Analysis of Impact of Province-Level Smokefree Policies on Smoking Status and Indoor Second-Hand Smoke Exposure in Indonesia Between 2013 and 2018 via a Difference-in-Differences Approach

Penulis: Rahim, Fitri Kurnia; Nurmansyah, Mochamad Iqbal; Nasir, Narila Mutia; Safira, Nanda; Ahsan, Abdillah
Informasi
JurnalNicotine and Tobacco Research
PenerbitOxford University Press
Volume & EdisiVol. 28,Edisi 1
Halaman143 - 155
Tahun Publikasi2026
ISSN14622203
Jenis SumberScopus
Abstrak
Introduction: Indonesia has one of the highest prevalences of smoking among males globally, and province-level policies are a key tool for addressing this challenge. We aimed to describe the implementation and characteristics of province-level smokefree policies in Indonesia, and assess their impact on self-reported smoking and indoor second-hand smoke (SHS) exposure. Methods: Data from two nationally-representative “RISKEDSAS” surveys (2013 and 2018) were employed for individual-level outcomes. Using data from the Smokefree Policy Evaluation Monitoring Dashboard, provinces were categorized into “control” and “intervention” groups based on policy implementation between these years, with intervention provinces categorized as “low” or “medium-to-high” strength of regulation. We fitted logistic regression models adjusted for respondents’ characteristics within a difference-in-differences framework for odds of smoking and SHS exposure outcomes, with interaction terms between year and policies’ strength of regulation representing policy effects. Results: Although interaction terms representing policy effects showed no reduction in odds of smoking in response to policies with low strength of regulation (OR: 1.01, 95% CI = 0.97–1.06, p = .502), we found a modest reduction in odds of smoking associated with medium-tohigh regulation strength policies (OR: 0.92, 95% CI = 0.90–0.95, p < .001). Policies of both strengths of regulation were significantly associated with a 7% reduction in odds of indoor SHS exposure (OR: 0.93). Conclusions: Although most Indonesian provinces now implement smokefree policies, further strengthening key policy dimensions including monitoring, enforcement and compliance, and efforts to tackle barriers to implementation, are needed to maximize impact. Implications: Indonesia has one of the highest prevalences of smoking among males globally, resulting in a significant attributable disease burden and economic costs. To our knowledge no previous study has attempted to assess impact of province-level smokefree policies in Indonesia. Our analysis found modest impacts of province smokefree policies, and greater effectiveness of those with medium-to-high strength of regulation, while also suggesting occurrence of positive spillover effects to geographically contiguous non-implementing provinces. It also highlights continuing gaps in dimensions of smokefree policies including monitoring, enforcement and compliance. © The Author(s) 2025. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.
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