Bidis and Kreteks

Fact sheet

July 2004

Bidis (pronounced “bee-dees”) are small, thin hand-rolled cigarettes imported to the United States primarily from India and other Southeast Asian countries.^1,2 They consist of tobacco wrapped in a tendu or temburni leaf (plants native to Asia), and may be secured with a colorful string at one or both ends.^1,2 Bidis can be flavored (e.g., chocolate, cherry, and mango) or unflavored.¹ They have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States.^1,3

Kreteks (pronounced “cree-techs”) are sometimes referred to as clove cigarettes.^4,5 Imported from Indonesia, kreteks typically contain a mixture consisting of tobacco, cloves, and other additives.^4,5 As with bidis, standardized machine-smoking analyses indicate that kreteks deliver more nicotine, carbon monoxide, and tar than conventional cigarettes.⁴ There is no evidence to indicate that bidis or kreteks are safe alternatives to conventional cigarettes.^3,5

Health Effects

• No research studies on the health effects of bidis have been conducted in the United States.² Research studies from India indicate that bidi smoking is associated with an increased risk for oral cancer,^6,7 as well as an increased risk for cancer of the lung,⁷ stomach,⁷ and esophagus.^7,8
   
• Research studies in India have shown that bidi smoking is associated with a more than three-fold increased risk for coronary heart disease and acute myocardial infarction (heart attack),^7,9 and a nearly four-fold increased risk for chronic bronchitis.⁷
   
• Kretek smoking is associated with an increased risk for acute lung injury, especially among susceptible individuals with asthma or respiratory infections.⁵
   
• No research studies on the long-term health effects of kreteks have been conducted in the United States. Research in Indonesia has shown that regular kretek smokers have 13−20 times the risk for abnormal lung function compared with nonsmokers.¹⁰

Current Estimates

• There are no national adult estimates for bidi or kretek smoking in the United States.
   
• An estimated 2.6% of high school students are current bidi smokers.¹¹ Bidi smoking is more than twice as common among male (3.7%) compared with female (1.5%) high school students.¹¹
   
• An estimated 2.4% of middle school students are current bidi smokers.¹¹ Bidi smoking is more common among male (3.1%) compared with female (1.7%) middle school students.¹¹
   
• An estimated 2.7% of high school students are current kretek smokers.¹¹ Kretek smoking is nearly twice as common among male (3.5%) than female (1.8%) high school students.¹¹
   
• An estimated 2% of middle school students are current kretek smokers.¹¹ Kretek use is more common among male (2.7%) compared with female (1.1%) middle school students.¹¹
   

References

1. CDC. Bidi use among urban youth—Massachusetts, March–April 1999. Morbidity and Mortality Weekly Report 1999;48(36):796–799. Available at http://www.cdc.gov/tobacco/research_data/youth/mmwr4836.pdf ( PDF). Accessed: July 2004.
    
2. Yen KL, Hechavarria E, Bostwick SB. Bidi cigarettes: an emerging threat to adolescent health. Archives Pediatrics & Adolescent Medicine 2000;154:1187–1189.
    
3. Watson CH, Polzin GM, Calafat AM, Ashley DL. Determination of the tar, nicotine, and carbon monoxide yields in the smoke of bidi cigarettes. Nicotine & Tobacco Research. 2003;5(5):747–753.
    
4. Malson JL, Lee EM, Murty R, Moolchan ET, Pickworth WB. Clove cigarette smoking: biochemical, physiological, and subjective effects. Pharmacology Biochemistry and Behavior 2003;74:739–745.
    
5. Council on Scientific Affairs. Evaluation of the health hazard of clove cigarettes. Journal of the American Medical Association 1988;260:3641–3644.
    
6. Rahman M, Sakamoto J, Fukui T. Bidi smoking and oral cancer: a meta-analysis. International Journal of Cancer 2003;106:600–604.
    
7. Rahman M, Fukui T. Bidi smoking and health. Public Health 2000;114:123–127.
    
8. Sankaranarayanan R, Duffy SW, Padmakumary G, Nair SM, Day NE, Padmanabhan TK. Risk factors for cancer of the oesophagus in Kerala, India. International Journal of Cancer 1991;49:485–489.
    
9. Pais P, Pogue J, Gerstein H, Zachariah E, Savitha D, Jayprakash S, Nayak, PR, Yusuf S. Risk factors for acute myocardial infarction in Indians: a case-control study. Lancet 1996;348:358–363.
    
10. Mangunnegoro H, Sutoyo DK. Environmental and occupational lung diseases in Indonesia. Respirology 1996;1:85–93.
     
11. CDC. Tobacco use among middle and high school students—United States, 2002. Morbidity and Mortality Weekly Report 2003;52(45):1096–1098. Available at http://www.cdc.gov/mmwr/PDF/wk/mm5245.pdf ( PDF). Accessed: July 2004.

Note: The next update of this fact sheet is scheduled for July 2005. More recent information may be available at the CDC’s Office on Smoking and Health Web site: http://www.cdc.gov/tobacco.

For Further Information

Office on Smoking and Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Mailstop K-50
4770 Buford Hwy., N.E.
Atlanta, GA 30341-3717
770-488-5705
http://www.cdc.gov/tobacco

Media Inquires: Contact the Office on Smoking and Health’s press line at 770-488-5493.
 

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This page last reviewed October 06, 2004

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