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.