Alternative Tobacco products
Hookahs - water pipes
Kreteks - clove cigarettes
Bidis - flavored cigarettes
HOOKAHS (Water Pipes)
Hookah (narghile, water-pipe) smoking is a common form of tobacco use in countries such as China, India, Pakistan, and many countries in the Middle East. Recently, the phenomenon has spread in the United States and Europe with the growth of Eastern and Arab cultures. Hookahs vary widely in shape and size, but the basic design includes: a head, consisting of a ceramic bowl with a conical cap; a metal body which is attached to a glass bottle partially filled with water; and a flexible tube with a mouthpiece affixed to the neck of the bottle. The tobacco (shisha, maassel, tumbâk, jurâk; moist, shredded tobacco mixed with sweeteners such as honey, molasses, and fruit) is placed in the head of the hookah with a heating apparatus (usually charcoal). Combustion begins in the head, where the smoke then passes through the water in the body of the pipe where it is cooled and diluted before traveling through the hose where the smoker inhales it.
Photo derived from: http://www.hooka-hookah.com/
The risks of waterpipe smoking are not as well known as the risks of cigarette smoking, but a growing body of research is exploring the risks. Many waterpipe smokers believe that hookah smoke is less harmful that cigarette smoke. This false belief leads many individuals to initiate tobacco use with waterpipe smoking. in a 30-60 minute smoking session, hookah smokers often inhale the equivalent amount of smoke that one would inhale smoking a pack of cigarettes. Many smokers believe that the water in the hookah will filter out any harmful toxins, making it safer to smoke than cigarettes. The water filtration in a hookah reduces some toxins, but does not reduce the level of tar inhaled from the smoke, which contains the most carcinogens. Hookah smokers may be at greater risk than cigarette smokers, as overall, waterpipe smokers are exposed to greater amounts of nicotine, carbon monoxide, and other toxins. 9
In addition, because of several factors, such as the low burning temperature of the tobacco and the air pressure required to inhale the smoke, waterpipe smokers often inhale much deeper, allowing the smoke to penetrate the lungs more deeply. Other health concerns of waterpipe smoking include the spread of infections diseases, such as tuberculosis, aspergillus, and heliobacter, which can be spread through the sharing of the pipe or by the uncontrolled process in which the tobacco is made. 9
KRETEKS (Clove Cigarettes)
Kretek is the Indonesian name for a clove cigarette. Most clove cigarettes are imported from Indonesia and are similar to American cigarettes in many ways. Clove cigarettes contain a mixture of shredded clove buds and tobacco, which produces a distinct, pungent smell. Clove cigarette smoke contains more nicotine, tar, and carbon monoxide than conventional cigarettes.6 Clove smokers are at greater risk for acquiring an acute lung injury, as well as developing abnormal lung functioning than non-smokers.7,8
Photo derived from: http://en.wikipedia.org/wiki/Kretek
Rates of adult kretek smoking in the U.S. are not known, but an estimated 2% of middle school students and 3% of high school students are current kretek smokers, with kretek smoking being more common among males than females.5
BIDIS (flavored cigarettes)
Bidis (pronounced "bee-dees") are thin, hand-rolled, filter-less cigarettes, consisting of flavored or unflavored tobacco wrapped in a tendu or temburini leaf (plants indigenous to India and Southeast Asian countries), and may be tied with a colored string at either end. Bidis are popular because they come in a wide variety of flavors (e.g., vanilla, strawberry, mango) and due to their size, resemble marijuana cigarettes. Bidis may be perceived as less harmful or more natural than conventional cigarettes. However, bidi smoke contains higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States. Also, due to the nature of the leaf wrapper, smokers must puff bidis with greater frequency than conventional cigarettes.1,2 Indian research studies indicate that bidi smokers are at greater risk for developing oral, lung, stomach, and esophagus cancer, as well as coronary heart disease, acute myocardial infarction, and chronic bronchitis than non-smokers.2,3,4
Photo derived from www.bullybeef.co.uk/beedies.htm
While prevalence rates of adult bidi smoking in the U.S. are not known, 2% of middle school students and 3% of high school students are current bidi smokers, with bidi smoking being more commonly used among males than females.5
References:
1 Watson, C., Polzin, G., Calafat, A., & Ashley, D. (2003). Determination of tar, nicotine, and carbon monoxide yields in the smoke of bidi cigarettes. Nicotine & Tobacco Research, 5, 747-753.
2 Rahman, M. & Fukui, T. (2000). Bidi smoking and health. Public Health, 114, 123-127.
3 Nayak, K., Gett, S., Sharda, D. & Misra, S. (1989). Treadmill exercise testing in asymptomatic chronic smokers to detect latent coronary heart disease. Indian Heart Journal, 41, 62-65.
4 Gupta, P., Murti, P. & Bhonsle, R. (1996). Epidemiology of cancer by tobacco products and the significance of TSNA. Critical Reviews in Toxicology, 26, 183-198.
5 Centers for Disease Control and Prevention (2005). Tobacco use, access, and exposure of tobacco in media among middle and high school students - United States, 2004. Morbidity & Mortality Weekly Report, 54 (12), p. 298.
6 Malson, J., Lee, E., Murty, R., Moolchan, E., & Pickworth, W. (2003). Clove cigarette smoking: Biochemical, physiological, and subjective effects. Pharmacology, Biochemistry, and Behavior, 73, 739-745.
7 Mangunnegoro, H. & Sutoyo, D. (1996). Environmental and occupational lung diseases in Indonesia. Respirology, 1, 85-93.
8 Anonymous. (1988). Evaluation of the health hazard of clove cigarettes. Council on Scientific Affairs. Journal of the American Medical Association, 260, 3641-3644.
9 Knishkowy, R. & Amitai, Y. (2005). Water-pipe (Narghile) smoking: An emerging health risk behavior. Pediatrics, 116, e113-e119.
Click here for link to full-text article.
10 Hatsukami, D. K. & Zeller, M. (2004). Tobacco harm reduction: The need for research to inform policy. Retrieved from
http://www.apa.org/science/psa/sb-hatsukami.html, April 2007.
11 Hamilton, W. L., diStefano-Norton, G., Ouellette, T. K., Rhodes, W. M., Kling, R., & Connolly, G. N. (2004). Smokers' responses to advertisements for regular and light cigarettes and potential reduced-exposure tobacco products. Nicotine & Tobacco Research, 6 (Suppl. 3), S353-S362.
