Paan, bidi and shisha
Tobacco that you do not smoke (including paan, betel quid and chewing tobacco) is not a 'safe' way to use tobacco. It causes cancer and can be as addictive as smoking. Find out the risks and how you can quit.
Chewing tobacco and cancer risk
Betel quid, paan or gutkha is a mixture of ingredients, including betel nut (also called areca nut), herbs, spices and often tobacco, wrapped in a betel leaf.
Chewing smokeless tobacco, such as paan or gutkha, is popular with many people from south Asian communities, but all forms of tobacco can harm your health.
Studies have also found that betel itself can raise the risk of cancer, so chewing betel quid without tobacco is still harmful.
Cigarettes, bidi and shisha
This is true whether you smoke cigarettes, bidi (thin cigarettes of tobacco wrapped in brown tendu leaf) or shisha (also known as a waterpipe or hookah).
Like cigarette smoke, waterpipe smoke contains cancer-causing chemicals and toxic gases such as carbon monoxide.
A 2016 analysis of several studies suggested that during 1 session on a waterpipe a person can take in up to:
- the same amount of tar as if they had smoked 25 cigarettes
- the same amount of carbon monoxide as if they had smoked 11 cigarettes
- the same amount of nicotine as if they had smoked 2 cigarettes
Quit smoking and tobacco
The most effective way to quit smoking and tobacco use is with expert help from a stop smoking adviser.
Your free local NHS Stop Smoking service can provide medication and expert support to help you quit.
Many services also offer support to help you stop using smokeless tobacco, such as paan.
You can call the Smokefree National Helpline for free on 0300 123 1044 (0300 123 1014 minicom) and ask to speak to an interpreter for the language you need.
The helpline is open 9am to 8pm Monday to Friday, and 11am to 4pm on Saturday and Sunday.
More on quitting smoking
Page last reviewed: 10 January 2019
Next review due: 10 January 2022