Yayi Suryo Prabandari

Community
and Local
advocacy
strategies for
implementing
anti-smoking
policies
Yayi Suryo Prabandari
QUIT TOBACCO INDONESIA Faculty of Medicine
Universitas Gadjah Mada (FM UGM) &
Department of Public Health – FM UGM
Yogyakarta-Indonesia
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The history and fact about tobacco in
Indonesia
Research result related SDH & Tobacco
The Policy in Indonesia & how to advocate
local regulation and community strategy
The Challenge:
The Combat to Cigarette Advertisement
1492
6000 SM
1596
> 700
cigarette
industries
1904
1891
1840-1940
1820
Tobacco Consumption in ASEAN
Viet Nam
14.11%
Brunei
0.04%
Cambodia
2.07%
Thailand
7.74%
Singapore
0.39%
Indonesia
46.16%
Philippines
16.62%
3rd in the world
Myanmar
8.73%
Malaysia
2.90%
Lao PDR
1.23%
Year
Male
Female
Total
1995*
53.9
1.7
27.2
2001*
62.9
1.4
31.8
2004*
63.0
5.0
35.0
2007**
65.3
5.1
35.4
2010***
65.9
4.2
34.7
*Kosen, Aryastami, Usman, Karyana, Konas Presentation IAKMI XI, 2010
** Ministry of Health, Basic Health Research, 2007 ( prevalence of > 10 years old)
*** Ministry of Health, Basic Health Research, 2010 (prevalence of > 15 years old)
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More than half (57%) of house hold in Indonesia
at least has one smoker and almost all smoker
(91,8%) smoke inside their house
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In 2005, there were 40,134 death (in a year) due
to passive smoking in Indonesia
*Ng N, Padmawati RS, Prabandari YS, Nichter M.. Smoking Behavior among Former Tuberculosis Patients in
Indonesia: Intervention Is Needed. The International Journal of Tuberculosis and Lung Disease. 2008;12(5):567-572.
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The danger of smoking are not well recognize
in Indonesia
Many people believe that smoking 10
cigarettes a day is not harmful if the smoker
uses a brand of cigarette considered
‘suitable’ for his body – some brands of clove
cigarette are even thought to be beneficial for
those with respiratory illness
Few data exist on the message received by TB
patients from health care professionals and
care givers.
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Methods: cross-sectional survey among 448 physicians working in
public health centers, district hospitals, provincial hospitals, medical
faculty, and residents in Sarjito hospital
Instrument: self-administered questionnaire
Result:
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Ever smokers among male physicians: 67 %
Among ever smokers, physicians who smoked during the last 30 days:
32%
Of those who smoked, 74% are daily smokers
Fifty percent of physicians have never tried to quit
The other 50% have tried to quit, but been unsuccessful
Ng N, Prabandari YS, Padmawati RS, Okah F, Haddock CK, Nichter M, Nichter M, Muramoto M, Poston WSC, Pyle SA, Mahardinata N, Lando HA.
Physician assessment of patient smoking in Indonesia: a public health priority. Tob Control. 2007 Jun;16(3):190-6
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Of male physicians who have ever smoked,
the median number of cigarettes considered
okay to smoke before being very harmful for
health was 10 cigarettes
This did not vary by work place (hospital, public
health center, or medical school)
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Among female physicians, the median # of
cigarettes deemed safe ranged between 3-5
depending on workplace.
Patient Exit Interview
• Objective: to examine patient reports of
doctors’ asking and advising patients to
quit smoking
• Method: exit interview survey in four
public health centers in Yogyakarta
• 72% of physicians
reported that they do
not routinely ask
patients about their
smoking status
• 34% (male) and
21(female) physicians
reported that they did
routinely ask patients
Doctor’ report
 Of the 355 male
patients interviewed,
41% of them were
smoking in the last 30
days
 Only 10% of all
patients were asked
by doctors about their
smoking behavior
during their clinical
encounter
Patient’ report
Ministry of Education
instruction no 4 1997:
Smoke Free School
Indonesian
Gov Reg on
Tobacco
Control (GRTS)
Number 109
2012 about
substance
protection that
contain addictive
substance, tobacco
effect for health
Indonesia has
not yet
ratified FCTC
Tobacco control
more
decentralized and
carried out locally
+
MPOWER
(WHO)
Local regulation
no 5 art 11 2007
SMOKE FREE
AREA
Yogyakarta
Governor
regulation no 39
2009
Governor
Yogyakarta
regulation no
39  7 SMOKE
FREE setting
Campaign and dissemination of Smoke
free area
Regulation cannot
be applied in the
house hold 
private area 
SMOKE FREE
HOUSE KAMPONG
Community
approach
• Community survey
• Qualitative methods for
exploring community
perception and opinion
(in-depth interview, FGD)
Initial
program
• Join in existing community meeting
•Women group (PKK)
•Men group
•Wife and husband (separate and
couple)
• Agreement on
establishing local
regulation
• Issued a petition
•Youth
•Community leader
•Coordination meeting
Local policy
development
Workshop for
developing
academic paper
and district
regulation
planning
Local
parliament
body
meeting
1. Local
parliament
initiative
2. Executive
recommendation
The steps of Smoke Free
Area District
Regulation Advocacy
QTI & Healthy Jogjakarta without Tobacco
General
meeting of local
parliament
District legislative
special meeting
2012
District Regulation
Special committee
General meeting
for final
regulation
approval
Local regulation
Governor Yogyakarta
no 5 art 11 2007
regulation
SMOKE FREE AREA
as Part of Air
Pollution Article
no 39 2009
SMOKE FREE AREA
REGULATION (7 areas)
Kulon Progo District : Limited Smoke Area – No 61 2009
Gunung Kidul District: Limited Smoke Area – No 22 2009
Sleman District: Limited Smoke Area – no 42 2012
Yogyakarta City – still a draft
Bantul District – still a draft
Waiting for District and
Municipality Regulation
on Smoke Free Area :
Out of 5 – There is a
district that has reached
the final step of the local
regulation approval
(Sleman)
Nichter M, Padmawati RS, Prabandari YS, Ng N, Danardono M, Nichter
M. 2008 Reading Culture from Tobacco Advertisements in Indonesia.
Tobacco Control 25(1): 1-23
YOGYAKARTA:
strategic location for
cigarette
advertisement
21
22
Thank you for the attention
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