- Volume 16 Issue 16
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A Cross Sectional Study of Kretek Smoking in Indonesia as a Major Risk to Public Health
- Palipudi, Krishna (Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC) ;
- Mbulo, Lazarous (Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC) ;
- Kosen, Soewarte (National Institute of Health Research & Development) ;
- Tjandra, Aditama (National Institute of Health Research & Development) ;
- Kadarmanto, Kadarmanto (Badan Pusat Statistik) ;
- Qureshi, Farukh (Country Office, World Health Organization) ;
- Andes, Linda (Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC) ;
- Sinha, Dhirendra N (South-East Asia Regional Office, World Health Organization) ;
- Asma, Samira (Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC)
- Published : 2015.11.04
Background: Tobacco smoking is a major cause of preventable disease and death worldwide. Kreteks are clove-flavored cigarettes made from a combination of tobacco and ground-clove mixed with a sauce, smoked widely in Indonesia. Because health and social consequences of kretek smoking are potentially as great as those of traditional cigarettes, this study examines the prevalence of kretek smoking in Indonesia and associated risk factors. Materials and Methods: The study used nationally representative Indonesia Global Adult Tobacco Survey data. Multiple logistic regression analysis was employed to identify correlates of kretek smoking. Results: One-third of Indonesian adults smoked tobacco of which about 90.0% smoked kreteks. Prevalence of kretek smoking among men (60.9%) was more than 25 times the rate among women (2.3%). Overall, the highest prevalence of kretek use was in the age group 45-54 years (36.5%), followed by 34-44 (35.1%), 25-34 (34.2 %), and 55-64 years (32.8%). By wealth index, prevalence of kreteks smoking among those in the middle index was almost 50% above the rate for the wealthiest group (36.4% vs 24.8% respectively). Logistic regression results showed that being male, being older, having less education, and being less wealthy were significant predictors of kretek smoking, while urban vs rural residence was not. Conclusions: Kretek smoking is common in Indonesia and is entrenched in the sociocultural fabric of the country. However, potential consequences of kretek smoking, particularly as risks for noncommunicable diseases, underscore the importance of a comprehensive approach to tobacco control as outlined in the World Health Organization's MPOWER strategies.
- Arnez M (2009). Tobacco and kretek: Indonesian drugs in historical change. Austrian Journal of South-East Asian Studies, 2, 49-69.
- Bader P, Boisclair D, Ferrence R (2011). Effects of tobacco taxation and pricing on smoking behavior in high risk populations: a knowledge synthesis. Int J Environ Res Public Health, 8, 4118-39. https://doi.org/10.3390/ijerph8114118
- Barber S, Adioetomo SM, Ahsan A, et al (2008). Tobacco economics in Indonesia. Paris: international union against tuberculosis and lung disease.
- Barraclough S (1999). Women and tobacco in Indonesia. Tob Control, 8, 327-32. https://doi.org/10.1136/tc.8.3.327
- Hanusz M (2000). Kretek: The culture and heritage of indonesia's clove cigarettes. tortola, british virgin islands, equinox publishing.
- California Department of Health/Tobacco Control Section (1998). A model for change. the california experience in tobacco control. sacramento, California Department of Health.
- Esson KM, Leeder SR (2004). The Millennium development goals and tobacco control: an opportunity for global partnership. Geneva, World Health Organization.
- Health Ministry of the Republic of Indonesia (2013). Regulation of the Health Minister of the Republic of Indonesia Number 28 of 2013 concerning imprinting of health warnings and health information on tobacco product packaging. Unofficial translation. Available at http://www.tobaccocontrollaws.org/files/live/Indonesia/Indonesia%20-%20MoH%20Decree%20No.%2028%20of%202013.pdf
- Hurt RD, Ebbert JO, Achadi A, Croghan IT (2012). Roadmap to a tobacco epidemic: transnational tobacco companies invade Indonesia. Tob Control, 21, 306-12. https://doi.org/10.1136/tc.2010.036814
- Institute for Public Health (2012). Report of the Global Adult Tobacco Survey (GATS) Malaysia, 2011. Kuala Lumpur, Malaysia, Ministry of Health Malaysia, 2012.
- Jha P, Chaloupka FJ (1999). Curbing the epidemic: governments and the economics of tobacco control. Washington, World Bank.
- Kaufman MR, Merritt AP, Rimbatmaja R, Cohen JE (2014). 'Excuse me, sire. Please don't smoke here'. A qualitative study of social enforcement of smoke-free policies in Indonesia. Health Policy and Planning, 1-8.
- Lawrence S, Collin J (2004). Competing with kreteks: transnational tobacco companies, globalisation, and Indonesia. Tob Control, 13 96-103. https://doi.org/10.1136/tc.2003.007054
- Malson JL, Lee EM, Murty R, et al (2003). Clove cigarette smoking: biochemical, physiological, and subjective effects. Pharmacol Biochem Behav, 74, 739-45. https://doi.org/10.1016/S0091-3057(02)01076-6
- Mathers CD, Loncar D (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 3, 442. https://doi.org/10.1371/journal.pmed.0030442
- Ministry of Health of Viet Nam (2010). Global Adult Tobacco Survey (GATS) Viet Nam. Hanoi, Ministry of Health.
- Nichter M, Nichter M, Pamawati RS, Ng N (2010). Developing a smoke free household initiative: an Indonesian case study. Acta Obstet Gynecol Scand, 89, 578-81. https://doi.org/10.3109/00016340903578893
- Ngi N, Weinhall L, Ohman A. (2007) "If I don't smoke, I'm not a real man-Indonesian boys' views about smoking." Health Educ Res, 22, 794-804.
- Palipudi KM, Gupta PC, Sinha DN, et al (2012). GATS Collaborative Group. Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey. PLoS One, 7, 33466. https://doi.org/10.1371/journal.pone.0033466
- Palipudi KM, Morton J, Hsia J, et al (2013). Methodology of the Global Adult Tobacco Survey -- 2008-2010. Global Health Promotion, 16, 1757-9.
- Piade JJ, Roemer, E, Dempsey R, et al (2014). Toxicological assessment of kretek cigarettes: Part 2: Kretek and Americanblended cigarettes, smoke chemistry and in vitro toxicity. Regul Toxicol Pharm, 70, 15-25. https://doi.org/10.1016/j.yrtph.2014.12.001
- Polzin GM, Stanfill SB, Brown CR, et al (2007). Determination of eugenol, anethole, and coumarin in the mainstream cigarette smoke of Indonesian clove cigarettes. Food Chem Toxicol, 45, 1948-53. https://doi.org/10.1016/j.fct.2007.04.012
- Prignot JJ, Sasco AJ, Poulet E, et al (2008). Alternative forms of tobacco use. Int J Tuberc Lung Dis, 12, 718-27.
- Pujari SJ, Palipudi KM, Morton J, et al (2012). Electronic data collection and management system for global adult tobacco survey. J Public Health Inform, 4, 1-20.
- Roemer E, Dempsey R, Schorp MK (2014). Toxocology assessment of kretek cigarettes: Part 1: Background, assessment approach, and summary of findings. Regul Toxicol Pharm, 70, 2-14. https://doi.org/10.1016/j.yrtph.2014.11.015
- Statistics Indonesia (Badan Pusat Statistik BPS) and Macro International (2008). Demographic and Health Survey 2007. Calverton, MD: BPS and Macro International.
- United Nations (2013). World Population Prospects: The 2012 Revision: Volume I: Comprehensive Tables. United Nations, New York.
- WHO (2003). Framework Convention on Tobacco Control. Geneva, World Health Organisation.
- WHO (2010a). Gender, women, and the tobacco epidemic. Geneva, WHO
- WHO (2010b). Global status report on noncommunicable diseases 2010. Geneva, WHO
- World Health Organization (2008). WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva, WHO.
- WHO International Agency for Research on Cancer (1985). IARC Monographs on the evaluation of the carcinogenic risk of chemicals to humans: tobacco habits other than smoking; Betel-Quid and Areca-Nut chewing; and some elated nitrosamines. Vol. 37. Lyon, IARC.
- World Health Organization, Regional Office for South East Asia (2012). Global adult tobacco survey: Indonesia Report 2011. Jakarta, Indonesian Ministry of Health.
- WHO Regional Office for South East Asia (2011). Global adult tobacco survey: Thailand report. Nonthaburi, Thailand, Thailand Ministry of Health.
- WHO South East Asia Regional Office (2009). Indonesia (Ages 13-15) Global Youth Tobacco Survey (GYTS) 2009. FACT SHEET. Available at http://www.searo.who.int/entity/noncommunicable_diseases/data/ino_gyts_fs_2009.pdf
- WHO, Regional Office for South East Asia (2008). Resolution of the WHO regional committee for South East Asia. SEA/RC61/R4 Tobacco control. Regionalcommittee meeting 61 New Delhi, India, 8-11.
- Estimating the Burden of Cancers Attributable to Smoking Using Disability Adjusted Life Years in Indonesia vol.17, pp.3, 2016, https://doi.org/10.7314/APJCP.2016.17.3.1577