Continuum of Risk

Different nicotine products carry different levels of risk. Understanding where each product falls on the continuum can help you make informed decisions about your health.

Cigarettes carry the highest health risks of all nicotine products.

As you move from left to right on the chart, the level of harm increases. Nicotine gum, patches, and lozenges pose significantly less risk than combustible products. The lowest level of risk is to use no nicotine at all.

The “risk” in the products shown in this chart comes mostly from how nicotine is delivered. Cigarettes contain over 7000 toxic compounds (commonly known as “tar”). These compounds are created by burning tobacco, and many are known to cause cancer or other diseases. Vaping and heated tobacco products avoid burning but still contain chemicals that deliver nicotine and added flavors into your lungs. Some new vaping devices have as much nicotine as five packs of cigarettes and can be more addictive than cigarettes. Pouches and lozenges may be the safest way to deliver nicotine, but they also contain high concentrations of nicotine.

Using both cigarettes and e-cigarettes — known as dual use — will not reduce your health risk. The biggest health benefits come from fully switching to a lower-risk product or quitting entirely.

Cutting down on cigarettes is only effective when part of a strategy to stop smoking entirely. If you simply reduce your number of cigarettes you smoke, you are likely to inhale more deeply or smoke each one more intensively to get the same level of nicotine.

Different nicotine products carry different levels of risk. Understanding where each product falls on the continuum can help you make informed decisions about your health. The idea that you can lower your risk of tobacco-related disease by using other nicotine products is controversial.

Cigarettes carry the highest health risks of all nicotine products, but no nicotine product is risk-free. Read what experts are saying.

Electronic cigarettes or vaping devices do not burn tobacco and therefore have much lower risk than cigarettes. These devices have evolved rapidly to become smaller and deliver higher doses of nicotine. They all involve heating a liquid that contains nicotine, ethylene glycol (which is used to create fog in theatrical productions) small quantities of metals and flavoring chemicals. Other chemicals may be formed during the heating process which creates a vapor which is inhaled. As vaping devices are relatively new, the long-term effects are unknown.

Heat-not-burn technology as used in the IQOS device uses gently heated tobacco for flavor and the vaping technology for delivering nicotine. As with vaping, the long-term effects are unknown.

Nicotine pouches are small fibrous sacks that contain powdered nicotine salts. The nicotine is absorbed through the mucous membranes of the mouth. The main risk is the absorption of large amounts of nicotine, which can cause palpitations and reflux.

Snus is a moist, smokeless tobacco product traditionally used in Sweden and Norway. It is placed under the upper lip, where nicotine is absorbed through the oral mucosa.