Positions of medical organizations , the World Health Organization<unk> ates that<unk>  use is a significant part of the overall world tobacco problem." , the American Cancer Society<unk> ates that "Using any kind of spit or<unk>  is a major health risk. It's less lethal than smoking tobacco, but less lethal is a far cry from safe." , the National Cancer Institute<unk> ates that "because all tobacco products are harmful and cause cancer, the use of all of these products should be<unk> rongly discouraged. There is no safe level of tobacco use. People who use any type of tobacco product should be urged to quit". A panel of experts convened by the National Institutes of Health (NIH) in 2006<unk> ated that the "range of risks, including nicotine addiction, from<unk>  products may vary extensively because of differing levels of nicotine, carcinogens, and other toxins in different products". According to a 2002 report by the Royal College of Physicians, "As a way of using nicotine, the consumption of non-combustible tobacco is of the order of 10–1,000 times less hazardous than smoking, depending on the product". As long ago as 1986, the advisory committee to the Surgeon General concluded that the use of<unk>  "is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous oral conditions and can lead to nicotine addiction and dependence". Smoking cessation Quitting<unk>  use is as challenging as smoking cessation. There is no scientific evidence that using<unk>  can help a person quit smoking. Harm reduction , the World Health Organization<unk> ates that "There is no evidence to recommend that any<unk>  product should be used as part of a harm reduction<unk> rategy." Tobacco companies that sell<unk>  products promote them as harm reduction products and a less harmful substitute to cigarettes. Safety<unk>  products vary extensively worldwide in both form and health hazards, with some evidently toxic forms such as from South Asia, and some forms with less hazards such as snus from Sweden. It is correlated with a number of adverse effects such as dental disease, oral cancer, oesophagus cancer, and pancreatic cancer, cardiovascular disease, asthma, and deformities in the female reproductive system. A correlation was identified between<unk>  and risk of fatal coronary artery disease and fatal<unk> roke. Use of<unk>  also seems to greatly raise the risk of non-fatal ischaemic heart disease among users in Asia, although not in Europe. It is estimated the safety risk of<unk>  is similar to that of electronic cigarettes, which has about 1% of the mortality risk of traditional cigarettes.<unk>  is not a healthy alternative to cigarette smoking. There is no safe level of<unk>  use. The declines in<unk>  initiation among adolescents and young adults is particularly relevant to improving the health of the nation because<unk>  use is often linked to subsequent cigarette initiation.<unk>  users can experience these negative health consequences at any age.<unk>  accounts for an abundance of deaths globally with a significant proportion of them attributed to Southeast Asia. Youth use of tobacco in any form is unsafe. Carcinogenicity Graphic from the 2016 Centers for Disease Control and Prevention report entitled<unk> : Health Effects.|alt=Graphic from the 2016 Centers for Disease Control and Prevention report entitled<unk> : Health Effects. The text<unk> ates,<unk> , like chew and dip, can cause CANCER of the MOUTH, ESOPHAGUS, AND PANCREAS." All tobacco products contain toxicants, and<unk>  products contain cancer-causing chemicals. The carcinogenic compounds occurring in<unk>  vary widely, which rely upon the kind of product and how it was manufactured. A 2017 review found "Overall, 28 carcinogens have been rigorously identiﬁed across a range of major<unk>  products, primarily from 3 groups of compounds: nonvolatile, alkaloid-derived TSNAs; N-nitrosoamino acids; and volatile N-nitrosamines. Among these carcinogens, researchers identify TSNAs as the most abundant in<unk>  and the most carcinogenic." The amounts of nicotine in saliva from using<unk>  could be at amounts that can cause cytotoxicity, according to in vitro<unk> udies. Other chemicals found in tobacco can also cause cancer. These include: A radioactive element (polonium-210) found in tobacco fertilizer. Chemicals formed when tobacco is cured with heat (polynuclear aromatic hydrocarbons—also known as polycyclic aromatic hydrocarbons). Harmful metals (arsenic, beryllium, cadmium, chromium, cobalt, lead, nickel, mercury). Products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in<unk> , eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers. The metabolic activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen, and micronuclei, which are an indicator of genotoxicity. These effects lead to further DNA damage and, eventually, oral cancer.<unk>  can cause white or gray patches inside the mouth (leukoplakia) that can lead to cancer. The World Health Organization has classified<unk>  products as human carcinogenic compounds, in particular tobacco-specific nitrosamines, which account for 76 to 91% of the total N-nitroso compound (NOC) burden. A 2014 review found there is "a number of ethnically linked<unk>  types that contain areca nut, a Group 1 carcinogen. Use of areca nut-containing<unk>  is known to cause oral cancer, yet despite this, prevalence is increasing in the Western Pacific." N-nitrosonornicotine and ketone are group 1 carcinogens to humans. These two nitrosamines found in<unk>  products are the main agents for the majority of cancers in<unk>  users.
Smokeless tobacco
Dissolvable tobacco
Heated tobacco product
Herbal smokeless tobacco
Herbal cigarette
Tobacco smoke
Cigarette
Electronic cigarette