Exotic cigarettes popular with minority youth.

Flavored Asian cigarettes, even more harmful than regular ones, are gaining a foothold among minority youth, according to a study of New Jersey middle- and high-schoolers appearing in the American Journal of Health Behavior.

Called "bidis," the exotic cigarettes from India and Southeast Asia are made of tobacco wrapped in a leaf and tied with a string. For the U.S. market, vanilla, cherry, root beer, or other flavors are added.

After sampling the New Jersey youth, Mary Hrywna, M.P.H., and colleagues found that about 12 percent of middle school students and 34 percent of high school kids used any kind of tobacco. However, 5 percent of the middle-schoolers and 9 percent of high school said they used bidis.

Black high school students were more likely to use bidis than white students. In middle school, Hispanic and black students were more than twice as likely as whites to smoke them.

Bidis' candy-like taste and a street reputation as "natural" products lead young people, especially minorities, to consider them safer than ordinary discount cigarettes, says Hrywna, of the University of Medicine and Dentistry of New Jersey in New Brunswick.

Students who believed that bidis were safer were more likely to smoke them, as were users of other tobacco products, the study showed.

But bidis deliver more nicotine than conventional cigarettes, increasing the likelihood of addiction and raising the risk of cancers of the throat, mouth, lungs, esophagus, stomach and liver, say the researchers.

Because enforcement of laws governing tobacco sales to minors concentrates on cigarettes, products like bidis or snuff are probably easier to buy, says Hrywna. Other researchers have found that bidis are often sold without tax stamps, suggesting they are imported illegally and thus can be sold more cheaply than conventional cigarettes.

"A comprehensive approach to youth tobacco prevention and cessation campaigns must address other tobacco products as well as cigarettes," says Hrywna. Those approaches should also pay attention to groups like black youth, who use bidis, cigars and cigarettes about equally.

Future research should try to understand just why minority youth are so attracted to bidis, says Hrywna. Tobacco control efforts must also combat the illusion that they are not as harmful as regular cigarettes.

"Public health messages targeted at youth must dispel the dangerous myth that other tobacco products like cigars and bidis are safer than conventional cigarettes," she says.

This study was supported by the New Jersey Department of Health and Senior Services and the Association of Schools of Public Health/American Legacy Foundation.
Cairo's popular waterpipes no safer than cigarettes

A single session smoking Egypt's popular shisha waterpipes yields a nicotine intake equivalent to more than one pack of cigarettes, the World Health Organization said on Wednesday.

Many Egyptians smoke shisha in the belief that forcing the smoke through the pipes' water container filters out some of the toxins in the nicotine. Not so, according to Hussein Gezairy, Regional Director for the World Health Organization.

"There's been a widespread false belief for decades now that shishas are less harmful and addictive than cigarettes," Gezairy said at a news conference announcing the release of the first report on the hazards of smoking Egypt's ubiquitous waterpipes.

But shisha smoke retained all the carcinogens of cigarette smoke while adding more carbon monoxide and a separate set of carcinogens from the use of burning coals to keep the nicotine flowing, coupled with the risk of infection with tuberculosis or hepatitis from shared mouthpieces, Gezairy said.

"A regular user of waterpipe...smokes 2-3 sessions per day. This translates into intake of nicotine equivalent to more than one pack of cigarettes per session for most waterpipe smokers," the study said.