Other Tobacco Products
Bidis and Kreteks
Bidis (pronounced "bee-dees") and kreteks (pronounced "cree-teks") are types of cigarettes usually imported to the United States from other countries. Both have higher amounts of nicotine, tar and carbon monoxide than conventional cigarettes sold in the U.S.
Bidis are small, thin hand-rolled cigarettes imported primarily from India and other Southeast Asian countries. The tobacco in bidis is wrapped in a tendu or temburni leaf (plants native to Asia) and may be tied with a colorful string at one or both ends. They are either flavored or unflavored.
Despite their small size, their toxin levels are higher than cigarettes because of the need to puff harder to keep bidis lit.
Kreteks are sometime referred to as clove cigarettes and are typically imported from Indonesia. They contain a mixture consisting of tobacco, cloves and other additives.
They may also contain a wide range of exotic flavorings and eugenol, which has an anesthetic effect, allowing them to be inhaled more deeply than cigarettes.
Health Effects of Bidi and Kretek Use
Research on the health effects of bidi and kretek smoking has only been done in India and Indonesia.
These studies suggest bidi smoking is associated with similar negative health effects as cigarette smoking, including increasing the risk of developing lung, oral, stomach, and esophageal cancer. Bidi smokers also have three times the risk for developing coronary heart disease and having a heart attack and four times the risk for chronic bronchitis, according to the Indian research.
Research in Indonesia indicates that kretek smokers have 13-20 times the risk of abnormal lung function compared with nonsmokers. Kretek smoking is associated with an increased risk of acute lung injury, especially among individuals with asthma or other breathing problems.
Current Estimate of Bidi and Kretek Use in the U.S.
There is no existing research to determine the number of US adults who smoke bidis and kreteks. However, an estimated 2 percent of high school students and 1.7 percent of middle school students are current bidi smokers. An estimated 1.7 percent of high school students and 1.1 percent of middle school students) are current kretek smokers (CDC, 2011).
In February 2014, the U.S. Food and Drug Administration issued its first order to stop the further sale and distribution of four types of bidis currently on the market. The action marks the first time the FDA used its authority under the Family Smoking Prevention and Tobacco Control Act to order a manufacturer of currently available tobacco products to stop selling and distributing them.
The products – Sutra Bidis Red, Sutra Bidis Menthol, Sutra Bidis Red Cone, and Sutra Bidis Menthol Cone – all manufactured by Jash International can no longer be sold or distributed across state lines or imported into the United States.
Centers for Disease Control and Prevention, Smoking and Tobacco Use. “Fact Sheet: Bidis and Kreteks,” February 2007 [accessed 2014 March 31].
United States Food and Drug Administration, press release, February 21, 2014.