It is difficult to escape the newscasts and warnings from the Surgeon General that smoking cigarettes is harmful to your health. But there are also other smoking devices, such as pipes and hookahs. Learn why all forms of smoking are bad for you.
If you have a cigarette habit you just cannot seem to give up, think twice before you switch to a cigar or pipe. These forms of smoking are not safe either. 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 directly inhale the smoke into their lungs, so they think they are not at risk for cancer or other smoking-related illnesses. However, second-hand smoke in the environment does get inhaled. 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 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.
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 either. 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.
Kreteks, more commonly known as clove cigarettes, 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 lung cancer and other lung diseases compared to non-smokers.
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 appear 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 3 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.
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. Their popularity is skyrocketing. Some smokers use them as an alternative, while others have turned to them to help them quit.
One promising review of 2 studies showed the 6-month quit rate for e-cigarettes was higher than a non-nicotine placebo. In one of the studies, e-cigarettes were as effective as nicotine patches after 6 months. Currently, the US Food and Drug Administration (FDA), along with several major anti-smoking organizations, have determined that there has not been enough research on e-cigarettes to make any claims about their safety or effectiveness in helping people quit smoking.
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 Lung Association
Canadian Cancer Society
Alternative smoked tobacco products. Maryland Resource Center website. Available at:
...(Click grey area to select URL)
Updated July 15, 2016. Accessed April 13, 2017.
Eissenberg T, Ward KD, Smith-Simone S, Maziak W. Waterpipe tobacco smoking on a US 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.
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.
Maziak W. The waterpipe: Time for action. Addiction. 2008;103(11):1763-1767.
Tobacco: Deadly in any form or disguise. World Health Organization website. Available at:
...(Click grey area to select URL)
Published 2006. Accessed April 13, 2017.
Tobacco use. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T114788/Tobacco-use. Updated January 17, 2017. Accessed April 13, 2017.
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.
Last reviewed April 2017 by Michael Woods, MD, FAAP
Last Updated: 5/13/2015