Forms of tobacco

Smoked tobacco
Cigarettes have been the most widely used form of
tobacco in theUnited States for several decades [51],
yet in recent years, cigarette smoking has been de-
clining steadily among most population subgroups.
In 2005, just over half of ever smokers reported be-
ing former smokers [3]. However, a considerable
proportion of the population continues to smoke.
In 2005, an estimated 45.1 million adult Americans
(20.9%) were current smokers; of these, 80.8% re-
ported to smoking every day, and 19.2% reported
smoking some days [7]. The prevalence of smoking
varies considerably across populations (Table 1.2),
with a greater proportion of men (23.9%) than
women (18.1%) reporting current smoking. Per-
sons of Asian or Hispanic origin exhibit the low-
est prevalence of smoking (13.3 and 16.2%, respec-
tively), and American Indian/Alaska natives exhibit
the highest prevalence (32.0%). Also, the preva-
lence of smoking among adults varies widely across
the United States, ranging from 11.5% in Utah to
28.7% in Kentucky [51]. Twenty-three percent of
high school students report current smoking, and
among boys, 13.6% report current use of smoke-
less tobacco, and 19.2%currently smoke cigars [52].
These figures are of particular concern, because
nearly 90% of smokers begin smoking before the
age of 18 years [53].
Other common forms of burned tobacco in the
United States include cigars, pipe tobacco, and bidis.
Cigars represent a roll of tobacco wrapped in leaf to-
bacco or in any substance containing tobacco [54].
Cigars’ popularity has somewhat increased over the
past decade [55]. The latter phenomenon is likely
to be explained by a certain proportion of smok-
ers switching cigarettes for cigars and by adoles-
cents’ experimentation with cigars [56]. In 1998,
approximately 5%of adults had smoked at least one
cigar in the past month [57]. The nicotine content
of cigars sold in the United States ranged from 5.9
to 335.2 mg per cigar [58] while cigarettes have a
narrow range of total nicotine content, between 7.2
and 13.4 mg per cigarette [59]. Therefore, one large
cigar, which could contain as much tobacco as an
entire pack of cigarettes is able to deliver enough
nicotine to establish and maintain physical depen-
dence [59].
Pipe smoking has been declining steadily over the
past 50 years [60]. It is a form of tobacco use seen
among less than 1% of Americans [60]. Bidi smok-
ing is a more recent phenomenon in the United
States. Bidis are hand-rolled brown cigarettes im-
portedmostly fromSoutheast Asian countries. Bidis
arewrapped in a tendu or temburni leaf [61]. Visually,
they somewhat resemble marijuana joints, which
might make them attractive to certain groups of
the populations. Bidis are available in multiple fla-
vors (e.g., chocolate, vanilla, cinnamon, strawberry,
cherry, mango, etc.), which might make them par-
ticularly attractive to younger smokers. A survey
of nearly 64,000 people in 15 states in the United
States revealed that young people (18–24 years of
age) reported higher rates of ever (16.5%) and
current (1.4%) use of bidis then among older adults
(ages 25 plus years). With respect to sociodemo-
graphic characteristics, the use of bidis is most com-
mon among males, African Americans, and con-
comitant cigarette smokers [62].Although featuring
less tobacco than standard cigarettes, bidis expose
their smokers to considerable amounts of hazardous
compounds. A smoking machine-based investiga-
tion found that bidis deliver three times the amount
of carbon monoxide and nicotine and almost five
times the amount of tar found in conventional
cigarettes [63].