Impact of district-level comprehensive tobacco control on smoking among adolescent boys in Indonesia: a synthetic control study (2013-2023).
other · Level III
Where this comes from
- Record sourced from PubMed, PMID 42325998.
- Also identified by DOI 10.1016/j.lansea.2026.100798 and PMC identifier 13276449.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Indonesia has one of the highest smoking prevalences globally, particularly among boys and men, yet national tobacco control implementation remains limited. We aimed to evaluate the impact of comprehensive district-level tobacco control measures on smoking prevalence among male adolescents in a decentralized policy environment. We applied a quasi-experimental synthetic control approach using panel data from 497 Indonesian districts between 2013 and 2023. Bogor City, which intensified local tobacco control measures from 2014 onward, served as the treated unit. Smoking prevalence data were drawn from nationally representative Riskesdas surveys (2013, 2018, 2023). Pre-intervention covariates measured in 2013-including socioeconomic, educational, and health service indicators-were used to construct synthetic controls. Robustness was assessed through sensitivity analyses and placebo tests. The primary outcomes were ever and current smoking among male adolescents; adult men were examined as a secondary outcome. Compared to synthetic controls, Bogor City experienced reductions in smoking prevalence among male adolescents: a 14.7 percentage point reduction in current smoking (43.4% relative reduction) and a 12.3 percentage point reduction in ever smoking (34.5% relative reduction). These gaps widened over time, suggesting sustained policy impact. Among adult men, the effect was more modest: ever smoking declined by 3.2 percentage points (3.9% relative reduction), whereas current smoking prevalence remained 11.3 percentage points higher than the synthetic control (19.5% relative difference), consistent with limited responsiveness among established smokers. District-level comprehensive tobacco control was associated with reductions in smoking among male adolescents in Indonesia, despite weak national enforcement. These findings underscore the potential of subnational action in preventing youth smoking and support the need for complementary national measures to strengthen tobacco control. Khalifa University of Science and Technology.