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Introduction: Indonesia is one of the countries with the highest number of tobacco advertisements, promotion, and sponsorship (TAPS) across the globe, which play a significant role in increasing smoking prevalence. Since 2019, Klungkung District has adopted a TAPS ban at point of sale (PoS). Accordingly, this study aims to evaluate compliance with the total TAPS ban at PoS in Klungkung and the factors associated. Methods: This cross-sectional study was conducted in the Klungkung district from August to October 2021. The survey involved 200 samples of PoS and also the managers, which selected using stratified simple random sampling for registered PoS and a walking protocol for unregistered PoS. Data was collected through observation using a checklist and interview using a structured questionnaire by eight well-trained enumerators. Data were analyzed using SPSS. Results: The study successfully observed 200 PoS and also interviewed 200 PoS managers. The result showed the compliance was 72.5%. Of 9 factors analyzed using regression analysis, it was found that factors associated with the compliance were knowledge and attitude PoS manager toward TAPS ban (OR=11.3; CI:1.233-103.414; p=0.008), perceived of socio-economic impact factor (OR=8.1; CI:3.584-18.400; p<0.01), and tobacco industry interference (OR=2.8; CI:1.441-5.594; p=0,003). Conclusions: Compliance with the TAPS ban at PoS remain sufficient, even though it has not reached the target. Factors mainly associated with the compliance were the attitude of PoS manager, and tobacco industry interference. Hence, socialization and enforcement should be improved and sustained. [ABSTRACT FROM AUTHOR]

Introduction: The city of Denpasar has implemented the smoke-free law for five years. However, the compliance remains low. Smoking remains highly accepted in society, and the provision of cigarettes in several religious and customary events. Hence, this study aims to assess how social smoking norms affect compliance with smoke-free laws. Methods: This was a cross-sectional study located in Denpasar, Bali, Indonesia. This study was conducted from December 2019 until February 2020. The sample size was 192 and was selected using multistage random sampling. Data were collected through interviews using a structured questionnaire then analyzed using multiple linear regression. Results: Descriptive norms of smoking affected the compliance in worship places (standardized coefficient beta of 0.175 and p=0.01). Moreover, the effect of descriptive norms to compliance was significantly moderated by perceived of injunctive norms (standardized coefficient beta of 0.216; p<0.01); benefits to one-self (standardized coefficient beta of 0.199; p<0.01); benefits to others (standardized coefficient beta of 0.164; p=0.02); anticipatory socialization (standardized coefficient beta of 0.146; p=0.03); similarity (standardized coefficient beta of 0.141; p=0.04); aspiration (standardized coefficient beta of 0.131; p=0.06); and local leader role (standardized coefficient beta of 0.129; p=0.06). Conclusion: The social norms of smoking remain an important predictor of compliance with the smoke-free law, particularly in countries with strong cultural characteristics. However, its effect could be moderated using appropriate culture-sensitive strategies. [ABSTRACT FROM AUTHOR]

Background: Since 2013, City of Denpasar government has adopted a smoke-free law. Implementation of the law faces several obstacles, partly due to the high social acceptability of smoking in the city, where cigarette and smoking has been deeply engrained within social life and become part of hospitality. This study aims to assess the smoke-free law compliance and to explore the social norms that may affect the compliance. Design and Methods: The study was a mix of cross-sectional compliance survey and qualitative exploration conducted in Denpasar in 2019. Survey included 538 samples, which were selected using stratified random sampling and a walking protocol. The qualitative data was collected through in-depth interviews and Focus Group Discussion (FGD) in four sub-districts of Denpasar. Results: Of the 538 venues, 32.9% complied with the seven compliance indicators. The university has the highest compliance (83.3%), while public places including worship places have a low compliance. The three most common violations were the absence of no-smoking signage (58.6%), provision of ashtray (17.5%), and smell of tobacco smoke (15.8%). The poor compliance was related to the lack of awareness of the regulation, and the fact that smoking is highly acceptable and part of the culture. The informants highlighted the essential role of public figures and potency of local policy as social disapproval of smoking. Conclusions: Compliance to the smoke-free law in Denpasar remains low, continuous education, socialization and improved supervision are crucial. Meanwhile, social and cultural acceptance of smoking is considered as an essential factor that hampers the implementation of the smoke free law. [ABSTRACT FROM AUTHOR]

This study aims to describe the compliance to the smoke-free legislation and to identify the associated factors. A cross-sectional study was conducted to assess the compliance at all smoke-free venues. A number of 5,500 smoke-free venues were involved. The data was collected on a six monthly basis through observation and interviews. The study observed 6,670 buildings. The compliance was 11.8% in the second semester of 2013 (1st) as the baseline, which increased to 62.0% in 2015 (5th). Meanwhile, the most common violations of smoke-free legislation were found to be cigarette butts, the provision of ashtrays and smoking. Factors that were associated with compliance were awareness, knowledge and support of the legislation and the presence of internal monitoring. The compliance with Bali’s smoke-free legislation remains suboptimal, despite showing increasing trends over time. Hence, continuous education and supervision should be conducted for venue managers to increase compliance. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) increases the risk of developing pulmonary tuberculosis (TB) disease. Therefore, pulmonary TB screening among DM patients is essential. This study aimed to identify factors associated with participation of DM type II patients in pulmonary TB screening using chest X-ray. This was a cross-sectional analytic study and was part of TB-DM screening study in Denpasar, Bali, Indonesia. The sample consisted of 365 DM type II patients selected by quota sampling among DM type II patients joining the screening program from January until March 2016 in 11 public health centres in Denpasar. Data were collected via structured interviews. The contributing factors were determined by modified Poisson regression test for cross-sectional data. From the findings, less than half (45.48%) of DM type II patients participated in chest X-ray examination for TB. Factors associated with participation in pulmonary TB screening were having a higher educational level [APR = 1.34, 95% CI (1.07–1.67)], having family member who developed pulmonary TB disease [APR = 1.47, 95% CI (1.12–1.93)], the travel time to referral hospital for screening being ≤ 15 minutes [APR = 1.6, 95% CI (1.26–2.03)], having health insurance [APR = 2.69, 95% CI (1.10–6.56)], and receiving good support from health provider [APR = 1.35, 95% CI (1.06–1.70)]. Therefore, training for health provider on providing counselling, involvement of family members in screening process, and improving the health insurance coverage and referral system are worth considering. [ABSTRACT FROM AUTHOR]

Currently, the main travel health surveillance system relies on ill-returned travelers data and has been mainly designed for countries of origin in developed regions. This study aims to develop an integrated travel health surveillance and information system for destination sites in Bali. The first stage of the project included mapping and geo-tagging of health hazards and risks as well as travel health facilities, involving 197 tourist attractions in 8 regencies and 1 city in Bali. Hazard identifications were performed and risk levels were assessed using a qualitative risk assessment matrix. Health and safety hazards, risk levels, and travel health services with their geographical positions were mapped. Based on types of tourist attractions, 59 (29.9%) were beaches, 28 (14.2%) were temples, and 25 (12.7%) were waterfalls. Of the 197 tourist attractions, 107 (54.3%) were categorized as low-risk areas, 77 (39.1%) medium-risk areas, and 13 (6.6%) high-risk areas. The most common hazards included lack of proper access, risks of slips, trips, and falls, risks posed by water-based activities, mosquitoes as vectors of diseases, risks of bites or scratches from rabid animal, mixed brews containing methanol, and hyperbaric condition in diving sites. The opportunity of providing site-specific preventive measures to travelers was highlighted in this study. [ABSTRACT FROM AUTHOR]

Introduction: Indonesia faces high burden on health and socio-economic from smoking. Besides conventional cigarettes, there is an increasing use of electronic cigarettes. This study aims to explore primary health professionals’ belief and attitude toward electronic cigarettes. Methods: We conducted a cross-sectional survey in Bali, Indonesia between October, and November 2021. A 185 sample of general practitioners (GP) and dentists working at primary health care were invited through consecutive and snowballing technique. Variables collected during the study were sociodemographic and clinical practice characteristics, smoking status, intention to quit smoking and, their belief and attitude toward electronic cigarettes. Data was analyzed descriptively. Results: The average age of the primary health care providers involved in the study was 37.65 years, 60% of them were female and a GP with median length of professional works 10 years. Only 3 (1.62%) were current smokers and 6 (3.24%) were ex-smokers, while 0.54% reported using electronic cigarettes. The majority of respondents agreed in the negative impacts of electronic cigarettes, however, 11.9% of them agree that electronic cigarettes are less dangerous than conventional cigarettes, 13.4% agree it can be used as smoking cessation and 9.2% agree that it should be recommended as a substitute of smoking. Conclusion: Primary health care professionals viewed electronic cigarettes as potential risk for health but some of them have neutral and less positive attitude, therefore, it is necessary to provide adequate information based on the growing evidence of negative impacts of electronic cigarettes. [ABSTRACT FROM AUTHOR]

A smoke-free workplace is important to reduce secondhand smoke exposure, raise awareness, encourage smoking cessation, and increase productivity. This study aimed to assess indoor smoking in the workplace as part of a smoke-free policy implementation and the factors associated. This was a cross-sectional study at workplaces in Indonesia from October 2019 to January 2020. The workplaces were divided into private workplaces owned by a company for business and government workplaces that run for public services. Samples were selected using stratified random sampling. Data collection follows time and area observation guidelines, starting in the indoor area and then outdoor. The observation was conducted for at least 20 min for each workplace in 41 districts/cities. Of the 2900 observed workplaces, 1097 (37.8%) were private and 1803 (62.92%) were government workplaces. The proportion of indoor smoking at government workplaces was 34.7%, higher compared to private (14.4%). The results were consistent for each indicator such as people smoking (14.7% vs. 4.5%), electronic cigarette use (0.7% vs. 0.4%), cigarette butts presence (25.8% vs. 9.5%), and smell of cigarette smoke (23.0% vs. 8.6%). The factors associated with indoor smoking were indoor ashtray availability (adjusted odds ratio [AOR] =13.7; 95% confidence interval [CI]: 10.6-17.5), indoor designated smoking area (AOR = 2.4; 95% CI: 1.4-4.0), presence of indoor tobacco advertising, promotion and sponsorships (AOR: 3.3; 95% CI: 1.3-8.89), whereas the presence of no smoking sign was a preventive factor (AOR = 0.6; 95% CI: 0.5-0.8). Indoor smoking remains high, particularly in government workplaces in Indonesia., Competing Interests: None

Objective: To assess tobacco promotion intensity, retailer behaviours and tobacco company efforts to link retailer marketing to online channels., Methods: We completed an audit of tobacco advertisements and promotions at 1000 randomly selected cigarette retailers in Denpasar, Bali, Indonesia that included an observation checklist, digital photos and structured interviews with retailers. We then calculated the tobacco promotion index for each retailer and made comparisons based on store types. Next, we conducted a photo analysis from 100 randomly selected retailers to explore links to online channels and other promotional cues to engage young people., Results: Mini-markets have both the highest total number of promotions and the highest indoor promotion index with a mean score of 5.1 and 3.7, respectively. Kiosks have the highest outdoor promotion index with a mean score of 1.6. Most of the retailers (98.9%) displayed cigarettes, more than half of kiosk retailers (54.8%) and mini-market retailers (56.3%) admitted selling cigarettes to young people, and 74% of kiosk retailers sell single stick cigarettes. We found links to online marketing, including two hashtags and a company website. Promotional materials also included youth-focused content such as English taglines, new products and small packs., Conclusion: Tobacco companies in Indonesia have strategically differentiated their advertisements based on retailer type and have bridged conventional retailer marketing to online channels. Reforming Indonesian tobacco laws to include bans on single sticks and small pack sales, point-of-sale advertising, including displays, and enforcement of laws on sales to minors is urgently required., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)