A reverse smoker is a person who smokes a cigarette, cigar, or cheroot with the lit end placed inside the mouth. Instead of puffing on the unlit end like conventional smoking, the burning tip sits on or near the tongue and palate while the smoker inhales. This practice is most common in rural coastal regions of India, particularly among women, and carries an unusually high risk of oral cancer.
How Reverse Smoking Works
The smoker lights one end of a hand-rolled tobacco product, then places that glowing end into the mouth. The smoking device is typically a “chutta,” a handmade cigar crafted from a few dried twigs of home-grown tobacco rolled in a semi-dried tobacco leaf. Chuttas range from about 1.5 grams for a small one to 7.5 grams for a large one. The smoker draws air through the chutta while the lit end sits inside the oral cavity, exposing the roof of the mouth, tongue, and inner cheeks to direct heat and concentrated smoke.
This might sound painful, but long-term practitioners develop thickened tissue on the palate that partially insulates against the heat. The habit is typically learned young and practiced for decades.
Where and Why People Smoke in Reverse
Reverse smoking is most prevalent in coastal rural Andhra Pradesh, India, especially in the Srikakulam and East Godavari districts. It also occurs in the Indian states of Odisha and Goa. Outside India, it has been documented in rural communities in the Philippines (particularly in Cabanatuan City), parts of South America, the Caribbean, Colombia, the Netherlands, and Sardinia. The practice is known locally in Andhra Pradesh as “Adda Poga.”
Women make up the majority of reverse smokers in nearly every community where the habit exists, with Sardinia being the only documented exception. It is considered a socially acceptable habit among adult women in these regions, and the most common reason people start is that they learned it from their mothers. Peer pressure and friendship are secondary factors.
There are also practical reasons behind the habit. Women who do household work near water report that holding the lit end inside the mouth keeps the chutta from being extinguished by splashing. Others say it prevents hot ashes from falling on nursing infants. In cold weather, particularly during farming, the internal heat is considered a benefit. Some communities also believe, incorrectly, that reverse smoking helps with asthma, controls bleeding gums, or reduces nausea during early pregnancy. Village and family elders sometimes actively recommend the practice during pregnancy, reflecting a deep lack of awareness about its health effects.
What It Does to the Mouth
The roof of the mouth takes the worst damage. The palatal mucosa, the tissue lining the hard palate, undergoes visible changes that include elevated white patches, red areas, ulcerations, and areas where the normal pigmentation is either increased or lost entirely. These changes often coexist in the same person, creating a patchwork of damaged tissue across the palate. The International Agency for Research on Cancer classifies these palatal changes as precancerous, meaning they represent an intermediate stage between normal tissue and cancer.
The combination of extreme heat, concentrated tobacco smoke, and direct chemical contact creates a level of tissue damage that conventional smoking rarely produces in the same location. In conventional smoking, the palate receives relatively indirect exposure. In reverse smoking, it becomes the primary target.
Cancer Risk
Palatal cancer, a relatively rare form of oral cancer in the general population, is strongly linked to reverse smoking. A cross-sectional study in rural Andhra Pradesh found that reverse smoking caused significantly more oral lesions than conventional chutta smoking. More strikingly, all nine newly diagnosed palatal cancers identified in the study occurred exclusively among reverse smokers, with zero cases in the conventional smoking group.
This makes reverse smoking one of the most direct and well-documented causes of a specific cancer type. Palatal cancers in reverse smokers typically arise in areas where precancerous palatal changes already exist, which is why the visible white patches and red lesions serve as warning signs. The association between reverse smoking and palatal cancer is particularly well documented among women in India, who make up the largest population of reverse smokers worldwide.
Other Health Effects
Beyond oral cancer, reverse smoking is associated with chronic obstructive lung disease, similar to conventional smoking but compounded by the unique inhalation pattern. The smoker draws heated air and concentrated combustion products directly across the oral tissues before they reach the throat and lungs, meaning both the mouth and the respiratory system absorb damage simultaneously.
The thermal injury alone is significant. While specific temperature measurements inside the mouth during reverse smoking have been studied, the visible tissue changes, including thickening, ulceration, and color changes on the palate, confirm that the heat exposure is intense enough to cause chronic damage over time. This repeated thermal and chemical assault is what drives the transformation from normal tissue to precancerous lesions to, in some cases, full malignancy.