E-cigarettes and Smokeless Tobacco

Reviewed by: HU Medical Review Board | Last reviewed: January 2017.

Because of the well-known risks of cigarette smoking, other ways of consuming nicotine have been developed, including smokeless tobacco and e-cigarettes (or electronic cigarettes). However, these other methods carry their own risks.

What are e-cigarettes?

E-cigarettes are electronic nicotine delivery systems (ENDS) in which users can inhale an aerosol (vapor) containing nicotine or other substances. Inhaling the chemicals through e-cigarettes is also called vaping. E-cigarettes are usually battery-operated and use heat to release the chemical-filled aerosol from a refillable cartridge. Since there is no burning tobacco, there is no cancer-causing tar, which has led some to believe that vaping with e-cigarettes is a safer alternative to cigarette smoking.1,2

What is in e-cigarettes?

However, the chemicals in e-cigarettes include nicotine, a base (usually propylene glycol), and flavorings or colorings. Nicotine is an addictive substance that has been shown in research to harm fetal health during pregnancy, negatively impact adolescent brain development, and increase the risk of heart disease. In addition, the flavorings or colorings in e-cigarettes are of particular concern, and researchers have found several cancer-causing chemicals such as formaldehyde, toluene, acetaldehyde, acrolein, and heavy metals such as cadmium, lead and nickel in e-cigarettes.1,2

Are e-cigarettes safe?

While e-cigarettes are fairly new and research is ongoing to determine their safety, initial research is indicating that e-cigarettes are not a safer alternative to cigarette smoking. E-cigarettes contain several cancer-causing chemicals, and inhaling the vapors delivers these chemicals deep into lung tissue. In addition, while there is no sidestream smoke (smoke coming off a burning cigarette), there is still the possibility for secondhand exposure of the chemicals to others nearby. Some studies have suggested that there could be loss of lung function with vaping, and the chemicals in the vapor can cause the cells in the bronchi of the lungs to grow more rapidly than normal, similar to the accelerated growth seen in cancer.2

What is smokeless tobacco?

There are several forms of smokeless tobacco, including chewing or spit tobacco, snuff or dipping tobacco, and dissolvable tobacco. All forms of smokeless tobacco contain nicotine, as well as many other chemicals that are known to cause cancer. At least 28 chemicals in smokeless tobacco have been found to cause cancer, including nitrosamines, which are formed during the growth and processing of the tobacco plant.3,4  While these forms of tobacco are not linked to lung cancer, they do increase the risk of the following cancers:

  • Cancer of the mouth, tongue, cheek, and gums
  • Cancer in the esophagus
  • Pancreatic cancer 3

Risks of smokeless tobacco

In addition, smokeless tobacco is linked to several other health problems, such as increased heart disease and high blood pressure, increased risk of heart attack, increased risk of stroke, increased risk of early delivery and stillbirth in pregnancy, gum disease, and oral lesions other than cancer.3,4

Some people have considered that smokeless tobacco can be used to help people quit smoking; however, there is no scientific evidence that supports this hypothesis. All tobacco products are harmful and cause cancer, and there are no “safe” tobacco products. People who use tobacco in any form are encouraged to quit to reduce their risks of cancer and improve their health.4

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