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.

Smoking behavior among former tuberculosis patients in Indonesia: intervention is needed.

SETTING: Five lung clinics in Jogjakarta Province, Indonesia. OBJECTIVE: To document smoking patterns among tuberculosis (TB) patients before diagnosis and following treatment, to identify smoking-related messages given by health professionals and DOTS providers and to identify predictors of smoking relapse. DESIGN: A cross-sectional survey of 239 male TB patients completed DOTS-based treatment during 2005-2006. Subjects were interviewed at home using a semi-structured questionnaire. Female patients were excluded, as very few smoke. RESULTS: Most TB patients quit smoking when under treatment, but over one third relapsed at 6 months post-treatment. About 30% were never asked about their smoking behavior or advised about quitting. Of relapsed smokers, 60% received only general health messages and not TB-specific smoking messages. DOTS providers are not currently involved in cessation activities. The perception that any level of smoking is harmless for ex-TB patients was a significant predictor for smoking relapse. CONCLUSION: Physicians and DOTS providers should be actively involved in smoking cessation activities among TB and ex-TB patients. Based on these data, the Quit Tobacco Indonesia Project is mounting a pilot intervention to train DOTS providers, who are mostly family members of patients, to deliver smoking cessation messages and reinforce the cessation advice provided by physicians during and following TB treatment.