Reading culture from tobacco advertisements in Indonesia.

BACKGROUND: Tobacco advertising in Indonesia is among the most aggressive and innovative in the world, and tobacco advertisements saturate the environment. Tobacco companies are politically and financially powerful in the country because they are one of the largest sources of government revenue. As a result, there are few restrictions on tobacco marketing and advertising. National surveys reveal that 62% of men and 1% to 3% of women are smokers. Over 90% of smokers smoke clove cigarettes (kretek). This paper examines the social and cultural reasons for smoking in Indonesia and discusses how the tobacco industry reads, reproduces and works with culture as a means of selling cigarettes. An analysis is provided of how kretek tobacco companies represent themselves as supporters of Indonesian national identity. This analysis is used to identify strategies to break the chains of positive association that currently support widespread smoking. METHODS: Between November 2001 and March 2007, tobacco advertisements were collected from a variety of sources, including newspapers and magazines. Frequent photographic documentation was made of adverts on billboards and in magazines. Advertisements were segmented into thematic units to facilitate analysis. In all, 30 interviews were conducted with smokers to explore benefits and risks of smoking, perceptions of advertisements and brand preferences. Focus groups (n = 12) were conducted to explore and pretest counter advertisements. RESULTS: Key themes were identified in tobacco advertisements including control of emotions, smoking to enhance masculinity and smoking as a means to uphold traditional values while simultaneously emphasising modernity and globalisation. Some kretek advertisements are comprised of indirect commentaries inviting the viewer to reflect on the political situation and one's position in society. CONCLUSIONS: After identifying key cultural themes in cigarette advertisements, our research group is attempting to engage the tobacco industry on "cultural ground" to reduce consumption and social acceptability. To do this, we need to take back social spaces that the tobacco industry has laid claim to through advertising. Active monitoring and surveillance of tobacco advertising strategies is necessary and legislation and enforcement to curb the industry should be put in place.

Serum retinol levels among preschool children in Central Java: demographic and socioeconomic determinants.

BACKGROUND: Vitamin A deficiency is a significant problem in many countries in the developing world. Reports have noted demographic and socioeconomic risk factors for vitamin A deficiency. 'Deficiency' has usually been defined by clinical signs and symptoms which represent only a small proportion of those children at increased risk for vitamin A preventable morbidity and mortality. METHODS: As part of a population-based trial of vitamin A to prevent childhood morbidity, we collected census data (n = 666), baseline socioeconomic data (n = 636) and sera (n = 666) from children aged 6-48 months in 25 adjacent villages in a rural area in Central Java, Indonesia; there was more than 95% participation. We used t tests, ANOVA, and a multiple variable linear regression model in our analyses. RESULTS: Differences in mean retinol level were detected for the following variables: village (P < 0.001), child's age (P = 0.03), size of sibship (P < 0.001), mother's occupation (P < 0.01), mother's education (P = 0.05), father's education (P = 0.03), monthly household earnings (P = 0.02), land ownership (P = 0.03), possession of ducks (P = 0.06), radio or tape player (P = 0.02), or a watch or clock (P = 0.07), and presence of a natural well (P = 0.09). Our regression model verified the predictive value of village, age, sibship, land ownership and earnings. CONCLUSIONS: We found that owning land and that the highest and lowest categories of reported household income were associated with higher serum retinol levels. We also noted clustering of serum retinol levels by village and discovered that children from larger sibships and infants had significantly lower serum retinol levels. Vitamin A supplementation of lactating mothers, particularly of high parity, and/or their infants should be considered.

PIP: Vitamin A deficiency is a significant problem in many countries in the developing world. Reports have noted demographic and socioeconomic risk factors for vitamin A deficiency. As part of a population-based trial of vitamin A to prevent childhood morbidity, census data (n = 666), baseline socioeconomic data (n = 636) and sera (n = 666) were collected from children 6-48 months old in 25 adjacent villages in a rural area in Central Java, Indonesia. Participation amounted to more than 95%. The analyses used t tests, ANOVA, and a multiple variable linear regression model. The distribution of serum retinol levels (in mcmol/l) in males shifted to the left relative to females, resulting in a higher proportion of males with a level 0.70 mcmol/l (20 mcg/dl); 216/346 males versus 173/320 females (p = 0.03). However, there was no significant difference in the means by gender. Differences in mean retinol level were detected for the following variables: village (p 0.001); child's age (p = 0.03); size of sibship (p 0.001); mother's occupation (p 0.01); mother's education (p = 0.05); father's education (p = 0.03); monthly household earnings (p = 0.02); land ownership (p = 0.03); possession of ducks (p = 0.06), radio or tape player (p = 0.02), or a watch or clock (p = 0.07); and presence of a natural well (p = 0.09). There was no significant difference in mean serum retinol level for mother's marital status; father's occupation; monthly household expenditures; house ownership; composition of floors, walls, or roofs; or possession of buffaloes, cattle, goats, kerosene light fixtures, televisions, or motorcycles. The regression model verified the predictive value of village, age, sibship, land ownership, and earnings. Owning land and the highest and lowest categories of reported household income were associated with higher serum retinol levels. Also clustering of serum retinol levels was noted by village, and children from larger sibships and infants had significantly lower serum retinol levels. Vitamin A supplementation of lactating mothers, particularly of high parity, and/or their infants should be considered.