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
- 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.
- 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].
- 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].
- 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].
- 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].
- 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].
- Rahman M, Fukui T.
Bidi Smoking and Health.
Public Health
2000;114:123–127 [cited 2007 Feb 23].
- 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].
- 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].
- Mangunnegoro H, Sutoyo DK.
Environmental and Occupational Lung Diseases in Indonesia.
Respirology.
1996;1:85–93 [cited 2007 Feb 23].
- 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
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.
Page last reviewed 02/28/2007
Page last modified 02/28/2007