Dr. Greene, my daughter has started smoking a new kind of chocolate cigarette called a "bidi". She assures me they are all natural and not harmful at all. She says they contain no drugs. Do you know about them? Are bidis safe? She also smokes vanilla and strawberry bidis.

Bidis are all the rage among teens. It is estimated that 3% of high school students and 2% of middle school students smoke them regularly. Dessert and smoking literally rolled into one! But this makes me rage! People who are trying to make a fortune have succeeded in putting another one over on our kids. Bidis are not new, and they are certainly not safe!

Soon after the Europeans discovered tobacco in the New World, Dutch and Portuguese traders decided to introduce tobacco to India and the East so that they would have highly profitable goods to carry in their ships in both directions.

Tobacco arrived in India in 1605.

For centuries now, the bidi, cheaply made from inferior ingredients, has been the cigarette of choice for those in poverty in India. Called "the poor man's cigarette," the bidi is made from the flakes and dust of dark tobacco leaves. Strong flavoring, such as vanilla, licorice, strawberry, cinnamon, or clove, is added to mask the poor quality of the tobacco. This concoction is then hand-rolled in a green or brown leaf by impoverished laborers in oppressive "factories." The unfiltered final product is a small, slim cigarette, tied at both ends with a colorful thread.

I have not heard of bidis in the United States containing illegal drugs, though I have heard of opium-laced bidis in China. In some provinces of China, puffs from lighted cigarettes are given to infants and toddlers to stop them from crying (Tobacco Control, 1993; 2:7-8).

Bidis have long been popular among the poor in Bangladesh, Pakistan, Afghanistan, Sri Lanka, Cambodia, and India who could not afford regular cigarettes. A single pack of bidis costs up to 40% of their average daily income. Bidis are now more popular than regular cigarettes in India, Bangladesh, Pakistan, and Nepal. Oral cancers have become the leading cause of cancer throughout this region, with 90% attributable to tobacco use (Tobacco or Health: A Global Status Report, World Health Organization, 1997).

India now produces more tobacco than does the United States and is a world leader in oral cancer. (India and the United States taken together produce only a fraction of the amount that world-leader China produces in conjunction with American tobacco companies).

Now bidis are arriving on the shelves of convenience stores and gas stations across the United States.