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Fact Sheet

Bidis and Kreteks

(updated February 2007)

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 of Bidis and Kreteks

• Research studies on the health effects of bidis have not 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 show 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
• Research studies on the long-term health effects of kreteks have not been conducted in the United States. Research in Indonesia shows that regular kretek smokers have 13−20 times the risk for abnormal lung function compared with nonsmokers.¹⁰

Current U.S. Estimates of Bidis and Kreteks Use

• There are no national estimates for bidi or kretek smoking among adults in the United States.
• An estimated 3% of high school students are current bidi smokers.¹¹ Bidi smoking is more than twice as common among male (4%) compared with female (2%) high school students.¹¹
• An estimated 2% of middle school students are current bidi smokers.¹¹ Bidi smoking is more common among male (3%) compared with female (2%) middle school students.¹¹
• An estimated 3% of high school students are current kretek smokers.¹¹ Kretek smoking is more common among male (3%) than female (2%) high school students.¹¹
• An estimated 2% of middle school students are current kretek smokers.¹¹ Kretek use is more common among male (2%) compared with female (1%) middle school students.¹¹

References

1. 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 [cited 2007 Feb 23]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4836a2.htm.
2. Yen KL, Hechavarria E, Bostwick SB. Bidi Cigarettes: An Emerging Threat to Adolescent Health. Archives Pediatrics & Adolescent Medicine. 2000;154:1187–1189 [cited 2007 Feb 23].
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 [cited 2007 Feb 23].
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 [cited 2007 Feb 23].
5. Council on Scientific Affairs. Evaluation of the Health Hazard of Clove Cigarettes. Journal of the American Medical Association. 1988;260:3641–3644 [cited 2007 Feb 23].
6. Rahman M, Sakamoto J, Fukui T. Bidi Smoking and Oral Cancer: A Meta-Analysis. International Journal of Cancer 2003;106:600–604 [cited 2007 Feb 23].
7. Rahman M, Fukui T. Bidi Smoking and Health. Public Health 2000;114:123–127 [cited 2007 Feb 23].
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 [cited 2007 Feb 23].
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 [cited 2007 Feb 23].
10. Mangunnegoro H, Sutoyo DK. Environmental and Occupational Lung Diseases in Indonesia. Respirology. 1996;1:85–93 [cited 2007 Feb 23].
11. Centers for Disease Control and Prevention. Tobacco Use, Access, and Exposure to Tobacco in Media Among Middle and High School Students—United States, 2004. Morbidity and Mortality Weekly Report [serial online]. 2005;54(12):297–301 [cited 2007 Feb 23]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5412a1.htm

For Further Information

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
E-mail: tobaccoinfo@cdc.gov
Phone: 1-800-CDC-INFO

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

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