A Primer on Emerging Tobacco Products

Tobacco comes in many forms. Some — like cigarettes, cigars, pipes, and chewing tobacco — you may recognize. Others — such as cigarillos or small cigars, e-cigarettes, snus or tobacco pouches, tobacco strips, orbs or other dissolvables, bidis, kreteks or clove cigars, dhoka, and hookah or water pipes — you may not. Here's a quick run-down of the nicotine products that are currently available.

a collection of e-cigarettes and other electronic nicotine delivery systemsE-Cigarettes (also called e-cigs, electronic cigarettes, vapes, vaporizers, vape pens, hookah pens, e-hookah, electronic pipes, and e-pipes)

E-cigarettes and other electronic nicotine delivery systems (ENDS) are tobacco products that allow a user to inhale an aerosol containing nicotine and other substances. They are not FDA-approved quit-smoking devices.

These products have not been proven to be safe alternatives to other forms of tobacco. They are, however, attractive to youth, including those who have never smoked cigarettes or other tobacco products. Research shows that e-cigarettes are rapidly gaining popularity among youths, tripling among middle and high school students in just one year.

In 2014, e-cigarettes became the most commonly used tobacco product among U.S. middle and high school students, surpassing cigarettes, which were the previous leader. By 2017, 2.1 million middle and high school students reported they were currently using e-cigarettes, and many parents, teachers, and school administrators were raising alarm about pervasive vaping in schools.

In September 2018, the U.S. Food and Drug Administration announced that it was taking a number of new steps to address the epidemic of youth e-cigarette use.

In what it called the largest coordinated enforcement effort in its history, the FDA said it had sent warning letters and notices of fines to more than 1,300 U.S. retailers and also had contacted manufacturers of the top five e-cigarette brands (Vuse, Blu, JUUL, MarkTen XL, and Logic) to request that they provide a plan for mitigating youth sales within 60 days. The FDA also warned that it was considering whether to restrict flavored e-cigarettes to address the current youth epidemic of e-cigarette use.

While the long-term impact of using e-cigarettes — or of secondhand exposure to e-cigarettes — is unknown at this point, current concerns include poisoning risk and reduced lung function.

There are also safety concerns, as some of these devices have exploded and caused injury or fires. Some consumers have sued for injuries and damages sustained when their e-cigarettes exploded. If you have had problems with e-cigarettes, vape products, or other electronic nicotine delivery systems, tell the FDA.

For more information, read the MDHHS e-cigarettes fact sheet or view the MDHHS Office of Recovery-Oriented Systems of Care infographic on e-cigarettes.

Smokeless Tobacco (also called chewing tobacco, spit tobacco, snuff, snus)

Spit tobacco and snuff are readily available throughout Michigan in candy flavors including mint, cinnamon, apple, berry, citrus, cherry, and peach.

Snus, a moist form of smokeless tobacco, typically is offered in small pouches similar to tea bags and is held in the mouth, either behind the upper lip or between the cheek or teeth and the gums. First developed in Sweden, snus are a "spit-free" form of tobacco and have been marketed aggressively in the United States as an alternative nicotine-delivery system in smoke-free environments. American snus are available in a variety of flavors, including spearmint, wintergreen, vanilla, and various fruits.

The fact that snus and, indeed all of today's smokeless tobacco products, can be purchased in a range of flavors helps make these products more attractive to youth who might otherwise not use them.

Despite the marketing campaigns, though, it is important to remember that all smokeless tobacco — no matter what form it takes — poses health risks and has been associated with oral, esophageal, stomach, and pancreatic cancers.

hookah, waterpipe, shisha, narghile, argilehHookah (also called waterpipe, shisha, narghile, argileh)

Hookah smoking involves using a water pipe or shisha to pass tobacco smoke through water or a distilled alcoholic beverage, such as vodka, before it is inhaled.

In an hour-long hookah session, a smoker can inhale 100-200 times the volume of smoke inhaled from a single cigarette. The charcoal used to heat the shisha also can increase health risks by exposing the user to high levels of carbon monoxide, metals, and cancer-causing chemicals and by exposing both users and non-users to the carcinogens in secondhand smoke that remains in the area.

There are special concerns related to hookah use, including the risk of transmitting tuberculosis, herpes and/or hepatitis and other infectious diseases. Research shows that hookah smokers are at risk for oral, stomach, lung, and esophageal cancers, reduced lung function, and decreased fertility.

Read more about hookah in the MDHHS Position Statement on Hookah Use.

little cigars (aka cigarillos)Cigars/ Cigarillos/ Little Cigars

Cigars, cigarillos and little cigars are readily available, come in a vast array of fruit and candy flavors, and are sold individually, often for as little as 25 cents each.

dissolvable tobacco productsDissolvable Products

Dissolvable products are made either of nicotine gel, such as Nicospan, or of finely ground tobacco pressed into a stick or oval form. However, the fact that they are oral products that involve swallowing tobacco juice increases concern about oral, esophageal and stomach cancers that could arise among long-term users.

  Related Resources

 

Photo credits: The images on this page first appeared on the U.S. Food & Drug Administration webpages Recognize Tobacco in its Many Forms and Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS).