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

Author: Marisa Healy, BSN, RN
Last Reviewed: September 25, 2023

"Exotic" smoking is often claimed to be a safer option 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 have higher levels of nicotine, tar, and carbon monoxide than standard cigarettes. Because they are thinner, you need to take about 3 times as many puffs per cigarette and will need deeper puffs than with standard cigarettes.

Bidis seem to have all the same health risks as 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 sold as being a "safer" alternative to cigarettes based on claims that the amount of tobacco smoked is lower and that the water may act as a filter to remove toxins. These claims are false! In fact, hookah smoke has more toxins (nicotine, carbon monoxide, tar, and more) than cigarette smoke. Hookah tobacco has all of the chemicals that cigarette tobacco does. A 1-hour hookah smoking session exposes smokers to 100-200 times more smoke than from a single cigarette. Hookah smoking delivers the same amount of nicotine as a cigarette, so it may be just as 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 shared with others 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 mix 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. The chemicals in cloves have been linked to lung injuries, asthma, and other lung diseases.

Are you ready to quit smoking?

Quitting is good for your health, no matter how long you have smoked tobacco. There are health benefits that start right away when you quit. This is true even for people who already have a smoking-related disease or cancer. It is never too late to quit smoking!

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

You may have withdrawal symptoms if you have used tobacco regularly for a few weeks or longer and suddenly stop or reduce the amount you use. Symptoms often start within a few hours of your last cigarette, dip, or chew and get worse about 2 to 3 days later. If you quit, you may have:

  • Dizziness that may last 1 or 2 days after quitting.
  • Feelings of depression, frustration, impatience, anger, anxiety, and irritability.
  • Trouble sleeping (falling asleep, staying asleep, and having bad dreams or nightmares).
  • Trouble focusing and feelings of 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 through the tough times. Learn more about these resources 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).
  • If you have sores or white patches in your mouth.


Centers for Disease Control and Prevention. 2018. Bidis and Kreteks.

Cleveland Clinic. Health Essentials. 2020. 3 Reasons why smoking hookah is harmful.

World Health Organization (WHO). 2023. Tobacco. Taken from https://www.who.int/news-room/fact-sheets/detail/tobacco

Centers for Disease Control and Prevention (CDC). 2021. Office on smoking and health. Taken from https://www.cdc.gov/tobacco/about/osh/index.htm

National Institutes of Health: National Institute on Drug Abuse. 2021. Taken from https://nida.nih.gov/publications/drugfacts/cigarettes-other-tobacco-products#:~:text=How%20do%20people%20use%20tobacco,or%20hookah%20(water%20pipe)


November 14, 2023

Join the Great American Smokeout for a Healthier Tomorrow

by Carolyn Vachani, MSN, RN, AOCN

October 12, 2023

3…2…1…Countdown to Medicare Open Enrollment

by Christina Bach, MSW, LCSW, OSW-C

October 11, 2023

3…2…1…Countdown to Medicare Open Enrollment

by Christina Bach, MSW, LCSW, OSW-C