Establishing a community-based smoke-free homes movement in Indonesia
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Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Center for Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
School of Anthropology, University of Arizona, Tucson, Arizona, United States
Mimi Nichter   

School of Anthropology, University of Arizona, Emil Haury Building, 85721 Tucson, Arizona, United States
Publish date: 2018-11-14
Submission date: 2018-02-25
Final revision date: 2018-10-22
Acceptance date: 2018-11-01
Tob. Prev. Cessation 2018;4(November):36
Indonesia has one of the highest male smoking rates in the world (67%) and secondhand smoke (SHS) exposure occurs in over 70% of households. To date, little research has investigated community recognition of the harms of secondhand smoke and support for a smoke-free homes (SFH) policy. This work discusses the development and implementation of a community-based SFH intervention attempting to establish SFH as a new social norm.

Research was conducted in Yogyakarta, Java. A proof-of-concept study ascertained the feasibility of mounting a community-based SFH initiative in urban neighborhoods. Educational materials on SHS were developed and pretested. An intervention was piloted and evaluated in the homes of 296 smokers residing in 4 communities. Health educators and community health volunteers were trained to implement SFH.

Prior to the intervention, 11% of smokers did not smoke inside their home; post-intervention 54% of smokers did not smoke inside their home. The Yogyakarta District Health Office has supported large scale implementation of smoke-free homes. To date, 135 urban communities have declared themselves as having SFH.

This is the first community-based SFH initiative to be carried out in South-East Asia. The SFH movement redefines smoking cessation as a health issue of women and children, ties family welfare to core cultural values, and offers women a leadership role in tobacco control. The sustainability of SFH in Yogyakarta has been achieved by working closely with multiple levels of government and has contributed to shifts in tobacco control policy in Indonesia.

Eriksen M, Mackay J, Ross H. The tobacco atlas. Atlanta, GA: American Cancer Society. New York: World Lung Foundation; 2014.
World Health Organization. Global adult tobacco survey: Indonesia report 2011. New Delhi: World Health Organization Regional Office for South East Asia; 2012.
Center for Data and Information Ministry of Health. Smoking behavior in Indonesian communities. Published May, 2015. Accessed February 23, 2018.
Nichter M, Padmawati RS, Danardono M, Ng N, Prabandari Y, Nichter M. Reading culture from tobacco advertisements in Indonesia. Tobacco Control. 2009;1(April):18(2):98-107. doi: 10.1136/tc.2008.025809
Rosser A. Contesting tobacco-control policy in Indonesia. Critical Asian Studies. 2015. 47(1). pp. 69-93(25). doi: 10.1080/14672715.2015.997083
Prabandari YS, Nichter M, Nichter M, Padmawati RS, Muramoto M. Laying the groundwork for tobacco cessation education in medical colleges in Indonesia. Education for Health. 2015;1(September):28(3):169. doi: 10.4103/1357-6283.178602
World Health Organization. Report on global tobacco epidemiology 2017: Monitoring tobacco use and prevention policies. Geneva: World Health Organization; 2017.
Bloch M, Althabe F, Onyamboko M, Kaseba-Sata C, Castilla EE, Freire S, et al. Tobacco use and secondhand smoke exposure during pregnancy: An investigative survey of women in 9 developing nations. American J. Public Health. 2008;9(October):1833-40. doi: 10.2105/AJPH.2007.117887
Wipfli HL, Samet JM. Second-hand smoke's worldwide disease toll. The Lancet. 2010;26 (November):377(9760):101-2. doi: 10.1016/S0140- 6736(10)61922-8.
Baxter S, Blank L, Everson-Hock ES, et al. The effectiveness of interventions to establish smoke-free homes in pregnancy and in the neonatal period: A systematic review. Health Ed. Research. 2011;26(January):265-82. doi: 10.1093/her/cyq092
Alwan N, Siddiqi K, Thomson H, Lane J, Cameron I. Can a community-based ‘smoke-free homes’ intervention persuade families to apply smoking restrictions at homes?. J of Public Health. 2010;7(October):33:48-54. doi: 10.1093/pubmed/fdq073
Mills AL, Messer K, Gilpin EA, Pierce JP. The effect of smoke-free homes on adult smoking behavior: A review. Nicotine & Tobacco Research. 2009;24(July):11(10):1131-1141. doi: 10.1093/ntr/ntp122
Hyland A, Higbee C, Travers MJ, et al. Smoke-free homes and smoking cessation and relapse in a longitudinal population of adults. Nicotine & Tobacco Research. 2009;3(April):11(6):614-618. doi: 10.1093/ntr/ntp022
Karasek D, Ahern J, Galea S. Social norms, collective efficacy, and smoking cessation in urban neighborhoods. American J. Public Health. 2012;102:343-351. doi:10.2105/AJPH.2011.300364
Blue S, Shove E, Carmona C, Kelly, MP. Theories of practice and public health: Understanding (un)healthy practices. Crit Pub Health. 2016:26 (1):36-50. doi: 10.1080/09581596.2014.980396
Bandura A. Exercise of human agency through collective efficacy. Current Directions Psychological Science. 2000;9(3):75-78. doi:10.1111/1467-8721.00064
Kaufman MR, Merritt AP, Rimbatmaja R, Cohen JE. ‘Excuse me, sir. Please don’t smoke here’. A qualitative study of social enforcement of smoke-free policies in Indonesia. Health Policy and Planning. 2015;22(September):30(8):995-1002. doi: 10.1093/heapol/czu103
Nichter M, Nichter M, Padmawati RS, Ng N. Developing a smoke free household initiative: An Indonesian case study. Acta Obstetricia et Gynecologica Scandinavica. 2010;(April):89(4):578-81. doi: 10.3109/00016340903578893
Nichter M, Nichter M, Muramoto M, Project Quit Tobacco International. Project quit tobacco international: Laying the groundwork for tobacco cessation in low-and middle-income countries. Asia Pac. J. Public Health. 2010;(July):22,3 181S-8S. doi: 10.1177/1010539510373023
Project Quit Tobacco International. http://www.quittobaccointernat.... Published February 2018. Accessed February 21, 2018.
Guinness P. Kampung, Islam and state in urban Java. Singapore: NUS Press National University of Singapore; 2009.
Newberry J. Rituals of rule in the administered community: The Javanese slametan reconsidered. Modern Asian Studies. 2007;(November):41(6):1295-329. doi: 10.1017/S0026749X06002575
Jankowiak WR, Bradburd D, eds. Drugs, labor, and colonial expansion. University of Arizona Press; 2003.
Heywood P., Choi Y. Health System Performance at the District Level in Indonesia after Decentralization. BMC International Health and Human Rights. 2010:10(3):1–12. doi:10.1186/1472-698X-10-3
Aspinall E. Health Care and Democratization in Indonesia. Democratization. 2014: 21(5):803-823. doi:10.1080/13510347.2013.873791
Ningsih FG, Jonyanis S. Clean and Health Living Behaviors in Gunung Kesiangan community. JOM FISIP. 2014;1(2):1-5.
Amos A, Greaves L, Nichter M, Bloch M. Women and tobacco: A call for including gender in tobacco control research, policy and practice. Tobacco Control. 2011;21(2):236-243. doi: 10.1136/tobaccocontrol-2011-050280