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JULY 2008
ORIGINAL RESEARCH
Exploring Use of Nontraditional Tobacco
Products Through Focus Groups with
Young Adult Smokers, 2002
Patricia Richter, PhD, Ralph Caraballo, PhD, Nisha Gupta, MPH, Linda L. Pederson, PhD
Suggested citation for this article: Richter P, Caraballo R,
Gupta N, Pederson LL. Exploring use of nontraditional
tobacco products through focus groups with young adult
smokers, 2002. Prev Chronic Dis 2008:5(3). http://www.
cdc.gov/pcd/issues/2008/jul/07_0106.htm. Accessed [date].
PEER REVIEWED
Abstract
Introduction
In 2002, 16 focus groups with young adult smokers who
used or had tried nontraditional tobacco products (e.g.,
bidis, shisha, herbal cigarettes, kreteks, cigars, herbal
smokeless products) were conducted in Dallas, Texas, and
Chattanooga, Tennessee, to gain an understanding of the
appeal of these products.
Methods
In each city, groups were segmented by race or ethnicity
and by educational status.
Results
Many consistent themes emerged across the groups.
Nontraditional tobacco use is not common among young
adult smokers. Although some products such as Black &
Mild and Swisher Sweets cigars are used frequently by
some groups, other products such as shisha, kreteks, and
herbal cigarettes are less well known and infrequently
used. Among focus group participants, use of nontraditional tobacco products tends to occur in clubs, during social
gatherings, or at times when cigarettes are unavailable.
More college students than those who were not in college
cited cost and inconvenience of purchasing nontraditional
tobacco products as reasons for not using them. All focus
group participants agreed that African Americans use
cigars more than do any other racial or ethnic group.
Conclusion
Overall, findings suggest that the reasons for trying
nontraditional tobacco products did not differ by race or
ethnicity. Family members and peers were mentioned as
the source of nontraditional tobacco products when first
used. Cost, convenience, taste, smell, and strength were
given as reasons both for using these products and for
discontinuing their use.
Introduction
Several noncigarette tobacco and herbal products are
available to adults in the United States, and they are
collectively referred to in this article as nontraditional
tobacco products (NTPs). These products are bidis, shisha
(water pipe, hookah, or hubble bubble), herbal cigarettes,
kreteks (clove cigarettes), cigars (e.g., Swisher Sweets,
Black & Mild), and herbal smokeless products (snuff or
chew); they are described in more detail in the Appendix.
The possibility that some of these products have fewer
deleterious health effects than traditional cigarettes has
recently been discussed (1), although there is not enough
evidence yet to prove or disprove this notion. Recent
research shows that young adult smokers perceive many
NTPs to be safer than cigarettes (2).
In 2004, 23.6% of U.S. adults aged 18 to 24 years (6.9
million) were cigarette smokers (3). There are noted differences in smoking prevalence for young adults who
are college students and those who are not. Those 18- to
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
www.cdc.gov/pcd/issues/2008/jul/07_0106.htm • Centers for Disease Control and Prevention
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VOLUME 5: NO. 3
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22-year-olds enrolled full time in college in 2002 were
less likely to report current cigarette use than their
peers who were not enrolled full time, and past-month
cigarette use was reported by 33% of full-time college
students (ages 18–22), compared with 46% of their unenrolled peers (4). Sixty percent of college students tried
cigarette smoking and more than 28% of college students
report that they are current smokers (3). However, traditional cigarettes are not the only tobacco product used
by young U.S. adults: in 2001, according to the National
Household Survey on Drug Use and Health, 11.4% (3.3
million) used cigars, 4.7% (1.4 million) used smokeless
tobacco, and 0.9% (0.3 million) used pipes (4). However,
some tobacco users used more than 1 type of tobacco
product. Rigotti et al (5) found that more than 50% of
college students who used tobacco used more than 1
type of tobacco product, with men (58.2%) using multiple
products more often than women (27.5%).
(African American or white). In Dallas, the same segmentation was used for level of education; however, the
Dallas groups were segmented by race/ethnicity (Hispanic
and white). There were about equal numbers of men and
women in each group.
We could find little information on why smokers start
using NTPs or why they continue using these products.
Use of NTPs by young adults may lead to use of traditional cigarettes. Given the variety of NTPs on the market, it is important to understand the characteristics of
NTP users; their perceptions about the health effects of
the products; and the reasons they try, use, and discontinue use of NTPs. To learn the appeal of these products and to understand factors related to their use, we
arranged for focus groups with young adult smokers who
used or had tried NTPs.
Recruitment screening included questions about current smoking and the use of NTPs. Current smokers
were defined as those who had smoked a cigarette during the previous 30 days, which is consistent with the
definitions of current smokers used by other studies
(e.g., Youth Risk Behavior Survey [6], National Youth
Tobacco Survey [7]). Current cigarette smokers were
recruited because most researchers believe that cigarette smokers are more likely than nonsmokers to have
experience with other tobacco and nontobacco products
and because we were interested in how NTP use relates
to the use of traditional cigarettes. Triers or users of
NTPs were those who reported that they had tried or
were currently using at least 1 of 6 NTPs (Appendix). To
ensure that the people who had only tried a product were
not overrepresented in a group, 30% of each discussion
group had to consist of current users of at least 1 NTP.
To ensure that several products could be discussed, no
more than 30% of the participants in each group could
have tried or used only 1 of the products.
Methods
In April 2002, 16 focus groups were conducted with
smokers aged 18–22 years who smoked or who had tried
NTPs. Focus group participants were men and women
divided into 2 groups by level of education: 1) those attending a 2- or 4-year college and 2) those not in college. The
not-in-college participants were not enrolled in any school,
not working on a general equivalency degree (GED), not
the recipient of a GED within the previous year, and not
planning to attend college during the next year. This study
was approved by the Internal Review Board of the Centers
for Disease Control and Prevention (CDC).
Eight focus groups were conducted in Chattanooga,
Tennessee, and another 8 in Dallas, Texas. In Chattanooga,
the groups were segmented by level of education and race
Recruitment
Staff at professional focus group facilities recruited
participants in both cities. In Chattanooga, white and
African American participants were recruited by telephone from the focus group facility’s database, which
included information on potential participants’ age. In
Dallas, white and Hispanic participants in the focus
group facility’s database were screened for eligibility and
recruited by e-mail or telephone. In Dallas, the facility
also advertised in campus newspapers for Hispanic students for the focus groups.
Recruitment statistics, including the total number
who were screened in each city and the number who
were eligible and agreed to participate, are in Table 1.
In total, 137 young adults — 69 college smokers and
68 not-in-college smokers — participated in the focus
groups. By race or ethnicity, they were divided into 3
groups: 70 non-Hispanic whites, 36 African Americans,
and 31 Hispanics.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
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VOLUME 5: NO. 3
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Content of the sessions
Results
On arrival at the focus group facility, participants provided demographic data and described their use of cigarettes and NTPs on a prediscussion information sheet. The
focus groups, which lasted about 2 hours, were conducted
in professional focus group facilities equipped with oneway mirrors, observer viewing rooms, client waiting areas,
and videotape and audiotape equipment. The participants
were informed about confidentiality and signed a consent
form before the discussions began. They were also told
that the discussion would be audiotaped and videotaped
to ensure an accurate record. Participants each received
$50.00 and, if they arrived at least 15 minutes before the
scheduled session time, were entered into a raffle for an
early bird prize of $25.
Summary of participants’ characteristics and their
cigarette and NTP use
The focus group guide and questions were divided into
7 sections. The first section consisted of 1) introducing
the facilitator and group members to each other and
2) discussing the topic and purpose of the focus group.
Section 2 consisted of questions about cigarette smoking
behavior. Sections 3 through 6 concentrated on NTPs
and included discussion of personal use, use by friends
and family, health perceptions about NTP use, and other
perceptions about NTP use. During section 7, participants were asked to design health messages that they
would use to communicate about NTPs with other people
their own age.
Most not-in-college participants (66.1%) had either a high
school diploma or a GED, and 67.6% were employed either
full- or part-time. Almost 60% of the college students were
either in their first or second year. Daily cigarette smoking was highest among white participants: more than 70%
reported that they smoked every day during the previous
month. Of participants in college, 70% smoked on fewer
than 20 days per month, whereas only 40% of the not-incollege participants smoked on fewer than 20 days per
month. Swisher Sweets and Black & Milds were used most
often by all participants, and shisha and kreteks were
used least often. None of the not-in-college participants
reported having used kreteks, and only 1 reported having
used a shisha. More than 50% of the participants reported
having first tried an NTP at age 14–17. Table 2 shows the
breakdown, by group and by NTP product, of those who
reported they had used a study NTP even once.
Many of the comments about trial, use, and discontinuance of NTPs were similar for all products; therefore, the
findings are organized around those 3 factors rather than
by product. Most of the discussion was on bidis, kreteks,
Black & Milds, and Swisher Sweets. Several participants
also described blunts (marijuana mixed with tobacco in a
cigar shell) when discussing cigar use (8,9).
Data analysis
Why are young adults trying NTPs?
The purpose of the analysis was to uncover common
and consistent themes and to note where any differences
appeared between or among population segments. Two
trained coders independently examined the transcripts
and applied codes (1- or 2-word interpretive descriptions)
to statements in the transcripts to develop categories
(a group or class of related codes). The categories were
then cross-classified to find relationships among them
and to detect the patterns of differences or similarities.
The coders discussed inconsistencies in coding until
they reached an agreement on the most appropriate
code. QSR NUD*IST 4 software (QSR International,
Bakersfield, California, 1991) was used to organize and
manage the text data and to support the coding process
by allowing the text to be marked for search, retrieval,
classification, and cross-classification.
Several factors were frequently mentioned when participants were asked why they tried NTPs. Among them were
social and family influences, substitution for traditional
cigarettes, and curiosity about the products and their taste
and smell.
Social and family influences
Across groups, participants said their first experiences
with NTPs occurred when they were with peers or family members. Several participants reported that a friend
offered them their first NTP in a social setting or that they
“bummed a hit” from a friend’s NTP. African Americans
frequently talked about being with family members such
as aunts, uncles, and cousins when they first tried these
products.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
www.cdc.gov/pcd/issues/2008/jul/07_0106.htm • Centers for Disease Control and Prevention
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VOLUME 5: NO. 3
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Substitute for cigarettes
Some participants in most groups reported that they
tried NTPs when cigarettes were not available.
Actually I think [I tried them] because I was out of
cigarettes and all my friends were smoking [Black
& Milds]. (white, not in college)
Curiosity
Participants in all groups reported that curiosity about
the way NTPs looked or smelled motivated them to try the
products. In addition, some participants mentioned being
curious about the products after hearing their friends talk
about how the products made them feel.
There were, like, some white boys that used to live
by me that used to smoke those [bidis and kreteks].
They smelled funny, so I just wanted to see what
they tasted like. (African American, college)
If I have a Black [& Mild] and a full pack of cigarettes, I will smoke the last Black [& Mild] before
I open that pack of cigarettes, because you just get
more from smoking the Black [& Mild] than from
smoking a cigarette. (African American, college)
Cost and convenience
Several participants commented that they were able to
purchase singles of an NTP rather than a pack. The ability to smoke an NTP in several sessions by extinguishing
it and relighting it was also seen as a convenience and a
reason to continue using the product.
[Cigars are] cheaper. It’s not like a cigarette, you
can buy just 1. (African American, college)
They smoke half of it [Black & Mild] and then put
it out and smoke the other half later. . . . Cloves
are like that, too. (white, college)
Occasional or recreational use
Why keep using them?
Several questions were asked to learn why participants continued to use NTPs and which products they
used. Most of the discussion focused on Black & Milds
and Swisher Sweets. Some participants in the African
American and Hispanic groups acknowledged using
Black & Milds and Swisher Sweets regularly or out
of habit. Some also reported that they continued to
smoke kreteks, but few continued using the other products. Several reasons were cited for continuing to use
NTPs: recreation, pleasant smell or taste, low cost,
convenience, duration (they last longer than traditional
cigarettes), and pharmacologic effects (they provide a
sensation of being high and intensify the effects of other
drugs such as alcohol or marijuana). Participants did
not give fewer health risks as a reason for continuing to
use NTPs.
Strength and duration
NTPs perceived by participants as “strong” were cigars
and clove cigarettes. Smoking these products resulted in
“getting more” than from a traditional cigarette. Cigars
and clove cigarettes were noted to last longer than traditional cigarettes.
Although daily use of NTPs appeared to be rare
among participants, NTP use often occurred at parties,
in clubs, and on special occasions. Some participants in
the Hispanic and African American not-in-college groups
discussed smoking cigars (Black & Milds and Swisher
Sweets) when socializing, but they did not use them
daily.
If I’m out with my boy at his apartment, we smoke
Blacks [Black & Milds] because it’s something you
can kind of pass around to everybody and just talk.
If I’m at a club or something, just me and a girl,
we smoke a cigarette. (African American, not in
college)
Taste or smell
All groups mentioned a pleasant taste or smell as
reasons for using the products and said that smoking
these products did not leave the smokers smelling of
cigarettes.
[Bidis] taste and they smell good, so it’s more like
incense that sticks to you rather than tar. (white,
college)
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
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VOLUME 5: NO. 3
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Perceived pharmacologic effects
Some participants in all groups stated that smoking
traditional cigarettes gave them a buzz or made them feel
high. Their responses when discussing NTPs suggest that
they look for the same sensation when using NTPs. Some
participants mentioned that they tried bidis because they
heard from others that they were like marijuana, but they
were disappointed because, although they felt an initial
high, they eventually ended up with a severe headache.
In contrast, the pharmacologic effects from smoking cigars
were almost uniformly described as pleasant.
It [a bidi] gave me a head rush. I was high for a
little while, but after a while I started getting a
headache. A nasty headache. (African American,
not in college)
And [if] you smoke them [Black & Milds] fast
enough, you will get a little buzz on them. (African
American, college)
Participants in all groups described smoking traditional
cigarettes while drinking alcohol and mentioned that
NTPs enhanced the effects of alcohol.
I like Swisher Sweets and Black & Milds. I think
they are a little bit smoother, but for me they are
stronger. I only smoke them when I drink. . . .
It kind of intensifies everything else. (Hispanic,
college)
Alternate uses of NTPs
Every group had reports of using marijuana in combination with cigars. Marijuana was spontaneously suggested
as an NTP by several participants in every group. Some
participants described splitting open the cigars, removing
the tobacco, and replacing the tobacco with marijuana.
Other participants described using NTPs to enhance the
effects of marijuana.
I’ve smoked marijuana in them but I haven’t ever
smoked just a Black & Mild. (white, college)
Why stop using NTPs?
Participants who had tried the NTPs but did not continue to use them were asked why they stopped using them
and what they did not like about the products. Participants
who occasionally used NTPs contributed to the discussion.
Interestingly, in all groups, the reasons cited for discontinuing use were the same as the reasons given for using
the products: strength, smell, taste, and cost. In addition,
convenience was given as a reason for using NTPs and
inconvenience as a reason for not using them. For white
college groups, strength of the products played a role in
discontinuing use. For African American not-in college
groups, preference for cigarettes was cited as a reason for
discontinuing. Hispanic participants frequently reported
that they did not like the smell of NTPs.
Strength
At least some participants in almost every group said
they did not like NTPs or discontinued using them because
they were too mild, and others said they were too strong
or harsh. For the African American and Hispanic college
groups, strength was not commonly given as a reason for
discontinuing use. Some participants in the not-in-college
groups also described having adverse reactions to the
products, such as headaches and lightheadedness, in part
because the product was too strong.
They [herbal cigarettes] were too mild so they
didn’t cut it anymore. (Hispanic, not in college)
[Herbal cigarettes] are too strong. (white, college)
I used to smoke [Black & Milds] . . . but it makes
my head hurt and my stomach hurt. They are too
strong for me. (Hispanic, not in college)
Cost and inconvenience
White and African American college students were more
likely to view the cost and inconvenience of purchasing
NTPs as reasons for not using the products than were
their noncollege counterparts. In every group, some people
commented that the products were difficult to locate and
therefore were inconvenient to use. In some groups, cigars
were described as inconvenient because of the length of
time it takes to smoke them.
Well, those cloves are pretty expensive, and you can
only buy them from the hours of 9 to 7 at Tobacco
Mart, so I decided to try to get the same effect in a
shorter time. So I know cloves last 4 times as long
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
www.cdc.gov/pcd/issues/2008/jul/07_0106.htm • Centers for Disease Control and Prevention
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as a regular cigarette does, so I just started smoking cigarettes instead. (white, college)
Smell and taste
In most groups, several participants reported that they
had stopped using a product because they did not like the
way it smelled or tasted.
They [herbal cigarettes] smell really bad. They
smell like tea bags on fire, and they taste about the
same way. (white, college)
there were no apparent racial or ethnic differences in reasons for trying nontraditional products. Family members
and peers were listed as sources of initial NTP use for all
groups. Taste, smell, cost, and strength of the products
were given as both reasons for using NTPs and for discontinuing use. Convenience was given as a reason for using
NTPs, and inconvenience as a reason for not using them.
Most focus group participants used NTPs at clubs, during
other social gatherings, or as an alternative to cigarettes.
Even when participants reported using NTPs more than
occasionally, they indicated that their NTP use (most commonly cigar use) often coincided with special activities or
events such as parties with friends.
Who are the perceived users of NTPs?
Participants were asked if they thought the use of these
products differed among racial or ethnic groups, between
men and women, or between people who were in college
and those who were not. There was general agreement
that African Americans were more likely than other
groups to smoke cigars. Some African American college
students said that NTP use was more common among
college students because they tended to experiment more
with different products. White and Hispanic groups agreed
that men were more likely than women to use NTPs.
Although the discussion guide developed for the groups did
not ask any specific questions about age group differences,
participants in the white groups frequently mentioned
that NTP use was more common among teenagers than
among adults, even young adults. They predicted that
these young smokers would outgrow the products and
graduate to traditional cigarettes eventually.
I think when you’re younger is when you try it, but
you grow out of it. You’re just like, go to the gas
station, get your pack of cigarettes, go home, smoke
them, same thing tomorrow. (white, not in college)
Discussion
Many common themes emerged across the groups. First,
it became clear that continued regular use of NTPs was
not common among the young adults who participated in
our focus groups. Although some products, such as Black &
Milds and Swisher Sweets, are widely used, other products
such as shishas, kreteks, and herbal cigarettes are less well
known and infrequently used. All groups agreed that cigar
use was more common among African Americans. Overall,
However, some differences between the groups were
noted. College participants were more likely than those
who were not in college to cite the cost and inconvenience
of purchasing NTPs as reasons for not using them. Whites
were more likely to discuss experimenting with NTPs as a
gateway to regular cigarette use.
These findings should be interpreted with caution because
of some limitations in the methods. The focus groups were
conducted in 2 midsized American cities, and the findings
may not be generalizable to other larger or smaller urban
areas or to rural areas. In addition, because of limited availability of some NTPs (such as shishas or kreteks), some
participants did not have experience with those products,
and hence, discussion about them was somewhat hampered. The focus groups were conducted in 2002, so the
findings may not be relevant to the current situation. Our
results are similar to survey data from Massachusetts in
which approximately 1 in 5 adolescents reported that they
liked the taste and smell of cigars, bidis, and kreteks, and
these products gave them something novel to try (10). Other
limitations include reliance on self-reported measures of
smoking behavior and NTP use and the possibility that the
participants withheld information or provided incomplete
or misleading information. Finally, as with all focus groups,
the tone and content of the discussions may have been
affected by group dynamics or by the participants’ knowledge that they were being audiotaped and videotaped.
Strengths of the study include the following:
• Each focus group was conducted in duplicate (i.e., 2
focus groups were conducted with each racial or ethnic
group of college smokers, and 2 were conducted with
each racial or ethnic group of not-in-college smokers).
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
6
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VOLUME 5: NO. 3
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This strategy allowed us to determine the replicability
of participants’ experiences and opinions.
• The recruiting strategy allowed each group to include
participants who had tried a variety of the products.
• We were able to investigate factors related to trial, use,
and discontinuation of NTPs by different racial or ethnic
groups and by groups with different levels of education.
Given the differences in the smoking rates of the
different subgroups and the suggestion that African
American students appear to be the fastest growing subpopulation of college student smokers (11), knowledge
of the possible differences in experience and perceptions
may be helpful to planners of targeted tobacco control
interventions.
Future research in other geographic locations may add
to the body of knowledge about the products and their
use. Inclusion of young adults from other racial or ethnic
groups such as Asian Americans, Arab Americans, and
Native Americans would provide insight into the use of
NTPs in other population segments. Segmenting groups
by sex would help delineate whether young men and
women differ in their use and perceptions about NTPs.
Young adults themselves provide valuable insight as to
how nontraditional and traditional tobacco products contribute to their social lives, risk taking, health concerns
and perceptions, and acceptance of future risks.
Acknowledgments
This work was performed while all authors were at the
Office on Smoking and Health, National Center for Chronic
Disease Prevention and Health Promotion, Centers for
Disease Control and Prevention, Atlanta, Georgia.
Author Information
Corresponding Author: Patricia Richter, PhD, Office on
Smoking and Health, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease
Control and Prevention, Mailstop K-50, 4770 Buford Hwy,
Atlanta, GA 30341-3717. Telephone: 770-488-5825. Email:
prichter@cdc.gov.
Author Affiliations: Ralph Caraballo, Linda L. Pederson,
Office on Smoking and Health, Centers for Disease
Control and Prevention, Atlanta, Georgia; Nisha Gupta,
Global AIDS Program, Centers for Disease Control and
Prevention, and the Consulate General of the United
States of America, Chennai, India. Dr Pederson is now an
independent consultant in Atlanta.
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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
www.cdc.gov/pcd/issues/2008/jul/07_0106.htm • Centers for Disease Control and Prevention
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Tables
Table 1. Recruitment Statistics of Participants in Focus Groups to Assess Use of Nontraditional Tobacco Products Among
Adults Aged 18–22, 2002
Characteristic
Chattanooga, Tennessee
Race of focus group participants (number of groups)
White ()
African American ()
White ()
Hispanic ()
3
0
10
7
36 (83)
36 (90)
3 (32)
31 (66)
Number screened for participation in focus groups
Number (%) screened who were eligible and agreed to participate.
Dallas, Texas
Table 2. Nontraditional Tobacco Products Reported as Ever Useda by Focus Group Participants, by Race or Ethnicity — Dallas,
Texas, and Chattanooga, Tennessee, 2002
Whites
Product
Cigars: Swisher
Sweets
Not in college
n = 35
n (%)
In college
n = 16
n (%)
African Americans
Not in college
n = 15
n (%)
In college
n = 18
n (%)
Not in college
n = 18
n (%)
Total
N = 137
n (%)
35 (100)
32 (91)
13 (81)
13 (87)
12 (67)
1 (78)
119 (87)
Cigars: Black & Mild
3 (97)
3 (97)
1 (88)
1 (93)
18 (100)
17 (9)
131 (96)
Herbal cigarettes
19 (5)
9 (26)
8 (50)
6 (0)
2 (11)
3 (17)
7 (3)
Bidis
10 (29)
6 (17)
5 (31)
3 (20)
5 (28)
3 (17)
32 (23)
7 (20)
8 (23)
2 (13)
(27)
2 (11)
1 (6)
2 (18)
Shishas
1 (3)
0 (0)
3 (19)
1 (7)
0 (0)
0 (0)
5 ()
Kreteks
5 (1)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
5 ()
Herbal smokeless
a
In college
n = 35
n (%)
Hispanics
Ever used indicates having tried at any time any of the 6 nontraditional tobacco products chosen for the study.
Appendix.
For this study, nontraditional tobacco products include the following:
Cigars: Products that contain air-cured, fermented tobacco. A Black & Mild
is a small cigar that can be smoked like a cigarette with the smoke inhaled
into the lungs. A Swisher Sweet is available as a thick cigar or a small,
inexpensive, cigarette-like cigar (cigarillo). A Swisher Sweet can be flavored
(e.g., menthol-flavored).
Herbal cigarettes: Vegetable-based cigarettes that manufacturers claim
contain no tobacco or nicotine. They are made of herbs such as ginseng,
jasmine, and catnip and may contain flavoring such as cherry, chocolate, or
marshmallow. They are often sold in colorful packaging that displays playful
or innocuous symbols (e.g., butterflies, leprechauns).
Smokeless herbal chews: Similar to chewing tobacco but with manufacturers’ claims of no tobacco or nicotine. They are made from herbal ingredients
such as red clover, orange peel, and bee pollen; they come in flavors such as
cinnamon, wintergreen, or licorice.
Bidis: Small, hand-rolled, usually flavored and unfiltered tobacco cigarettes
from India and southeast Asia. In the United States, they come in a variety
of flavors, such as chocolate, vanilla, strawberry, root beer, or mango; they
cost about half as much as regular cigarettes.
Kreteks (clove cigarettes): Cigarettes from Indonesia containing a mixture
of tobacco leaves and cloves. The name kretek is derived from the crackling
sound that cloves make when burned.
Shisha: A type of tobacco used when smoking a shisha or hookah pipe. It
is made from tobacco leaves mixed with fruit shavings or flavoring. It is held
together by a sweet, sticky molasses. Common flavors include apple, strawberry, apricot, and, recently, cola and cappuccino.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only
and does not imply endorsement by any of the groups named above.
8
Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2008/jul/07_0106.htm
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