Policy incoherence and tobacco control in Indonesia: an analysis of the national tobacco-related policy mix

Barriers and opportunities for improving smoke-free area implementation in Banda Aceh city, Indonesia: a qualitative study

OBJECTIVES

To investigate the challenges and opportunities for implementing smoke-free areas (SFAs) within eight area categories using the WHO Framework Convention on Tobacco Control as a framework for analysis.

DESIGN

This study used qualitative methods (in-depth interviews and document reviews). All transcripts from the interviews and formal documents were coded using NVivo V.11 software and analysed using an inductive thematic analysis.

SETTING

Banda Aceh, Indonesia.

PARTICIPANTS

Seventy-three participants were interviewed, stratified by ages (18-59 years): policymakers (n=4), SFA implementers (n=33), SFA's non-compliance prosecutors (n=2), SFA observers (n=4), communities/respected figures (n=30); and 10 documents were reviewed.

RESULTS

Barriers to the effective implementation of SFAs were identified: conflict of interests of Banda Aceh authorities in implementing SFA policies; inadequate monitoring, evaluation and implementation of SFAs among involved actors; inadequate public communication of SFAs to communities; and misunderstanding of 'enclosed areas' as SFAs. However, some important opportunities were identified: the Ministry of Education promotes SFA at schools; and smoking prohibition as part of sharia and other religions' recommendations.

CONCLUSIONS

This research is the first study to examine SFAs to understand the challenges and opportunities for improving SFA policy implementation by interviewing various key respondents in Banda Aceh (religious leaders and respected figures). These key stakeholders' roles are crucial to enhance the implementation of SFA policies in Banda Aceh (currently suboptimal) and other populous Muslim areas in Indonesia or other countries because smoking contradicts Islamic teachings and other religions' tenets. Further, the findings propose policymakers and involved agencies strengthen public communication, execution, monitoring and evaluation, and enforcement of SFA policies in Aceh. Finally, the application of methods and results from this study to other local areas in Indonesia or other developing nations is necessary to facilitate further understanding more about the applicability, advantages and limitations of this study.

Implications of nicotine vaping products for tobacco control in ASEAN low-income and middle-income countries: in-depth interviews with experts from the region

OBJECTIVES

The use of nicotine vaping products (NVPs) has increased in low-income and middle-income countries (LMICs) in the Association of Southeast Asian Nations (ASEAN) region; however, it is uncertain what implications the presence and use of NVPs have for tobacco control.

DESIGN

In-depth interviews were conducted to explore ASEAN tobacco control experts' (n=11) views on the rise of NVP use in ASEAN LMICs, current NVP policies, the potential harm reduction and smoking cessation utilities of these devices, and what implications they may have for tobacco control. Data were analysed using inductive, reflexive thematic analysis.

RESULTS

Five themes emerged: (1) NVPs threaten tobacco control in ASEAN LMICs; (2) commercial factors influence youth appeal and access: product attributes, marketing, supply chains; (3) opposition to the smoking cessation and harm reduction utilities of NVPs; (4) policies are inconsistent and fragmented in the region; and (5) tobacco industry power and tactics have been used to capture NVP markets.

CONCLUSIONS

ASEAN tobacco control experts believe that NVPs pose a threat to youth and non-smokers in LMICs in the region, largely because of tobacco industry NVP marketing activities. They do not support the use of NVPs for smoking cessation or harm reduction and call for more restrictions and consistent policy enforcement across the region to protect young people, while also cautiously recognising that use of NVPs may have some benefits for smokers.

Smoking behavior among junior high school students based on the theory of planned behavior in Madura, Indonesia

OBJECTIVE

This research aimed to assess attitudes, subjective norms, and intentions about early smoking behavior among junior and senior high school students in Sampang, Madura, Indonesia.

CONTENT

Teenagers' smoking behavior is a phenomenon that needs careful examination and is easily recognized today. In Indonesia, the frequency of teenage smokers aged 10-18 years is growing every year. This age group is essential since most regular smokers start to smoke at this age. Although the Indonesian government has made preventive efforts, the prevalence of tobacco use remains high and continues to rise among younger age citizens. This research employed descriptive analysis with a cross-sectional approach. A total of 174 teenagers were chosen to participate in this study using a purposive sampling approach among junior high and high school students in Sampang District who smoke. Data were collected using questionnaires and evaluated with statistical regression tests with 95% confidence intervals (CI).

SUMMARY

The findings revealed that attitudes, subjective norms, and intentions were linked to early smoking behavior in teenagers in the Sampang District, Madura. The results were attitude (OR=5.27, 95% CI: 4.89-5.61), subjective norm (OR=1.78, 95% CI: 1.51-2.05), PBC (OR=2.05, 95% CI: 1.66-2.40), and intention (OR=4.16, 95% CI: 3.86-4.47). Early smoking behavior in Sampang is primarily driven by the impression of poor parental disruptive behavior and a strong urge to smoke among teenagers, along with significant peer support.

OUTLOOK

These findings can be utilized to address some of the key issues identified in order to prevent smoking in teenagers by establishing an atmosphere that avoids the stimulation in smoking behavior.

Kretek Cigarettes and Particulate Matter Emissions-An Aerosol Spectrometric Study on Typical Indonesian Brands Flavored With Cloves

INTRODUCTION

In Indonesia, smoking is widespread. The same applies to second-hand smoke (SHS) exposure. More than 90% of Indonesian smokers smoke clove cigarettes, so-called Kreteks. They often contain more tar and nicotine than conventional cigarettes, but little is known about particulate matter (PM) emissions. In smokers' homes, SHS is the main source of PM that is hazardous to health. This study presents data of PM emissions from Kreteks.

METHODS

SHS was generated in a closed 2.88 m³ measuring chamber. PM fractions (PM10, PM2.5, PM1) of three popular Kretek brands (two king-sized and one slim-sized) in comparison to conventional cigarettes and a reference cigarette were measured by laser aerosol spectroscopy in real-time.

RESULTS

The king-sized Kreteks reached PM10 and PM2.5 mean concentrations of up to about 3000 µg/m³, and PM1 mean concentrations of up to about 2700 µg/m³. Consequently, these Kreteks emitted up to about 100% more PM10 and PM2.5, respectively 84% more PM1 than the reference cigarette, and up to about 260% more PM10 and PM2.5, respectively 234% more PM1 than the other investigated cigarettes.

CONCLUSIONS

PM emissions from Kreteks can be very high. The Indonesian public should be informed and warned about it, considering the high prevalence of smoking and SHS exposure, in particular. The Indonesian tobacco control regulation is limited, and it is overdue to start with a serious and effective tobacco control policy. PM declaration to government authorities could be useful in smoking prevention and tobacco control.

IMPLICATIONS

Research data are limited for Kretek cigarettes, including data on particulate matter (PM). The clove buds in Kretek cigarettes are for flavoring the smoke and shall soften the smoke feeling. That makes them very popular in Indonesia, in particular. The declaration of PM data of Kreteks and other tobacco products can play a key role in a more effective tobacco policy to reduce consumption of tobacco products, not only in Indonesia. To provide data on PM emissions, this study ascertained PM amounts in passive smoke from Indonesian Kreteks.