Vape store density and proximity to schools in Denpasar, Bali, Indonesia.

OBJECTIVE: Electronic cigarettes (e-cigarettes) use among youth in Indonesia is rising, and there is no regulation surrounding sale of e-cigarettes. This study aims to map the distribution and density of vape stores and their proximity to schools and cafes as well as assess selling of e-cigarettes to youth under 18 years in Denpasar, Bali. METHODS: Using QGIS V.3.18.1 software, we conducted a geographic mapping of all vape stores followed by a survey of the retailers (n=107). Data were collected in April 2022. Several measures explored included retailers' density based on the size and population of subdistricts, retailers' proximity to school. Retailers were asked about selling to youth under 18 years, then its association with distance to schools and other variables were explored. RESULTS: We mapped 122 vape stores across Denpasar city with a density of 1.56 per km2 of the occupied land for housing, 0.16 stores per 1000 total population and 1.06 stores per 1000 youth population. More than a quarter of the schools (28.3%) and the universities (25.6%) had at least one vape store in 250 m radius, while 97.2% of the stores were within 500 m of a café. Of the 107 vape store retailers interviewed, almost half (43.9%) reported selling vapes to youth under 18 years. CONCLUSIONS: Retail availability of e-cigarettes will contribute to the increasing use of this product, especially without a minimum legal sales age. The government should urgently prohibit selling to youth, regulate e-cigarette advertising, promotion and sponsorship and prohibit e-cigarette use where conventional smoking is prohibited.

The implementation of smoke-free workplace policy and the determinants affecting indoor smoking in Indonesia.

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.

Perception of childbirth experiences of Japanese women in Bali, Indonesia: a qualitative study.

BACKGROUND: Maternal healthcare services in Indonesia have seen dramatic improvements over the past 25 years and yet there is still room for improvement. The perception, by the women, of the perinatal care provided, is a vital input to further improving these services. This study examines how the perinatal care provided is experienced by Japanese women in Bali, using an interview survey. METHODS: We conducted semi-structured interviews, from August to October 2017, with 14 Japanese women living in Badung Regency and Denpasar City in Bali Province, Indonesia to report their perception of the perinatal care they experienced during their pregnancies. The interview guide included among others, the reasons for choosing specific (perinatal care) health facilities and their satisfaction with their experience of using the antenatal, delivery, and postnatal care services. The data were analysed using the qualitative content analysis method. RESULTS: From the interview data, 12 categories across five themes were extracted. Participants reported experiencing various concerns during their pregnancies such as difficulty in obtaining perinatal care related information. From the beginning of their pregnancies, participants gradually established trusting relationships with midwives, but in many situations, they were disappointed with their childbirth experiences, as they felt that the care provided was not woman-centred. Through their own efforts and with the support of family members and other Japanese residents, many women were able to eventually regard their childbirth experiences as positive. Nevertheless, some women could not overcome their negative impressions even years after childbirth. CONCLUSIONS: Participants desired close attention and encouragement from nurses and midwives. Our results suggest that Japanese women in Bali expected a woman-centred perinatal care and active support from nursing/midwifery staff during their pregnancies and postnatal care.

Geo-mapping of hazards, risks, and travel health services in Bali: Results from the first stage of the integrated travel health surveillance and information system at destination (TravHeSID) project.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The opportunity of providing site-specific preventive measures to travelers was highlighted in this study.

The Implementation of Early Detection in Tuberculosis Contact Investigation to Improve Case Finding.

The early detection of Tuberculosis (TB) among TB contacts is a strategy to find TB cases in earlier stage and to stop the transmission. This study aimed to assess the implementation of early detection in TB contact investigation to improve TB case finding. This was an operational research study conducted in Badung District, Bali, Indonesia. The samples were TB contacts, identified in the period July through September (third quarter) 2017. Contacts were household members who were living and sharing a room at least for 3 months with infectious TB patients and were not previously diagnosed with TB. Data were collected through face-to-face interview using structured questionnaires and registration reviews using a checklist. We visited 124 TB patients and successfully identified 498 contacts, thus the ratio of contacts to cases is 4:1. All TB contacts were invited to participate in TB screening and evaluation program. A total of 100 (20.1%) contacts have attended at least one examination session and 41 contacts have completed all sessions. Ten TB cases were found among the contacts, of which four of them were adults (three bacteriologically confirmed and one clinically confirmed) and six were children (aged under 15 years). The positivity rate among children was higher (46.2%) compared with adults (14.3%). The positivity rate of confirmed TB among contacts with any TB symptoms was 43.8% and that without symptoms was 12.0%. The contribution of early detection in TB contact investigation to improve TB case finding was 8.1% through all TB patients. The early detection in TB contact investigation yielded additional notified cases, especially among children. A comprehensive education, covering cognitive and psychological aspect, is needed to encourage TB contacts to completely participate in early detection program until their diagnosis is confirmed.

From glass boxes to social media engagement: an audit of tobacco retail marketing in Indonesia.

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.

Factors Associated with Participation in Pulmonary Tuberculosis Screening Using Chest X-Ray among Diabetes Mellitus Type II Patients in Denpasar, Bali, Indonesia.

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.