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BACKGROUND: Indonesia shoulders a significant tobacco burden, with almost two million cases of tobacco-related illnesses and more than two hundred thousand tobacco-related deaths annually. Indonesian tobacco control is progressing but lags behind other countries. Our study evaluates factors that contribute to the slow progress of tobacco policy change in Indonesia from the perspective of tobacco control experts (TCEs). METHOD: We conducted qualitative interviews with four international and ten national TCEs, who have been active in tobacco control for at least 5 years. Our interview guideline included questions on the current tobacco control situation in Indonesia and explored reasons why tobacco control is progressing so slowly. The interviews were conducted either in English or Bahasa Indonesia, recorded and then transcribed verbatim. We conducted a thematic analysis based on five core causal factors for policy adoption: institutions, networks, socio-economic factors, agendas and ideas. RESULTS: The multistage delay of tobacco policy adoption is principally due to political structures and policy hierarchy, complex bureaucracy, unclear roles and responsibilities, and a high degree of corruption. The low bargaining position and lack of respect for the Ministry of Health also contributes. There are contrasting frames of tobacco as a strategic economic asset and tobacco control as a sovereignty threat. There is an imbalance of power and influence between well entrenched and resourced tobacco industry networks compared to relatively young and less established tobacco control networks. The policy agenda is likely influenced by the privileged position of tobacco in Indonesia as a socially acceptable product with high consumption. There are constraints on transferring ideas and evidence to successful policy adoption. CONCLUSION: Tobacco companies have substantially influenced both policy decisions and public perceptions, signifying a power imbalance within the government system and broader networks. Acceding to and ...

ABSTRAK Kabupaten Tabanan memberlakukan peraturan kawasan tanpa rokok pada restoran, namun dalam penerapannya masih rendah. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang memengaruhi kepatuhan penerapan KTR oleh pengelola dengan memerhatikan larangan merokok total pada restoran di Kabupaten Tabanan. Penelitian ini merupakan penelitian analitik kuantitatif dengan rancangan crossectional. Sampel penelitian yaitu pengelola restoran yang berada di Kabupaten Tabanan. Besar sampel menggunakan total sampling dengan jumlah 110 restoran, dengan jumlah yang berpartisipasi 87 restoran (79% response rate). Data dianalisis dengan menggunakan regresi logistik. Hasil penelitian menunjukkan bahwa kepatuhan restoran dalam menerapkan larangan merokok total sebesar 26,44%. Faktor yang memengaruhi kepatuhan penerapan KTR yaitu umur pengelola (OR=3,45; 95% CI: 1,10-10,84), pengetahuan pengelola (OR=3,56; 95% CI: 0,96-13,16), sikap pengelola (OR=2,45; 95% CI: 0,72-8,30), serta persepsi dampak bisnis pengelola (OR=4,62; 95% CI: 1,12-19,07) berpeluang meningkatkan kepatuhan KTR. Kepatuhan pengelola restoran di Kabupaten Tabanan terhadap penerapan larangan merokok total relatif rendah. Masih banyak terdapat indikator yang belum terpenuhi dalam implementasi kepatuhan restoran. Perlu adanya dukungan berbagai sektor dalam meningkatkan kepatuhan seperti pengelola, pengunjung, maupun pemerintah sebagai pembuat kebijakan. Kata Kunci: rokok, kepatuhan, KTR, restoran. ABSTRACT Tabanan regency applied smoke-free by law (SFL) in restaurant but the implementation was still low. This study aimed to determine the factors that influence the compliance of the implementation of smoke-free area by restaurant owners through looking complete smoking ban restaurant in Tabanan Regency. This was a quantitative analytic study with a cross-sectional design. The study samples were restaurant owners/managers in Tabanan Regency. The number of sampling on this study was set by respondent's rate respond (79% response rate). Data was analyzed using logistic regression. The results showed that the compliance of restaurant manager to total smoking ban was low (26.44%). The factors that influence compliance SFL such as the age of the manager (OR=3.45; 95% CI: 1.10-10.84), the manager's knowledge (OR=3.56; 95% CI: 0.96-13.16), the manager's attitude (OR=2.45; 95% CI: 0.72-8.30), as well as the perception of the impact of the manager's business (OR=4.62; 95% CI:1.12-19.07) has significantly association with compliance. The compliance of restaurant managers in Tabanan Regency on the implementation of total smoking ban was relatively low. There are still many indicators that have not been fulfilled. There needs concrete support to improving the compliance such as managers, customers, and government as policy makers. Key Words: cigarrete, compliance, smoke-free area, restaurant.

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.

AbstractBackground:This study aimed to investigate gender differences in social environmental factors of psychological distress among Indonesian adolescents.Methods:This was a cross-sectional study using the data from the 2015 Indonesia Global School-based Student Health Survey. Binary logistic regression was used to assess the influences of main independent variables – social environmental factors (i.e., peer support, having close friends, bullying victimisation, physical fight, physical attack, parental supervision, connectedness, bonding), demographic characteristics, and health-related behaviours on the measures of psychological distress (loneliness, anxiety-induced sleep disturbance, and a combination of both measures as psychological distress).Results:The prevalence of psychological distress measured as loneliness, anxiety-induced sleep disturbance, and combined psychological distress was 6.12%, 4.52%, and 8.04%, respectively. Findings from multivariate analyses indicated that bullying victimisation, physical attack, experience of hunger (a proxy of socioeconomic status), and sedentary behaviour were associated with all measures of psychological distress. Meanwhile, age, gender, drug use, parental connectedness and bonding, and having no close friends were correlates of one or two measures of psychological distress. Based on gender-stratified analyses, experience of hunger, sedentary behaviour, bullying victimisation, and having no close friends were consistently associated with measures of psychological distress among both girls and boys. In addition, the influence of some social environmental factors, such as parental connectedness, peer support, and physical attack, were more salient among girls.Conclusions:The findings suggest that social environmental factors, demographic characteristics, and health-related behaviours were associated with psychological distress, and the associations appeared to differ by gender. Interventions that include improving positive social environmental factors (e.g., reducing interpersonal violence, encouraging positive relationships with parents and peers) and promoting healthy behaviours (e.g., less sedentary behaviour, preventing substance use) might help reduce the risk of psychological distress among Indonesian adolescents.