CHAPTER types of tobacco use Smoking tobacco 1 Tobacco smoking is the act of burning dried or cured leaves of the tobacco plant and inhaling the smoke. Combustion releases biochemically active compounds in tobacco, such as nicotine and TSNA, and allows them to be absorbed through the lungs.

Smokeless tobacco ROLL-YOUR-OWN MANUFACTURED CIGARETTES igarettes account for the largest share of manufactured Smokeless tobacco is usually consumed orally or nasally, without burning or combustion. Roll-your-own Manufactured cigarettes are tobacco products in the world—96 percent of total There are two main types of smokeless tobacco: snuff and chewing tobacco. (RYO) cigarettes are the most commonly consumed sales. Except for chewing tobacco in India and smoking cigarettes hand-filled tobacco products worldwide. C They consist of shredded or of kreteks in Indonesia, cigarettes are the most common method by the smoker from of consuming tobacco throughout the world. fine-cut, loose tobacco reconstituted tobacco, processed with hundreds of chemicals and The invention of the cigarette-rolling machine in 1881 rolled in a cigarette paper. RYO cigarette rolled into a paper-wrapped accelerated the tobacco pandemic by mass-producing pocket- cylinder. Usually tipped with a DRY SNUFF smokers are exposed sized packets of cigarettes. Unlike tediously hand-rolled to high concentrations cellulose acetate filter, they cigarettes and bulky water pipes, manufactured cigarettes offered Dry snuff is powdered tobacco of tobacco particulates, tar, nicotine, and tobacco-specific nitrosamines are lit at one end and inhaled a convenient and portable method to maintain addiction, even that is inhaled through the nose (TSNAs), and are at increased risk for developing cancers of the mouth, through the other. and absorbed through the nasal while driving a motor vehicle, working in a factory, or taking a pharynx, larynx, lung, and esophagus. MOIST SNUFF mucosa or taken orally. Once Most Prevalent: Worldwide stroll. widespread, particularly in Europe, Most Prevalent: Europe and New Zealand In the current era of economic globalization, some forms of the use of dry snuff is in decline. tobacco, historically localized to specific regions of the world Most Prevalent: Europe (such as the hookah and bidi), have spread to every continent. CIGARS For instance, Indonesian kreteks—clove-flavored, loosely packed Cigars are made of air-cured and fermented tobaccos with a tobacco-leaf wrapper. The long aging and tobacco cigarettes—are currently being marketed to youth in fermentation process produces high concentrations of carcinogenic compounds that are released on many industrialized countries. These regional forms of tobacco combustion. The concentrations of toxins and irritants in cigars are higher than in cigarettes. Cigars come in many shapes and sizes, from cigarette-sized cigarillos to double coronas, cheroots, stumpen, chuttas, sometimes gain footholds in new countries based on their exotic Moist snuff is a small amount of ground and dhumtis. In reverse chutta and dhumti smoking, the ignited end of the cigar is placed inside the mouth. cachet, but they rarely, if ever, displace manufactured cigarettes tobacco held in the mouth between for a significant market share. Instead, they frequently serve as the cheek and gum. Manufacturers are Most Prevalent: Worldwide a gateway to addiction, luring youth and other fad smokers into increasingly prepackaging moist snuff lifelong dependence on cigarettes. into small paper or cloth packets to make the product more convenient. Other moist snuff products are known as khaini, snus, BIDIS KRETEKS shammaah, nass, or naswa. Bidis consist of a Kreteks are clove-flavored cigarettes widely Most Prevalent: Worldwide small amount of smoked in Indonesia. They may contain a wide sun-dried, flaked range of exotic flavorings and eugenol, which tobacco hand- has an anesthetic effect, allowing for deeper and wrapped in dried more harmful smoke inhalation. temburni or Chewing tobacco tendu leaf Most Prevalent: Indonesia Oral smokeless tobacco products are placed in the mouth, cheek, or inner lip and (Diospyros sp.) sucked (dipped) or chewed. Tobacco pastes or powders are similarly used, placed and tied with string. on the gums or teeth. Sometimes referred to as “spit Despite their small size, WATER PIPES bidis deliver more tar and tobacco” because users spit out the built-up tobacco Water pipes, also known as shisha, hookah, narghile, carbon monoxide than manufactured cigarettes juices and saliva, this mode of tobacco consumption or hubble-bubble, operate by water filtration and became associated with American baseball players because users are forced to puff harder to keep There is no safe way to indirect heat. Flavored tobacco is burned in a smoking during the twentieth century. The tobacco industry bidis lit. Bidis are found throughout South Asia use tobacco—whether bowl covered with foil and coal. The smoke is cooled ! exploited these sports heroes to market their tobacco and are the most heavily consumed smoked inhaled, sniffed, sucked, by filtration through a basin of water and consumed products to youth. Smokeless tobacco causes cancer in tobacco products in India. or chewed; whether through a hose and mouthpiece. humans and leads to nicotine addiction similar to that some of the harmful Most Prevalent: South Asia produced by cigarette smoking. Most Prevalent: North Africa, the Mediterranean region, ingredients are reduced; and parts of Asia. or whether it is mixed There are many varieties of smokeless tobacco, including with other ingredients. plug, loose-leaf, chimo, toombak, gutkha, and twist. Pan masala or betel quid consists of tobacco, areca nuts (Areca catechu), slaked lime (calcium hydroxide), sweeteners, and flavoring agents wrapped in a betel leaf (Piper betel). There are endless varieties of pan masala, PIPES STICKS including kaddipudi, hogesoppu, gundi, kadapam, zarda, Pipes are made of briar, slate, clay, or other substances. Tobacco is Sticks are made from sun-cured pattiwala, kiwam, and mishri. placed in the bowl, and the smoke is inhaled through the stem. In tobacco and wrapped in cigarette Southeast Asia, clay pipes known as sulpa, chillum, and hookli are paper—for example, hand-rolled Most Prevalent: India widely used. brus.

Most Prevalent: Worldwide Most Prevalent: Papua New Guinea 20 21