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Progress of smoke-free policy adoption at district level in Indonesia: A policy diffusion study

Artikel i vetenskaplig tidskrift
Författare Wahyu Septiono
Mirte A.G. Kuipers
Nawi Ng
Anton E. Kunst
Publicerad i International Journal of Drug Policy
Volym 71
Nummer/häfte September
Sidor 93-102
ISSN 0955-3959
Publiceringsår 2019
Publicerad vid Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa
Sidor 93-102
Språk en
Länkar dx.doi.org/10.1016/j.drugpo.2019.06...
Ämnesord Diffusion of innovations, District, Indonesia, Policy, Smoke-free policy
Ämneskategorier Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi

Sammanfattning

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. © 2019

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