The Perspective
FALL 2011

Warning: Alternative smoking products may be even more hazardous to your health

Several new tobacco products are emerging as the smoke-free movement spreads across the nation. While many of these products look or sound less threatening than traditional tobacco products, they still contain nicotine and produce toxins that are bad for you. Because many of the products are still new to the American market, there is little or no research to know for certain the health risks associated with their use.


Growing in popularity in the Las Vegas area, hookah originated in India and dates back at least 500 years. A hookah is a device, also known as a water pipe, that heats up flavored tobacco (called Shisha) and then cools the smoke in water before it is inhaled. Smoking hookah is particularly popular among college students, and many believe it to be safer than smoking traditional cigarettes.

According to Malcolm Ahlo, health educator, “Many people believe that the Shisha is safer because it is flavored, doesn’t taste bad or produce an offensive odor. Some people even claim that it’s only fruit. This is not true. Shisha contains tobacco and tar.”

Ahlo also explained that contrary to popular belief, the water does not filter out the harmful chemicals while smoking hookah. “It’s like saying the filter at the end of a cigarette makes smoking safe,” he said.

Recent studies show that smoking hookah might actually be worse than cigarettes because users smoke over a longer period of time, take more puffs and inhale more deeply. A typical hookah session can last as long an hour during which time smokers can inhale the equivalent of 100 cigarettes.


Snus (pronounced “snoos”) is a Swedish smokeless tobacco product that dates back several centuries. This moist powder is used like traditional snuff, with a “pinch” between the cheek and gum. However, this form of snuff doesn’t need to be spit out.

It is packaged in two ways: loose, which requires the user to portion out a pinch; and prepackaged in the same material as teabags. Because of its unique processing using steam instead of fire, snus contains lower amounts of nitrosamines—organic compounds known to cause cancer. However, this product contains more nicotine than cigarettes.

Because snus is placed in the mouth, the negative health effects are similar to snuff. A user may develop lesions in the mouth, gum recession and cancer of the mouth or tongue.

Dissolvable tobacco products

Dissolvable tobacco products, also known as orbs, sticks or strips, are among the newest smokeless tobacco products on the market. Their appeal is that they do not require chewing or spitting; and they are odorless and discreet. These products are packaged like breath mints or dissolvable strips, and are typically flavored. Their nicotine content varies from 0.6 mg (less than one cigarette) to 4.0 mg (almost four cigarettes).

They are marketed as an alternative to cigarettes or chewing tobacco and not as a smoking cessation tool.

Electronic cigarettes

Electronic cigarettes, also known as e-cigarettes, are nicotine-delivering devices that look and act like cigarettes. They have a battery, a vaporizer, a cartridge filled with a solution (usually liquid nicotine) and an inhaler. When assembled, an e-cigarette looks just like a real cigarette. The smoker puffs on the inhaler, a battery causes the tip of the “cigarette” to glow and the heat generated by the battery turns the solution into a vapor that is inhaled. E-cigarettes’ appeal is that they produce a vapor, versus smoke, and they are available with varying degrees of nicotine.

A recent product sampling by the Food and Drug Administration (FDA) showed that users still inhale nicotine, toxic chemicals and other carcinogens even though they are using virtual cigarettes. The manufacturers may not have all of the kinks worked out with the new product, as explained by Maria Azzarelli, the health district’s tobacco control program coordinator. “The quality control process used to manufacture electronic cigarettes is inconsistent or non-existent,” she said. “In one study, the FDA tested three different e-cigarettes that were all labeled as containing the same level of nicotine. The results showed that each device emitted different levels of nicotine with each puff.”

All of these alternative tobacco products, regardless of how they are processed or how “natural” they appear to be, still contain nicotine. Nicotine is the addictive chemical found in tobacco products that increases the release of brain chemicals to help regulate mood and behavior. Dopamine, one of those chemicals, makes you feel good. Tobacco users typically get a “high” or “rush” with their first use of the day. When nicotine intake is reduced, the effects are the opposite of a boost: anxiety, irritability, restlessness, difficulty concentrating, depression, frustration or anger, increased hunger, insomnia and digestive problems. Nicotine can be toxic when ingested in large amounts, especially in small children.

Negative health effects and disease are not usually associated with nicotine, but with the products containing it. Tobacco use can cause numerous types of cancer, heart disease and lung disease, and increases the risk for stroke and peripheral vascular disease. In fact, the CDC reports that more deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined.

Bottom line? “Tobacco use of any kind is risky, even in moderation,” emphasizes Azzarelli. All of the aforementioned products, used separately or in conjunction with regular tobacco products, continue to feed the nicotine addiction and fuels your dependence on tobacco.

To combat the high use of tobacco in Clark County, the health district created the tobacco control program in 1999 with federal grant funds. The program was charged with preventing local youth from using tobacco products, promoting helpful ways for adults and youth to stop using tobacco and to eliminate the public’s exposure to second-hand smoke. To accomplish these goals, the program raises awareness and educates the public through media campaigns, social marketing, counter-marketing strategies, community initiatives, the Get Healthy Clark County and Viva Saludable websites, surveys, collaboration with community partners and outreach activities.

Since the program’s inception in 1999, smoking rates among adults have declined from 30 percent to 22.9 percent, and among children have declined from 33 percent to 17 percent in Clark County. In 2010, the health district received $14.6 million as part of the Communities Putting Prevention to Work initiative. Most of the funds were distributed to community partners to reduce tobacco use in Clark County.

To quit smoking, seek the assistance of trained professionals who can help you kick the habit in a healthy, supportive way instead of looking to alternative tobacco products. Call the Nevada Tobacco Users Helpline at 1-800-QUITNOW or go to

The Southern Nevada Health District’s Office of Chronic Disease Prevention & Health Promotion encourages healthy lifestyles through education, promotion and participation in community partnerships and activities. The programs encourage residents to get moving, be safe, eat better and live smoke-free. Information in English is available at and in Spanish at

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