Health risks of alternative tobacco products

Health risks of alternative tobacco products

Last Updated: May 1, 2021
HealthLinkBC File Number: 30b
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What kinds of tobacco products are sold in B.C.?

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

  • Smokeless, chew or spit tobacco
  • Cigars, cigarillos and pipe tobacco
  • Heated tobacco products
  • Bidis
  • Hookah or waterpipe tobacco

E-cigarettes and vaping liquids are not considered tobacco products, even though they contain nicotine, the addictive substance found in all tobacco products.

Are alternative tobacco products safe?

There is no safe level of tobacco products or e-cigarette use. Some people may use other tobacco products because they prefer them to cigarettes or because they think these are safer than cigarettes. However, inhalation or ingestion of these products all carry a health risk. Some of these products have many of the same toxic chemicals as cigarettes, including nicotine. Some have similar health risks as cigarettes in addition to having their own risks distinct from those of cigarettes. Some alternative tobacco products deliver more nicotine than cigarettes, which increases the risk of addiction and nicotine poisoning.

The bottom line is that all tobacco and vapour products have risks, and the best thing you can do for your health is avoid them. For help in reducing or quitting any tobacco or vapour product, talk to your health care provider or visit the QuitNow website.

What are the health risks of different tobacco products?

Smokeless tobacco

Smokeless tobacco is not burned and is instead designed to be sucked, chewed or kept in the mouth. Examples include chewing tobacco, snuff and snus. Smokeless tobacco products can be flavoured and are often sweetened with sugar.

  • Chewing tobacco comes in a loose-leaf form or a solid form, called a plug. Chewing tobacco is kept between the cheek and gums for several hours at a time
  • Snuff is finely-ground tobacco that can be dry or moist, and packaged in pouches or packets (also known as dip). Some types of snuff are sniffed or inhaled into the nose, and others are placed in the mouth
  • Snus comes in pouches that resemble small tea bags, which are placed in the cheek or between the teeth and gums

Smokeless tobacco products contain the same cancer-causing chemicals as cigarettes, including formaldehyde and cadmium. They also contain nicotine and are addictive.

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, dental diseases, including receding gums and tooth decay

Heated tobacco products

Heated tobacco products (HTPs) are electronic devices that heat tobacco to a very high temperature so you can inhale nicotine without smoke. They are also called heat-not-burn products. The emissions created from heated tobacco products generally contain lower levels of harmful ingredients than the smoke from regular cigarettes and as HTPs do not burn tobacco, they do not produce carbon monoxide. However, that does not mean HTPs are safe. Research suggests that they contain many of the same harmful ingredients as regular cigarettes, as well as other harmful ingredients not present in regular cigarettes.

HTPs are a relatively new product and not enough research has been done to demonstrate the short- and long-term health risks of using these products.

Cigars, cigarillos and pipe tobacco

Cigars are rolls of tobacco wrapped in a tobacco leaf or other tobacco-containing substance.

Cigarillos are small cigars. A cigar may take 1-2 hours to smoke and can have as much tobacco as a full pack of cigarettes.

Cigar smoking causes cancers of the mouth, lung, stomach and throat. It is also linked to gum disease and tooth loss. Regular cigar smokers who inhale have an increased risk of coronary heart disease and chronic obstructive pulmonary disease.

Pipe tobacco

Pipe smoking typically consists of loose-leaf tobacco that is fire-cured and burned in a traditional smoking pipe with a bowl and mouthpiece. Similar to cigars, the health risks are greater for pipe smokers who inhale, including increased risk of cancers of the head, neck, heart and lungs. Even if users do not inhale, they are still exposed to toxic chemicals in the tobacco smoke released by the pipe.


Bidis, or beadies are thin hand-rolled cigarettes of tobacco wrapped in leaves and tied with colourful strings. They can come in flavours such as chocolate or mango or can be unflavored. Bidis originated in India and are most popular among South Asian cultures.

Bidis have higher concentrations of nicotine, tar and carbon monoxide than conventional cigarettes. They include the same cancer-causing chemicals as other tobacco products and are highly addictive. People who smoke bidis increase their risk of heart disease and cancers of the mouth, lung, stomach and throat. Bidi smoking also increases your risk of emphysema and chronic bronchitis.


Hookahs are a form of waterpipe that is used to smoke specially-made tobacco, in flavours such as apple, mint, cherry, watermelon and coconut. Tobacco-free herbal shisha is an alternative product used in hookahs.

The tobacco or shisha is placed in the head of the hookah underneath a hot charcoal. The person inhales through the hose and the smoke passes through a water bowl before it is inhaled.

Hookahs are not a safe alternative to cigarettes. Some people think that the water reduces the amount of chemicals they inhale from hookah smoking. But smoking tobacco or herbal shisha through a waterpipe exposes you to many of the same cancer-causing chemicals as in cigarettes, at similarly high levels. The exception is herbal shisha, which does not contain nicotine.

In addition, hookah smoking leads you to inhale more smoke over a longer period compared to cigarettes. One puff from a hookah is almost equivalent to the smoke from one whole cigarette. In a typical hookah session, you can inhale an amount of smoke equivalent to around 100 cigarettes. Additionally, the charcoal used to heat the tobacco in a hookah can raise health risks by producing high levels of carbon monoxide, metals and cancer-causing chemicals. Non-tobacco based or herbal shisha also produces carbon monoxide and can increase your risk of certain cancers.

E-cigarettes or vaping products ("vapes")

Vaping products are battery-powered devices that heat a liquid, usually containing nicotine, into a vapour which is then inhaled. Other names for vaping products include e-cigarettes, vapes, vape pens, mods or e-hookahs. Some are designed to look like cigarettes, some are the size of a USB or pen and others are much larger and may be modifiable.

Vaping products do not contain tobacco but contain a variety of other chemicals including nicotine. They are as or even more addictive than cigarettes. It depends on how frequently and forcefully you inhale, on the concentration of nicotine in the pods you buy, and on the power settings of the device.

So far, research has started to show that vaping can increase blood pressure, decrease lung function and harm the immune system. They may also cause lung and heart disease.

To date, vaping has not been proven to be a safe, permanent solution for quitting smoking. Instead, Nicotine Replacement Therapy (NRT) (e.g. nicotine patch or gum) or quit-smoking medications combined with behavioural coaching should be used as a first choice. For those who do want to try vaping to quit, it's important to quit smoking cigarettes entirely before switching to vaping. "Dual use" of both products increases health risks. It's also important to make a plan to eventually quit vaping. If you are considering vaping to help quit or reduce harms of smoking, talk to your health care provider.

Are tobacco products that are labelled "natural", "organic" or "additive-free" safe to use?

Some tobacco products may be labelled as natural, organic or additive-free. This wording is mainly used for marketing purposes. These tobacco products are not safer than regular cigarettes, as they contain tobacco and carry the associated health risks. There is no safe tobacco product. Bidis are an example of a tobacco product that is promoted as natural, but they carry the same health risks as all other tobacco products.

For more information

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

In this article, the term tobacco use refers to use of commercial products, not the use of tobacco in traditional cultural practice.