A Cross Sectional Study of Kretek Smoking in Indonesia as a Major Risk to Public Health

Background: Tobacco smoking is a major cause of preventable disease and death worldwide. Kreteks areclove-flavored cigarettes made from a combination of tobacco and ground-clove mixed with a sauce, smokedwidely in Indonesia. Because health and social consequences of kretek smoking are potentially as great as thoseof traditional cigarettes, this study examines the prevalence of kretek smoking in Indonesia and associated riskfactors. Materials and
Methods: The study used nationally representative Indonesia Global Adult Tobacco Surveydata. Multiple logistic regression analysis was employed to identify correlates of kretek smoking.
Results: Onethirdof Indonesian adults smoked tobacco of which about 90.0% smoked kreteks. Prevalence of kretek smokingamong men (60.9%) was more than 25 times the rate among women (2.3%). Overall, the highest prevalenceof kretek use was in the age group 45-54 years (36.5%), followed by 34-44 (35.1%), 25-34 (34.2 %), and 55-64years (32.8%). By wealth index, prevalence of kreteks smoking among those in the middle index was almost50% above the rate for the wealthiest group (36.4% vs 24.8% respectively). Logistic regression results showedthat being male, being older, having less education, and being less wealthy were significant predictors of kreteksmoking, while urban vs rural residence was not.
Conclusions: Kretek smoking is common in Indonesia andis 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 approachto tobacco control as outlined in the World Health Organization’s MPOWER strategies.