• All Forms of Smoking Are Bad for You

    It is difficult to escape the newscasts and warnings from the Surgeon General that smoking cigarettes is harmful to your health. But what about other kinds of smoking? What about the pipe your grandfather smoked? Or the hookah your college-aged neighbors smoke? Learn why all forms of smoking are bad for you.

    Pipes and Cigars

    cigar One study has shown that for cigarette smokers who just cannot seem to quit, switching to cigars or pipes can reduce their risk of smoking-related illness by about 50%. However, that does not mean that these forms of smoking are safe. Smokers of cigars and pipes still face much higher rates of cancers, heart disease, and chronic obstructive pulmonary disease (COPD) than non-smokers.
    Cigars may seem sophisticated, but that does not make them safe. One large cigar can contain as much tobacco as an entire pack of cigarettes! Many cigar smokers do not inhale the smoke into their lungs, so they think they are not at risk for cancer or other smoking-related illnesses. Even without inhaling, nicotine is slowly absorbed through the lining of the mouth. In addition, the other toxins in tobacco can cause cancers of the mouth, larynx, and esophagus. Cigar smokers who do inhale face all the same risks as cigarette smokers—cancer, chronic bronchitis, emphysema, stroke, and heart disease, just to name a few!
    Pipe smoking is not very common in the United States today—rates of pipe smoking in men have fallen since the 1960s and have always been low in women. Pipes might seem harmless, but studies have shown that people who smoke pipes exclusively have similar or higher rates of smoking-related illness to those who smoke cigars. A Swedish study has shown that pipe smokers are at a higher risk of developing pancreatic cancer, and a study done in the United States shows a link between pipe smoking and bladder cancer.

    “Exotic” Smoking: Waterpipes, Cloves, and Bidis

    More exotic forms of tobacco smoking have become popular, especially among young people. These forms of tobacco use may seem more natural than cigarettes and thus safer, attracting people who would not normally smoke. But these trendy ways of smoking are not a safer way to smoke tobacco.


    Waterpipes, also known as hookahs, narghiles, shishas, or gozas, are common in China, India, Pakistan, and many Middle Eastern countries. They are also gaining popularity among young people worldwide, and waterpipe use has been described as a new epidemic of tobacco use. One survey of a United States college campus found that 20% of students had used a waterpipe in the past 30 days. A waterpipe uses a special kind of tobacco that is often mixed with a sweetener, like honey. The tobacco is heated in the bowl of the waterpipe. Smoke passes through the body of the waterpipe (where it is cooled by water), before it is sucked out of the hose by the smoker. Smoking a waterpipe is often a social event, with waterpipe “bars” and cafés where friends can gather and smoke together.
    Even though it may sound like fun, waterpipes are not a safe way to smoke tobacco. A smoking session can last as long as 60 minutes, so you could actually inhale more smoke than a cigarette smoker could. Waterpipe smokers also tend to inhale more deeply, so more smoke penetrates the lungs. Along with increasing your risk of smoking-related illness, smoking a waterpipe exposes you to more smoke and carbon monoxide than cigarette smoking. Dangerous heavy metals such as cadmium are also present in the tobacco used in waterpipes. There is also an increased risk of infectious disease, since smokers often share the pipe.


    Clove cigarettes (or “cloves”) are usually imported from Indonesia. They are a mixture of shredded clove buds and tobacco. Cloves usually contain about 30%-40% cloves and 60%-70% tobacco. They may also contain clove oil or other additives. Cloves have been shown to deliver more nicotine, tar, and carbon monoxide to the smoker than cigarettes. Smoking cloves has also been linked to asthma and other lung diseases.


    Bidis are thin, hand-rolled cigarettes that contain flavored or unflavored tobacco wrapped with a temburini leaf (a plant native to Southeast Asia). They are often tied at each end with colorful string. They come in a variety of flavors, like mango, vanilla, and strawberry. They are appealing to many younger smokers because they are “fun” and cost less than regular cigarettes.
    However, there is nothing fun about the effects of smoking bidis. Because they are so small, they require three times as many puffs as regular cigarettes, meaning more smoke gets into your lungs. Though they contain less tobacco, bidis do expose smokers to other harmful substances, like tar, ammonia, and carbon monoxide. Bidi smokers are at risk for all the diseases that come with cigarette smoking.

    Other Ways to Get Your Fix

    Maybe you are considering a much different form of tobacco use. Eliminating the smoke may not solve the problem.
    Electronic cigarettes (“e-cigarettes”) turn liquid nicotine into a vapor that can be puffed. Even though there is no smoke, e-cigarettes are not a safe alternative. The FDA has found traces of toxic chemicals in two popular brands of e-cigarettes.

    No Safe Way to Smoke

    Whether it is cigarettes, cigars, or cloves, the evidence is clear—there is no safe way to smoke. Even smokeless versions have risks. If you currently smoke cigarettes, there is no safe alternative. Whether you choose a nicotine replacement or an alternative method, quitting is the best choice you could make.


    American Cancer Society http://www.cancer.org/

    American Lung Association http://www.lungusa.org

    National Cancer Institute http://www.cancer.gov

    Smokefree.gov http://www.smokefree.gov/


    Canadian Cancer Society http://www.cancer.ca/

    Health Canada http://www.hc-sc.gc.ca/

    The Lung Association http://www.lung.ca/


    Alternative tobacco products. Maryland Resource Center website. Available at: http://www.mdquit.org/index.php/tobaccoinfo/alternative.html. Accessed June 22, 2011.

    Eissenberg T, Ward KD, Smith-Simone S, Maziak W. Waterpipe tobacco smoking on a U.S. College campus: prevalence and correlates. J Adolesc Health. 2008;42(5):526-529.

    Henley SJ, Thun MJ, Chao A, Calle EE. Association between exclusive pipe smoking and mortality from cancer and other diseases. J Natl Cancer Inst. 2004;96(11):853-861.

    Hurt RD. Electronic cigarettes—a safe way to light up? Mayo Clinic website. Available at: http://www.mayoclinic.com/health/electronic-cigarettes/AN02025. Updated December 2009. Accessed June 22, 2011.

    Hurt RD. Hookah smoking: is it safer than cigarettes? Mayo Clinic website. Available at: http://www.mayoclinic.com/health/hookah/AN01265. Updated February 20, 2010. Accessed June 22, 2011.

    Iribarren C, Tekawa IS, Sidney S, Friedman GD. Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men. N Engl J Med. 1999;340(23):1773-1780.

    McCoy K. Nicotine Addiction. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated March 2011. Updated June 22, 2011.

    Maziak W. The waterpipe: time for action. Addiction. 2008 Nov;103(11):1763-1767.

    Questions about smoking, tobacco, and health. American Cancer Society website. Available at: http://www.cancer.org/Cancer/CancerCauses/TobaccoCancer/QuestionsaboutSmokingTobaccoandHealth/index. Updated January 2011. Accessed June 22, 2011.

    Tobacco use disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated May 2011. Accessed June 22, 2011.

    Wald NJ, Watt HC. Prospective study of effect of switching from cigarettes to pipes or cigars on mortality from three smoking related diseases. BMJ. 1997;314(7098):1860-1863.

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