Smoking Is More Than Cigarettes
Smoking Is More Than Cigarettes
Linda Hyder Ferry (Associate Professor, Preventive Medicine and Family Medicine, Loma Linda University School of Medicine) gives expert video advice on: What is a 'hookah' or 'shisha'?; Are hookah or shisha water pipes safer than cigarettes?; What is a 'bidi'? and more...
What is a 'hookah' or 'shisha'?
A 'hooka' or 'shisha' is a way to heat tobacco, and bring it with suction through bubbling water, the gas, so that it cools, and then the cooled vapor is breathed into someone's lungs. It's a habit that actually originated in the Middle East and has now infiltrated the whole world. Tobacco itself was not the only thing originally breathed in 'hooka' pipes, but tobacco is what's legally supposed to be used. It's spreading around college campuses in the United States at an amazing rate. People think, oh, but this isn't like smoking that hot smoke into your lungs, it's cooler so it must be safer. And it's flavored, it frequently has a flavor, so people think this must be totally different from smoking a cigarette.
Are hookah or shisha water pipes safer than cigarettes?
In fact, research in the last few years has shown that the amount of nicotine that you get from smoking a hookah pipe or shisha through these water pipes actually has a very high level of nicotine, and it does not decrease significantly, as you would think through bubbling through water, the particulate effect in the airways - such as someone with asthma would be sensitive to. So hookah pipe smoking is not safe, and will never be safe, because tobacco particulates, when heated and burned, carry toxic, carcinogenic and addictive substances, even though the carbon monoxide level might be a little lower depending on the method you use. I would never recommend someone using that as an alternative to smoking. The other interesting thing is that when you share, or use a hookah pipe yourself, you're usually doing this for a much more prolonged period of time, not just a 3 to 7 minute puff of 6 to 10 puffs on a cigarette. So the amount of toxins you're exposed to is much higher.
What is a 'bidi'?
Bidi'ss are tobacco leaves rolled largely by the cottage industry in India and shipped around the world. These tobacco leaves sometimes have flavorings in them, or different scents in them. They're colored sometimes, and wrapped in a way, and produced in a way that they are not tracked. They are not marketed internationally by a company, and they have access to adolescents and children in a way that cigarettes typically don't, because you have to show your age. However, a "bidi" is a nicotine product, a tobacco leaf that is not safe, does not have any safety manufacturing built into it at all. The amount of nicotine you can get from a "bidi" cigarette can approximate a very small manufactured cigarette by a typical manufacturer.
Are clove cigarettes safer than traditional cigarettes?
Clove cigarettes generally do not have nicotine in them, although they can be associated with nicotine in cloves. Generally, a clove cigarette actually burns the clove particles or the whole cloves embedded into another substance. The clove cigarettes themselves do create a significant oral and airway stimulation that people can become habituated to and enjoy. If there is no tobacco in a clove cigarette, you will not become addicted to nicotine. They are not safe because there's smoke. Smoke in the lungs is not safe. Depending on the particulate, just the burning process itself is what creates a lot of the cancer producing tars. So, just because you may not have tobacco in there does not mean breathing smoke from anything, marijuana included, is safe to take into the human lung.
What are the risks of smoking herbal cigarettes?
Well, technically, nicotine from a plant is a herb. So, a tobacco cigarette is an herbal cigarette, if you make the definition that way. But, if you're talking about a non-nicotine, non-tobacco product that is lit and inhaled into the lungs from herbs. Is that safe? It is not safe, because the whole product of combustion, of tar formation, of carbon monoxide that occurs during production is damaging to the nasal, the oral, the throat, and the lung passageways where you breathe smoke in. So, no smoke is safe to take into the lungs, no matter what it is. It may not have nicotine in it that then creates a second problem, which is an addiction in the brain. But, it still creates all of the airway problems, and the increased risk of cancer. It's not nicotine itself that causes all of the cancer going through. It's all of the other products from the burnt ash, the particulate matter, and all of the sixty-three forms of cancer-producing agents you can find when you start burning up leaves of anything, herbal or tobacco.
How does a cigar differ from a cigarette?
A cigar is manufactured quite differently than a cigarette. A cigarette is a composite delivery device with crushed tobacco leaves, chemicals, and things to make it burn. It is a very complex manufacturing process to create a cigarette with the paper around the outside, with the flavors, and the aromas inside. A cigar is made quite differently. A cigar is tightly rolled specific leaves from a certain type of tobacco plant. Some of them have some flavors or aromas put in them, but most of them are "very natural" and simply are just these tightly woven and rolled up leaves. A cigar when burned, because it doesn't have all the manufacturing to make it burn effectively, is a very inefficient device to burn tobacco and inhale. Therefore its carbon monoxide levels are tremendously higher than smoking a cigarette. Carbon monoxide is not safe and all of the other particle matters that come through burnt cigarettes versus cigar smoke are different in ph levels, therefore meaning the acid and base balance, meaning where is it absorbed, the mouth, the throat or all the way into the lungs. Some cigar smoke does not get inhaled all the way into the lungs. Some cigar smokers have the tendency to puff and blow but that doesn't mean that some of the smoke is still in the air around you when you take a breath in doesn't get into your lungs.
Are cigars safer than cigarettes?
The amount of carcinogens are not much different. In fact, the nicotine can even be higher. One large fat cigar, even if it's not even lit, if it's just kept in someone's mouth, you'll absorb nicotine from just the contact of the tobacco leaf end of the cigar sitting in the mouth without it even being lit. So it acts almost like a chewing tobacco by being there. So you get nicotine from the cigar at fairly high levels, a large cigar has about as much nicotine as a casually smoked pack of cigarettes. Carbon monoxide levels are higher, and oral cancer is greater. If you don't inhale it deeply and directly into the lungs, not quite as much damage as a habitual cigarette smoker but when you balance one for the other, you cannot consider that safe.
Is it safe to smoke a cigar if I don't inhale?
Well, in reality, your mouth is a very good absorption of nicotine. So, cigar smokers have high nicotine levels. Just because you aren't breathing it into the lung, not taking the particulates down into your lungs, means that you aren't having as much distribution and trauma in that area, but you are still doing a lot more in the mouth, because cigar smoke is a lot hotter than cigarette smoke is. The damage to the lip and the tongue is actually greater with people who are cigar smokers. People who are pipe smokers have a similar effect compared to a cigarette where basically your lips are in touch with a paper or cotton filter that is not so hot and does not have tobacco in it. The second thing is that when you breathe in the smoke that you've blown out from your cigar, it still is in the air around you, and you are breathing that second hand smoke into your lungs. So, you're still getting lots of the second hand smoke burning off end of the cigar and the smoke you breathed into your mouth and blew out. It is still coming back in through your nose and back into your body and into your lungs. So, cigar smokers don't have zero effect in their lungs like non-smokers do. They think they do, but it's not true. They still have some emphysema. They still have some increased risk of lung cancer, but it is not as great a risk as the person who deeply inhales cigarette smoke into their lungs. Is cigar smoking safe? Not safe. No tobacco product used in a human body is safe.
How likely is it that a cigar smoker will develop cancer or chronic lung disease?
Cigar smokers are not immune to all of the complications we usually associate with cigarette smoking. Some people think a more natural product, a cigar or piped tobacco, is less damaging because they don't take it into their lungs, they puff it out generally, although not everyone does. And that it is safer somehow because it doesn't have additives. Well the reality is that's not true. When you look at the long term affects of people who have smoked cigars for years and people who've smoked cigarettes for the same period of time for years, the increase risk of cancer is evident compared to people who have never used those products in both users, cigar users pipe users and cigarette users, because tobacco products themselves are not safe - the way they're used, and their inherent components are not safe. Are cigar smokers at risk for the same affects as cigarette smokers? No, they aren't. They have their own. They have much higher oral cancer rates than people who are cigarette smokers because of the way its used. Because of the heat in the mouth and that puffing in the mouth is primarily the means for a cigar smoker to use that product. So, I would encourage someone who uses cigars to say, "Why? Why do I use it? What do I need from it? Am I willing to accept the risk instead and just live in denial that this is safe - safer than a cigarette?" It's not true. If you want to see some statistics get on the internet and it's not hard to find them.
Is chewing tobacco safe?
Chewing tobacco is a product used in a couple different ways. Many people call it spit tobacco because you don't generally swallow what occurs when you put saliva and chewing tobacco in someone's mouth, but chewing tobacco, or spit tobacco, sits generally in one place in someone's mouth. Most people don't have four, five or six places they keep their spit tobacco. And that place, the mucosal membranes and the gums around the teeth, react to the toxins and the carcinogens and many of the, for example benzopyrenes, which are known to be carcinogens sit there for long periods of time in contact with the mouth. You don't have that combination and end up with a safe product. One of the problems is that much of what is considered spit tobacco or chewing tobacco is fermented. So in addition to the products from the tobacco plant, you have alcohol. Alcohol and tobacco together constantly affecting the mucous membranes creates significant deterioration and increase the risk of cancer more than either one alone. So, is chewing tobacco safe? Not for baseball players, not for teenagers, not for anyone. It is not safe. It is not a safe product.