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 2007-2013 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 over-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. Multilevel 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 vs. no SFP: OR:0.71, 95%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 vs. no SFP: OR:1.08; 95%CI:1.04-1.12). District SFP exposure was associated with higher odds of smoking continuation (strong SFP vs. no SFP: OR:1.07, 95%CI:1.01-1.14) and current smoking (strong SFP vs. no SFP: OR:1.09, 95%CI:1.05-1.14), but with lower odds of smoking intensity (moderately strong SFP vs. 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 the policy implementation and enforcement