# data[].attributes.body
how do you feel about what you have created?
I feel good about what I have created; its the most I have ever typed at once.

What are you most proud of?
how long the essay is.

What was the hardest part of the research process?
picking a topic. most of the topics where either being covered or I didn't care about.

What have you learned?
MLA is very particular for no apparent reason, I know everyone needs credit but do you need to cite a magazine differently than a book.

What do you want the world to know about your topic?
If smoking kills then why do you ( someone who smokes) smoke, you cant really blame it on the addiction because that's something that can be overcome do you really want to die a slow death from cancer.

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What are your thoughts about how you will organize your information? what seems to be the logical order of ideas?
I think i'll start with what classifies as a tobacco product then the negative side effects, the positive side effects and the reason that tobacco products aren't illegal.

What background information will be essential for you to include in your paper so your topic makes sense to any reader?
I"ll need to include why Tobacco products haven't been made illegal.

How do you plan to keep track of which ideas come from which article as you start your outline?
Ill label what info comes from where.

What creative ideas do you have for your introduction or conclusion?
I don't have any ideas so far but as i plan out my essay I think I'll come up with something.

How many paragraphs do you need?
I wont know till I start writing.

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Article #4
•Hawaii aims to be the first state that bans menthol cigarettes by making the legal purchasing age 100 years old within 5 years
•the tobacco industry no longer holds as much political power
•“In my view, you are taking people who are enslaved from a horrific addiction and freeing people from horrific enslavement," (Creagan)

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CLOSE

Hawaii may once again be at the nation's forefront when it comes to setting smoking policy.

The first state to raise the minimum age for purchasing tobacco products to 21 is considering a measure that would effectively forbid cigarettes in five years.

State Rep. Richard Creagan, a medical doctor, sponsored legislation that aims to phase in a ban, raising the age requirement to 30 in 2020, 40 in 2021, 50 in 2022 and 100 in 2024. The bill, likely to be debated in committee this week, would exempt electronic cigarettes, cigars and smokeless tobacco.

Should the measure become law, it could mark the first step toward a more comprehensive prohibition down the road. After Hawaii raised the legal smoking age to 21 in 2016, five other states - California, New Jersey, Massachusetts, Oregon and Maine - raised the legal age to buy cigarettes to 21.

Cigarette-smoking rates have tumbled nationally for years. According to the Centers for Disease Control and Prevention, the figure sank from 20.9 percent of American adults in 2005 to 15.5 percent in 2016, the latest year for which national figures are available. For those younger than 18, the rate is below 7 percent.

"Because smoking rates are getting so low, we can actually start thinking about what I call end-game strategy, meaning we're at the point where we can feasibly just make smoking history,'' said Michael Siegel, a professor at Boston University's School of Public Health. "We couldn't even talk about it when there was a large percentage of people smoking because there were too many people affected.''

American smoking rates decreased from 20.9 percent in 2005 to 15.5 percent in 2016. (Photo: Terroa / Getty Images)

Siegel said the five-year target for banishing cigarettes is probably optimistic. Creagan's ambitious bill may get watered down in the Legislature, and it will probably face opposition from the tobacco industry.

Leading cigarette producer Altria, formerly known as Philip Morris, did not return calls seeking comment.

Siegel pointed to two factors that may pave the wave for cigarette smoking to eventually become a distant memory preserved in film noir movies.

First and foremost is the emergence of e-cigarettes - also known as vapes, mods, ENDS (electronic delivery nicotine systems) or the brand name Juul.

Though unsafe for youths and highly addictive in general because of their nicotine content, e-cigarettes have nowhere near the 7,000 chemicals found in the smoke from regular cigarettes. For adults who smoke, they are regarded as a much safer option.

More: Altria purchases 35% stake in Juul in deal worth $12.8 billion

More: Nearly half of Americans have heart disease, study says

The other key development has been the evolution of the tobacco industry, which doesn't wield nearly as much political clout as it did in past years.

Battered for years by campaigns that highlighted the deadly nature of its products, Big Tobacco had to adapt, and it found a useful vehicle in e-cigarettes, which derive their nicotine from a type of tobacco plant. In December, Altria bought a 35 percent stake in Juul for $12.8 billion.

"The tobacco industry itself is preparing for this," Siegel said. "They see this coming, and they are already diversifying. The cigarette companies themselves are talking about shifting from combustible nicotine to other forms of nicotine."

Even though Hawaii ranks toward the lower end nationally in smoking rates, Creagan said he introduced his legislation because taxes and regulations were not effective enough in keeping people from lighting up.

He wants the Aloha State to be the first in the country to ban cigarettes entirely. He countered charges of governmental overreach by saying the state is obligated to protect its citizens from dangerous products.

"In my view, you are taking people who are enslaved from a horrific addiction and freeing people from horrific enslavement," Creagan told the Hawaii Tribune-Herald. "We, as legislators, have a duty to do things to save people's lives. If we don't ban cigarettes, we are killing people."

Lynn Kozlowski, an expert in tobacco policy who teaches at the State University of New York at Buffalo, questioned whether legislation is the right approach in further snuffing out smoking habits.

He said he approves of exempting e-cigarettes and smokeless tobacco because they provide less harmful alternatives to smoking, but cigars don't quite fit into that category, at least not when their smoke is inhaled.

Kozlowski said history has shown forbidding access is not the most effective way of modifying adult behavior. He's wary a black market for cigarettes may develop if they're banned.

"If you can use ways to make the public fully aware of how dangerous cigarettes are, understand the differential risks, differentially tax these products, that's been shown to have an effect on bringing smoking down," Kozlowski said. "A ban is not a tool I would turn to at this time."

Read or Share this story: https://www.usatoday.com/story/news/nation/2019/02/05/smoking-ban-hawaii-aims-ban-cigarettes-tobacco-legislation/2774631002/

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No smoking? Hawaii lawmaker wants to say goodbye to cigarettes forever

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CLOSE Hawaii may once again be at the nation's forefront when it comes to setting smoking policy. The first state to raise the minimum age for purchasing tobacco products to 21 is considering a measure that would effectively forbid cigarettes in five years. State Rep.

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How do you feel about your information and the research process so far?
I feel pretty good the info I have found backs up my argument and the counter argument doesn't have a strong enough case to defend itself.

What types of information do you have?
I have info like information like what the possible side effects of tobacco product use are.

Do you understand your topic fully? What gaps are there in your research that you may need to explore more
I Do, I fully understand my topic. I think i may need to find out why its not already illegal.

Is there anything confusing or conflicting in your research?
why are tobacco products still legal?

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Article #3
•16 million Americans are living with smoking related illnesses
•In 2016, $9.5 billion was spent on advertising and promotion of cigarettes and smokeless tobacco combined
•In fiscal year 2019, states will collect a record $27.3 billion from tobacco taxes and settlements in court

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Article #2
• Current smokers have a lower risk of developing ulcerative colitis
• There is an association between smoking and a lower incidence of Parkinson's disease
•women who smoke have been consestantly reported to develop uteran cancer
•Mothers can develop hypertension during pregnancy which can result in abnormal kidney function
•smocking helps the mind
•people with psychiatric conditions have a higher likelihood of smoking

# data[].attributes.body
Article #1
• the use of terms like low tar and mild have been banned from cigarette ads by the FDA because they made people believe they were less harmless
•Mental cigarettes are not safer they may be even more dangerous
•Cigars are not safer than cigarettes, one cigar can contain the amount of tobacco found in one pack of cigarettes
•Hookah smoking is viewed as a safe alternative to smocking, in fact smoking hookah is far more dangerous. you'll find all the same chemicals as in cigarettes but in more concentrated amounts

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Centers for Disease Control and Prevention

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Read through a Fast Facts fact sheet that discusses diseases and death, costs and expenditures, cigarette smoking in the US, and the impact of smoking and tobacco use.

# data[].attributes.body
Why did you pick your topic?
I chose my topic for two reasons, one multiple people in my extended family smoke cigarettes, and two, according to the center for disease control it is the number one cause of preventable death.

What intrigues you about this topic based on your research so far?
I saw that one of the three articles found an association between a lowered reported case of Parkinson's in those who smoke.

Have you learned anything about this issue that you didn't know before?
I learned that fact about Parkinson's.

What questions will guide your research?
The only thing i need to look for is reasons not to ban Tobacco products, There are currently 16 million Americans with a smoking related disease. That alone is reason enough to ban tobacco products.

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Important note: smoking may offer a limited degree of protection in some individuals against the development of a small number of diseases, outlined below. However this information is of little relevance to public health, given that the amount of disease that tobacco may be said to prevent is insignificant in comparison with the far greater incidence of disease caused by smoking. Smoking kills one in two of its users.

Tobacco use confers a small degree of protection against several diseases and conditions, described in the sections below. It is estimated that in 2004-05, tobacco use prevented about 148 deaths in Australia, a very low number compared to the 15 050 deaths caused by smoking in that same year. On the basis of these figures, tobacco might be said to save about one life for every 100 deaths it causes. Moreover, there is nothing to suggest that possible protection conferred against one disease will stop a given smoker from developing another tobacco-caused disease. So, for example, an individual who may have avoided Parkinson's disease due to his or her smoking still runs a significant risk of dying from heart disease, lung cancer, or any of the multiplicity of other tobacco-caused diseases. Equally, smoking does not prevent Parkinson's disease in all smokers.

While tobacco use cannot in any way be recommended as a prophylactic for these diseases and conditions, research on the mechanisms by which smoking appears to confer a protective effect against development of certain disease processes may lead to therapeutic benefits.

Ulcerative colitis is a serious bowel disease in which the inner lining of the colon and rectum becomes inflamed and permanently damaged.[4] Current smokers have a lower risk of developing ulcerative colitis, compared to non-smokers and ex-smokers, and according to the US Surgeon General, the evidence suggests that this protective relationship may be causal. A dose-response relationship has also been found, such that greater pack-years or numbers of cigarettes smoked per day were associated with a decreased risk of ulcerative colitis.Nicotine in tobacco smoke is thought to be the component that is most likely to affect the course of the disease. However, smokers have a greater risk of developing Crohn's disease, another inflammatory disease of the bowel (see Section 3.12.2 ). Due to the devastating effects of tobacco use, smoking is not recommended as treatment for ulcerative colitis, even though one research study has canvassed this as an extreme possibility for ex-smokers with steroid-dependent and resistant ulcerative colitis. Various forms of nicotine therapy are undergoing research to evaluate any possible benefits for individuals with this bowel disease.

An association between smoking and a lower incidence of Parkinson's disease has been observed in a number of studies. An analysis of longitudinal studies found a protective effect against Parkinson's disease for current and former smokers compared with those who had never smoked; the risk of Parkinson's disease was reduced by about half among ever smokers (RR 0.51; 95% CI, 0.43-0.61) and this protective effect was more pronounced among current smokers, where the risk was about one-third that of never smokers (RR 0.35; 95% CI, 0.26-0.47). Similar findings of a protective effect for Parkinson's disease were also reported from a case-control study conducted in Japan. Nicotine is thought to be the chemical in tobacco smoke mostly likely to be implicated in this finding, but there may be other chemicals or compounds involved. Based on data from 2004-05 we can derive theoretical estimates that about 97 deaths from Parkinson's disease are prevented by smoking in Australia annually. Finally, recent research also suggests that nicotine can improve compromised semantic processing in Parkinson's disease, and also influence semantic processing in healthy older individuals; however, the 2014 US Surgeon General's report found that controlled trials of the effects of nicotine on cognitive function in patients with Parkin¬son's disease are limited, with inconsistent findings.

Epidemiological studies have consistently reported that active cigarette smoking is inversely associated with developing cancer of the endometrium (the membrane lining of the uterus) in women who have reached menopause. A recent meta-analysis found that cigarette smoking was significantly associated with a reduced risk, especially so among postmenopausal women, where a 29% reduction in risk was found (RR 0.71; 95% CI, 0.65-0.78). Very similar results have been reported from recent studies conducted in Poland although the researchers are at pains to point out their important finding that in postmenopausal women, obesity is an important modifier of the association between cigarette smoking and the risk of endometrial cancer. The Polish researchers found that obese women showed the greatest risk reduction for current smoking (OR 0.47; 95% CI, 0.27-0.81), a finding that further underscores the need for caution in interpreting these 'favourable effects' of cigarette smoking, considering the toxic and carcinogenic effects of tobacco.

Women who smoke may also have a decreased risk for uterine fibroids and endometriosis, but the evidence for this is not conclusive. Development of endometrial cancer is predominantly influenced by exposure to the hormone oestrogen, and the protection conferred by smoking is likely to be due to the 'anti-oestrogenic' effect of chemicals in tobacco smoke. This same interaction works to increase the risk among smokers of developing osteoporosis, and reaching menopause earlier than non-smokers (see ).

Based on data from 2004-05 we can derive theoretical estimates that smoking may prevent the loss of about 52 lives from endometrial cancer in Australia. However the numbers of lives saved that can be statistically attributed to the prevention of endometrial cancer among smokers pales into insignificance compared with the numbers of deaths due to other diseases caused by tobacco use, particularly in the light of the evidence that has established that smoking causes cancer of the uterine cervix.

Pre-eclampsia is a potentially serious condition in pregnancy in which the mother develops high blood pressure, fluid retention and abnormal kidney function. Smokers are less likely to develop pre-eclampsia than non-smokers; recent research points to the impact of smoking on the ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) as one possible pathway, however the mechanism by which the observed protective effects occur remains poorly understood. A study using Swedish birth registry data on more than 600 000 births examined the effects of snuff and cigarette smoking on pre-eclampsia risk and whether changes in tobacco habits during pregnancy affected the risk of developing term pre-eclampsia. Compared with non-tobacco users, light smokers experienced a one-third reduction in risk (OR 0.66; 95% CI, 0.61-0.71) and heavy smokers a halving of risk (OR 0.51; 95% CI, 0.44-0.58) with ORs lower for term than preterm pre-eclampsia. The study found that tobacco combustion products rather than nicotine are the probable protective ingredients against pre-eclampsia in cigarette smoke and further concluded that it is smoking behaviour in the middle or late rather than in the beginning of pregnancy that seems to have the greatest effect on the risk of pre-eclampsia.A potential mediator of these associations might be carbon monoxide (CO), as it has vasoprotective properties, and CO and CO-releasing molecules lower soluble fms-like tyrosine kinase-1 (sFlt-1; a protein that is higher in women who develop preeclampsia) and soluble endoglobinin in vitro cultures.

The US Surgeon General has concluded that 'the decreased risk of pre-eclampsia among smokers compared with non-smokers does not outweigh the adverse outcomes that can result from prenatal smoking' (p576). These conclusions are underscored by findings from a recent case-control study conducted in Canada where notwithstanding a (non-significant) reduction in the risk of pre-eclampsia, persistent smoking was also associated with a 10-fold increase in the risk of low birthweight (OR 10.2; 95% CI, 2.49-41.8) and a four-fold increase in the risk of preterm birth (OR 3.59; 95% CI, 1.06-12.1).

A meta-analysis of research into the effects of nicotine and smoking on human performance found positive effects of nicotine or smoking on six domains: (i) fine motor, (ii) alerting attention-accuracy, (iii) response time (RT), (iv) orienting attention-RT, (v) short-term episodic memory-accuracy, and (vi) working memory-RT (effect size range = 0.16 to 0.44). There is evidence that nicotine may stimulate immediate and sustained improvements in working memory, that nicotine replacement in smokers avoids cognitive impairment through direct pharmacological effects on brain neuronal activity, and that nicotine may improve prospective memory (the retrieval and implementation of a previously encoded intention). Note however that smoking in the longer term has been associated with cognitive decline-see Section 3.23.

The prevalence of smoking is higher among people with psychiatric conditions. The reasons for this are complex and are discussed in greater detail elsewhere ( Chapter 1, Section 1.10.2 and Chapter 9, Section 9.6.4, but one motivating factor for smoking is that tobacco may be regarded by some individuals as a way of relieving unpleasant symptoms of certain types of mental illness, and could therefore be seen as helpful.

There is evidence that the action of nicotine in enhancing mood and concentration is more pronounced in some individuals with depression and cognitive problems (issues relating to mental awareness and judgement), and also that nicotine can help relieve unwelcome side effects from medication, particularly among patients being treated with antipsychotic drugs. These effects may occur because of different actions of nicotine on the brain chemistry reward system, which have been observed in individuals with particular psychiatric conditions.

It has been suggested that nicotine transiently enhances sustained attention in schizophrenia patients, and that these research findings might provide insights for the development of new treatment strategies for attention deficit and sensory disruption which occur in schizophrenia. However, in a 2012 Cochrane Review update, the authors reviewed all randomised controlled trials examining nicotine as a treatment for people with schizophrenia, and found no studies that met their inclusion criteria. Hence, there is a need for high quality research that investigates the effects of nicotine for schizophrenia. Limited research also suggests that nicotine might help alleviate some of the symptoms of ADHD, such as impulsiveness and memory deficits, which may explain the higher prevalence of smoking in this group.

Higher smoking rates among the mentally ill mean that they bear a disproportionate burden of morbidity and mortality from tobacco. Clinical and epidemiological data indicate that cigarette smoking increases the risk for the development and maintenance of panic disorder and that cessation may be one of the relevant steps in treatment, while a recent case-control study suggests that smoking may be a risk factor for late-onset major depression. Smokers with severe mental health illnesses have been identified in the Australian National Tobacco Strategy as requiring specialised strategies to assist in cessation. See also Chapter 7, Section 7.19.

Some studies have suggested that smoking may be associated with a reduced risk of developing thyroid cancer, particularly for women; however this protective effect has not been found in all studies and more research is required before a definitive statement can be made.

Early epidemiological studies suggested a protective effect of smoking for melanoma. More recent analyses from two large prospective cohort studies provides limited evidence to suggest that smoking may reduce melanoma risk; analyses by smoking status provided inconsistent data and no clear dose-response pattern was found. This weakens the argument for a cause-effect relationship between smoking and a protective effect for melanoma.

3.28.9 Other possible health 'benefits'

There is some evidence that smokers and users of smokeless tobacco are less likely to develop aphthous stomatitis (common mouth ulcers). One recent study found that the possible protective effect of smoking was only present when there was heavy cigarette smoking or smoking for long periods of time (>5 years) and no significant associations were found between intensity or duration of smoking and clinical severity of aphthous stomatitis lesions. Transient increased incidence of mouth ulcers is commonly reported by individuals on quitting smoking.

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References

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Important note: smoking may offer a limited degree of protection in some individuals against the development of a small number of diseases, outlined below. However this information is of little relevance to public health, given that the amount of disease that tobacco may be said to prevent is insignificant in comparison with the far greater incidence of disease caused by smoking.

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Tobacco hurts and kills people. In fact, smoking causes about 1 in 5 deaths in the United States.

There are many forms of tobacco on the market, and people often think some forms are safe and don't cause health problems. This isn't true.

Other tobacco products, like e-cigarettes, hookahs, edibles, heat-not-burn cigarettes, and smokeless tobacco, contain some of the same chemicals as regular combustible cigarettes. It's important to know that even though e-cigarettes do not contain tobacco, the Food and Drug Administration (FDA) classifies them as "tobacco products."

Regular (combustible) cigarettes

Regular cigarettes, called combustible cigarettes, contain tobacco, added chemicals, a filter, and a paper covering. People who smoke them expose themselves to over 7,000 chemicals when they inhale the smoke from their cigarettes. People around them are also exposed to the same chemicals through secondhand smoke.

Cigarette smoking accounts for almost all tobacco-related illnesses and deaths in the United States.

Light, hand-rolled, natural, or herbal cigarettes

Some people believe that "light" and "low-tar" cigarettes have lower health risks. But studies have shown that the risk of serious health effects is not lower in light or low-tar cigarettes. Because of this, the FDA has banned use of the terms "light," "mild," and "low" in any cigarette sales unless the FDA specifically allows it − and so far, it hasn't.

Hand-rolled cigarettes are no safer than commercial brands. In fact, life-long smokers of hand-rolled cigarettes have a higher risk of cancers of the larynx (voice box), esophagus (swallowing tube), mouth, and pharynx (throat) when compared with people who smoke machine-made cigarettes.

Some cigarettes are now being sold as "all natural." They're marketed as having no chemicals or additives and rolled with 100% cotton filters. There's no proof they are healthier or safer than other cigarettes, nor is there good reason to think they would be. Smoke from all cigarettes, natural or otherwise, has many chemicals that can cause cancer (carcinogens) and toxins that come from burning the tobacco itself, including tar and carbon monoxide.

Even herbal cigarettes with no tobacco give off tar, particulates, and carbon monoxide and are dangerous to your health.

Menthol cigarettes

Menthol cigarettes are not safer than unflavored cigarettes. In fact, they could be even more dangerous.

Menthol cigarettes tend to be "easier" to smoke - the added menthol produces a cooling sensation in the throat when the smoke is inhaled. It lessens the cough reflex and covers the dry feeling in the throat that smokers often have. People who smoke menthol cigarettes can inhale deeper and hold the smoke in longer. This helps to explain why people who smoke menthol cigarettes and get lung cancer often have their cancers located in certain parts of the lung. It also might be a reason why it is harder for people who smoke menthol cigarettes to quit.

The specific dangers of menthol cigarettes are an active area of research, but they are at least as dangerous as unflavored cigarettes. It's important to note the tobacco industry often targets African Americans for the sale of menthol cigarettes.

Cigars and little cigars

Many people view cigar smoking as more sophisticated and less dangerous than cigarette smoking. Yet one large cigar can contain as much tobacco as an entire pack of cigarettes.

Most cigars are made of a single type of aged, air-cured or dried tobacco that's fermented in a multi-step process. The fermentation causes chemical and bacterial reactions that change the tobacco. This is what gives cigars a different taste and smell from cigarettes. Cigars come in many sizes:

The smallest, known as little cigars or small cigars, are about the size of cigarettes. Other than the fact that they are brown and maybe a little longer, they look like cigarettes. They come in flavors like mint, chocolate, or fruit, and many have filters. They're often sold in packs of 20. Most people smoke these small cigars exactly the same way as cigarettes.

Slightly larger cigars are called cigarillos, blunts, or cheroots. They contain more tobacco than little cigars, and are also often flavored. Studies suggest that some people smoke them more like cigarettes than cigars, inhaling and smoking every day. They look like small versions of traditional cigars, but they can be bought in small packs.

True large cigars may contain more than half an ounce of tobacco - as much as a whole pack of cigarettes. It can take from 1 to 2 hours to smoke a traditional large cigar.

Almost all cigarette smokers inhale, but most larger cigar smokers don't. This could be because cigar smoke tends to irritate the nose, throat, and breathing passages. A new trend among cigar companies is to change the fermenting process to make cigar smoke easier to inhale. The filters on the smaller cigars also help smokers inhale.

There's a lot of nicotine in cigars

Full size cigars can have as much nicotine as an entire pack of cigarettes.

Cigarettes have an average of about 8 milligrams (mg) of nicotine, but only deliver about 1 to 2 mg of nicotine.

Many popular brands of larger cigars have between 100 and 200 mg, or even as many as 444 mg of nicotine.

No matter the size, cigars are tobacco, and the smoke from them contains the same cancer-causing substances found in cigarette smoke. All cigars are dangerous to your health.

Regular cigar smokers are 4 to 10 times more likely to die from cancers of the mouth, throat, larynx, and esophagus than non-smokers. For those who inhale, cigar smoking appears to be linked to death from cancer of the pancreas and bladder, too.

Smoking more cigars each day or inhaling cigar smoke leads to more exposure and higher health risks. The health risks linked to occasional cigar smoking (less than daily) are less clear. Like cigarettes, cigars give off secondhand smoke, which is also dangerous.

Electronic or e-cigarettes (vaping devices)

Using electronic or e-cigarettes is often called vaping or JUULing. JUUL is a certain very popular brand of e-cigarette. The liquid in these devices is heated and creates an aerosol of tiny particles (sometimes called a "vapor") that is inhaled by users. Although the term "vapor" may make it sound harmless, it is not water vapor. Instead, it's an aerosol that consists of propylene glycol plus flavor ingredients, and it can be harmful. E-cigarette aerosol can also contain nicotine and other substances that are addictive and can cause lung disease, heart disease, and cancer.

It's especially important to know that all JUULs and most other e-cigarettes contains nicotine, the same addictive drug that is in regular cigarettes, cigars, hookah, and other tobacco products.

Because their use is so recent, little is known about the possible harms of long-term e-cigarette use. Studies in lab animals have documented lung damage and some chromosomal abnormalities that may signal a risk for cancer. Because this is such a rapidly evolving field, there is no consensus yet about the harms of vaping. More research is needed over a longer period of time to know what the long-term health effects may be.

There have been reports of severe lung illnesses in some people who vape. Most (but not all) of these cases have been linked to the vaping of off-market cannabis products that contain vitamin E acetate oil. The American Cancer Society is closely watching for new research about the effects of using e-cigarettes and other new tobacco products. Read more in What Do We Know About E-cigarettes?

Clove cigarettes (kreteks)

Clove cigarettes, also called kreteks (KREE-teks), are a tobacco product with the same health risks as cigarettes. Kreteks are imported from Indonesia. They contain tobacco, ground cloves, clove oil, and other additives.

Like other flavored cigarettes, kreteks are used mostly by younger smokers. They are nearly ideal in design as a "trainer cigarette" - giving kids another way to try tobacco and get addicted to nicotine. The false image of these products as clean, natural, and safer than regular cigarettes seems to attract some young people who might otherwise not start smoking. But they are not safer than cigarettes, and researchers are looking into whether the cloves might even cause additional problems.

Kreteks have been linked to lung problems, such as lower oxygen levels, fluid in the lungs, and inflammation. Regular kretek smokers have up to 20 times the risk for abnormal lung function (blocked airways or poor oxygen uptake) compared with non-smokers.

Bidis (flavored cigarettes)

Bidis or "beedies" are thin, flavored cigarettes that originated in India and other Southeast Asian countries. They are hand-rolled in an unprocessed tobacco, tendu, or temburi leaf (plants native to Asia) and may be tied with colorful strings on the ends. They tend to cost less than regular cigarettes and they give the person using them a quick buzz from the high levels of nicotine.

Even though bidis have less tobacco than regular cigarettes, they deliver 3 to 5 times more nicotine than regular cigarettes, as well as other harmful substances, such as tar and carbon monoxide. They are unfiltered. And because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette.

Some people think they are safer and more natural than regular cigarettes. But bidis appear to have all of the same health risks of regular cigarettes, including many types of cancer. Bidi smokers have much higher risks of heart attacks, emphysema, chronic bronchitis, and cancer than non-smokers.

Hookahs (water pipes)

Hookah is also called narghile (NAR-guh-lee) smoking. It started in Asia and the Middle East. A water pipe is used to burn tobacco that has been mixed with flavors such as honey, mint, licorice, molasses, or fruit, and the flavored smoke is inhaled through a long hose. Usually, the tobacco mixture, which is called shisha (SHE-shuh), is heated using charcoal. (The charcoal itself produces carbon monoxide and other toxins.)

Hookah smoking has become popular among younger people in the US as a social event which lets the smokers spend time together and talk as they pass the mouthpiece around.

Newer forms of hookah smoking include steam stones that have been soaked in fluid and are used instead of tobacco and battery powered hookah pens. Both of these create a vapor that's inhaled. Hookah pens work the same way as electronic or e-cigarettes [see Electronic or e-cigarettes (vaping devices)]. Some sellers advertise that these are purer and healthier alternatives to regular hookahs, but this has not been proven.

Hookahs are marketed as a safe alternative to cigarettes. This claim is false. The water does not filter out the toxins. In fact, hookah smoke has been shown to contain toxins like carbon monoxide, nicotine, tar, and heavy metals, in concentrations that are as high, or even higher, than those in cigarette smoke - it carries many of the same health risks. But because the use of hookahs is generally less frequent than the use of cigarettes, it is likely that a person's overall exposure to the toxic ingredients is less.

Several types of cancer, including lung cancer, have been linked to hookah smoking. It affects the heart, too, causing coronary artery disease, an increased heart rate, and high blood pressure. Lung damage, carbon monoxide intoxication, chronic bronchitis, emphysema, dental problems, and osteoporosis have also been linked to hookah use. There's also a risk of passing infections while sharing a hookah.

Hookahs also put out secondhand smoke from both the tobacco and the burning charcoal used as a heat source.

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Tobacco hurts and kills people. In fact, smoking causes about 1 in 5 deaths in the United States. There are many forms of tobacco on the market, and people often think some forms are safe and don't cause health problems. This isn't true.