Are Flavored Cigarettes Safer?

Q: What can you tell me about “bidis,” a type of clove-flavored cigarette from India? Are they better or worse for you than regular cigarettes?-- Greg

A: Bidis (pronounced “bee-dees”) are hand-rolled cigarettes imported into the United States from India and elsewhere in Southeast Asia. The cigarettes are small and thin and have been hand-rolled in the leaves of tendu or temburni plants native to Asia. Some are flavored with chocolate, cherry or mango.

Clove flavored cigarettes called kreteks (pronounced “cree-techs”) are imported from Indonesia and contain tobacco, cloves and other additives.

Both bidis and kreteks have higher concentrations of nicotine, tar and carbon monoxide than traditional cigarettes. According to the American Lung Association of Oregon the smoke from a bidi contains three times as much nicotine and carbon monoxide and five times as much tar as smoke from regularly filtered cigarettes. Due to their higher nicotine levels bidis are more addictive than normal cigarettes.

No studies of the health effects of either bidis or kreteks have been done in the United States, but studies from India indicate that smoking bidis is associated with increased risks of lung cancer, oral cancer and cancers of the esophagus and stomach.

Indian studies also have found more than three times the normal risk of heart disease and heart attack and nearly four times the normal risk of chronic bronchitis among bidis smokers. And, according to the U.S. Centers for Disease Control and Prevention (CDC), Indonesian studies have shown that regular smoking of kretek cigarettes increases the risk of abnormal lung function 13-20 times compared with nonsmokers.

The CDC estimates that three percent of U.S. high school students smoke bidis and three percent smoke kreteks. Boys are more likely to smoke these cigarettes than girls. Among middle school students, an estimated two percent smoke bidis and two percent smoke kreteks.

Unhappily, U.S. cigarette manufacturers now produce an assortment of flavored cigarettes that health authorities have warned are an attempt to attract young teenage smokers. Teenagers may not realize that no matter where they come from or what they’re flavored with, cigarettes are made with tobacco and present the same – or worse – threats to health as ordinary unflavored products.

Remember that inhaled nicotine is just as addictive as crack cocaine or crystal methamphetamine. Moreover, young people need to know that wrapping tobacco in a leaf and flavoring it with a natural substance such as cloves doesn’t make it any less dangerous than it would be in more conventional forms.

Andrew Weil, M.D.