They're sweet. They're cheap. They're small and worst of all, they're trendy. Bidis, tiny flavored cigarettes from India, are luring a new generation of young smokers to tobacco and raising alarms among public health officials and anti-smoking groups.
In a new study scheduled to be published in the Morbidity and Mortality Weekly Report, Massachusetts state public health researchers will report high rates of bidi use among urban youth there, a pattern of use that experts say likely reflects use elsewhere also.
While the study's results are embargoed until publication, Massachusetts Public Health Commissioner Howard Koh said the findings point to a serious new threat to anti-smoking efforts among youth in grades seven to 12. "The study found that the prevalence of bidi use was disturbingly high," Koh said. "This is catching hold."
Bidis are slim, hand-rolled cigarettes that have been sold in the United States for more than 20 years. These unfiltered cigarettes resemble marijuana joints, but instead of paper, they are wrapped in tendu leaves, which are less permeable to air and require the smoker to inhale more deeply. Pronounced beedies, these appealing cigarettes are packaged in a variety of colorful boxes or come wrapped in small cone-shaped paper packages. They cost between $1.50 to $3.50 per pack and are sold in tobacco shops and so-called "head shops." Even some health food stores have jumped into the market, selling bundles of bidis tied with string as a so-called "natural" form of tobacco.
Numerous studies show that bidis deliver greater amounts of nicotine, tar and carbon monoxide than standard cigarettes. The most recent analysis, released last week by the National Institute on Drug Abuse (NIDA), found that 11 out of 12 brands of bidis analyzed contained higher concentrations of nicotine than the unfiltered cigarette American Spirit. The tests, which were conducted for NIDA by Murty Pharmaceuticals of Lexington, Ky., also found that the average nicotine concentration of bidis was about 28 percent higher than that found in American Spirit.
"Studies in the U.S. and in India have found that bidis have three times more carbon monoxide and about five times the amount of tar compared to filtered cigarettes," said epidemiologist Samira Asma at the Centers for Disease Control and Prevention's Office of Smoking and Health. "They also contain more phenol, ammonia, nitrosamines and hydrogen cyanide."
Teens who smoke bidis often mistakenly consider them to be a safer alternative to cigarettes. "Kids seem to have the impression that bidis are not as addictive and that they are safer than commercial cigarettes," said Wallace Pickworth, a clinical pharmacologist at NIDA. "That is part of their appeal."
Bidis are also smoked differently than standard cigarettes. They don't burn easily and must be re-lit frequently. "They look and are smoked more like a marijuana cigarette," Pickworth said. "It seems like there's a ritual involved with smoking them."
University of Arizona anthropologist Mark Nichter, who has studied bidis in India for 25 years, said that in the United States, bidis are sometimes used as training to teach young smokers how to draw the long, deep "hits," or breaths, favored by marijuana smokers. One student told Nichter that his friends wouldn't smoke marijuana with him until he learned how to smoke bidis first because they didn't want him to waste the marijuana.
The taste of bidis also seems to draw many young smokers. In India, bidis contain plain tobacco with no flavoring. In the United States, however, they are sold in candy-store flavors such as cinammon, mango, orange, chocolate, watermelon, raspberry, vanilla and menthol.
"They are flavored so that some of the noxious elements are muted or blunted," said Edward A. Jacobs, chair of the American Academy of Pediatrics' committee on substance abuse. "They are potentially quite harmful and quite alluring because of the flavors."
Where and how the flavoring is being added has not yet been determined. Bidis remain a cottage industry in India, where poor families often survive by rolling them for the manufacturer. But anti-smoking advocacy groups contend that the flavors are added specifically to capture the American teen market. "We strongly believe that these companies are creating flavored bidis to entice children," said Bill Novelli president of the Campaign for Tobacco-Free Kids. "It's not the first time that a tobacco company has done this."
Some tobacco researchers hope that the growing use of bidis among American youth will serve as a wake-up call. "It's almost like a Third World revenge" for the sale of millions of American cigarettes overseas, said Greg Connelly, who studies bidis for the Massachusetts Department of Public Health. "While the U.S. dumps cigarettes into Third World countries, we have India dumping bidis here. It sends a message that we need to protect kids throughout the world" against tobacco.
By law, bidis are not to be sold to anyone under 18 years of age. Each packet is also required to carry the Surgeon General's warning about tobacco as well as a tax stamp. But a 1998 study by the San Francisco Tobacco Free Project found that bidis were sold to minors without age identification twice as often as regular cigarettes. Some 41 percent of bidis purchased had no tax stamp and seven out of 10 packs failed to carry the health warning about smoking.
Sen. Tom Harkin (D-Iowa) last week asked the Food and Drug Administration and the Federal Trade Commission to crack down on youth access to bidis. "This disturbing trend is further evidence that immediate action is needed to protect our kids from the lies and deception of the tobacco industry both in the U.S. and overseas," Harken said.
Whether that will be enough to mute the appeal of bidis among youth smokers is not clear. The SmartGirl Web site (http://www.smartgirl.com), a site devoted to the concerns of teenage girls, surveyed users in February about smoking cigarettes, marijuana and bidis. Only 20 percent of those polled said that they had ever heard of or seen bidis. But as one 15-year-old noted, "I've never even heard of bidis. But I'll tell you one thing. If the media starts going on about how bad bidis are for you, I guarantee that for every one kid who you stop from smoking, you'll have 10 more wanting to try it."
As the University of Arizona's Nichter warns, there are already exotic, new tobacco products poised to become the next bidis in the U.S. market. On the horizon: pan masala, a potent chewing tobacco laced with araca nut, spices and lime and sold in appealing sachets.
"The Indian government is considering banning it," Nichter said. "It's very carcinogenic and India is the number one country in the world for oral cancer. But it tastes good. It gives you a real kick. It's being marketed very aggressively and no one know that you are doing it. There are a lot of 12- and 13-year-olds in India already popping it into their mouths."
CAPTION: Bidis come in a range of candy-store flavors and package styles, many of which fail to carry the health warning and tax stamp normally require on cigarette packages.