Questions About Smoking, Tobacco, and Health

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What about more exotic forms of smoking tobacco, such as clove cigarettes, bidis, and hookahs?

Many forms of flavored tobacco have become popular, especially among younger people. Flavored cigars, clove cigarettes, bidis, and hookahs often appeal to those who want something a little different. They also give young people another way to experiment with tobacco.

The false image of these products as clean, natural, and safer than regular cigarettes seems to attract some who may otherwise not start smoking. But these products carry many of the same risks of cigarettes and other tobacco products, and each has its own additional problems linked to it.

Flavored cigars

As of October 2009, federal laws have banned flavored cigarettes. It’s not illegal to have or smoke them, but it is illegal to sell them in the United States. Tobacco companies are working around this by making flavored small cigars as a replacement product, and kids and young adults are using them. See our documents Cigar Smoking and Child and Teen Tobacco Use to learn more.

Clove cigarettes

Clove cigarettes, also called kreteks (kree-teks), originated in Indonesia and other Southeast Asian countries. They contain 60% to 70% tobacco and 30% to 40% ground cloves, clove oil, and other additives. The chemicals in cloves have been linked to asthma and other lung diseases.

Users often have the mistaken notion that smoking clove cigarettes is safer than smoking regular cigarettes. But this is a tobacco product with the same health risks as cigarettes. In fact, clove cigarettes have been shown to deliver more nicotine, carbon monoxide, and tar than regular cigarettes.


Bidis or “beedies” are flavored cigarettes that originated in India and other Southeast Asian countries. They are hand-rolled in an unprocessed tobacco leaf and tied with colorful strings on the ends. Their popularity has grown in part because they come in many candy-like flavors (strawberry, vanilla, licorice, and grape), and because they tend to cost less than regular cigarettes.

Even though bidis contain less tobacco than regular cigarettes, they deliver higher levels of nicotine (the addictive substance in tobacco) and other harmful substances, such as tar, ammonia, and carbon monoxide. The higher nicotine levels give the smoker a quick buzz. Because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette. They are unfiltered.

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

Hookah (water pipes)

Hookah (or narghile, pronounced nar-guh-lee) smoking started in the India and the Middle East. Users burn flavored tobacco (called shisha [she-shuh]) in a water pipe and inhale the smoke through a long hose. It has become popular among young people.

Hookah smoking is usually a social event in which smokers talk as they pass the pipe around. It’s thought of as a safer alternative to cigarettes because the percentage of tobacco in the product smoked is low and people think the water filters out the toxins. This is false. The water does not filter out many of the toxins. In fact, hookah smoke contains more toxins such as nicotine, carbon monoxide, tar, heavy metals, and other hazardous substances, than cigarette smoke. And users breathe in secondhand smoke, as well as toxins released from the heat sources used to burn hookah tobacco. It has been suggested that in a typical 1-hour hookah smoking session, users may breathe in 100 to 200 times the amount of smoke, 9 times the amount of carbon dioxide, and nearly twice the amount of nicotine they would get from one cigarette.

Several types of cancer have been linked to hookah smoking, including lung, mouth, and bladder cancer. Hookah use is also linked to other unique risks not found with cigarette smoking. For example, infectious diseases can be spread by sharing the pipe or through the way the tobacco is prepared.

Advertisers now offer newer forms of hookah smoking that can include steam stones or even battery powered hookah pens. Both of these create a vapor that is inhaled, which makes them much more like electronic cigarettes. Some are advertised as being purer and healthier alternatives to regular hookahs, even though less is known about them.

Bottom line

All forms of tobacco are dangerous. Even if the health risks were smaller for some tobacco products as opposed to others, all tobacco products contain nicotine, which can lead to increased use and addiction. Tobacco is not safe in any amount or form.

Last Medical Review: 02/13/2014
Last Revised: 02/13/2014