Bidis and Kreteks
- Bidis are small, thin hand-rolled cigarettes imported to the United States primarily from India and other Southeast Asian countries. 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. Bidis can be flavored (e.g., chocolate, cherry, and mango) or unflavored.1,2
- Kreteks—sometimes referred to as clove cigarettes—are imported from Indonesia and typically contain a mixture of tobacco, cloves, and other additives.3,4
- Bidis and kreteks have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States.1,3,5,6
- Neither bidis nor kreteks are safe alternatives to conventional cigarettes.4,5
Because of the low prevalence of use, a limited amount of research on the long-term health effects of bidis has been conducted in the United States.7 However, research studies from India indicate that bidi smoking is associated with cancer and other health conditions.2
- Smoke from a bidi contains 3 to 5 times the amount of nicotine as a regular cigarette and places users at risk for nicotine addiction.7
- Bidi smoking increases the risk for oral cancer, lung cancer, stomach cancer, and esophageal cancer.6,8,9,10
- Bidi smoking is associated with a more than threefold increased risk for coronary heart disease and acute myocardial infarction (heart attack).6,11
- Bidi smoking is associated with emphysema10 and a nearly fourfold increased risk for chronic bronchitis.6
Because of the low prevalence of use, a limited amount of research on the long-term health effects of kreteks has been conducted in the United States. However, research studies from Indonesia indicate that kretek smoking is associated with lung problems.
- Kretek smoking is associated with an increased risk for acute lung injury (i.e., lung damage that can include a range of characteristics such as decreased oxygen, fluid in the lungs, leakage from capillaries, and inflammation), especially among susceptible individuals with asthma or respiratory infections.4
- Regular kretek smokers have 13 to 20 times the risk for abnormal lung function (e.g., airflow obstruction or reduced oxygen absorption) compared with nonsmokers.12
Percentage of U.S. students who were current bidi smokers in 200913
- 1.6% of all middle school students
- 1.2% of female middle school students
- 2.0% of male middle school students
- 2.4% of all high school students
- 2.1% of female high school students
- 2.7% of male high school students
Percentage of U.S. students who were current kretek smokers in 200913
- 1.2% of all middle school students
- 0.7% of female middle school students
- 1.6% of male middle school students
- 2.4% of all high school students
- 1.9% of female high school students
- 2.9% of male high school students
-Current smokers are defined as persons who reported smoking 1 or more bidis or kreteks in the 30 days preceding the survey.
- Centers for Disease Control and Prevention. Bidi Use Among Urban Youth—Massachusetts, March–April 1999. Morbidity and Mortality Weekly Report [serial online]. 1999;48(36):796–799 [accessed 2011 Feb 15].
- Bidi Cigarettes: An Emerging Threat to Adolescent Health. Archives Pediatrics & Adolescent Medicine. 2000;154:1187–1189 [cited 2011 Feb 15].
- Clove Cigarette Smoking: Biochemical, Physiological, and Subjective Effects. Pharmacology Biochemistry and Behavior. 2003;74:739–745 [cited 2011 Feb 15].
- World Health Organization.
Tobacco: Deadly in Any Form or Disguise .
Geneva: World Health Organization, 2006 [accessed 2011 Feb 15].
- Determination of the Tar, Nicotine, and Carbon Monoxide Yields in the Smoke of Bidi Cigarettes. Nicotine & Tobacco Research. 2003;5(5):747–753 [cited 2011 Feb 15].
- Bidi Smoking and Health. Public Health 2000;114:123–127 [cited 2011 Feb 15].
- Bidi Cigarette Use Among Young Adults in 15 States. Preventive Medicine 2004;39:207–11 [cited 2011 Feb 15].
- Bidi Smoking and Oral Cancer: A Meta-Analysis. International Journal of Cancer 2003;106:600–604 [cited 2011 Feb 15].
- Risk Factors for Cancer of the Oesophagus in Kerala, India. International Journal of Cancer. 1991;49:485–489 [accessed 2011 Feb 15].
- Gupta PC, Asma S. Bidi Smoking and Public Health . New Delhi: Ministry of Health and Family Services, Government of India, 2008 [accessed 2011 Feb 15].
- Risk Factors for Acute Myocardial Infarction in Indians: A Case-Control Study. Lancet 1996;348:358–363 [cited 2011 Feb 15].
- Environmental and Occupational Lung Diseases in Indonesia. Respirology 1996;1:85–93 [accessed 2011 Feb 15].
- Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2000–2009. Morbidity and Mortality Weekly Report 2010;59(33):1063–8 [accessed 2011 Feb 15].
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