Avoid tobacco in any form

DEAR DOCTOR K: Is smokeless tobacco safer than cigarettes? What about other non-cigarette tobacco products?

DEAR READER: It’s tempting to think so, but there is no safe way to use tobacco. Any level of tobacco, in any form, increases your risk of heart attack, stroke, emphysema, chronic bronchitis, pneumonia, lung cancer and other cancers.

Don’t fool yourself into thinking that any tobacco products are safe to use.

• Chewing tobacco: Tobacco can cause cancer and other health problems even when it is chewed rather than inhaled. Chewing tobacco increases the risk of cancer of the cheek and gums by about 50 times.

• Snuff: The same goes for snuff.

• Cigars: Since cigar smokers usually smoke less often than cigarette smokers, they may think their habit is a safe one. That’s a mistake. Cigar tobacco contains more nitrate than cigarette tobacco. The smoke it produces contains more toxins of various types that raise cancer and heart risks.

• Pipes: Because you didn’t inhale as deeply as with cigarettes, people thought pipe smoking was safer than the ravages of cigarettes. In fact, it’s like cigar smoking: maybe a little safer than cigarettes (except for mouth and throat cancer), but much riskier than not smoking.

• Water pipe: Hookah smoking is widely perceived to be less harmful and less addictive than smoking cigarettes or other forms of tobacco. In fact, my colleagues here at Harvard who study tobacco use say that hookahs are becoming more popular among young tobacco users. But they are as addictive as cigarettes – and perhaps even more harmful. When people smoke a water pipe, they often smoke for long periods of time.

• Electronic cigarettes:E-cigarettes, are battery-powered devices that were developed to gradually get people off cigarettes. They vaporize a solution of nicotine dissolved in water and propylene glycol, a fluid that helps nicotine dissolve. While they’re often advertised as free of cancer-causing substances, the Food and Drug Administration is not convinced.

In short, there is no safe form of tobacco.