Tobacco advertising, promotion, sponsorship and youth smoking behavior: The Indonesian 2019 Global Youth Tobacco Survey (GYTS).

INTRODUCTION: Tobacco advertisement, promotion, and sponsorship (TAPS) in all forms influences youth smoking behaviors. TAPS exposure enhances their smoking frequency and vulnerability. A 2018 Indonesia Ministry of Health (MoH) Survey showed increased smoking prevalence among youth aged 10-18 years. Thus, our objective was to analyze the relationship between TAPS and the increased Indonesian youth smoking behavior. METHODS: We conducted a secondary analysis of the Indonesian 2019 Global Youth Tobacco Survey. The sample size differed in each variable: current smokers n=3386, ever smoker n=3666, and cigarette consumption per day n=1355. We adjusted for socioeconomic and demographic variables and used logistic regression with youth smoking prevalence as the outcome and TAPS variables as the primary exposures. RESULTS: The current male youth smoker prevalence was 38.3%, ever smoker was 67%, and high consumption per day smoker (≥2 cigarettes per day) was 39.1%. Youth respondents exposed to the promotion or sponsorship of cigarette products showed an increase in three smoking behaviors. In particular, when youth respondents were exposed to more than one type of cigarette promotion (AOR=1.67, 95% CI: 1.33-2.09) or noticed one type of cigarette sponsorship (AOR=2.06, 95% CI: 1.44-2.93), their odds of all three smoking behaviors (current smoker, ever smoker, and high consumption smoker) increased. CONCLUSIONS: TAPS increase smoking behaviors among Indonesian youth. Therefore, to protect Indonesian youth health in the future, strategic action is needed to reduce youth smoking by banning all forms of TAPS in Indonesia.

The influence of anti-smoking messages to Indonesian youth smoking behavior: the Indonesian 2019 Global Youth Tobacco Survey (GYTS).

INTRODUCTION: Various anti-tobacco promotions have emerged in order to reduce the detrimental impacts of tobacco advertising on adolescents. The objective of this study is to explore the relationship between the exposure to anti-smoking messages and Indonesian youth smoking behavior. METHOD: We used secondary data from the Indonesian 2019 Global Youth Tobacco Survey (GYTS). The participants were students from grades seven to twelve. We used multiple logistic regression to assess the relationship of anti-smoking messages exposure on the smoking behavior variable. We used complex samples process logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and controlling for relevant covariables. RESULTS: The percentage of the exposure to anti-smoking messages in all types were not more than 25% in each outcome variables. The results also showed that in the current smoker variables, adolescent who exposed to the two variables of anti-smoking messages increased the odds to become current smoker. The variables were anti smoking messages in media (AOR 1.41; 95% CI 1.15-1.73) and in school (AOR 1.26; 95% CI 1.06-1.50). On the other hand, in the smoking susceptibility variables, there were no variables of anti-smoking messages that had relation with it. CONCLUSIONS: The study concluded that there were only two variables of the anti-smoking messages that had relation with the Indonesian youth smoking behavior, which were current smokers. Unfortunately those variables increased the odds of the respondents to become current smokers. Indonesia government should develop media following international best practices to convey the anti-smoking messages.

Policy to expand hospital utilization in disadvantaged areas in Indonesia: who should be the target?

BACKGROUND: The disadvantaged areas are one of the government's focuses in accelerating development in Indonesia, including the health sector. The study aims to determine the target for expanding hospital utilization in disadvantaged areas in Indonesia. METHODS: The study employed the 2018 Indonesian Basic Health Survey data. This cross-sectional study analyzed 42,644 respondents. The study used nine independent variables: residence, age, gender, marital, education, employment, wealth, insurance, and travel time, in addition to hospital utilization, as a dependent variable. The study employed binary logistic regression to evaluate the data. RESULTS: The results found that average hospital utilization in disadvantaged areas in Indonesia in 2018 was 3.7%. Urban areas are 1.045 times more likely than rural areas to utilize the hospital (95% CI 1.032-1.058). The study also found age has a relationship with hospital utilization. Females are 1.656 times more likely than males to use the hospital (95% CI 1.639-1.673). Moreover, the study found marital status has a relationship with hospital utilization. The higher the education level, the higher the hospital utilization. Employed individuals have a 0.748 possibility to use the hospital compared with those unemployed (95% CI 0.740-0.757). Wealthy individuals have more chances of using the hospital than poor individuals. Individuals with all insurance types are more likely to utilize the hospital than those uninsured. Individuals with travel times of ≤ 1 h are 2.510 more likely to use the hospital than those with > 1 h (95% CI 2.483-2.537). CONCLUSION: The specific targets to accelerate the increase in hospital utilization in disadvantaged areas in Indonesia are living in a rural area, being male, never in a union, having no education, being employed, being the poorest, uninsured, and having a travel time of > 1 h. The government should make a policy addressing the problem based on the research findings.

Geographic and Socioeconomic Inequalities in Delays in COVID-19 Vaccinations: A Cross-Sectional Study in Indonesia.

BACKGROUND: Previous studies have provided evidence of inequalities in the coverage of COVID-19 vaccination. However, evidence of such inequalities in delays in vaccinations is lacking. Our study examined the socioeconomic and geographic disparities in terms of days to get the first and second dose of COVID-19 vaccinations in Indonesia. METHODS: We conducted a cross-sectional study using the WhatsApp messaging app and social media platforms during December 2021-February 2022. We distributed the questionnaire through our university network to reach all regions. We included 3592 adults aged 15+ years in our analysis. We used two main dependent variables: days to receive the first dose (after national vaccine rollout) and days to receive the second dose (after receiving the first dose). We examined a range of socioeconomic and geographic indicators, including education level, income level, formal employment, working in health facilities, being a health worker, and region. We controlled for sex, age, religion, and urbanicity. We performed multivariate logistic regressions in STATA 15. RESULTS: Our findings show considerable delays in getting the first dose among participants (160.7 days or about 5.4 months on average) from Indonesia's national COVID-19 vaccination rollout on 13 January 2021. However, we found a shorter period to receive the second dose after receiving the first dose (41.1 days on average). Moreover, we found significant socioeconomic (i.e., education, income, formal employment, working in health facilities, and being a health worker) and geographic (i.e., in and out of the Java region) inequalities in terms of delays in getting the first dose. However, we did not find significant inequalities in getting the second dose for most inequality indicators, except for working in health facilities. By region, we found that participants living in more deprived areas (out of the Java region) received the second dose 4.9 days earlier. One of the study's key limitations is that there may be an inherent bias with respect to socioeconomics factors since it was conducted online (web-based). CONCLUSIONS: While there were considerable delays in getting the first dose, especially among those of a lower socioeconomic status and those in more deprived areas, the waiting time for the second dose was relatively similar for everyone once they were in the system. Effective efforts to address inequalities are essential to ensuring the effectiveness of the national COVID-19 vaccination rollout.

Barriers for multiparous women to using long-term contraceptive methods in Southeast Asia: case study in Philippines and Indonesia.

BACKGROUND: Multiparous women are supposed to be able to end their reproductive cycle to decrease population growth. This study aimed to analyze barriers for multiparous women to use long-term contraceptive methods (LTCM) in the Philippines and Indonesia. METHODS: The study population was women aged 15-49 years old who have given birth to a live baby > 1 in the Philippines and Indonesia. The weighted sample size was 12,085 Philippines women and 25,543 Indonesian women. To identify variables associated with the use of LTCM, we analyzed place of residence, age group, education level, marital status, employment status, and wealth status. The final step employed multinomial logistic regression. RESULTS: In both countries, the results showed that variables associated with non-user LTCM were younger women, living in rural areas with poor education. Women without partner and unemployed had higher probability to not use LTCM. Finally, low wealth status had a higher probability than the richest multiparous to not use LTCM. CONCLUSION: The study concluded that there were six barriers for multiparous women to use LTCM in the Philippines and Indonesia. The six obstacles were living in rural areas, being younger, poor education, single, unemployed, and low wealth.

Self-efficacy in physical activity and glycemic control among older adults with diabetes in Jagir Subdistrict, Surabaya, Indonesia.

Diabetes in older adults has shown an increase in prevalence, especially in urban areas of Indonesia. This study aimed to assess the relationship between self-efficacy in physical activity and glycemic control in older adults' population with diabetes mellitus in Indonesia. This research used cross sectional design that involved 52 adults with diabetes, aged between 55-90 years old who regularly attended the older adult's health post (Posyandu Lansia) at Jagir Sub-district, Surabaya. Those who had physical disabilities were excluded from the study. Questionnaires were used to measure the physical activity and two types of self-efficacy whilst the glycemic control was measured using HbA1c in basal condition. The relationship between the variables was tested using Pearson and partial correlation test. Results show that the level of physical activity was insufficient (216.4 ± 343.5 MET) with only 32.7% (N = 17) of the participants was categorized as being physically active. The mean of the HbA1c indicated poor glycaemic control (8.63 ± 2.34%) with majority of them (76.9%, N = 40) was in the poor glycaemic control group (HbA1c ≥ 6.5%). Their self-efficacy was at the average level (Against the barriers:52.65 ± 13.23; Engage in physical activity: 59.06 ± 26.2). The self-efficacy in performing the physical activity was found significantly related to the duration of physical activity (r = 0.278, p = 0.046). Other relationships, however, were not significant (p > 0.05). In conclusion, self-efficacy to engage in physical activity is paramount to increase the physical activity among the older adults. Nevertheless, further longitudinal research on self-efficacy in physical activity management is needed.

The community psychosocial burden during the COVID-19 pandemic in Indonesia.

BACKGROUND: Restricting community mobility during COVID-19 can potentially trigger anxiety, depression and stress in the community. The study aims to analyze variables associated with the community psychosocial burden (anxiety level) during the co-19 pandemic in Indonesia. METHODS: This study collected data (n = 8,031) online. Psychosocial burden was measured based on the anxiety level which include 5 aspects, such as economic, religious, educational, employment, and social issues. Each question used a Likert scale. Six independent were examined, such as age, gender, religion, marital, education, and employement. In the final stage, a multivariate test was performed using a multinomial logistic regression. RESULTS: Someone older experienced less high anxiety. The age group of 20-29 years was 4,330 times likely to experience higher anxiety than the age group of ≥50 years. While, those in the age group of 40-49 years weer 2,322 times more likely to have higher anxiety than those in the age group of ≥50 years. Male respondents had lower possibility of medium to high anxiety than females. Respondents with secondary and lower education had 3,117 times possibilities to experience higher anxiety than those with high education level. CONCLUSION: Four variables affected the psychosocial burden i.e, anxiety level of community in Indonesia. These involved age, gender, education, and employement.

Ownership of mother and children's health book and complete basic immunization status in slums and poor population.

Background: The percentage of complete immunization in urban areas is higher than rural areas. The purpose of the study was to analyze the relationship between ownership of Maternal and Child Health (MCH) books with Complete Basic Immunization (CBI) coverage in slums and poor areas. Design and Methods: A rapid survey was conducted in selected slums and poor groups based on medical records from Public Health Center. Informants were mothers with a sample of 325 infants aged 12 to 23 months. Results: The lowest coverage of CBI for slum and poor residents is Pasuruan, which is 55.4%. The results of statistical analysis showed that there was a significant relationship between ownership of MCH books and the complete coverage of basic immunization in Malang (P = 0.000; PR = 3.682); Pasuruan (P = 0.002; PR = 1.854); Sidoarjo (P = 0.000; PR = 4.042); Surabaya (P = 0.000; PR = 2.425). Conclusions: It is recommended that the government should improve access to complete immunization programs in slums and poor population.

The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study.

This study sought to assess the effectiveness of religious cigarette health warning labels (HWLs) in Indonesia, a country with a high public health burden from tobacco use. The study tested different religious and nonreligious messages related to suicide, secondhand smoke (SHS) and gangrene. Participants were smokers and non-smokers from Surabaya, Indonesia (n = 817). Participants rated each HWL for its effectiveness on a scale of 1 to 10 (1 = "not at all", 10 = "extremely") with respect to 10 items. Nonreligious HWLs were marginally superior for SHS and suicide while religious HWLs were marginally superior for gangrene. Given the close rating scores between religious and nonreligious HWLs, they were functionally equal in effectiveness. With proper assessment of potential unintended consequences, the implementation of religious HWLs could be considered for a proportion of HWLs.

Self-efficacy to Engage in Physical Activity and Overcome Barriers, Sedentary Behavior, and Their Relation to Body Mass Index Among Elderly Indonesians With Diabetes.

OBJECTIVES: Elderly individuals with diabetes should maintain a normal body mass index (BMI) to help control their blood glucose levels. This study investigated barriers to physical activity (PA), self-efficacy to overcome those barriers, and PA self-efficacy among elderly individuals with diabetes in relation to BMI. METHODS: This cross-sectional study included 56 participants. Data were collected by a questionnaire interview and direct measurements for anthropometric data. PA self-efficacy was measured using 8 questions describing different levels of PA, where participants rated the strength of their belief that they could engage in that activity. Self-efficacy to overcome barriers was measured using 10 questions capturing participants' confidence in their ability to engage in PA despite different possible barriers. Mean scores for these parameters were analyzed using the chi-square test and the independent t-test. RESULTS: In total, 89.3% of participants had a low PA level and 58.9% had more than 3 hours of sedentary activity per day. Furthermore, 55.4% were obese and 14.3% were overweight. The mean scores for PA self-efficacy and self-efficacy to overcome barriers were 59.1± 26.4 and 52.5±13.8, respectively. PA level was related to BMI (p<0.001; r=0.116) and sedentary activity (p<0.05; r=0.274). PA self-efficacy and age were not related to BMI. Barriers to PA were associated with PA levels (p<0.05). CONCLUSIONS: Physical inactivity was a major problem in elderly individuals with diabetes, and was correlated with higher BMI. Lower levels of PA might be mediated by sedentary activity.

Visibility and hotspots of outdoor tobacco advertisement around educational facilities without an advertising ban: Geospatial analysis in Surabaya City, Indonesia.

INTRODUCTION: Despite having over 60 million smokers in 2018, Indonesia still lacks tobacco control measures, including an outdoor tobacco advertising ban. This study aimed to provide evidence on the visibility and hotspots of advertisements around educational facilities in a city without a ban. METHODS: We collected data on the locations of outdoor tobacco advertisements and schools and universities in Surabaya city. We conducted buffer and hotspots analyses using ArcMap. Using Getis-Ord Gi* statistics, hotspot analysis identifies significant clusters with a high number of advertisements. RESULTS: We found 307 large and medium-sized outdoor tobacco advertisements and 1287 educational facilities (1199 schools, 88 universities). Almost 80% of those advertisements (237 units) were just 300 m away (10-minute walk) from primary schools and high schools in the city. More than half of all schools (652) and two-thirds of all universities (59) were inside hotspots where there were statistically significant clusters with a high number of advertisements. These hotspots were more densely populated and more-deprived areas. CONCLUSIONS: There was high visibility of large and medium-sized outdoor tobacco advertisements around educational facilities in the city without the ban.

The Effectiveness of Nutrition Education for Overweight/Obese Mother with Stunted Children (NEO-MOM) in Reducing the Double Burden of Malnutrition.

(1) Background: In households experiencing the double burden of malnutrition, stunted children are in a better position for growth improvement when parents are able to direct their resources to support nutrition requirements. This study assesses the effectiveness of maternal nutrition education to reduce child stunting. (2) Methods: This was a Randomized Controlled Trial involving pairs of overweight/obese mothers with stunted children aged 2 to 5 years old in urban Indonesia. Methods: Seventy-one mother-child pairs were randomly assigned to receive either a 12-week nutrition education or printed educational materials. Mixed factorial ANOVA was used to test for between-group differences over time in relation to child's height, weight, maternal self-efficacy, outcome expectation, and caloric intake. (3) Results: Across groups, there was a significant effect of time on child height and weight but no significant differences were observed between-groups. Maternal self-efficacy, outcome expectations in providing animal protein for the children (p-value = 0.025) and mother's total caloric intake (p-value = 0.017) favored the intervention group over the comparison group. (4) Conclusions: The behavioral intervention produced strong improvement in maternal self-efficacy to engage in physical activity, eat fruits and vegetables and to provide children with growth-promoting animal protein, but did not significantly influence child height gain.

Household Food Insecurity as a Predictor of Stunted Children and Overweight/Obese Mothers (SCOWT) in Urban Indonesia.

(1) Background: The double burden of malnutrition has been increasing in countries experiencing the nutrition transition. This study aimed to determine the relationship between household food insecurity and the double burden of malnutrition, defined as within-household stunted child and an overweight/obese mother (SCOWT). (2) Methods: A cross-sectional survey was conducted in the urban city of Surabaya, Indonesia in April and May 2015. (3) Results: The prevalence of child stunting in urban Surabaya was 36.4%, maternal overweight/obesity was 70.2%, and SCOWT was 24.7%. Although many households were food secure (42%), there were high proportions of mild (22.9%), moderate (15.3%) and severe (19.7%) food insecurity. In a multivariate logistic regression, the household food insecurity access scale (HFIAS) category significantly correlated with child stunting and SCOWT. Compared to food secure households, mildly food insecure households had the greatest odds of SCOWT (adjusted odds ratio (aOR) = 2.789; 95% confidence interval (CI) = 1.540⁻5.083), followed by moderately food insecure (aOR = 2.530; 95% CI = 1.286⁻4.980) and severely food insecure households (aOR = 2.045; 95% CI = 1.087⁻3.848). (4) Conclusions: These results support the hypothesis that the double burden of malnutrition is related to food insecurity, and the HFIAS category is a predictor of SCOWT.

The effectiveness of nutrition education for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition in Indonesia: study protocol for a randomized controlled trial.

BACKGROUND: Nutrition transition in developing countries were induced by rapid changes in food patterns and nutrient intake when populations adopt modern lifestyles during economic and social development, urbanization and acculturation. Consequently, these countries suffer from the double burden of malnutrition, consisting of unresolved undernutrition and the rise of overweight/obesity. The prevalence of the double burden of malnutrition tends to be highest for moderate levels (third quintile) of socioeconomic status. Evidence suggests that modifiable factors such as intra-household food distribution and dietary diversity are associated with the double burden of malnutrition, given household food security. This article describes the study protocol of a behaviorally based nutrition education intervention for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition. METHODS: NEO-MOM is a randomized controlled trial with a three-month behavioral intervention for households involving pairs of 72 stunted children aged 2-5 years old and overweight/obese mothers (SCOWT) in urban Indonesia. The SCOWT pairs were randomly assigned to either an intervention group or to a comparison group that received usual care plus printed educational materials. The intervention consisted of six classroom sessions on nutrition education and home visits performed by trained community health workers using a motivational interviewing approach. The primary outcomes of this study are the prevalence of double burden of malnutrition as measured in SCOWT, child's height-for-age z-score (HAZ) and maternal body mass index (BMI). DISCUSSION: Because previous studies are mainly observational in nature, this study advances understanding of the double burden of malnutrition through a fully powered randomized controlled trial. The intervention assists participants in self-administered goal setting to improve diet and child feeding behaviors by improving self-efficacy. Maternal self-efficacy may be enhanced through vicarious and active mastery of experiences gained during six sessions of nutrition education and verbal persuasion during home visits. TRIAL REGISTRATION: The Universal Trial Number (UTN) for this study is U1111-1175-5834. This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) and is allocated the registration number: ACTRN12615001243505 on 12 November 2015.