Other forms of tobacco favored by young people

Kreteks and bidis

Clove and other flavored cigarettes are used mostly by younger smokers. They are nearly ideal in design as a “trainer cigarette” — giving kids another way to experiment with tobacco and get addicted to nicotine. The false image of these products as clean, natural, and safer than regular cigarettes seems to attract some young people who might otherwise not start smoking. But they are not safer than cigarettes, and each has its own additional problems.

New federal laws banned flavored cigarettes as of October 2009; it’s not illegal to have or smoke them, but it is illegal to sell them in the US. They can still be found in online shops hosted from other countries. US tobacco companies are working around this ban by making flavored small cigars (see the next section) as a replacement product.

Clove cigarettes (kreteks)

Clove cigarettes, also called kreteks (kree-teks), are a tobacco product with the same health risks as cigarettes. They are mainly sold from Indonesia or other Southeast Asian countries. Kreteks contain 60% to 70% tobacco and 30% to 40% ground cloves, clove oil, and other additives. They deliver more nicotine, carbon monoxide, and tar than regular cigarettes.

Kretek smokers have higher risks of asthma and other lung diseases than non-smokers. Kreteks can cause lung problems right away, such as lower oxygen levels, fluid in the lungs, and inflammation. Regular kretek smokers have up to 20 times the risk for abnormal lung function (blocked airways or poor oxygen uptake) compared with non-smokers. But kretek users often have the mistaken notion that smoking clove cigarettes is a safe alternative to smoking tobacco — this is not true.

Flavored cigarettes (bidis)

Flavored cigarettes, called bidis or beedies, are mainly sold from India or other Southeast Asian countries. They have become popular with young people in the United States in recent years. This is in part because they are sold in candy-like flavors such as chocolate, cherry, strawberry, licorice, and orange. Some people think they are safer and more natural than regular cigarettes. They tend to cost less than regular cigarettes and they give the smoker a quick buzz due to the high levels of nicotine.

Bidis are tobacco hand-rolled in a tendu or temburi leaf (plants native to Asia) and tied with colorful strings on the ends. Even though bidis contain less tobacco than regular cigarettes, they deliver 3 to 5 times more nicotine than regular cigarettes. They are unfiltered. And because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette.

Bidis appear to have all of the same health risks of regular cigarettes, if not more. Bidi smokers have much higher risks of heart attacks, heart disease, emphysema, chronic bronchitis, and some cancers than non-smokers.

Cigars

Cigars are often thought to be less harmful, less addictive, and more stylish than cigarettes — though this is not true. Since 1998, small cigars have been the fastest growing product on the cigar market. They look much the same as cigarettes except for their color, and are also sold in packs.

Because they are cigars, they are not taxed as much or regulated the way cigarettes are. This makes them cheaper and easier for kids to get. Since the widespread use of small cigars is fairly recent, most surveys haven’t asked about them separately from large cigars. But a 2010 study of 12th graders found that 30% of boys and 16% of girls had smoked small cigars in the past year.

Another appeal to youth is the flavorings commonly used in small cigars. Fruit, candy, and chocolate flavors attract kids. US laws have made flavored cigarettes illegal, which seems to have prompted some to use flavored small cigars instead. It’s expected that the small and flavored cigar problem will get even worse as tobacco companies take advantage of the lack of regulation of these products.

Cigars are just as addictive and deadly as cigarettes. The smaller ones are often inhaled and smoked every day, just like cigarettes. Even when cigar smoke is not inhaled, smokers are breathing cigar smoke from the air around them. It’s no wonder that cigars cause many of the same types of cancer and other illnesses as cigarettes.

You can learn more about cigars and the ways tobacco companies are using them to get around tobacco taxes and regulations in our document called Cigar Smoking.

Hookahs (water pipes)

Hookah is also called narghile (nar-guh-lee) smoking. It started in Asia and the Middle East. It involves burning tobacco that has been mixed with flavors such as honey, molasses, or dried fruit in a water pipe and inhaling the flavored smoke through a long hose. Usually, the tobacco mixture, which is called shisha (she-shuh), is heated using charcoal. Hookah smoking is usually a social event which allows the smokers to spend time together and talk as they pass the pipe around. It’s becoming more and more popular among younger people in Western countries. A 2011 study found that 26% of high school students surveyed had used a hookah, and about 11% had smoked one in the past month. For young people, hookahs are a popular and socially acceptable way to smoke tobacco.

Hookahs are marketed as being a safe alternative to cigarettes. This claim is false. The water does not filter out the toxins. In fact, hookah smoke has been shown to contain concentrations of toxins, such as carbon monoxide, nicotine, tar, and heavy metals, that are as high or higher than those that are seen with cigarette smoke. People tested after hookah smoking have been found to have higher levels of carbon monoxide in their blood than those who had smoked a cigarette.

Several types of cancer, including lung cancer, have been linked to hookah smoking. Hookah is also linked to other unique risks not associated with cigarette smoking. For example, infectious diseases including tuberculosis (which can infect the lungs or other parts of the body), aspergillus (a fungus that can cause serious lung infections), and helicobacter (which can cause stomach ulcers) may be spread by sharing the pipe or through the way the tobacco is prepared.