• Smoking through a waterpipe originated centuries ago in Persia
  • Growing in popularity among youth worldwide, including the U.S.
  • The most understudied of all cigarette alternatives, and potentially the most dangerous
  • Falsely perceived to be safe and non-addictive
  • Have many of the same biological effects on the lungs and cardiovascular system as cigarettes  
  • More research is needed to provide the foundation for accurate consumer education



  • Have the same lung-injury risks as cigarettescigar
  • Curing and fermenting process of cigar tobacco leads to more toxins than cigarettes, even for small cigars
  • One large cigar has as much tobacco as a whole pack of cigarettes
  • Small, flavored cigars tend to appeal to younger smokers
  • Use is increasing among adolescents and educated, higher-earning adult males and females
  • May be a gateway to cigarette smoking


Electronic cigarettes

  • Battery-operated devices with cartridges that deliver nicotine vapor when users inhaleE-cigarette © iStockphoto
  • Rapidly gaining in popularity, especially among youth, those with proximity to cigarette smokers, former smokers and smokers seeking to quit traditional cigarettes
  • Could potentially reduce cigarette use among current smokers
  • Have fewer side effects than smoking-cessation medications
  • Have the potential to be a bridge to cigarette use among younger and new tobacco users
  • More research is needed to determine the safety risks, which so far are unknown


Smokeless tobacco

Smokeless tobacco © iStockphoto
  • Can be inhaled, chewed or sucked
  • All forms include carcinogens, however in some products at lower levels than cigarettes
  • Inhaled forms are more associated with greater lung toxicity than other forms
  • Noninhaled forms could be linked with pancreatic cancer and cardiovascular disease
  • Swedish-style version called snus is air-dried or sun-cured to form a moist powder that is placed under the upper lip
  • Snus could have fewer health risks than cigarettes and help reduce cigarette smoking