Geographic distribution, socio-economic disparity and policy determinants of smoke-free policy adoption in Indonesia

BACKGROUND: Indonesia has the second highest smoking prevalence among adult males in the world, and smoking prevalence is increasing among youths. OBJECTIVE: To evaluate the smoke-free policy (SFP), a flagship national tobacco control programme, by providing evidence on geographic distribution, socio-economic disparities and policy determinants of SFP adoption by district in Indonesia. METHODS: We employed spatial and quantitative methods to obtain data respectively on geographic distribution of SFP adoption, and on disparities and associations between national and provincial SFP regulations and SFP adoption by the districts. RESULTS: Twenty-one of 34 provinces, and 345 of 514 districts adopted SFP. We found significant geographic disparities: all districts outside of Papua were up to 6.3 times more likely to adopt the policy and to implement it for a period of up to 3 years longer in duration. We also found significant socio-economic disparities: urban districts, those that were wealthiest and those most educated were respectively 3.9, 9.1 and 2.8 times more likely to adopt the policy. Moreover, districts in provinces that had SFP regulation were 3.2 times more likely to adopt. Finally, the adoption rate in the period after the 2012 national regulation was up to 7.8 times higher than that before. CONCLUSION: In addition to geographic and socio-economic disparities, national and provincial regulations and policies were determinants of SFP adoption.