The development of local smoke free policy of Indonesia in 2004 - 2015

Abstract

Background Many low-income countries develop tobacco control policies not only national levels, but also at local levels. The dynamics underlying the development of local-level policies are still poorly understood. This study aimed to map and understand the development of local-level policies regarding smoke-free area, as the main tobacco control strategy in Indonesia, in 2004-2015. Methods We used an official government data base with data on smoke free policies for Indonesia's 33 provinces and 510 municipalities. The extent of smoke free policies was expressed in a summary scale derived from the Tobacco Control Scale (TCS) to map, and to relate these scores to provincial-level scores and to characteristics of municipalities. Results By 2015, about 30 percent of the municipalities had smoke-free policies. Many municipalities enacted such policies before these were introduced at province. Municipalities with stronger policies clustered within specific parts of the Indonesian archipelago. Municipalities within provinces with high TCS score were more likely to have smoke-free policies (OR=1.91; CI95%: 1.09-3.35) but no difference was found between low and intermediate group. Smoke-free policies were more common in municipalities with high urbanization rate (OR=2.65; CI95%: 1.46-4.84), high population density (OR=4.35; CI95%: 2.29-8.22), and high GDP per-capita (OR=2.26; CI95%: 1.27-4.02). Conclusions There was little evidence for a top-down development of tobacco control policy in Indonesia. Provincial tobacco control policy seemed to have stimulated local policies only if they were fully developed. Trends at local levels followed instead a diffusion pattern, with local tobacco control policies starting in clusters of areas with higher population density or economic development.

Keywords

• WCTOH