Cigarettes aren’t the only way people use tobacco…


Chewing tobacco is a form of smokeless tobacco, most popular amongst South Asian communities, which comes in the form of leaves or plugs which you chew inside your cheek. Chewing tobacco consists of betel quid, also known as “paan” or “gutkha” and is a mixture of ingredients that includes the betel or areca nut, herbs and spices; these are then all wrapped inside a betel leaf. The chewing releases the flavour and nicotine, producing excess saliva, before it is spat out.

There are many misleading messages, mainly from manufacturers, regarding the safety and benefits of chewing tobacco. Like cigarettes, it still releases chemicals and poisons. Due to the chemicals being released in your mouth, and sometimes the tobacco juices swallowed, there is a significantly increased risk of throat, oesophagus, stomach and pancreatic cancers – but the most prevalent is mouth cancer, with users of chewing tobacco being four times more likely to suffer. Cancer Research UK notes that there is good evidence that using smokeless tobacco also increases the risk of liver cancer as well as heart disease and periodontal disease. Betel nut, one of the main ingredients of chewing tobacco, can cause cancer itself, so chewing betel quids can cause mouth cancer, even if no tobacco is added.


It is a common misconception that smoking roll-ups is more natural, organic and pure than tailor-made cigarettes and therefore doesn’t contain as many chemicals. However, roll-up tobacco is grown in the same place and manufactured in the same factories as tailor-made cigarettes. In fact, all manufactured cigarettes are tested for smoke yields and rolled tobacco generally comes out with higher levels of tar and nicotine, as well as exposing users to the same 4,000+ chemicals as tailor-made cigarettes. Many roll-up smokers don’t use a filter which only further increases the risk of negative health problems, including infertility, heart disease, lung disease and cancer, in particular mouth, oesophagus, pharynx and larynx cancers. Despite any attempts to control the amount of tobacco used in roll-up cigarette, no amount of tobacco is safe.


Waterpipes, also known as hookah, shisha or hubble-bubble pipes, are predominantly used to smoke tobacco, but can be used to smoke other products as well. Typically, the tobacco is mixed with fruit flavours and sugar syrups – the smoke is then passed through water before being inhaled. Traditionally, waterpipes are used in the Middle East, but shisha bars can be found all over the UK.

It is a common misconception that smoking waterpipes is less harmful and less addictive than other forms of smoking, with the belief being that the water filters out the harmful substances. Waterpipes still produce significant levels of tar, nicotine, carbon monoxide, nitric oxide and various carcinogens (cancer causing chemicals). A World Health Organisation study has suggested that during one session on a waterpipe (approximately 1 hour), a person can ‘puff’ around 200 times, which is the equivalent of consuming 100 cigarettes (based on 20 puffs per cigarette).


Cigars are tobacco wrapped in tobacco leaves and unlike shop bought cigarettes do not normally have filters. It is reported that a single large cigar can contain as much tobacco as an entire pack of cigarettes and contains more nicotine. Actually, cigars contain elevated levels of most toxins found in cigarettes, due to their size and the tobacco fermentation process. This means there is an increased risk of negative health effects such as of gum disease, tooth loss and cancer of the oral cavity (mouth, throat, lip and tongue).


In pipes, the tobacco often sits in a bowl, with a stem that connects the bowl to the mouthpiece and at times can be equipped with a filter. Although, with a pipe you do not typically inhale the smoke, the same health risks still apply due to there being the same toxins and carcinogens (cancer causing chemicals) present. These health risks include: teeth problems, gum, heart and lung disease and cancer, in particular oral cancer.

Did you know…

If you have a lung condition, you might feel that you have already damaged your lungs and that there is little point in giving up.

In fact, it is never too late to quit smoking, and giving up could help you to feel a lot better.  If you have a lung condition such as COPD, you are more likely to feel increasingly breathless if you smoke or if you are exposed to second-hand smoke.  Giving up smoking is the most important thing you can do to stop your condition getting worse.

By quitting, you can significantly slow down the speed at which you are losing lung function, and improve your quality of life, and that of those around you.