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Alternative forms of tobacco use [Review Article]

Authors: Prignot, J. J.1; Sasco, A. J.2; Poulet, E.2; Gupta, P. C.3; Aditama, T. Y.4

Source: The International Journal of Tuberculosis and Lung Disease, Volume 12, Number 7, July 2008 , pp. 718-727(10)

Publisher: International Union Against Tuberculosis and Lung Disease

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BACKGROUND: A review of the available scientific literature concerning forms of tobacco use other than regular cigarettes, cigars and pipes, the nature of such products, prevalence data and trends, health effects, regulatory issues and preventive measures.

RESULTS: Narghile (water pipe), bidis, kreteks and other forms of oral tobacco are traditionally used in many low-income countries, and some of these are currently spreading to the Western countries. They are all linked to negative effects similar to, and often greater than, those associated with common cigarette smoking. Various potentially reduced exposure products (PREPs), including snus, targeted at smokers aware of the health risks of regular cigarettes, have recently been developed by the tobacco industry. Their pathogenic potential varies widely and is not fully known; it is in any case greater than that of pure nicotine forms (such as medicinal nicotine). Their use as cigarette substitutes should not be considered even by inveterate smokers who are unable or unwilling to quit nicotine before further independent evaluation and control.

CONCLUSIONS: There is no such thing as a safe tobacco product. Like cigarettes, alternative forms of tobacco use need regulatory measures that are adapted to local situations and supplemented by preventive measures within the World Health Organization's Framework Convention for Tobacco Control.

Keywords: PREPs; bidis; kretek; narghile; smokeless tobacco

Document Type: Review Article

Affiliations: 1: University of Louvain, Louvain, Belgium 2: Team of Epidemiology for Cancer Prevention, Institut National de la Santé et de la Recherche Médicale (INSERM) CRE U897, Bordeaux and Victor Segalen University of Bordeaux 2, Bordeaux, France 3: Healis Sekhsaria Institute for Public Health, Nav Mumbai, India 4: Pulmonology Department, University of Indonesia, Jakarta, Indonesia

Publication date: July 1, 2008

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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