title: A Cross Sectional Study of Kretek Smoking in Indonesia as a Major Risk to Public Health.
abstract: 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.
  
  
  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.
authors.affiliation: Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, US E-mail : gou8@cdc.gov, vyp7@cdc.gov.
authors.forename: Krishna
authors.initials: K
authors.lastname: Palipudi
authors.forename: Lazarous
authors.initials: L
authors.lastname: Mbulo
authors.forename: Soewarte
authors.initials: S
authors.lastname: Kosen
authors.forename: Aditama
authors.initials: A
authors.lastname: Tjandra
authors.lastname: Kadarmanto
authors.forename: Farukh
authors.initials: F
authors.lastname: Qureshi
authors.forename: Linda
authors.initials: L
authors.lastname: Andes
authors.forename: Dhirendra N
authors.initials: DN
authors.lastname: Sinha
authors.forename: Samira
authors.initials: S
authors.lastname: Asma
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D012923:Social Class; D011795:Surveys and Questionnaires; D027842:Syzygium; D055815:Young Adult; D014026:Nicotiana