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Amalia B, Astuti PAS, Cohen JE. Five years of discourse related to Indonesia tobacco control reform: a content analysis of online media coverage. Tob Control 2024:tc-2024-058661. [PMID: 39179375 DOI: 10.1136/tc-2024-058661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND In 2017, Indonesia initiated the amendment of its 11-year-old tobacco control regulation (PP 109/2012) to reduce smoking among youth, but the process was stalled. The proposed changes in the regulation include a full ban on tobacco advertising, promotion and sponsorship (TAPS), increasing health warning label (HWL) size and regulating electronic cigarettes (e-cigarettes). This study analysed the arguments and actors for and against the PP 109/2012 amendment in online media articles. METHOD Content analysis of 326 online articles reporting on the PP 109/2012 amendment published from 2018 to 2023, retrieved from the Tobacco Watcher platform. We coded articles for statements supporting or opposing the amendment (position statement), content of the arguments used to support (supporting argument) and oppose (opposing argument) the amendment, actors presenting the arguments and tobacco control measures. We iteratively reviewed and coded data and presented the frequency of categories. RESULTS Of 332 position statements, 53.3% were against the amendment. The main categories of supporting arguments (N=1448) included smoking trends (21.1%), health implications (16.6%), science-based evidence (9.6%) and protecting the population (9.2%). Opposing arguments (N=1413) emphasised the tobacco farmers' welfare (16.6%), impact on the industry (16.4%) and current regulation is sufficient (11.0%). Supporting actors were predominantly health-related entities and government officials (89.3%), while 62.1% of opposing actors included trade and Islamic groups, the tobacco industry and front groups. HWLs, e-cigarette/heated tobacco product regulation and TAPS were the main (77.8%) tobacco control measures mentioned in the proamendment arguments, while HWLs, TAPS and cigarette sale restrictions were the dominant (79.3%) tobacco control measures in anti-amendment arguments. CONCLUSION Indonesia's tobacco control reform faced opposition by false claims primarily from industry allies, resulting in a 5-year delay in enactment. Future tobacco control media advocacy must address these claims and emphasise the alignment of economic interests with public health goals.
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Affiliation(s)
- Beladenta Amalia
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta Pusat, Jakarta, Indonesia
| | - Putu Ayu Swandewi Astuti
- Public Health and Preventive Medicine, Udayana University Faculty of Medicine, Denpasar, Bali, Indonesia
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Even D, Abdalla SM, Maani N, Galea S. News media as a commercial determinant of health. Lancet Glob Health 2024; 12:e1365-e1369. [PMID: 38908393 DOI: 10.1016/s2214-109x(24)00191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/31/2024] [Accepted: 04/25/2024] [Indexed: 06/24/2024]
Abstract
Commercial determinants of health frameworks aim to identify the features and actions of corporate entities that can influence health. This Viewpoint conceptualises the work of the news media as a set of commercial forces and provides a framework that can help researchers better understand how features and actions of the news media shape health and health equity. We discuss four key features of news media action that can shape health: agenda setting, framing, priming, and tactics of persuasion. Beyond the direct role of the media in shaping health, we also explore pathways (ie, public relation activities, advertising, and economic pressures) in which the media is used by other commercial actors to affect health. A better understanding of how news media operates can help inform efforts to improve media actions to aid in improving population health outcomes.
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Affiliation(s)
- Dan Even
- School of Public Health, Boston University, Boston, MA, USA; Moshe Prywes Center for Medical Education, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | - Nason Maani
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
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Dadras O. Predictor of smoking cessation among school-going adolescents in Indonesia: a secondary analysis based on the transtheoretical model of behavioral change. Front Psychiatry 2024; 15:1374731. [PMID: 38516262 PMCID: PMC10954880 DOI: 10.3389/fpsyt.2024.1374731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction This study elucidates the complex journey of adolescents toward smoking cessation, investigating the association of relevant demographic factors, advertising, promotion, anti-cigarette messages, and individual knowledge and attitudes with being in different smoking cessation stages. Methods Utilizing data from the 2019 Indonesia Global Youth Tobacco Survey, this secondary analysis included adolescents who reported ever smoking. The Transtheoretical Model (TTM) guided the categorization of the outcome variable into three smoking cessation stages based on the responses to two questions related to the intention and timing of the smoking cessation. This included contemplation, action, and maintenance stages. Multinomial logistic regression analyzed the associations between each independent variable and being in each stage of smoking cessation. The study comprised 3596 Indonesian adolescents from grades 7-12, of which 2484 responded to two questions related to intention and timing of smoking cessation and were included in regression analysis. Results Findings indicate that males and those aged ≥16 were predominantly in contemplation phase. Early smoking initiation, usage of other tobacco products, and exposure to various forms of smoke increased the likelihood of being in contemplation and action phases. Parental smoking, school smoking exposure, and second-hand smoke were significant contemplation phase predictors. Exposure to tobacco advertising was linked to an increased likelihood of being in contemplation and action phases, whereas anti-cigarette messages showed no significant impact. Awareness of cigarette and second-hand smoke harms reduced the odds of being in the contemplation phase, while enjoying smoking and willingness to accept cigarettes from friends increased the odds of being in contemplation and action phases rather than in maintenance phase. Conclusion Addressing age, gender, cultural influences, environmental factors, and attitudes towards smoking through tailored interventions is vital for aiding smoking cessation in Indonesian adolescents. Strengthened tobacco control in schools and public places is recommended to bolster these efforts. Longitudinal studies are required to explore the evolving patterns of smoking cessation behaviors over time, enhancing our understanding of the factors influencing sustained cessation.
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Affiliation(s)
- Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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Artanti KD, Arista RD, Fazmi TIK. The influence of social environment and facility support on smoking in adolescent males in Indonesia. J Public Health Res 2024; 13:22799036241228091. [PMID: 38304307 PMCID: PMC10832422 DOI: 10.1177/22799036241228091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Background The high number of smokers in Indonesia, including adolescents, causes high morbidity due to smoking. Reducing the incidence of smoking-related disease in Indonesia needs to be done by reducing the number of smokers. This can be done by preventing smoking as early as possible, including during adolescence. The study aimed to assess the prevalence of adolescent male smokers and determine the social environment and facility support that influences smoking behavior in adolescent males aged 15-18 years in Surabaya, Indonesia. Design and method A cross-sectional study was performed from 1st October 2021 to 31st January 2022 on adolescent males aged 15 to 18 from senior high schools in Surabaya. 369 respondents completed a self-administered questionnaire about social environment and facility support that influence smoking behavior. The questionnaire result of the questionnaire was computed using bivariate analysis to examine the relationship between social environment, facility support, and smoking behavior. Result Of the 369 eligible participants, 95 (25.7%) were smokers, while the remaining 274 were not. The factors affecting smoking among adolescents were families influence (p = 0.000; PR = 4.805; CI = 2.923-7.900), friends influence (p = 0.000; RP = 3.987; CI = 2.4906.383), and advertisements influence (p = 0.000; RP = 3.137; CI = 2.275-4.325). Facility support was not found to be too influential (p = 0.399; RP = 0.767; CI = 0.472-1.245). Familia influence was the strongest factor in smoking among adolescent males aged 15 to 18. Conclusions Integrated programs and policies are needed to prevent and rehabilitate adolescents from smoking behavior. Improving their understanding of the health impacts of smoking is also needed.
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Affiliation(s)
- Kurnia Dwi Artanti
- Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Ahsan A, Amalia N, Rahmayanti KP, Adani N, Wiyono NH, Endawansa A, Utami MG, Yuniar AM. Health taxes in Indonesia: a review of policy debates on the tobacco, alcoholic beverages and sugar-sweetened beverage taxes in the media. BMJ Glob Health 2023; 8:e012042. [PMID: 37813444 PMCID: PMC10565181 DOI: 10.1136/bmjgh-2023-012042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/14/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION One of the WHO's 'best buys' in controlling non-communicable diseases and their risk factors is to impose health taxes. While the Indonesian political process inhibits the implementation of health tax policy, studies to discuss the issue remain limited. METHODS We employed media analysis to document health tax policy dynamics, for example, the changes in policy timeline and key actors' statements. We conducted an article search in the Open-Source Intelligence database using appropriate terminology on three commodities, for example, tobacco, alcoholic beverages and sugar-sweetened beverages (SSB). RESULTS Throughout the 15 years of implementation (2007-2022), tobacco has received the most policy attention compared with the other two commodities. This is mainly related to the increasing tariff and reforming the tax structure. As Indonesia is a Muslim-majority country, alcohol consumption is low, and a tax on alcoholic beverages was nearly unchanging and lacked media coverage. Ministry of Finance (MoF) officials are key opinion leaders often cited in the media for health taxes. MoF's support for health taxes is important to pass and implement health taxes. While SSB taxation is emerging, key opinion leaders' media statements imply policy contestation, leading to delayed implementation. The policy debates on tobacco taxation implied election years as a major challenge for health tax passages. During the political years, anti-health tax arguments emerged from politicians. While the political contestation on SSB concluded that accentuating the health tax arguments in favour of public health generates the strongest opposition against taxation from the industry. CONCLUSIONS Politics of tobacco tax implementation are complex-compared with the other two commodities. The political context drives the divided views among policy-makers. Policy recommendations include generating public allies with key religious opinion leaders, continuing capacity building for politicians and Ministry of Health, and generating evidence-based arguments in favour of public health for MoF.
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Affiliation(s)
- Abdillah Ahsan
- Department of Economics, Faculty of Economics and Business, University of Indonesia, Depok, West Java, Indonesia
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Nadira Amalia
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Krisna Puji Rahmayanti
- Department of Public Administration, Faculty of Administrative Science, University of Indonesia, Depok, Indonesia
| | - Nadhila Adani
- Center for Research in Islamic Economics and Business, Universitas Indonesia Faculty of Economics and Business, Depok, West Java, Indonesia
| | - Nur Hadi Wiyono
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Althof Endawansa
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Maulida Gadis Utami
- Demographic Institute, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Adela Miranti Yuniar
- Center for Research in Islamic Economics and Business, Universitas Indonesia Faculty of Economics and Business, Depok, West Java, Indonesia
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Stubbs T, White VM, Kong M, Toumbourou JW. Uncovering the advertising and promotional strategies of tobacco companies in Cambodia: recall of below-the-line marketing among young male smokers. Tob Control 2023; 32:614-619. [PMID: 35177539 DOI: 10.1136/tobaccocontrol-2021-057063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/28/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Tobacco companies have used below-the-line marketing in novel ways to promote their brands to youth in low/middle-income countries in Southeast Asia. This study explores how young male smokers in Cambodia experience below-the-line marketing strategies. METHODS Convenience sampling was used to recruit 147 young male smokers (18-24 years) in Cambodia in early 2020. Local research assistants conducted mixed-methods interviews with participants in Khmer or English. Participants recalled exposure to below-the-line marketing strategies and provided in-depth descriptions about their experiences with individual sales promotions. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using thematic analysis. RESULTS 54% of participants recalled exposure to at least one below-the-line marketing strategy, including point-of-sale promotions (32.7%), individual sales promotions (27.9%) and online advertising (14.3%). Participants described individual sales promotions in public settings, and recalled that promoters were mostly female, attractive and targeted young males. Tactics used to encourage young people to accept promotional offers included free cigarettes and sample packets, swapping current cigarettes for new brands and collecting consumer details after interviewing. The brands and product features of cigarettes being promoted were readily described by participants. CONCLUSION This study provides evidence that illegal below-the-line marketing is still occurring in Cambodia, and increased monitoring and enforcement of advertising restrictions is needed.
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Affiliation(s)
- Thomas Stubbs
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Victoria M White
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mom Kong
- Cambodian Movement for Health, Phnom Penh, Cambodia
| | - John W Toumbourou
- Centre for Drug use, Addictive and Anti-social behaviour Research, School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
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Megatsari H, Damayanti R, Kusuma D, Warouw TS, Nadhiroh SR, Astutik E, Dewi DMSK, Sebayang SK. The influence of anti-smoking messages to Indonesian youth smoking behavior: the Indonesian 2019 Global Youth Tobacco Survey (GYTS). BMC Public Health 2023; 23:907. [PMID: 37202738 PMCID: PMC10197388 DOI: 10.1186/s12889-023-15830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/06/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Various anti-tobacco promotions have emerged in order to reduce the detrimental impacts of tobacco advertising on adolescents. The objective of this study is to explore the relationship between the exposure to anti-smoking messages and Indonesian youth smoking behavior. METHOD We used secondary data from the Indonesian 2019 Global Youth Tobacco Survey (GYTS). The participants were students from grades seven to twelve. We used multiple logistic regression to assess the relationship of anti-smoking messages exposure on the smoking behavior variable. We used complex samples process logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and controlling for relevant covariables. RESULTS The percentage of the exposure to anti-smoking messages in all types were not more than 25% in each outcome variables. The results also showed that in the current smoker variables, adolescent who exposed to the two variables of anti-smoking messages increased the odds to become current smoker. The variables were anti smoking messages in media (AOR 1.41; 95% CI 1.15-1.73) and in school (AOR 1.26; 95% CI 1.06-1.50). On the other hand, in the smoking susceptibility variables, there were no variables of anti-smoking messages that had relation with it. CONCLUSIONS The study concluded that there were only two variables of the anti-smoking messages that had relation with the Indonesian youth smoking behavior, which were current smokers. Unfortunately those variables increased the odds of the respondents to become current smokers. Indonesia government should develop media following international best practices to convey the anti-smoking messages.
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Affiliation(s)
- Hario Megatsari
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Rita Damayanti
- Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Dian Kusuma
- Department of Health Services Research and Management, School of Health & Psychological Sciences, University of London, London, UK
| | | | | | - Erni Astutik
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Laili K, Ratih SP, Gayatri RW, Adi S. The impact of exposure to cigarette advertising and promotion on youth smoking behavior in Malang Regency (Indonesia) during the COVID-19 pandemic. J Public Health Afr 2022. [PMID: 37497142 PMCID: PMC10367028 DOI: 10.4081/jphia.2022.2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The prevalence of teen smokers has increased during the Covid-19 pandemic. Smoking behavior occurs due to exposure to advertising and the promotion of cigarettes. This quantitative research was conducted using cross-sectional approach. The purpose of the study was to analyze the relationship between advertising exposure and cigarette promotion on adolescent smoking behavior in Malang Regency during the pandemic using the chi-square test. Random sampling on students from several high schools or equal degree in the Kepanjen District was done with a total of 145 respondents. The results showed that there was no significant relationship between age, types of cigarette advertising media at the point of sale, outdoor media, social media, internet, and newspapers or magazines by adolescent smoking behavior during the Covid-19 pandemic (p-value > 0.05). Exposure to cigarette advertisements on television, total exposure to cigarette advertisements, cigarette promotion, and gender had a significant relationship with adolescent smoking behavior during the pandemic (p value < 0.05). Adolescents are quite highly exposed to the various types of advertisements and promotions of cigarettes that can influence increased smoking behavior during the pandemic.
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Stubbs T, White V, Yong HH, Toumbourou J. Tobacco industry influence in low- and middle-income
countries in the ASEAN region: Qualitative interviews with
tobacco control experts during the COVID-19 pandemic. Tob Induc Dis 2022; 20:108. [DOI: 10.18332/tid/155391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022] Open
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Murukutla N, Magsumbol MS, Raskin H, Kuganesan S, Dini S, Martinez-Mejia C, Rachfiansyah, Aguilar BGR. A content analysis of e-cigarette marketing on social media: Findings from the Tobacco Enforcement and Reporting Movement (TERM) in India, Indonesia and Mexico. Front Public Health 2022; 10:1012727. [PMID: 36424977 PMCID: PMC9679495 DOI: 10.3389/fpubh.2022.1012727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background The use of e-cigarettes is proliferating globally, especially among youth and even children. Marketing is a known risk factor for e-cigarette initiation, yet little is known of e-cigarette marketing on social media in low- and middle-income countries. This study compares e-cigarette social media marketing in India, Indonesia, and Mexico, three such countries with different regulatory environments. Methods Instances of e-cigarette marketing on social media platforms were identified via the Tobacco Enforcement and Reporting Movement (TERM), a digital tobacco marketing monitoring system. Through systematic keyword-based searches, all tobacco marketing posts observed between 15 December 2021 and 16 March 2022 were included in the analysis. The final sample included 1,437 e-cigarette-related posts on Instagram, Facebook, Twitter, YouTube, and TikTok, which were systematically content analyzed by independent coders after inter-reliability (Cohen's Kappa K > 0.79) was established using a theory-derived codebook. The final data is represented in percentages and frequencies for ease of presentation. Results We observed e-cigarette marketing online in all countries studied, yet there was variation in the volume of marketing and types of accounts identified. In India, where e-cigarettes were comprehensively banned, we identified 90 (6%) posts; in Mexico, where e-cigarettes were partially restricted, 318 (22%) posts were observed; and in Indonesia, where there were no restrictions, 1,029 (72%) posts were observed. In both India and Mexico, marketing originated from retailer accounts (100%), whereas in Indonesia, it was primarily product brand accounts (86%). Across countries, e-cigarettes were mostly marketed directly to sell products (India: 99%, Indonesia: 69% and Mexico: 93%), though the sales channels varied. Product features, including e-liquid flavors, device colors and technical specifications, was the most prominent message framing (India: 86%; Mexico: 73%; Indonesia: 58%). Harm reduction messaging was most popular in Mexico (8%) and was not common in Indonesia (0.3%) or India (0%). Conclusion Our study provides important insights for tobacco control stakeholders on the evolving nature of e-cigarette marketing in low- and middle-income countries. It underscores the presence of e-cigarette marketing, including in countries where comprehensive regulations exist, and suggests the importance of continuous monitoring to keep up with industry practices and strengthen tobacco control stakeholder efforts to counter them.
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Affiliation(s)
- Nandita Murukutla
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Melina S Magsumbol
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Hana Raskin
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Sharan Kuganesan
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Silvia Dini
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Carlos Martinez-Mejia
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
| | - Rachfiansyah
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY, United States
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Guan R, Zhang M, Yang X. Relationship Between School Music Context and Music Career Choice Among Chinese Adolescents: A Framework Based on a Context–Process–Outcomes Model. Psychol Res Behav Manag 2022; 15:3473-3484. [DOI: 10.2147/prbm.s370598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/05/2022] [Indexed: 12/02/2022] Open
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The state of health in Indonesia's provinces, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health 2022; 10:e1632-e1645. [PMID: 36240829 PMCID: PMC9579357 DOI: 10.1016/s2214-109x(22)00371-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Analysing trends and levels of the burden of disease at the national level can mask inequalities in health-related progress in lower administrative units such as provinces and districts. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to analyse health patterns in Indonesia at the provincial level between 1990 and 2019. Long-term analyses of disease burden provide insights on Indonesia's advance to universal health coverage and its ability to meet the United Nations Sustainable Development Goals by 2030. METHODS We analysed GBD 2019 estimated cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 286 causes of death, 369 causes of non-fatal health loss, and 87 risk factors by year, age, and sex for Indonesia and its 34 provinces from 1990 to 2019. To generate estimates for Indonesia at the national level, we used 138 location-years of data to estimate Indonesia-specific demographic indicators, 317 location-years of data for Indonesia-specific causes of death, 689 location-years of data for Indonesia-specific non-fatal outcomes, 250 location-years of data for Indonesia-specific risk factors, and 1641 location-years of data for Indonesia-specific covariates. For subnational estimates, we used the following source counts: 138 location-years of data to estimate Indonesia-specific demographic indicators; 5848 location-years of data for Indonesia-specific causes of death; 1534 location-years of data for Indonesia-specific non-fatal outcomes; 650 location-years of data for Indonesia-specific risk factors; and 16 016 location-years of data for Indonesia-specific covariates. We generated our GBD 2019 estimates for Indonesia by including 1 915 207 total source metadata rows, and we used 821 total citations. FINDINGS Life expectancy for males across Indonesia increased from 62·5 years (95% uncertainty interval 61·3-63·7) to 69·4 years (67·2-71·6) between 1990 and 2019, a positive change of 6·9 years. For females during the same period, life expectancy increased from 65·7 years (64·5-66·8) to 73·5 years (71·6-75·6), an increase of 7·8 years. There were large disparities in health outcomes among provinces. In 2019, Bali had the highest life expectancy at birth for males (74·4 years, 70·90-77·9) and North Kalimantan had the highest life expectancy at birth for females (77·7 years, 74·7-81·2), whereas Papua had the lowest life expectancy at birth for males (64·5 years, 60·9-68·2) and North Maluku had the lowest life expectancy at birth for females (64·0 years, 60·7-67·3). The difference in life expectancy for males between the highest-ranked and lowest-ranked provinces was 9·9 years and the difference in life expectacy for females between the highest-ranked and lowest-ranked provinces was 13·7 years. Age-standardised death, YLL, and YLD rates also varied widely among the provinces in 2019. High systolic blood pressure, tobacco, dietary risks, high fasting plasma glucose, and high BMI were the five leading risks contributing to health loss measured as DALYs in 2019. INTERPRETATION Our findings highlight that Indonesia faces a double burden of communicable and non-communicable diseases that varies across provinces. From 1990 to 2019, Indonesia witnessed a decline in the infectious disease burden, although communicable diseases such as tuberculosis, diarrhoeal diseases, and lower respiratory infections have remained a main source of DALYs in Indonesia. During that same period, however, all-ages death and disability rates from non-communicable diseases and exposure to their risk factors accounted for larger shares of health loss. The differences in health outcomes between the highest-performing and lowest-performing provinces have also widened since 1990. Our findings support a comprehensive process to revisit current health policies, examine the root causes of variation in the burden of disease among provinces, and strengthen programmes and policies aimed at reducing disparities across the country. FUNDING The Bill & Melinda Gates Foundation and the Government of Indonesia. TRANSLATION For the Bahasa Indonesia translation of the abstract see Supplementary Materials section.
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Fauzi R, Arumsari I, Maruf MA, Ahsan A. Association of Tobacco Advertising, Promotion, and Sponsorship (TAPS) exposure on smoking intention and current smoking behavior among youth in Indonesia. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2120432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ridhwan Fauzi
- Faculty of Public Health, Universitas Muhammadiyah Jakarta, Jakarta, Indonesia
| | - Imas Arumsari
- Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. Hamka, Jakarta, Indonesia
| | | | - Abdilah Ahsan
- Faculty of Economics and Business, Universitas Indonesia, Depok, Indonesia
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Donaldson SI, Dormanesh A, Perez C, Majmundar A, Allem JP. Association Between Exposure to Tobacco Content on Social Media and Tobacco Use: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:878-885. [PMID: 35816331 PMCID: PMC9274450 DOI: 10.1001/jamapediatrics.2022.2223] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/23/2022] [Indexed: 11/14/2022]
Abstract
Importance Exposure to tobacco-related content on social media may foster positive attitudes toward tobacco products and brands, and influence the likelihood of initiating or continuing use of tobacco, especially among adolescents and young adults. Objective To perform the first systematic review and meta-analysis, to our knowledge, on studies that examined the association between exposure to tobacco content on social media and lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Data Sources Tobacco, social media, and marketing search terms were entered into online databases, including MEDLINE, ISI Web of Science, Scopus, and PsychINFO. Study characteristics, including research design and methods, sampling strategy, and demographics, were assessed for each study. Study Selection Studies reporting odds ratios (ORs) for self-reported exposure to, or experimentally manipulated, tobacco content on social media and lifetime tobacco use, past 30-day tobacco, and susceptibility to use tobacco among never users. The systematic search produced 897 independent articles, of which 29 studies met inclusion criteria. Data Extraction and Synthesis A 3-level random-effects meta-analysis was used to estimate ORs, 95% CIs, and heterogeneity (I2) for each tobacco use outcome. Study quality and publication bias were assessed. Main Outcomes and Measures Lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Tobacco use included e-cigarettes, cigarettes, and other (cigar, hookah, smokeless tobacco). Results The total sample size across the 24 included datasets was 139 624, including 100 666 adolescents (72%), 20 710 young adults (15%), and 18 248 adults (13%). Participants who were exposed to tobacco content on social media, compared with those who were not exposed, had greater odds of reporting lifetime tobacco use (OR, 2.18; 95% CI, 1.54-3.08; I2 = 94%), past 30-day tobacco use (OR, 2.19; 95% CI, 1.79-2.67; I2 = 84%), and susceptibility to use tobacco among never users (OR, 2.08; 95% CI, 1.65-2.63; I2 = 73%). Subgroup analyses showed similar associations for tobacco promotions, active engagement, passive engagement, lifetime exposure to tobacco content, exposure to tobacco content on more than 2 platforms, and exposure to tobacco content among adolescents and young adults. Conclusions and Relevance Findings suggest that a comprehensive strategy to reduce the amount of tobacco content on social media should be developed by federal regulators. Such actions may have downstream effects on adolescent and young adult exposure to protobacco content, and ultimately tobacco use behaviors.
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Affiliation(s)
- Scott I. Donaldson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Allison Dormanesh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Cindy Perez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Anuja Majmundar
- Tobacco Control Research, Surveillance and Health Equity Science, American Cancer Society, Inc, Kennesaw, Georgia
| | - Jon-Patrick Allem
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
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Ling PM, Kim M, Egbe CO, Patanavanich R, Pinho M, Hendlin Y. Moving targets: how the rapidly changing tobacco and nicotine landscape creates advertising and promotion policy challenges. Tob Control 2022; 31:222-228. [PMID: 35241592 PMCID: PMC9233523 DOI: 10.1136/tobaccocontrol-2021-056552] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/01/2021] [Indexed: 01/18/2023]
Abstract
Tobacco, nicotine and related products have and continue to change rapidly, creating new challenges for policies regulating their advertising, promotion, sponsorship and sales. This paper reviews recent commercial product offerings and the regulatory challenges associated with them. This includes electronic nicotine delivery systems, electronic non-nicotine delivery systems, personal vaporisers, heated tobacco products, nicotine salts, tobacco-free nicotine products, other nicotine products resembling nicotine replacement therapies, and various vitamin and cannabis products that share delivery devices or marketing channels with tobacco products. There is substantial variation in the availability of these tobacco, nicotine, vaporised, and related products globally, and policies regulating these products also vary substantially between countries. Many of these products avoid regulation by exploiting loopholes in the definition of tobacco or nicotine products, or by occupying a regulatory grey area where authority is unclear. These challenges will increase as the tobacco industry continues to diversify its product portfolio, and weaponises 'tobacco harm reduction' rhetoric to undermine policies limiting marketing, promotion and taxation of tobacco, nicotine and related products. Tobacco control policy often lags behind the evolution of the industry, which may continue to sell these products for years while regulations are established, refined or enforced. Policies that anticipate commercial tobacco, nicotine and related product and marketing changes and that are broad enough to cover these product developments are needed.
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Affiliation(s)
- Pamela M Ling
- Department of Medicine and Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Roengrudee Patanavanich
- Department of Community Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Mariana Pinho
- Tobacco Control Project, ACT Health Promotion (Brazil), Rio de Janeiro, Brazil
| | - Yogi Hendlin
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
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16
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Astuti PAS, Assunta M, Freeman B. Tobacco Control Stakeholder Perspectives on the Future of Tobacco Marketing Regulation in Indonesia: A Modified Delphi Study. J Prev Med Public Health 2021; 54:330-339. [PMID: 34649395 PMCID: PMC8517369 DOI: 10.3961/jpmph.21.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Tobacco control in Indonesia is very lenient compared to international standards. This study explored the perspectives of tobacco control stakeholders (TCSs) on the likelihood of advancing tobacco marketing regulation in Indonesia. METHODS Data were collected from TCSs who were members of the Indonesia Tobacco Control Network group in a modified Delphi study. We collected the data in 2 waves using a questionnaire that comprised a set of closed and open-ended questions. For this paper, we analysed 2 of the 3 sections of the questionnaire: (1) tobacco advertising, promotions, and sponsorship (TAPS) bans, and (2) marketing and retailing regulations. We conducted a descriptive analysis of the scores using Stata/IC.13 and summarised the comments for each item. RESULTS The TCSs viewed the measures/strategies across all aspects of TAPS and tobacco marketing regulation as highly desirable, but provided varied responses on their feasibility. They rated political feasibility lower than technical feasibility for most measures. Advancing TAPS measures and prohibition of selling to minors were considered more attainable by sub-national governments, while prohibition of tobacco corporate social responsibility was considered as the least feasible measure in the next 5 years. CONCLUSIONS Despite little optimism for substantial national-level change, there is a positive expectation that sub-national governments will strengthen their tobacco control regulation. It is paramount that the government reduce tobacco industry leverage by implementing Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. Extending advocacy networks beyond tobacco control groups and framing tobacco control more effectively are necessary steps.
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Affiliation(s)
- Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Bali, Indonesia
- Udayana Center for NCDs, Tobacco Control and Lung Health, Udayana University, Denpasar, Indonesia
| | - Mary Assunta
- South East Asia Tobacco Control Alliance (SEATCA), Bangkok, Thailand
| | - Becky Freeman
- School of Public Health, The University of Sydney, Sydney, Australia
- Prevention Research Collaboration (PRC), Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Kunst AE. Tobacco use in young people: being emic to end the epidemic. LANCET PUBLIC HEALTH 2021; 6:e439-e440. [PMID: 34051922 DOI: 10.1016/s2468-2667(21)00114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Anton E Kunst
- Department of Public and Occupational Health Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, Netherlands.
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