Fundamentals of Tobacco Interventions
Module1
Tobacco Products
A cigarette is a highly engineered drug delivery device that is designed to transfer nicotine to the brain as quickly as possible, which creates a greater potential for addiction. In fact, cigarettes deliver nicotine to the brain in as little as 10 seconds (Zevin, Gourlay & Benowitz, 1998).
While many of your clients may smoke cigarettes, you should be aware of other types of tobacco products. Your clients may use more than one product and their use may impact their ability to quit tobacco.
The information below outlines types of other tobacco products as well as the harms associated with their use.
Blunts are composed of a hollowed out cigar (removal of the tobacco) that is filled with cannabis (marijuana).
Harms: The cigar paper (tobacco leaf) used in a blunt contains nicotine and tobacco, which may interact with the cardiovascular and subjective effects of cannabis (Penetar et al., 2005).
Hookah/Shisha/Waterpipes/Nargileh: flavoured tobacco mixed with molasses is smoked by allowing charcoal heated air to pass through a perforated piece of aluminum foil. This smoke is “pulled” through the mechanism (by the inhalation of the user), cooled as it bubbles through the water in the base, and then passed through a hose and into the mouthpiece (Maziak, 2013).
Harms: The smoke produced from a water pipe contains numerous toxins that are known to cause lung cancer, heart disease, and other diseases (Knishkowy & Amitai, 2005).
Chew is composed of cut tobacco leaves, known as a ‘wad’, which is placed between the cheek and gum.
Harms: Smokeless tobacco has been associated with:
- Precancerous oral lesions,
- Periodontal disease,
- Kidney cancer,
- Oral cancer,
- Pancreatic cancer,
- Cancer of the digestive system (Ebbert et al., 2011).
Snuff is composed of fermented, ground-up moist tobacco that is usually placed between the bottom lip and gum, referred to as “dipping.”
Harms: Smokeless tobacco has been associated with:
- Precancerous oral lesions,
- Periodontal disease,
- Kidney cancer,
- Oral cancer,
- Pancreatic cancer,
- Cancer of the digestive system (Ebbert et al., 2011).
Snus is the Swedish form of Snuff and has lower levels of risk as it is sterilized, thereby decreasing the number of nitrosamines (carcinogens) in the product (Mayo Clinic, 2011).
Harms: Smokeless tobacco has been associated with:
- Precancerous oral lesions,
- Periodontal disease,
- Kidney cancer,
- Oral cancer,
- Pancreatic cancer,
- Cancer of the digestive system (Ebbert et al., 2011).
Pipes are not as popular as other forms of tobacco. The tobacco used in pipes delivers the nicotine in a more alkaline state that allows it to then be absorbed by the oral or nasal mucosa (Slade, 1993).
Harms: Pipes use similar tobacco to cigars and chew and thus have a similar level of toxicity (Slade, 1993).
Dissolvable tobacco are products composed of finely ground tobacco compressed into sticks, strips and orbs that dissolve in the mouth and do not require any spitting (Mishina & Hoffman, 2014).
Harms: Little is known about the harms of dissolvable tobacco; however, they also contain nicotine and are addictive (Mishina & Hoffman, 2014).
Cigars are a variation on the traditional cigarette, wrapped in tobacco leaf wrappers. Cigarillos are a cigarette-sized cigar and can often be found in various flavoured forms.
Harms: May lead to higher carbon monoxide intake per gram of tobacco burned as well as higher levels of nitrogen oxides, carcinogenic nitrosamines, and ammonia (Shopland, 1998).
Herbal cigarettes are cigarettes that do not contain tobacco or nicotine but instead contain natural ingredients (e.g., rose petals).
Harms: While this product may not contain many of the other compounds found in tobacco products, there is harm associated with the combustion of any materials as it produces carbon monoxide and other carcinogens.
Reflection
Take a moment and reflect on the various types of tobacco products that your clients use. Do you routinely ask your clients if they use other tobacco products beyond cigarettes? What are some questions you can ask your clients to ensure that you are capturing all individuals who use tobacco?