Bidis and Kreteks

Bidis are small, thin, hand-rolled cigarettes imported to the United States, primarily from India and other Southeast Asian countries. They comprise 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, 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

Health Effects

Bidis

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 adverse health conditions.²

• Bidis are a combustible tobacco product. Smoke from a bidi contains three to five 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

Kreteks

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

Current Estimates

Bidis

Percentage of U.S. students who were current bidi smokers* in 2014¹³

• 0.5% of all middle school students
• 0.3% of female middle school students^†

• 0.9% of all high school students
• 0.6% of female high school students
• 1.2% of male high school students

*Current smokers are defined as persons who reported smoking 1 or more bidis or kreteks in the 30 days before they participated in a survey about this topic.

^†Data for middle school males are statistically unreliable as sample size was <50 or relative standard error was >0.3; therefore an estimate is not provided.

Kreteks

• The Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) of 2009 prohibits the sale of flavored cigarettes in the United States; therefore, data on the use of kreteks are no longer collected. For the latest estimates of kretek use among U.S. middle school and high school students, please see the article entitled Tobacco Use Among Middle and High School Students—United States, 2013.¹⁴

References

1. Centers for Disease Control and Prevention. Bidi Use Among Urban Youth—Massachusetts, March–April 1999. Morbidity and Mortality Weekly Report 1999;48(36):796–9 [accessed 2015 Nov 9].
2. Yen KL, Hechavarria E, Bostwick SB. Bidi Cigarettes: An Emerging Threat to Adolescent Health. Archives Pediatrics & Adolescent Medicine, 2000;154:1187–9 [cited 2015 Nov 9].
3. Malson JL, Lee EM, Murty R, Moolchan ET, Pickworth WB. Clove Cigarette Smoking: Biochemical, Physiological, and Subjective Effects. Pharmacology Biochemistry and Behavior, 2003;74:739–45 [cited 2015 Nov 9].
4. World Health Organization. Tobacco: Deadly in Any Form or Disguise. [PDF–1.2 MB] Geneva: World Health Organization, 2006 [accessed 2015 Nov 9].
5. 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):747–53 [cited 2015 Nov 9].
6. Rahman M, Fukui T. Bidi Smoking and Health. Public Health 2000;114:123–7 [cited 2015 Nov 9].
7. Delnevo CD, Pevzner ES, Hrywna M, Lewis MJ. Bidi Cigarette Use Among Young Adults in 15 States. Preventive Medicine 2004;39:207–11 [cited 2015 Nov 9].
8. Rahman M, Sakamoto J, Fukui T. Bidi Smoking and Oral Cancer: A Meta-Analysis. International Journal of Cancer 2003;106:600–4 [cited 2015 Nov 9].
9. 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;49:485–9 [cited 2015 Nov 9].
10. Gupta PC, Asma S. Bidi Smoking and Public Health. [PDF–2.52 MB] New Delhi: Ministry of Health and Family Services, Government of India, 2008 [accessed 2015 Nov 9].
11. 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;348:358–63 [cited 2015 Nov 9].
12. Mangunnegoro H, Sutoyo DK. Environmental and Occupational Lung Diseases in Indonesia. Respirology 1996;1:85–93 [cited 2015 Nov 9].
13. Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2011–2014. Morbidity and Mortality Weekly Report 2015;64(14):381–5 [accessed 2015 Nov 9].
14. Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2013. Morbidity and Mortality Weekly Report 2014;63(45):1021–6 [accessed 2015 Nov 9].