Children's Exposure to Secondhand Smoke during Ramadan in Jakarta, Indonesia

The geographic distribution of retail tobacco outlets in Yogyakarta, Indonesia

INTRODUCTION

Tobacco smoking prevalence in Indonesia is among the highest in the world. Research worldwide identifies that physical access to tobacco through retail outlets is related to increased tobacco smoking. Tobacco outlet density is very high in many Indonesian cities, so tobacco access may contribute to the high prevalence of tobacco use in that country. The aim of this study was to examine distributions of tobacco outlets in one Indonesian city, Yogyakarta, in relation to social and physical environmental conditions.

METHODS

For this cross-sectional ecological study, we virtually audited randomly selected street segments (n = 1099) using Google Street View. The outcome of interest was a count of tobacco advertising banners (indicating the presence of retail outlets). Exposures were physical environmental conditions (scales of main roads, physical decay, presence of schools, mosques, churches) and social conditions measured at the neighbourhood level (concentrated disadvantage, age composition, population density).

RESULTS

Tobacco banners were present on 36.4% of sampled street segments, including 55 (37%) of 147 streets with schools; a total of 1381 banners were identified. Multilevel negative binomial regression models for street segments nested within neighbourhoods found the prevalence of tobacco banners per 100 m was lower near schools (RR = 0.66, 95% CI 0.45, 0.97) and was not associated with other exposure measures.

DISCUSSION AND CONCLUSIONS

Retail tobacco outlets are ubiquitous in Yogyakarta. Although they are relatively less prevalent on streets with schools, the high absolute values and wide spatial distribution means all residents of Yogyakarta are exposed to tobacco outlets.

Implementation of smoke-free law in Denpasar Bali: Between compliance and social norms of smoking

Background: Since 2013, City of Denpasar government has adopted a smoke-free law. Implementation of the law faces several obstacles, partly due to the high social acceptability of smoking in the city, where cigarette and smoking has been deeply engrained within social life and become part of hospitality. This study aims to assess the smoke-free law compliance and to explore the social norms that may affect the compliance. Design and Methods: The study was a mix of cross-sectional compliance survey and qualitative exploration conducted in Denpasar in 2019. Survey included 538 samples, which were selected using stratified random sampling and a walking protocol. The qualitative data was collected through in-depth interviews and Focus Group Discussion (FGD) in four sub-districts of Denpasar. Results: Of the 538 venues, 32.9% complied with the seven compliance indicators. The university has the highest compliance (83.3%), while public places including worship places have a low compliance. The three most common violations were the absence of no-smoking signage (58.6%), provision of ashtray (17.5%), and smell of tobacco smoke (15.8%). The poor compliance was related to the lack of awareness of the regulation, and the fact that smoking is highly acceptable and part of the culture. The informants highlighted the essential role of public figures and potency of local policy as social disapproval of smoking. Conclusions: Compliance to the smoke-free law in Denpasar remains low, continuous education, socialization and improved supervision are crucial. Meanwhile, social and cultural acceptance of smoking is considered as an essential factor that hampers the implementation of the smoke free law.

Monitoring Compliance and Examining Challenges of a Smoke-free Policy in Jayapura, Indonesia

BACKGROUND

In Indonesia, 61 million adults smoked in 2018 and 59 million were exposed to secondhand smoke at offices or restaurants in 2011. The Presidential Decree 109/2012 encouraged local governments to implement smoke-free policy (SFP) with Jayapura city enacted a local bill (1/2015) in 2015.

OBJECTIVE

This study aims to evaluate the compliance and explore the challenges in implementing.

METHODS

We conducted a mixed-methods study. The quantitative method assessed the compliance to six criteria (as per the bill) including having signage, no smoking activity, no selling, no advertisement, no smoke, and no ashtray at SFP facilities. We surveyed 192 facilities including health facilities, educational facilities, places of worship, government offices, and indoor/outdoor public facilities. The qualitative method explored challenges in implementing through by interviewing 19 informants (government officers, students and community).

RESULTS

The compliance rate to all six criteria was 17% overall, ranging from 0% at outdoor public facilities to 50% at health facilities. We found no spatial patterning as shown by similar compliance rates between SFP facilities within and outside of 1-kilometer around the provincial and city health offices. Implementation challenges included (a) limited budget for enforcement, (b) lack of support from local non-government organizations and universities, (c) lack of public awareness at facilities, and (c) lack of examples from local leaders.

CONCLUSION

The overall compliance was low in Jayapura city due to many challenges. This provides lessons learnt for tobacco control policy in the areas that are least developed and farthest from the central government.