"Exotic" Smoking Practices (Hookah, Bidis and Clove Cigarettes)

"Exotic" smoking has often been promoted as a safe alternative to traditional tobacco products. The following article describes the health risks associated with these practices and provides resources for quitting tobacco altogether.

Bidis or "beedies"

These unfiltered, sometimes flavored cigarettes are mainly imported from and used in India. They contain higher concentrations of nicotine, tar, and carbon monoxide than standard cigarettes. Because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette, and also require deeper puffs than are used during smoking of standard cigarettes. 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, chronic bronchitis, and some cancers than non-smokers. Bidi smoking is associated with lung, mouth, laryngeal (voice box), esophageal, and stomach cancers. The health risks are increased as the amount smoked and the number of years one has smoked increases.

Hookah (water pipes)

Hookah (or narghile) smoking started in the Middle East. Flavored tobacco (called shisha) is burned in a water pipe and the smoke is inhaled through a long hose. It is marketed as being a "safe" alternative to cigarettes based on claims that the percentage of tobacco in the product smoked is low, and the water may act as a filter to remove toxins; however, these claims are false! In fact, hookah smoke contains more toxins such as nicotine, carbon monoxide, tar, and other hazardous substances, than cigarette smoke. Hookah tobacco contains all of the carcinogens and chemicals that cigarette tobacco does. A 1-hour hookah smoking session exposes smokers to 100-200 times the amount of smoke from a single cigarette. Hookah smoking delivers the same amount of nicotine as a cigarette, so it may be equally addictive.

Hookah smokers are at risk for the same cancers as cigarette smokers: lung, mouth, esophagus, and stomach. The toxins in the smoke are also known to cause heart and lung diseases. Hookah pipes are often communally used and are not well cleaned, which poses a risk of spreading infectious diseases such as herpes, hepatitis, tuberculosis, the common cold, strep, and COVID-19.

Clove Cigarettes

Clove cigarettes, also called kreteks, are a combination of tobacco, clove products (clove oil and ground cloves) and other additives, imported from Indonesia. Because these are mostly a tobacco product (60-80% of the cigarette is tobacco), they have the same risks as cigarette smoking. Some think that smoking clove cigarettes is a safe alternative to smoking tobacco. But clove cigarettes are a tobacco product with the same health risks as cigarettes. The chemicals in cloves have been linked to acute lung injuries, asthma, and other lung diseases.

Are You Ready to Quit Smoking?

Quitting is beneficial, no matter how long a person has smoked tobacco. Quitting smoking has major health benefits that start right away. This is true even for people who already have a smoking-related disease or cancer. Some say that it is too late to quit smoking because the damage is already done is not true. It is never too late to quit smoking!

Symptoms of withdrawal from tobacco

Stopping or cutting back tobacco use can cause nicotine withdrawal, which can affect a person both physically and mentally. Physically, the body is reacting to the absence of nicotine. Mentally and emotionally, one is faced with giving up an addiction, which calls for big changes in behavior and routine. Both the physical and mental factors must be dealt with to quit and stay smoke-free.

Those who have used tobacco regularly for a few weeks or longer, and suddenly stop or greatly reduce the amount used, may have withdrawal symptoms. Symptoms usually start within a few hours of the last cigarette, dip or chew and get worse about 2 to 3 days later when most of the nicotine and its by-products are out of the body. Quitters may experience: 

• Dizziness may last 1 or 2 days after quitting.
• Feelings of depression, frustration, impatience, anger, anxiety, and irritability. 
• Trouble sleeping including trouble falling asleep, staying asleep, and having bad dreams or nightmares. 
• Trouble concentrating and restlessness.
• Headaches. 
• Increased appetite.

Withdrawal symptoms can last for a few days to up to several weeks. These uncomfortable feelings can lead you to start using tobacco again, but remember they will get better every day that you stay tobacco-free! Nicotine replacement products and other medications can help you get through the tough times. There are also resources online and in the community - learn more in the resources for quitting below.

Resources for Quitting

Quitting tobacco is not easy, but you can do it! Whether you're a smoker or someone who uses smokeless tobacco, to have the best chance of quitting and staying smokefree, you need to know what you're up against, what your options are, and where to go for help. Below are some resources that will help you.

Smoking cessation. Where do I start?
Start here for help in creating a plan to quit, tips for coping with common obstacles and resources for support and smoking cessation programs.

Smoking Cessation Aids
This article reviews the available treatments, both pharmacologic (drug) and non-pharmacologic, to aid in successful smoking cessation.

Life After Tobacco

Unfortunately, quitting tobacco cannot completely erase the damage done from previous smoking. You should always be honest with healthcare providers about your smoking history and be aware of the risks associated with this history.

As recommended by the American Cancer Society, you should tell your healthcare provider about any of the following symptoms:

• Any change in a cough (for example, you cough up more phlegm or mucus than usual).
• A new cough.
• Coughing up blood.
• Hoarseness.
• Trouble breathing.
• Wheezing.
• Chest pain.
• Loss of appetite.
• Weight loss.
• Feeling tired all the time (fatigue).
• Frequent lung or respiratory infections (like pneumonia or bronchitis).
• Development of sores or white patches in your mouth.