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When it comes to the dangers of tobacco use, it doesn’t matter whether you smoke it, chew it, or inhale it. There is no safe way to indulge in tobacco use.


While most of the research about the harmful effects of tobacco has focused on cigarette smoking, researchers are now discovering that many of the harmful effects are the same or worse when it comes to the use of “smokeless” tobacco products, as well as secondhand smoke.

In a recent study of 27,000 people from 52 countries, Canadian researchers found that tobacco use was one of the most important causes of heart attacks around the world. This research concluded that all forms of tobacco use and exposure, including chewing tobacco and secondhand smoke, significantly increased the risk of heart attacks.

Some of the specific findings included:

  1. Chewing tobacco more than doubles heart attack risk. Chewing and smoking increases the risk more than fourfold.
  2. Just one to seven hours of secondhand-smoke exposure per week increases heart attack risk by 24%.
  3. More than 21 hours a week of secondhand smoke exposure increases the heart attack risk by 62%.
  4. Switching to a water pipe won’t help. It still increases the risk of heart attack.

Smokeless Tobacco Is Just As Dangerous

While the dangers of smoking cigarettes have been big news for many years, the similar dangers of smokeless or “spit” tobacco have been less well publicized. Some tobacco companies are taking advantage of this gap in the public perception about chewing tobacco. As smoking continues to be banned in more and more public places, tobacco companies are positioning smokeless tobacco products – chewing tobacco and “snuff” – as alternative ways to indulge in tobacco use. (Chewing tobacco is generally large, loose leaves of tobacco; snuff is finely ground tobacco that comes loose in a can or contained in a small bag, and is inserted between the cheek and gum.)

“Tobacco of any kind contains nicotine and other harmful chemicals that are addictive and dangerous,” says Patrick Carter, MD, Chief of Family Medicine at Kelsey-Seybold Clinic. “It’s a misconception that smokeless tobacco products are any safer than cigarettes. In fact, sometimes these products can be even more addictive, as they generally deliver a higher dose of nicotine. A cigarette has about 1.8 mg of nicotine, but an average dose of snuff has about 3.6 mg and chewing tobacco is 4.6 mg.”

More Young People Are Smoking

Disturbingly, smokeless tobacco use is higher among young people. According to the CDC's 2004 National Youth Tobacco Survey, about 5.9% of high school students and 2.9% of middle school students reported using “spit” tobacco at least once in the 30 days before the survey. Not surprisingly, male students were more likely to use spit tobacco than female students, as professional athletes, particularly baseball players, are commonly seen using it on TV.

Smokers Are at Risk for Heart Disease and Stroke

There are many physiological mechanisms that link tobacco products to heart disease, but one of the most prominent reasons is that nicotine, the addictive substance in tobacco, causes your heart to beat faster and your blood pressure to go up.

Nicotine has also been shown to reduce blood flow to blood vessels’ interior lining, called the endothelium. Damage to the endothelium is an early marker of atherosclerosis, which is the build-up of plaque in the arteries that can block blood flow and lead to heart attacks and strokes.

“Regardless of how users get the nicotine from tobacco, it ends up in the bloodstream,” explains Dr. Carter. “With smoking and second-hand smoke, the nicotine enters through the lungs, then enters the bloodstream. With chewing tobacco and snuff, it enters the bloodstream through the gums and the digestive system. However, the nicotine does the same damage regardless of how it is absorbed.”

Even as far back as 1986, the US Surgeon General warned that the use of smokeless tobacco is not a safe substitute for smoking cigarettes or cigars, primarily because these products cause various cancers and non-cancerous conditions. “However, now we know that heart disease is also a major risk,” says Dr. Carter. “So, here is yet another reason to quit tobacco if you’ve started, or not to start using tobacco in the first place.”

Another problem that smoking has in common with other forms of tobacco use: they are both addicting and they are both difficult habits to break. But the good news is that there is more support than ever if you want to quit tobacco use in any form.

Ask Your Doctor for Help

“The most important first step in quitting is deciding that you are going to quit,” explains Dr. Carter. “The psychological battle is just as important as the physical battle to quit nicotine. Once you’ve made up your mind, then talk to your personal doctor. There are many methods and medications that can help people overcome nicotine addiction. Your doctor can help you decide the best plan for you.”

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Patrick Carter, MD, MBA, FAAFP

​​I try to have an open, friendly relationship with my patients so that they can feel comfortable asking and telling me anything. I enjoy seeing patients over long periods of time, because I feel a long-term doctor-patient relationship is the best way to give and receive medical care. I also like to laugh and have fun with my patients; I think it often does more good than medications.