TY - JOUR
T1 - Progress of smoke-free policy adoption at district level in Indonesia: A policy diffusion study
AU - Septiono, Wahyu
AU - Kuipers, Mirte A. G.
AU - Ng, Nawi
AU - Kunst, Anton E.
PY - 2019
Y1 - 2019
N2 - Background: Even though Indonesia has not ratified the Framework Convention on Tobacco Control (FCTC), district and provincial stakeholders are increasingly adopting smoke-free policies (SFPs). This study aimed to 1) assess whether local SFP adoption in Indonesia followed a horizontal or vertical diffusion pattern and 2) identify district characteristics that are associated with the SFP adoption. Methods: Policy documents enacted during 2004–2015 were compiled from 33 provinces and 510 districts in Indonesia. First, we described the geographical distributions of the policy adoption. Second, we ran logistic regression to assess the associations of district SFP adoption with having adjacent districts that had adopted SFPs (i.e. horizontal diffusion) and being situated in a province that had adopted SFPs (i.e. vertical diffusion). Third, the associations between district characteristics (population density, GDP, tobacco production) and SFP adoption were assessed using logistic regression. Results: By 2015, a total of 17 provinces and 143 districts had adopted SFPs. Districts with SFPs were more concentrated in the western part of Indonesia. Adoption was more likely in districts of which adjacent districts had already adopted SFPs (OR: 2.02; 95%CI: 1.26–3.23), and less likely when the province had already adopted SFPs (OR: 0.19; 95%CI: 0.11 – 0.34). Adoption was more likely in districts with higher GDP (OR high vs low GDP: 3.28; 95%CI: 1.80–5.98) and higher population density (OR high vs low density: 6.57; 95%CI: 3.63–11.9). High tobacco production showed a strong inverse association with SPF adoption (OR high vs. no production: 0.36; 95%CI: 0.17–0.74). Conclusions: Smoke-free policy adoption in Indonesian districts followed a horizontal diffusion pattern, with poorer and rural districts lagging behind in their policy adoption. Our results indicate that local-level policy development is important for smoke-free policy adoption in countries with decentralised governments, but that effective advocacy is needed to counteract tobacco industry interference.
AB - Background: Even though Indonesia has not ratified the Framework Convention on Tobacco Control (FCTC), district and provincial stakeholders are increasingly adopting smoke-free policies (SFPs). This study aimed to 1) assess whether local SFP adoption in Indonesia followed a horizontal or vertical diffusion pattern and 2) identify district characteristics that are associated with the SFP adoption. Methods: Policy documents enacted during 2004–2015 were compiled from 33 provinces and 510 districts in Indonesia. First, we described the geographical distributions of the policy adoption. Second, we ran logistic regression to assess the associations of district SFP adoption with having adjacent districts that had adopted SFPs (i.e. horizontal diffusion) and being situated in a province that had adopted SFPs (i.e. vertical diffusion). Third, the associations between district characteristics (population density, GDP, tobacco production) and SFP adoption were assessed using logistic regression. Results: By 2015, a total of 17 provinces and 143 districts had adopted SFPs. Districts with SFPs were more concentrated in the western part of Indonesia. Adoption was more likely in districts of which adjacent districts had already adopted SFPs (OR: 2.02; 95%CI: 1.26–3.23), and less likely when the province had already adopted SFPs (OR: 0.19; 95%CI: 0.11 – 0.34). Adoption was more likely in districts with higher GDP (OR high vs low GDP: 3.28; 95%CI: 1.80–5.98) and higher population density (OR high vs low density: 6.57; 95%CI: 3.63–11.9). High tobacco production showed a strong inverse association with SPF adoption (OR high vs. no production: 0.36; 95%CI: 0.17–0.74). Conclusions: Smoke-free policy adoption in Indonesian districts followed a horizontal diffusion pattern, with poorer and rural districts lagging behind in their policy adoption. Our results indicate that local-level policy development is important for smoke-free policy adoption in countries with decentralised governments, but that effective advocacy is needed to counteract tobacco industry interference.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85067852414&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31254728
U2 - https://doi.org/10.1016/j.drugpo.2019.06.015
DO - https://doi.org/10.1016/j.drugpo.2019.06.015
M3 - Article
C2 - 31254728
SN - 0955-3959
VL - 71
SP - 93
EP - 102
JO - International journal on drug policy
JF - International journal on drug policy
ER -