The impact of local smoke-free policies on smoking behaviour among adults in Indonesia: a quasi-experimental national study

Aims: To investigate to what extent the adoption of local smoke-free policies (SFPs) in Indonesia in 2007–13 was associated with changes in adult smoking behaviour. Design: A quasi-experimental study. Setting: Indonesia, 2007 and 2013. Participants: A total of 1 052 611 > 25-year-old adults. Data were derived from the 2007 and 2013 Indonesian national health survey. Measurements: For both years, provincial and district SFPs were identified from government documents in 497 districts in 33 provinces. Multi-level logistic regression analysis assessed the association of adoption of provincial and district SFPs between 2007 and 2013 with smoking continuation (among ever-smokers), current smoking and high smoking intensity (among current smokers). We controlled for survey year, SFP in 2007, socio-demographics and district characteristics. Findings: Provincial SFP exposure was associated with lower odds of smoking continuation [strong SFP versus no SFP: odds ratio (OR) = 0.71, 95% confidence interval (CI) = 0.66–0.76] and smoking intensity (strong SFP: OR= 0.91, 95% CI = 0.86–0.97), but also with higher odds of current smoking (strong SFP versus no SFP: OR = 1.08; 95% CI = 1.04–1.12). District SFP exposure was associated with higher odds of smoking continuation (strong SFP versus no SFP: OR = 1.07, 95% CI = 1.01–1.14) and current smoking (strong SFP versus no SFP: OR = 1.09, 95% CI = 1.05–1.14), but with lower odds of smoking intensity (moderately strong SFP versus no SFP: OR = 0.95, 95% CI = 0.91–0.99). Conclusions: There may be an association between the adoption of local smoke-free policies in Indonesia and decreased adult smoking intensity. However, the evidence is inconsistent, which may reflect problems with policy implementation and enforcement,.