smoking session—hookah smokers may absorb higher concentrations of the toxins found in cigarette smoke. -- A typical 1-hour-long hookah smoking session involves inhaling 100–200 times the volume of smoke inhaled from a single cigarette.
- 26. 25 Hookah **Compared with Cigarettes** --Hookah smokers are at risk for the same kinds of diseases 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 to smoking cigarettes.**
- 27. 26 Hookah **Health Effects HookahSmoke and Cancer** -- The charcoal used to heat tobacco in the hookah increases the health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals.
- 28. 27 Hookah **Health Effects HookahSmoke and Cancer** -- Even after it has passed through water, the smoke produced by a hookah contains high levels of toxic compounds, including carbon monoxide, heavy metals, and cancer-causing chemicals. -- Hookah tobacco and smoke contain numerous toxic substances known to cause lung, bladder, and oral cancers.
- 29. 28 Hookah **Health Effects HookahSmoke and Cancer** -- Irritation from exposure to tobacco juices increases the risk of developing oral cancers. The irritation by tobacco juice products is likely to be greater among hookah smokers than among pipe or cigar smokers because hookah smoking is typically practiced (with or without inhalation) more often and for longer periods of time. **Other Health Effects of Hookah Smoke**
- 30. 29 Hookah **Health Effects HookahSmoke and Cancer** -- Hookah tobacco and smoke contain numerous toxic substances known to cause clogged arteries and heart disease. -- Infectious diseases may be transmitted by sharing a hookah.
- 31. 30 Hookah **Health Effects HookahSmoke and Cancer** -- Babies born to women who smoked one or more water pipes a day during pregnancy have lower birth weights (were at least 3½ ounces less) than babies born to nonsmokers and are at an increased risk for respiratory diseases. **Hookahs and Secondhand Smoke**
- 32. 31 Hookah **Health Effects HookahSmoke and Cancer** -- Secondhand smoke from hookahs poses a serious risk for nonsmokers, particularly because it contains smoke not only from the tobacco but also from the heat source (e.g., charcoal) used in the hookah.
- 33. 32 Low yield cigarettes Afterthe landmark 1964 Surgeon General's Report on the health consequences of smoking, cigarette manufacturers began heavily marketing cigarettes labeled "light," "low," and "mild" (or similar descriptors). Cigarettes with "light/low/mild" labels delivered less tar or nicotine in standardized machine measurements. They were often referred to as "potentially reduced-exposure products," and advertisements implied that they were safer than regular or "full-flavor" cigarettes.
- 34. 33 Low yield cigarettes However,due to passage of the Family Smoking Prevention and Tobacco Control Act, manufacturers are now prohibited from manufacturing for sale or distribution any tobacco products for which the label, labeling, or advertising contains the descriptors "light," "low," or "mild" or any similar descriptors.
- 35. 34 Low yield cigarettes Thereis no strong scientific evidence that low-yield cigarettes are less harmful than regular cigarettes. Smoking cessation is the only way smokers can avoid the health risks of smoking (see CDC's Smoking Cessation fact sheet for more information). Cigarette DesignLow-yield cigarettes were defined by measuring tar on standardized smoking machines.
- 36. 35 Low yield cigarettes Cigarettebrands that yield approximately 1–6 mg of tar were historically called "ultra light." Those with approximately 6–15 mg of tar were called "light." Brands yielding more than 15 mg of tar were called "regular" or "full flavor."
- 37. 36 Low yield cigarettes Thefollowing cigarette design changes over the past decades affected the tar and nicotine measurements: Addition of different size and density filters Ventilation holes in the cigarettes to bring in air and dilute the smoke measured
- 38. 37 Low yield cigarettes Chemicaladditives in the paper and/or tobacco Tobacco (i.e., using different types, blends, and curing methods) Changes in cigarette design have not made cigarettes safe.
- 39. 38 Low yield cigarettes Nostrong scientific evidence exists indicating that changes in cigarette design have resulted in a decrease in the diseases caused by smoking cigarettes. Compensatory SmokingMost smokers are addicted to nicotine, and, consequently, compensate when smoking low-yield cigarettes in order to take in more nicotine than estimated by a smoking machine.
- 40. 39 Low yield cigarettes Manysmokers block the ventilation holes, thus inhaling more tar and nicotine than measured by machines. Many smokers inhale longer, harder, and more frequently when smoking low-yield cigarettes to get more nicotine.
- 41. 40 Low yield cigarettes Smokersmay get as much or more tar and nicotine from cigarettes with low-yield ratings as from regular cigarettes because of the ways they compensate when smoking them. Smokers Who Use Low-Yield CigarettesUse of low- tar products increases dramatically as age, education level, and income level increase.
- 42. 41 Low yield cigarettes Useof low-yield cigarettes is higher among women than men. Many smokers consider smoking low-yield cigarettes, menthol cigarettes, or additive-free cigarettes to be safer than smoking regular cigarettes, even though no strong scientific evidence exists to substantiate these beliefs.
- 43. 42 Low yield cigarettes Manysmokers may have switched to low-yield brands instead of quitting; smokers may be misled by the implied promise of reduced toxicity underlying the marketing of such brands. Health Risks of SmokingExisting research does not support recommending that smokers switch to low-yield cigarettes.
- 44. 43 Low yield cigarettes Nostrong scientific evidence exists indicating that changes in cigarette design have resulted in a decrease in the diseases caused by cigarettes.
- 45. 44 Nicotine Replacement This medicationguide was created to provide you with a general understanding of the current medications used by smokers who are trying to quit. Please note that this guide may not include every medication available. All of these medications have been shown to be useful for helping smokers quit. There is no one medication that works best for all smokers. Always read the instructions on the package carefully and talk with your doctor or pharmacist if you have questions. The dosing information bel
- 46. 45 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**These medications are called "first-line" because many smokers use these when they first try to quit. If the first-line medications don’t work, they might try a "second-line" medication instead.
- 47. 46 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**Nicotine replacement therapy (NRT) helps smokers quit by reducing their craving sensations. These craving sensations happen when the body goes through withdrawal from the nicotine in tobacco. NRT products provide controlled amounts of nicotine. Individuals reduce their use of NRT products over time, allowing their bodies to gradually adjust to increasingly lower nicotine levels. Nicotine Patches-Over-the-Counter
- 48. 47 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**The nicotine patch is placed on the skin and supplies a small and steady amount of nicotine to the body. Nicotine patches contain varied amounts of nicotine (21 mg, 14 mg, or 7 mg, for example) and the user reduces the dose over time. Nicotine Gum- Over-the-Counter
- 49. 48 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**Nicotine gum is chewed to release nicotine that is absorbed through tissue inside the mouth. The user chews the gum until it produces a tingling feeling, then places (parks) it between the cheek and gum tissue. Nicotine gums have varied amounts of nicotine (typically 2 mg or 4 mg) to allow users to reduce the amount of nicotine in their bodies. Nicotine Lozenges- Over-the-Counter
- 50. 49 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**Nicotine lozenges look like hard candy and are placed in the mouth to dissolve slowly. The nicotine lozenge (typically a 2 mg or 4 mg dose of nicotine) releases nicotine as it slowly dissolves in the mouth. Nicotine Inhaler- Prescription
- 51. 50 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**A nicotine inhaler is a cartridge attached to a mouthpiece. Inhaling through the mouthpiece delivers a specific amount of nicotine to the user. Nicotine Nasal Spray- Prescription
- 52. 51 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**Nicotine nasal spray is a pump bottle containing nicotine, which is inserted into the nose and sprayed. Nicotine nasal spray can be used for fast craving control, especially for heavy smokers. **First-Line Medications: Other** Bupropion- Prescription
- 53. 52 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**Bupropion, also known as Zyban®, helps to reduce nicotine withdrawal symptoms and the urge to smoke. Bupropion can be used safely with nicotine replacement products. Varenicline Prescription
- 54. 53 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**Varenicline, also known as Chantix®, is a prescription medication that eases nicotine withdrawal symptoms and blocks the effects of nicotine from cigarettes if the user starts smoking again. **Second-Line Medications** Nortriptyline- Prescription
- 55. 54 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**Nortriptyline, also known as Aventyl®, is generally prescribed to treat depression; however nortriptyline has been prescribed to assist with smoking cessation when the first-line medications do not work. The use of nortriptyline for smoking cessation has not been approved by the Food and Drug Administration (FDA). Clonidine- Prescription
- 56. 55 Nicotine Replacement **First-Line Medications:Nicotine Replacement Therapy (NRT)**Clonidine, also known as Catapres®, is generally prescribed to treat high blood pressure; however clonidine may reduce tobacco withdrawal symptoms when first-line medications do not work. The use of clonidine for smoking cessation has not been approved by the FDA.