Tobacco Products


Cigarettes (and cigars, blunts, etc.) are the most common form of tobacco use. In addition to tobacco and nicotine, cigarette smoke contains over 4,000 chemicals, including over 60 carcinogens,2 such as Ammonia (used as a cleaning agent), Formaldehyde (used in embalming), and Acetone (used as a paint thinner).3


The Indonesian name for a clove cigarette is a Kretek. Clove cigarettes contain a mixture of shredded clove buds and tobacco, which produces a distinct, pungent smell. Clove cigarette smoke contains more nicotine, tar, and carbon monoxide than conventional cigarettes.4 Clove smokers are at greater risk for acquiring an acute lung injury, as well as developing abnormal lung functioning than non-smokers.1, 5

Shisha/Hookah Tobacco

Hookah (narghile, water-pipe) smoking is a common apparatus for tobacco use in countries such as China, India, Pakistan, and many countries in the Middle East. Recently, the phenomenon has spread in the United States and Europe with the growth of Eastern and Arab cultures, as well as in college populations. Hookahs vary widely in shape and size, but the basic design includes: a head, consisting of a ceramic bowl with a conical cap; a metal body which is attached to a glass bottle partially filled with water; and a flexible tube with a mouthpiece affixed to the neck of the bottle.

The tobacco (shisha, maassel, tumbâk, jurâk; moist, shredded tobacco mixed with sweeteners such as honey, molasses, and fruit) is placed in the head of the hookah with a heating apparatus (usually charcoal). Combustion begins in the head, where the smoke then passes through the water in the body of the pipe where it is cooled and diluted before traveling through the hose where the smoker inhales it.


Photo derived from:

While the risks of hookah smoking are not as well known as the risks of cigarette smoking, a growing body of research is beginning to indicate these risks. Many hookah smokers falsely believe that hookah smoke is less harmful that cigarette smoke. This false belief leads many individuals to initiate tobacco use with hookah smoking. Hookah smokers often inhale the equivalent amount of smoke of one pack of cigarettes in a 30-60 minute smoking session. Many smokers believe that the water in the hookah will filter out any harmful toxins, making it safer to smoke than cigarettes. While the water filtration in a hookah does reduce some toxins, it does not reduce the level of tar inhaled in the smoke, which contains the most carcinogens. Hookah smokers may be at greater risk for harm from smoking than cigarette smokers, as hookah smokers are exposed to greater overall amounts of nicotine, carbon monoxide, and other toxins.6

In addition, because of several factors, such as the low burning temperature of the tobacco and the air pressure required to inhale the smoke, hookah smokers often inhale much deeper, allowing the smoke to more deeply penetrate the lungs. Other health concerns of hookah smoking include the spread of infections diseases, such as tuberculosis, aspergillus, and heliobacter, which can be spread through the sharing of the pipe or in the uncontrolled process by which the tobacco is made.6

Potentially Reduced Exposure Products (PREPs)

What are PREPs?
The best way to reduce the harm caused by smoking is to quit. While the adverse effects of smoking are well documented, not all smokers are ready to quit. In the past several years, tobacco companies have recognized this growing market and have introduced several potentially reduced exposure products (PREPs). PREPs are tobacco-based products that claim to reduce the exposure to and harm from the toxins found in tobacco.7

Some of these products are nicotine delivery devices that are lit the same way as a cigarette, but heat rather than burn (e.g. Eclipse, Accord), which (in theory) reduces the number of toxic combustion products. Others claim to achieve reduced levels of toxins through different tobacco curing or fermentation processes, or by adding chemicals (such as palladium) to the tobacco leaves (examples of cigarettes include OMNI and Advance cigarettes). Still others claim to contain reduced nicotine levels by using genetically engineered tobacco leaves (e.g. Quest). Lastly, there are several oral non-combustible tobacco products (either, hard, tobacco lozenges, or "cigaletts", e.g. Ariva and Stonewall, or tobacco packets, e.g. Revel and Exalt) being marketed as tobacco alternatives to smoking, but not cessation products.

Are PREPs less harmful? While quitting smoking is the surest way to reduce risk for disease from tobacco, several caveats should be noted when discussing PREPs. While the companies that market PREPs claim they reduce consumers' exposure to harmful toxins, independent research has not produced evidence to warrant claims that they significantly reduce risk of disease or toxin exposure. Indeed, the way in which PREPs are advertised is confusing to many consumers, leading them to erroneously believe that PREPs are safer or will help them quit smoking, claims which have not been confirmed.8


  1. Stats on smoking prevalence Substance Abuse and Mental Health Services Administration. Results from the 2004 National Survey on Drug Use and Health: National Findings. DHHS Pub. No. SMA 05-4062, 2005.
  2. Centers for Disease Control and Prevention. Tobacco Use in the United States. Retrieved August, 2006 from:
  3. Tobacco Contains Over 4,000 Chemicals: Know the Facts! Retrieved August, 2006 from
  4. Malson, J., Lee, E., Murty, R., Moolchan, E., & Pickworth, W. (2003). Clove cigarette smoking: Biochemical, physiological, and subjective effects. Pharmacology, Biochemistry, and Behavior, 73, 739-745.
  5. Anonymous. (1988). Evaluation of the health hazard of clove cigarettes. Council on Scientific Affairs. Journal of the American Medical Association, 260, 3641-3644.
  6. Krishkowy, R. & Amitai, Y. (2005). Water-pipe (Narghile) smoking: An emerging health risk behavior. Pediatrics, 116, e113-e119. Click here for link to full-text article.
  7. Hatsukami, D. K. & Zeller, M. (2004). Tobacco harm reduction: The need for research to inform policy. Retrieved from, April 2007.
  8. Hamilton, W. L., diStefano-Norton, G., Ouellette, T. K., Rhodes, W. M., Kling, R., & Connolly, G. N. (2004). Smokers' responses to advertisements for regular and light cigarettes and potential reduced-exposure tobacco products. Nicotine & Tobacco Research, 6 (Suppl. 3), S353-S362.
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