A device that heats tobacco without burning claims to be safer than cigarettes. Don’t be fooled into thinking it’s harmless! There is no safe type of tobacco use.
These heat-not-burn tobacco products became legal in the United States in 2019. They are different from vape pens, pod-based devices like JUUL, and e-cigarettes.
What is IQOS?IQOS is a brand of heated tobacco products that is being marketed as “a better alternative to smoking.” Because the tobacco is heated, the company claims that it has less chemicals than burned tobacco. These claims are based solely on research conducted by the tobacco industry. Independent studies are needed to help understand the health effects of using heat-not-burn devices.The IQOS heat-not-burn device uses a disposable tobacco unit called called a “HEET” or “HeatStick” filled with compressed ground tobacco, which is inserted into an electronic holder. Each “HeatStick” contains about the same amount of nicotine as one cigarette. An electronic heat element warms the stick and releases an aerosol that the user inhales.
Facts about heat-not-burn tobacco devices:
They produce an aerosol that contains nicotine, chemicals, additives, and flavorings by heating tobacco.
They contain about the same amount of nicotine as traditional cigarettes.
They are available in convenience stores and specialty shops.
They are NOT the same as e-cigarettes: these products use tobacco to deliver nicotine, whereas e-cigarettes use a liquid to deliver nicotine.
They give off secondhand aerosol that is unsafe to breathe (like a cigarette).
Heated tobacco products are NOT safe!
Heated tobacco products contain tobacco. There is no safe type or level of tobacco use, and there is no evidence that heated tobacco products are safer than traditional cigarettes.
They also contain many chemicals and components that have been designated as harmful by the FDA, including:
Carbon Monoxide
Nicotine
Heavy metals like arsenic, lead, and mercury
Acetone (found in nail polish remover)
Ammonia (found in fertilizers and household cleaners)
Benzene (found in gasoline)
This device can lead teens to become lifelong smokers.
Companies that make products like e-cigarettes and vape pens claim they can help smokers quit. But evidence is showing they lead to traditional cigarette use and are a way for the tobacco industry to attract new customers.
Beware of their sale to youth. Heated tobacco products are sleek, high-tech devices that are being designed and marketed in ways that are known to attract youth. While the legal age to buy tobacco products, including IQOS, is 21, online stores don’t always ask for proof of age.
Heated tobacco products are highly addictive: IQOS and other heated tobacco products contain nicotine. Teens and young adults are easily addicted to nicotine. The US Surgeon General has declared that youth use of nicotine in any form is unsafe.
Menthol flavors are used to lure teens: For decades, the tobacco industry has used menthol and other flavors to attract young smokers. Menthol masks the harshness of cigarette smoke, making them easier to smoke and harder to quit. Menthol cigarette use is more common among young smokers than other age groups.
Prevention is the most effective way to protect kids from tobacco.
E-cigarettes are exploding in popularity and are being used by both adolescents and adults. These products are not a safe alternative to cigarette smoking.
What are e-cigarettes?
E-cigarettes, personal vaporizers, vape pens, e-cigars, pod systems, e-hookah, or vaping devices, produce aerosolized liquid that contains nicotine and other substances inhaled by the user. They can resemble traditional tobacco products like cigarettes, cigars, pipes, or common gadgets like flashlights, flash drives, or pens.
The liquid solution used in e-cigarettes is usually flavored and appeals to children and adolescents. While flavors were nationally banned in 2019, this ban excludes mint and menthol flavors. Additionally, this ban excludes disposable e-cigarette devices, which are sold in many appealing flavors, are relatively inexpensive, and are increasingly popular with adolescents.
How common are e-cigarettes?
E-cigarettes are the most commonly-used tobacco product among teens. In 2020, e-cigarettes remained the most common tobacco product used by high school (20%) and middle school (5%) students in the last 30 days. Children are exposed to e-cigarette advertising in the media, and in magazines and billboards. Although it is illegal for e-cigarettes to be sold to youth under age 21, they can be ordered online.
Why e-cigarettes are not safe
The solution in e-cigarette devices and vapor contains harmful chemicals like antifreeze (made from one of two chemicals: propylene glycol or ethylene glycol), diethylene glycol, and aldehydes (like formaldehyde) which is ranked as one of the most significant cardiovascular toxins also found in cigarette smoke
Secondhand smoke/vapor from e-cigarettes is harmful to growing lungs. In fact, studies show long-term, measurable effects on lung health, function, and development.
The nicotine in e-cigarettes is addictive and can harm brain development.
Youth who use e-cigarettes are more likely to smoke traditional cigarettes in the future.
In some cases, e-cigarette devices have exploded, causing burns or fires.
E-cigarettes can be used to smoke or “vape” marijuana, herbs, waxes, and oils.
Due to the lack of regulation, the chemical compounds in an e-cigarette device can vary between brands.
Are e-cigarettes good way to help quit smoking?
E-cigarettes are not recommended as a way to quit smoking. They are not yet regulated nor approved for smoking cessation by the U.S. Food and Drug Administration. The long-term health effects to users and bystanders are still unknown.
The best way to protect your children is to never smoke or vape near them. Talk with your doctor about quitting all tobacco. Never smoke indoors, in your car, or in places that children spend time.
Remember
It’s important to help protect children and teens people from using or being exposed to the harmful vapor from e-cigarettes. Talk with your pediatrician for more information about these products and keeping your child safe and healthy.
In a world where the tobacco industry is constantly adjusting their strategies to get new users hooked, it can be hard for parents to keep up with all the dangerous forms of tobacco available. Tobacco companies market their products in several forms, and while some may look harmless, all have the potential to cause health problems.
In addition to cigarettes, there are many other forms of tobacco that parents should be aware of.
Note: Because the tobacco industry is always coming up with new products, this page is a constant work in progress.
Other forms of smoking
E-cigarettes: E-cigarettes are a type of electronic smoking device. Some people do not view using an e-cigarette as smoking, and instead call it “vaping.” E-cigarettes are available in a wide variety of youth-friendly flavors, and can be refilled with liquid. This liquid often contains nicotine—a highly addictive chemical. Young children have been poisoned and killed from these liquid nicotine containers. E-cigarettes are very popular with youth. A recent Centers for Disease Control and Prevention (CDC) survey showed that e-cigarettes are the tobacco product teens use the most—even more than cigarettes.
Heat-Not-Burn Tobacco Products: Heat not burn products, such as IQOS, are marketed by tobacco companies as a better alternative to smoking because the tobacco is heated, not burned. However, these products still contain nicotine, which is highly addictive, in addition to chemicals, additives, and flavorings that are unsafe to inhale or breathe secondhand.
Cigars: A cigar is a large, tightly rolled bundle of tobacco wrapped in leaf tobacco (or another substance containing tobacco) that is smoked. Cigars contain the same carcinogens as cigarettes, so that even if cigar smoke is not inhaled, cigar smokers are still at risk from the carcinogens in the smoke they produce. Cigars are sold in a variety of flavors, and can be purchased in low numbers, which make them both cheap and popular with youth. The U.S. Food and Drug Administration (FDA) does not yet regulate cigars.
Little cigars and cigarillos: Little cigars are sold in larger packs, and typically come with filtered tips, indicating that they are meant to be inhaled like cigarettes. Little cigars usually contain 1 gram of tobacco, whereas cigarillos are a little larger than little cigars, and typically contain 3 grams of tobacco. The FDA does not yet regulate little cigars or cigarillos.
Hookah: Hookahs, or waterpipes, are a more socially-oriented form of tobacco use. Groups of people sit around a hookah, and tobacco—usually flavored—is heated, filtered by water, and passed through a hose to a mouthpiece, where it is inhaled, then passed to the next person in the group. Hookah use can lead to several types of cancers, as well as heart and lung diseases. In addition, because multiple people are sharing a mouthpiece, there is also a risk of hepatitis, herpes, and tuberculosis. Hookah bars and lounges are gaining popularity as a way for people to socialize and embrace multiculturalism while smoking. These lounges are especially popular with younger populations like college students and teens.
Bidis: A bidi is a hand rolled, leaf-wrapped cigarette. Bidis can be tied with a string at one or both ends. A bidi can be flavored with child-friendly flavors like chocolate or cherry. The amount of nicotine in bidi smoke is 3-5 times higher than the amount of nicotine in cigarette smoke. Several research studies have found that many of the same health problems associated with cigarettes can be common with bidi use.
Kreteks: Known as cloves or clove cigarettes, kreteks contain a rolled mixture of tobacco, cloves, and other additives. As with bidis, kretek use can cause some of the same health problems that cigarette smoking causes such as difficulty breathing, coughing up blood, and other lung problems.
Menthol cigarettes: Providing a cool, minty sensation, menthol cigarettes mask the harshness of smoking. Menthol’s cooling, numbing properties may permit larger puffs, deeper inhalation or allow smoke to stay in the lungs for a longer period of time, and is used as a local anesthetic to relieve throat irritation. Menthol cigarettes are popular with African American smokers—83% of African American smokers smoke mentholated cigarettes, compared to only 24% of White smokers. The FDA’s Tobacco Products Scientific Advisory Committee has concluded that removing menthol cigarettes from the market will improve the public health of the U.S., and the FDA is determining whether regulatory actions should be taken.
Forms of smokeless tobacco
Many people falsely believe that because there is no smoke, there is no danger. This is not true. Smokeless tobacco still contains many dangerous chemicals and ingredients that can cause harm to the body. In addition, some forms are easier to disguise use, as there is no tell-tale smoke. This may make it easier for children to use tobacco products.
Chewing tobacco: Known as spit tobacco, or chew, chewing tobacco can come in loose-leaf strips of shredded tobacco leaves, or in the form of a plug, where the tobacco is pressed together, wrapped in a tobacco leaf, then twisted to resemble a rope. The most common form is loose-leaf, which means the strips of tobacco are sweetened and packaged in a foil pouch. In each form, the user takes a piece from the package, and places it in their mouth, between their gums and cheek. Chewing tobacco users are at risk for gum loss, cancers, stained teeth, and oral sores.
Snuff: Snuff is also referred to as pinch, or dip, and is a finely-ground form of tobacco that can be either dry or moist. Dry snuff is often a powder-like consistency, and can be inhaled through the nostrils, taken orally, or placed between the gums and cheek, as is common to do with moist snuff.
Snus: Snus is moist snuff that originated in Sweden. Snus is dispensed in packets, or sachets (like miniature tea bags), and placed between the gums and cheek. Snus contains between 3-10mg of nicotine (compared to about 1.5mg in cigarettes), depending on the portion size, and is marketed as a safer alternative to smoking for scenarios when smoking is prohibited. Snus is also designed so that there is no need to spit the product juices out, as is the case with other forms of smokeless tobacco, and this may make the product more attractive to teens. Snus contains many of the same dangers as other smokeless forms of tobacco, despite intense marketing as a safer alternative to cigarettes.
Pellets and other candy-like forms of tobacco: Tobacco that is meant to dissolve in the user’s mouth is given the broad term “dissolvable tobacco.” Several tobacco companies have created dissolvable tobacco in the form of sticks, strips, or orbs. This can incorporate the orbs (which resemble tic tac candies), strips (resembling breath strips that you place on your tongue to freshen your breath), and sticks (resembling slightly larger toothpicks) that are currently in some markets around the U.S. These items resemble candy or mints, and are easy to mistake for candy or mint packaging, making it a danger to children. These dissolvable forms of tobacco typically dissolve in anywhere from three minutes (for a strip) to 30 minutes (for a stick), and the nicotine content in each differs—some contain more nicotine than a typical cigarette, some contain less. There is a significant concern for accidental overdose by youth that may not recognize these products as tobacco. A child putting several orbs in their mouth at the same time, thinking they are candy, could consume a dangerous amount of nicotine at once.
Many of these forms of tobacco are available in flavors and are easier to get than cigarettes. The American Academy of Pediatrics (AAP) recommends that flavors be banned from all tobacco products, , and that tobacco product prices be increased so that it is harder for teens to get these products.
Some of these forms are commonly found in social settings, and it is important to have conversations with your children about abstaining from tobacco use, and resisting peer pressure.
Chewing tobacco, snuff, snus, and dissolvable tobacco in the shape of sticks, pellets, and strips are all types of tobacco products that are not smoked but used in other ways. All types of smokeless tobacco contain nicotine and chemicals that may cause cancer (carcinogens).
Chewing Tobacco
Chewing tobacco comes in 3 forms:
Loose leaves
Plugs
Twists or rolls
A piece (plug, wad, or chew) of tobacco is placed between the cheek and gum. Users chew on it for several hours and spit out the tobacco juices and saliva as they build up.
Snuff and Snus
Snuff and snus are ground tobacco. Moist snuff and snus are sold in cans or sachets (pouches that look like tea bags). Users put a pinch of moist snuff between the cheek or lip and gum. Sachets are placed between the cheek and gum. Dry snuff is a powdered form sold in cans. A pinch of dry snuff can be placed in the mouth or sniffed up the nose.
Other Forms of Smokeless Tobacco
The newest forms of smokeless tobacco are finely ground dissolvable tobacco that is flavored and shaped into sticks, pellets, or strips. These forms melt in the users’ mouth within 3 to 30 minutes, delivering nicotine. These new stick forms of smokeless tobacco contain 3 times more nicotine than an average cigarette. These forms of tobacco are not widely available as other types, and tobacco companies have been known to target specific areas to test these products out.
Smokeless Tobacco is Addictive
Nicotine in smokeless tobacco is what gives users a buzz. It also makes it very hard to quit.
Every time smokeless tobacco is used, the body gets used to the nicotine and starts to crave it. Craving is one of the signs of addiction. Another sign of addiction is called tolerance. This is when the body adjusts to the amount of tobacco needed to get a buzz. With continued use, more and more tobacco is needed to get the same feeling.
Many smokeless tobacco users say it is harder to quit smokeless tobacco than cigarettes.
Smokeless Tobacco is Not Safe
Some people believe smokeless tobacco is OK because it does not cause health problems from smoke and smoking. This does not make smokeless tobacco safe, however. Some smokeless tobacco delivers more nicotine than cigarettes, making addiction more likely. There are also direct effects of smokeless tobacco on the mouth.
Bad breath. Smokeless tobacco can give you really bad breath and discolored teeth. This will not help anyone’s social life.
Dental problems. Smokeless tobacco’s direct and repeated contact with the gums causes the gums to recede and become diseased, leading to loose teeth. Many forms of smokeless tobacco also contain sugar. This mixes with the plaque on the teeth to form acid that eats away at tooth enamel to cause cavities and chronic painful sores.
Cancer. Cancer of the mouth (including the lip, tongue, and cheek) and throat can occur most often at the spot in the mouth where the tobacco is held. Surgical removal of cancer is often needed, and parts of the face, tongue, cheek, or lip must often be removed too.
Leukoplakia. A white, leathery-like patch called leukoplakia may form in the mouth. The patches vary in size and shape and can become cancerous. If you have a patch in your mouth, your doctor should examine it right away.
Other harmful effects:
Heart problems. The constant flow of nicotine into your body causes many side effects including increased heart rate, increased blood pressure, and sometimes irregular heartbeats, which may increase risk for sudden death from a condition (ventricular arrhythmias) in which the heart does not beat properly.
Nicotine poisoning. The new forms of smokeless tobacco look like candy or breath strips, making them attractive to all ages, even children. While tobacco from a cigarette tastes bitter and unpleasant, the new forms are minty and flavorful, increasing their potential for poisoning.
Smokeless Tobacco is Popular with Youth, Too Smokeless tobacco is not used by adults alone—recent surveys from the Centers for Disease Control and Prevention (CDC) have shown that youth are using smokeless tobacco more frequently, and in addition to other types of tobacco products.
The American Academy of Pediatrics (AAP) recommends that prices for tobacco products be raised to discourage use by youth and that use of tobacco products in media (TV, movies, video games) be banned. The AAP supports a movement to eliminate smokeless tobacco use by Major League Baseball players. A few cities have already banned smokeless tobacco from their baseball parks.
Tips to Quit
Trying to quit can be difficult, but it is not impossible. Here are some tips:
Pick a quit date and throw out all of your smokeless tobacco products.
Ask for help. You can successfully quit with help and support!
Call your doctor.
Go online to a smokeless tobacco quitting resource, such as http://mylastdip.com.
Call a national toll-free telephone counseling resource, such as 1-800-QUIT-NOW.
Ask your friends, family, teachers, and coaches for support and encouragement. Tell friends you are quitting and ask them to not offer you smokeless tobacco or other nicotine products. Ask a friend to quit with you.
Chew on something else. A few good examples are sugarless gum, pumpkin or sunflower seeds, or apple slices.
Stay busy with healthier activities. You could work on a hobby, listen to music, or volunteer your time. Exercise can help relieve any tension caused by quitting. Try biking, walking, running, or other sports.
Everyone is different, so develop a personalized plan that works best for you. Set realistic goals so you will be more likely to achieve them.
Reward yourself. Save the money that you would have spent on smokeless tobacco and use it for something special. Treat yourself to your favorite restaurant, a special purchase, or an event. Spend time with family and friends who are supportive.
Early Signs of Oral Cancer
Your chances of being cured are higher if oral cancer is found early. Check your mouth often, looking closely at the places where you hold the tobacco. See your doctor right away if you have any of the following:
A sore that bleeds easily and does not heal
A lump or thickening in your mouth or neck
Soreness or swelling that does not go away
A red or white patch that does not go away
Trouble chewing, swallowing, or moving your tongue or jaw
If you use smokeless tobacco, your doctor and dentist should carefully examine your mouth at each checkup.
