Pipe Tobacco Health Risks

How the Risks of Pipe Tobacco Compare to Cigarettes

Table of Contents
View All
Table of Contents

Smoking tobacco out of a pipe has been a worldwide practice for centuries, despite pipe tobacco's health risks. Historically, pipes were used ceremonially, with the practice gradually gaining mainstream popularity over the years.

Pipe smoking has been dwindling since the 1960s, but is still favored by a small percentage (approximately 1.5%) of smokers in the United States today, especially older men. Pipe smoking is still common in Sweden, where as many as one-quarter of adult males smoke a pipe.

It is important to be aware of the health risks of pipe tobacco. Let's explore these risks and learn more about how smoking pipe tobacco compares to smoking cigarettes.

Risks of Pipe Tobacco
Verywell / JR Bee

Pipe Tobacco Ingredients

Pipe tobacco is loose-leaf tobacco most commonly grown in northern middle Tennessee, western Kentucky, and Virginia. It is fire-cured, which involves slowly smoking the drying tobacco leaves over a smoldering hardwood fire inside of a barn or structure.

The process can take days to weeks, and the end result is a tobacco that is low in sugar and high in nicotine. Most pipe tobacco is aromatic, having had a flavoring added to the finished product that gives it a depth and richness in taste and smell.

Is Pipe Tobacco Addictive?

Pipe tobacco is addictive. An average pipe bowl contains 1 to 3 grams of tobacco, with an average of 30 to 50 milligrams of nicotine per gram. Smokers don't tend to inhale pipe smoke as much as cigarette smokers, but some nicotine still reaches the bloodstream after being absorbed through the lining of the mouth.

Health Impact of Pipe Tobacco

You might think that because most pipe smokers don't inhale, the health risks are minimal. While there isn't a lot of scientific data on the health effects of pipe smoking, we do know that there are risks.

Pipe smoking is associated with a number of illnesses that are also common in cigar and cigarette smokers.


Pipe smokers face an elevated risk of cancers of the mouth, including the tongue, larynx, and throat. Smokers who inhale pipe smoke also have an elevated risk of lung, pancreatic, and bladder cancer.

Lung Disease

Pipe smokers face an increased risk of developing chronic obstructive pulmonary disease (COPD). While cigarette smoking is usually the main cause of COPD, other forms of tobacco like pipe smoking and cigars can also result in tobacco smoke inhalation and damage to delicate lung tissue.

Heart Disease

People who smoke pipes might face an elevated risk of death from heart disease, especially those who inhale the smoke. More research needs to be done in this area.

Erectile Dysfunction

Like smoking cigarettes or cigars, smoking pipe tobacco can damage blood vessels throughout the body, including those that supply blood to the penis. That is because nicotine acts as a vasoconstrictor.

Dental Problems

Smoking pipe tobacco causes damaging effects on the mouth, including bad breath, discolored teeth, gum disease, and tooth loss.

Pipe Tobacco vs. Cigarettes vs. Hookah Tobacco

You might wonder how smoking a pipe compares to other types of smoking in terms of health risks. There is data comparing pipe use to cigarette and hookah use.


Researchers who have looked at health risk differences between pipe smoking and cigarettes have concluded that they both carry essentially the same risks for early death from diseases that can be linked to tobacco, including:

  • Cardiovascular disease
  • Ischemic heart disease
  • Lung cancer
  • Stroke
  • Other smoking-related cancers

The only appreciable difference between the two forms of tobacco use is method and frequency of use. Pipe smokers tend not to inhale (as much) as cigarette smokers, and they smoke less often during the course of a day.


Hookah tobacco is smoked through a water pipe. The Centers for Disease Control and Prevention (CDC) notes that this is not a safe alternative to smoking cigarettes.

While both hookah tobacco and pipe tobacco are hazardous to health, there are some differences between the two.

Amount and Frequency

A hookah pipe bowl can contain 10 to 15 grams of tobacco (shared among a few users), while most regular pipe bowls hold 1 to 3 grams of tobacco. Hookah is typically smoked at a hookah lounge or in a social setting, so hookah smokers might only smoke once every few days or once a week. Pipe smokers also smoke infrequently, but many light up a pipe once (or a few times) a day.

Nicotine Level

A hookah session can last 45 minutes to an hour, with smokers inhaling 100 to 200 times the volume of smoke from a single cigarette.

A bowl of pipe tobacco is smaller, and smokers don't inhale as much, so getting an accurate measure of nicotine absorption is difficult. However, a 3-gram bowl of tobacco with 150mg of nicotine can deliver a small amount of nicotine into the bloodstream.


All tobacco products contain many toxins that come from a variety of sources: pesticides in the field where it is grown, additives, and chemical changes that occur when tobacco with additives is burned. Tar, arsenic, carbon monoxide, and polonium-210 are just a few of the harmful chemicals in tobacco smoke.

It is important to note that pipe tobacco often does still contain additives, so using it as an alternative to cigarettes does not mean that it is any "healthier." All tobacco products contain harmful toxins and carcinogenic compounds that can produce damaging health effects.

To date, upwards of 7,000 chemicals and 70 carcinogenic compounds have been identified in tobacco and tobacco smoke.

Federal Regulations on Pipe Tobacco

In 2016, the Food and Drug Administration (FDA) extended a rule that gives the FDA regulatory authority over all tobacco products, including pipe tobacco. The manufacture, packaging, and labeling of all tobacco products must meet FDA guidelines, as well as how products are advertised, promoted, sold and even imported.

As of Dec. 20, 2019, the legal age limit is 21 years old for purchasing cigarettes, cigars, or any other tobacco products in the U.S.

The FDA also has authority over components used with tobacco products. In this case, that would mean the pipes used to smoke the tobacco.

Labeling Guidelines

All newly regulated tobacco products in the U.S. are required to include the following warning label on packaging: "WARNING: This product contains nicotine. Nicotine is an addictive chemical."

If the manufacturer submits a self-certification form to the FDA, along with proof that their newly regulated product is nicotine-free, then the required label will read: "This product is made from tobacco."

Ultimately, federal regulation over tobacco products helps to protect consumers. While all tobacco products are hazardous to health, FDA guidelines are meant to ensure that manufacturers are not able to secretly manipulate tobacco recipes in ways that could cause more harm than they already do.

A Word From Verywell

It has been well documented that there is no safe level of exposure to tobacco smoke. This is true regardless of the form tobacco comes in. Smokers and non-smokers all face risks to their health when breathing in tobacco smoke. If you are a smoker who is trying to find an alternative to cigarettes, know that the only good choice is to wean yourself off of tobacco entirely.

There are a number of ways to quit successfully. Nicotine is highly addictive, and quitting is difficult. But it's possible to do the work now to quit and shed the limits addiction puts on your life. Others have done it, and you can, too.

13 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. King BA, Dube SR, Tynan MA. Current tobacco use among adults in the United States: findings from the National Adult Tobacco SurveyAm J Public Health. 2012;102(11):e93-e100. doi:10.2105/AJPH.2012.301002

  2. U.S. Food and Drug Administration. Pipe tobacco.

  3. Taghavi S, Khashyarmanesh Z, Moalemzadeh-Haghighi H, et al. Nicotine content of domestic cigarettes, imported cigarettes and pipe tobacco in IranAddict Health. 2012;4(1-2):28-35.

  4. Malhotra J, Borron C, Freedman ND, et al. Association between cigar or pipe smoking and cancer risk in men: a pooled analysis of five cohort studies. Cancer Prev Res (Phila). 2017;10(12):704-709. doi:10.1158/1940-6207.CAPR-17-0084

  5. Rodriguez J, Jiang R, Johnson WC, MacKenzie BA, Smith LJ, Barr RG. The association of pipe and cigar use with cotinine levels, lung function, and airflow obstruction: a cross-sectional study. Ann Intern Med. 2010;152(4):201-10. doi:10.7326/0003-4819-152-4-201002160-00004

  6. Tverdal A, Bjartveit K. Health consequences of pipe versus cigarette smoking. Tob Control. 2011;20(2):123-30. doi:10.1136/tc.2010.036780

  7. Black CE, Huang N, Neligan PC, et al. Effect of nicotine on vasoconstrictor and vasodilator responses in human skin vasculature. Am J Physiol Regul Integr Comp Physiol. 2001;281(4):R1097-104. doi:10.1152/ajpregu.2001.281.4.R1097

  8. Couch ET, Chaffee BW, Gansky SA, Walsh MM. The changing tobacco landscape: What dental professionals need to knowJ Am Dent Assoc. 2016;147(7):561-569. doi:10.1016/j.adaj.2016.01.008

  9. Centers for Disease Control and Prevention. Hookahs.

  10. U.S. Food and Drug Administration. Hookah tobacco (shicha or waterpipe tobacco).

  11. American Cancer Society. Harmful chemicals in tobacco products.

  12. U.S. Food and Drug Administration. Chemicals in cigarettes: from plant to product to puff.

  13. U.S. Food and Drug Administration. Selling tobacco products in retail stores.

By Terry Martin
Terry Martin quit smoking after 26 years and is now an advocate for those seeking freedom from nicotine addiction.