Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
SPECTRUM Consortium, Nottingham, UK.
Nicotine Tob Res. 2021 Aug 4;23(8):1274-1282. doi: 10.1093/ntr/ntab016.
The objective of this study is review the evidence on the health risks associated with smoking kretek cigarettes compared with not smoking or smoking regular cigarettes.
We conducted a systematic literature search in five electronic databases: EMBASE (Ovid), ASSIA, PubMed and Scopus. Since kretek use is largely restricted to Indonesia, we identified additional studies using an online search for grey literature and studies in Indonesian journals and the National Library of Indonesia. We included relevant search terms in English ("kretek" and "clove cigarettes") and Bahasa ("rokok" and "merokok"). We selected studies which compared any health outcome between smokers of kretek cigarettes and non-smokers or smokers of regular cigarettes. We included studies in any smokers compared to non-smokers in Indonesia, since most Indonesian smokers use kretek, but analysed these separately. Study data were extracted by a single reviewer and checked by two reviewers. Methodological quality was assessed using the Newcastle-Ottawa scale.
We identified 32 studies, all from Indonesia. There were 31 cross-sectional studies and one case control study. This systematic review identified a relatively limited number of studies, and most of these were of poor quality as assessed by the Newcastle Ottawa score. They were generally cross-sectional, small and lacking justification for sample size, had high potential for selection bias because of lack of data on non-respondents or those lost to follow up, and missing information about the statistical analysis. Fourteen studies looked specifically at kretek exposure and eighteen looked at any type of cigarette exposure but were conducted in Indonesia are therefore likely to predominantly reflect kretek exposure. Kretek were found to be associated with oral cancer, cardiovascular disease, chronic health disease, myocardial infarction, asthma, and oral diseases.
Although existing studies are of poor quality, kretek are likely to be at least as harmful as regular cigarettes.
本研究旨在回顾与吸烟丁香烟相关的健康风险的证据，与不吸烟或吸烟普通香烟相比。
我们在五个电子数据库中进行了系统的文献检索：EMBASE（Ovid）、ASSIA、PubMed 和 Scopus。由于丁香烟的使用主要限于印度尼西亚，我们使用在线搜索灰色文献以及印度尼西亚期刊和印度尼西亚国家图书馆中的研究来确定额外的研究。我们使用英语（“kretek”和“丁香香烟”）和印尼语（“rokok”和“吸烟”）中的相关搜索词。我们选择了比较丁香烟吸烟者与非吸烟者或普通香烟吸烟者之间任何健康结果的研究。我们将在印度尼西亚比较任何吸烟者与非吸烟者的研究包括在内，因为大多数印度尼西亚吸烟者使用丁香烟，但分别对这些研究进行了分析。由一名评审员提取研究数据，并由两名评审员进行检查。使用纽卡斯尔-渥太华量表评估方法学质量。
我们确定了 32 项研究，全部来自印度尼西亚。其中有 31 项横断面研究和 1 项病例对照研究。本系统评价确定了相对有限数量的研究，并且根据纽卡斯尔渥太华评分，大多数研究质量较差。它们通常是横断面的，规模较小，缺乏对样本量的理由，由于缺乏对未答复者或失访者的数据，存在选择偏倚的高风险，并且缺乏关于统计分析的信息。有 14 项研究专门研究了丁香烟的暴露情况，18 项研究研究了任何类型的香烟暴露情况，但在印度尼西亚进行，因此可能主要反映了丁香烟的暴露情况。丁香烟与口腔癌、心血管疾病、慢性健康疾病、心肌梗死、哮喘和口腔疾病有关。
尽管现有研究质量较差，但丁香烟可能至少与普通香烟一样有害。
