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©2013 UpToDate ® Print Email Alternate forms of tobacco Alternate names Description Comments Smoked tobacco Cigar Cigarillo, figurado Depending on size, nicotine content may be up to 4 times that of a cigarette. Hookah Pipes, waterpipe, hubble bubble, narghile, shisha Lit tobacco bubbles through water and inhaled through a shared mouthpiece. Use of black 'air-cured' tobacco has higher risk of esophageal cancer. The filtering effect of water does not make it less dangerous. Bidi Hand-rolled, leaf-wrapped cigarette, often with sweet flavors such as chocolate or cherry. Nicotine content is 3 to 5 times that of a cigarette. Kretek Clove cigarette Rolled mixture of tobacco, cloves, and other additives. Smokeless tobacco Chewing tobacco Chew, spit tobacco Shredded tobacco leaves, often sweetened, and available as loose-leaf, "plug" or "twist". It is used by holding it in the mouth between the gum and cheek. Chewing tobacco is associated with substantial risks for gum disease, mouth cancer, and oral sores; it also causes stained teeth, bad breath, and loss of taste. Snuff Pinch, dip Finely ground tobacco, either dry or moist. Dry snuff is usually inhaled through the nostrils; moist snuff is usually held in the mouth for absorption, similar to chewing tobacco. Similar to above chewing tobacco. Snus A form of moist snuff, dispensed in packets or sachets. These are held in the mouth for absorption, similar to chewing tobacco, but designed so that spitting is not required. Nicotine content is 2 to 6 times that of a cigarette. Dissolvable tobacco Dissolvable tobacco strips, sticks, or orbs (pellets similar to tic-tac candies). Delivers 1/2 to 2 times the nicotine of a cigarette. Allows for covert use of tobacco; risk of inadvertent toxic ingestion by young children. High content of un-ionized nicotine leads to rapid absorption and potentially increases nicotine toxicity. e-cigarette Electronic cigarette, vapor cigarette Battery powered device that provides doses of nicotine for inhalation. A nicotine-containing liquid is put into the device in a cartridge or in drops. e-cigarettes are widely available from internet sources. Health risks relative to cigarette smoking, and value in smoking cessation, if any, remain unclear. Courtesy of Drs. Marianna Sockrider and JB Rosen