Alternative Smoked Tobacco Products

Hookahs (Water Pipes)

A hookah (also known as narghila) is a tobacco water pipe consisting of a bowl, body, water basin, and one or multiple hoses. Please click here to view more information about hookah.

Why do people use hookahs?

• Some believe that hookah smoke is less harmful than cigarettes because it is filtered through water¹.
• College student users tend to claim that smoking hookah is an alternative to cigarettes or drinking².
• In addition to the chemicals and carcinogens that come from burning tobacco, hookah smoke has additional chemicals from the burning charcoal³.

Kreteks (Clove Cigarettes)

• Kretek is a cigarette blended with tobacco and shredded clove buds⁴.
• Research does not support the belief that clove cigarettes are safer than conventional cigarettes⁵.
• Analyses indicate that smoke produced from clove cigarettes deliver more nicotine, tar, and carbon monoxide than conventional cigarettes⁵.
• Current research indicates that clove cigarettes pose similar health risks posed by conventional cigarettes such as lung cancer and general respiratory problems⁶.
• In 2009, cigarettes flavored with “fruit, candy, or clove” were banned by the Family Smoking Prevention and Tobacco Control Act⁷. Since then, clove filtered small cigars (no longer cigarettes) have become available⁸. The difference being that they are now wrapped in tobacco rather than paper.

Percentage of U.S. students who were current Kretek smokers in 2012⁹

These rates are lower than in 2009¹⁰. Current use was based on self-reported use in the past 30 days^9,10.

• Middle School – 0.5% of all students
  • 0.4% of female students
  • 0.6% of male students
• High School – 1.0% of all students
  • 0.5% of female students
  • 1.5% of male students

Bidis

• Bidis (also spelled beedi or beedie; pronounced "bee-dees") are hand-rolled filter-less cigarettes that consist of tobacco wrapped in a tendu leaf (Diospyros mebunoxylon)¹¹, a plant native to India and Sri Lanka.
• Bidi users are exposed to three times the tar of a conventional cigarette¹².
• Bidis require more puffs per minute to stay lit than conventional cigarettes¹³. This can subject users to increased levels of carcinogens.
• A variety of studies have found that bidi use is associated with greater likelihood of developing several oral-related problems as well as some chronic conditions¹¹ such as:
  • Esophageal cancer¹⁴
  • Stomach cancer¹⁵
  • Lung Cancer¹⁶

• Workers who hand-roll bidis are exposed to tobacco dust and flakes—resulting in detectable levels of biomarkers such as cotinine in workers with no tobacco habit(fix up sentence)^17,18. Bidi rolling is associated with chromosomal abnormalities¹⁹. This appears to be due to tobacco dust inhalation and general tobacco exposure by workers²⁰.

Percentage of U.S. students who were current bidi smokers in 2012⁹

These rates are lower than in 2009¹⁰. Current use was based on self-reported use in the past 30 days^9,10.

• Middle School – 0.6% of all students
  • 0.4% of female students
  • 0.7% of male students
• High School – 0.9% of all students
  • 0.5% of female students
  • 1.3% of male students

The notion that hookah, clove cigarettes, and bidis are safe alternatives to conventional cigarettes is not supported. Research indicates that they can cause equal or greater harm than conventional cigarettes to individuals who use them.

 

Additional Resources:

• TobaccoFree.org: Reducing Hookah Use
• Center for Disease Control:  Hookah Fact Sheet
• Food and Drug Administration: Extending Authorities to Additional Tobacco Products
• Center for Disease Control and Prevention: Tobacco Product Use in Middle and High School Students 2011 & 2012
• CNN Freedom Project: Information about Bidi Child Workers