Health Risks of Alternative Tobacco Products

HealthLinkBC File Number: 
Last Updated: 
December 2015

What is the range of tobacco products sold in B.C.?

When people think of tobacco products, they usually think of cigarettes, but there are a range of alternative tobacco products. Examples of tobacco products sold in B.C. include:

  • smokeless tobacco or spit tobacco;
  • cigars, cigarillos, and pipe tobacco;
  • bidis;
  • kreteks or clove and other herbal cigarettes; and
  • hookah or waterpipe tobacco.

Are alternative tobacco products safe?

No. Many people use alternative tobacco products because they think these are safer than cigarettes or that these products will help them quit smoking. However, most products have many of the same toxic chemicals as cigarettes and can be addictive and harmful to your health.

What are the health concerns of the different types of tobacco products?

Smokeless tobacco

Some forms of tobacco are designed to be placed inside the mouth. This is called smokeless tobacco. Examples include: chew, plug, snuff, and snus.

  • Chew is a leafy form of tobacco sold in pouches. A person keeps the chew between the cheek and gums for several hours at a time. It is also known as a wad.
  • Plug is chew tobacco pressed into a hard block and placed between the cheek and gum.
  • Snuff is ground-up moist tobacco sold in cans. It is usually placed between the bottom lip and gum. It is also known as dipping.
  • Snus is a finely ground form of moist smokeless tobacco. Snus is appealing to youth because it comes in many flavours and can be used discretely (without others noticing).

Smokeless tobacco can be as addictive as smoking cigarettes. A person who uses 8 to 10 dips or chews a day may be exposed to the same amount of nicotine as a person who smokes 30 to 40 cigarettes a day.

Smokeless tobacco is flavoured with licorice, mint or fruit extracts and sweetened with sugar. However, smokeless tobacco has over 3,000 chemicals including 28 known cancer-causing chemicals, such as formaldehyde and cadmium.

People who use smokeless tobacco are at higher risk of:

  • mouth cancer, including cancers of the lip, tongue and cheeks;
  • cancers of the throat, sinus, and stomach;
  • heart disease, stroke and high blood pressure; and
  • dental diseases, including receding gums, tooth decay.

Cigars, cigarillos, and pipe tobacco

Cigarillos, or small cigars, can cost less than cigars and come in many flavours. Cigar smokers may spend up to an hour smoking a large cigar, which can have as much tobacco as a full pack of cigarettes.

Cigar smoking causes cancers of the mouth, lung, stomach and throat. Regular cigar smokers who inhale have an increased risk of coronary heart disease and chronic obstructive pulmonary disease.


Bidis, or beadies, are thin cigarettes of tobacco wrapped in leaves and tied with colourful strings.

Because bidis are wrapped in a leaf rather than paper, youth may believe these are a safe, natural alternative to cigarettes.

Despite having less tobacco than regular cigarettes, bidis can have higher levels of nicotine, tar and carbon monoxide. Bidis do not stay lit easily, so people who smoke them need to puff harder and inhale deeper into their lungs to keep them lit.

People who smoke bidis increase their risk of heart disease and cancers of the mouth, lung, stomach and throat.


Kreteks are Indonesian cigarettes made of tobacco, ground cloves and other additives. Kreteks are sometimes labeled natural tobacco. This can be misleading because natural tobacco can be as harmful as regular cigarettes.

People who smoke kreteks are at a higher risk of various forms of lung damage including fluid in the lungs, leakage from capillaries, and inflammation, and have 13 to 20 times the risk of abnormal lung function compared to non-smokers.


Hookahs are a form of waterpipe tobacco smoking that originated in Persia and India. The tobacco is mixed with flavour and placed in the head of the hookah underneath a hot charcoal. The smoker inhales through the hose and the smoke passes through a water bowl before it is inhaled.

Hookahs are not a safe alternative to cigarettes. Smoking tobacco through a waterpipe exposes the smoker to many of the same cancer causing chemicals as cigarettes. In addition, the smoker can inhale more smoke over a longer period of time compared to cigarettes. In one session of smoking a hookah, the user can inhale the amount of smoke equivalent to 100 cigarettes.

Are tobacco products that are labeled “natural”, “organic” or “additive-free” safe to use?

Some tobacco companies label products as natural, organic or additive-free. These tobacco products are not safer than cigarettes. When burned, tobacco and its by-products are the most deadly ingredients in cigarettes. Bidis and kreteks are examples of tobacco products that are promoted as natural.

Are E-cigarettes safe to use?

Electronic smoking products (also known as e-cigarettes, electronic cigarettes or vapour) which claim to help people quit smoking or contain nicotine are not approved by Health Canada for sale or use in Canada. The safety, efficiency, and quality of these products have not been fully evaluated by Health Canada and these products may pose health risks. For more information about e-cigaretes, visit QuitNow

For More Information

For information about the health risks of smoking and how you can quit smoking, visit the following websites:

Is it an emergency?

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If you are concerned about a possible poisoning or exposure to a toxic substance, call Poison Control now at 1-800-567-8911.

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