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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
- 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.
- Yen KL, Hechavarria E, Bostwick SB. Bidi cigarettes: an emerging
threat to adolescent health. Archives Pediatrics & Adolescent Medicine
2000;154:1187–1189.
- 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.
- 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.
- Council on Scientific Affairs. Evaluation of the health hazard of
clove cigarettes. Journal of the American Medical Association
1988;260:3641–3644.
- Rahman M, Sakamoto J, Fukui T. Bidi smoking and oral cancer: a
meta-analysis. International Journal of Cancer 2003;106:600–604.
- Rahman M, Fukui T. Bidi smoking and health. Public Health
2000;114:123–127.
- 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.
- 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.
- Mangunnegoro H, Sutoyo DK. Environmental and occupational lung
diseases in Indonesia. Respirology 1996;1:85–93.
- 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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