HomeHealth For YouThere's No Safe Way To Smoke: Alternate Tobacco Products Are Just As Harmful

There's No Safe Way To Smoke: Alternate Tobacco Products Are Just As Harmful

E-cigarettes are one of the alternative tobacco products that have been banned by the Ministry of Health. 

Along with increasing global efforts to reduce the prevalence of tobacco cigarette smoking, many non-cigarette forms of tobacco and nicotine have inevitably emerged in the past few decades. Some of these include bidiskreteksnarghile (water pipes), snus (Swedish moist snuff) as well as other forms of oral tobacco. And consumption of these alternative tobacco products has been on the rise in developed nations, due to factors such as the mistaken belief that they are less hazardous than cigarettes, false advertising as well as unrecognised addiction. 

In fact, the Ministry of Health (MOH) in Singapore has recognised this, recently announcing a ban on alternative tobacco products ("Alternative tobacco products to be banned" The Straits Times, 16 June 2015). By August 2016, all alternative tobacco products with the exception of traditional cigarettes, tobacco derivatives and medicinal products registered under the Medicines Act will be prohibited.

The harmful effects of tobacco and nicotine usage have well-documented and thus, as a country, we should be aggressive in reducing the number of tobacco cigarette smokers in order to ensure a healthier community. 

While non-cigarette products are often touted as safer alternatives to cigarette smoking, many studies have proven otherwise. According to experts from the International Agency for Research on Cancer (IARC), smokeless tobacco products can contain up to 30 cancer-causing agents. One of these carcinogens are the tobacco-specific nitrosamines (TSNA) which are formed during the growing, curing, fermenting and ageing of tobacco. Research evidence has also found that smokeless tobacco can cause precancerous lesions and cancer, especially of the oral cavity, particularly at the site of tobacco placement.

Studies in India, Pakistan and Sudan concur, describing large increases in the risk of oral cancers related to the use of different smokeless products. Another study from Sweden further suggests an association between the use of snus and risk of type 2 diabetes and use during pregnancy affecting the weight of infants. 

Various studies have shown that individuals who use alternate tobacco products like electronic cigarettes, oral tobacco,narghile, cigars and snus all report varying degrees of health consequences. For example, emissions from e-cigarettes contain ultra-fine particles which travel deep into the lung and cause tissue inflammation. The mist contains at least 10 chemicals known to cause cancer, birth defects and/or reproductive harm. Oral tobacco users also suffer from unrecognised addiction, possible cancers of the head, mouth, neck, throat, as well as oral health concerns like bad breath and tooth decay. And while users often perceive narghile to be safer than cigarettes, it actually produces significantly higher levels of toxic gases and cancer-causing chemicals due to the involvement of charcoal. Lastly, studies have also evidenced that with cigars, the risk of lung cancer can increase up to 2.5 times that of non-smokers. 

Another product which has emerged from tobacco companies are moist smokeless products that are spitless, of which snus is widely regarded as a "harm reduction" product among Swedish men. Much of the health effects of snus are conflicting, although it is known that they can deliver relatively high doses of nicotine. This then fuels concerns that increased use of snus may lead to nicotine dependence, resulting in smoking as a 'gateway effect'. In fact, recent data from Sweden has stated that among those who start with snus, 20% later go on to pick up smoking. 

Why then, is the usage of alternative tobacco products so prevalent despite its documented adverse effects?

Unlike in the case with cigarettes, scientific knowledge about alternative tobacco products remain obscure and limited, making it difficult for policymakers to regulate users' access to their products. Alternative tobacco products also remain an endorsements to smokers who want to quit smoking and as a result, studies have shown that the use of alternate tobacco products do not promote or aid with the number of successful attempts to quit. Furthermore, advertising tactics by manufacturers often oversell the purported albeit unsubstantiated health benefits. Consumers, especially young adults users, are generally confused or lack the understanding of the health risks and cases of unrecognised addiction associated with using different "trendy" tobacco products and alternate tobacco products. 

It is imperative to understand that the health risks of alternative tobacco products are comparable, if not, greater than that of conventional cigarettes. We need to be diligent in being updated and understanding innovation trends in the tobacco industry, in order to better put in place effective strategies that will limit promotion, marketing and use of alternative tobacco products. 

Be ahead of innovation in tobacco industry

This letter was first published in The Straits Times Forum on 18 June 2015, Wednesday (A29). 


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