Cigarette retailer density around schools and neighbourhoods in Bali, Indonesia: A GIS mapping
Putu A. S. Astuti 1, 2, 3  
Ketut H. Mulyawan 1, 3
More details
Hide details
Department of Public Health and Preventive Medicine, Universitas Udayana, Denpasar, Indonesia
The University of Sydney School of Public Health, Sydney, Australia
Udayana Center for NCDs, Tobacco Control and Lung Health (Central), Universitas Udayana, Denpasar, Indonesia
Department of Biostatistics and Population Studies, Universitas Airlangga, Banyuwangi, Indonesia
Prevention Research Collaboration (PRC), Charles Perkins Centre, The University of Sydney, Sydney, Australia
Putu A. S. Astuti   

Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Jl. PB. Sudirman, Denpasar, Bali 80232, Indonesia
Publish date: 2019-07-05
Tob. Induc. Dis. 2019;17(July):55
The presence and density of tobacco retailers is associated with the perception of high availability of cigarettes and ease of purchase. Indonesia is the second largest cigarette market in the world with an increasing smoking rate among young people aged 10–18 years. Our study aims to assess density of cigarette outlets in neighbourhoods and around schools, and to evaluate correlation between retailer proximity to schools and retailer selling practices.

We conducted a geographical mapping and then an audit survey of 1000 randomly selected cigarette retailers in Denpasar, Bali, Indonesia. We measured neighbourhood retailer density, and retailer proximity to schools. We linked the coordinate data to the audit data to assess the association between retailer distance from schools with likelihood of selling tobacco to young people and selling single cigarette sticks.

We mapped 4114 cigarette retailers in Denpasar, the most common type was a kiosk, 3199 (77.8%), followed by mini market/convenience stores, 606 (14.7%). Retailer density was 32.2/km2 and 4.6/1000 population. We found that 37 (9.7 %) of the 379 schools in Denpasar have at least one cigarette retailer within a 25 m radius and 367 (96.8%) within a 250 m radius. Of the 485 audited retailers within a 250 m radius of a school, 281 (57.9%) admitted selling cigarettes to young people and 325 (67.0%) sold cigarettes as single sticks. Cigarette retailers were less likely to sell cigarettes to young people based on distance from schools, but this was only significant at the furthest distance of more than 500 m from schools.

In an unregulated retailer setting such as Indonesia, cigarette retailers are ubiquitous and selling to young people is commonplace. The Indonesian government should enforce the prohibition on selling to young people and should regulate cigarette retailers to reduce youth access to cigarettes.

The authors thank R. Rosemary and A.W. Prastyani for their support throughout the project, and the enumerators for their valuable contribution to the study. We also thank the reviewers for their thoughtful review of our paper.
All the authors have completed and submitted an ICMJE form for disclosure of potential conflicts of interest and they declare that they have no competing interests, financial or otherwise, related to the current work. All the authors report grants from Australia Indonesia Centre, during the conduct of the study. P.A.S. Astuti, K.H. Mulyawan, N.D. Kurniasari and B. Freeman report also grants from the Australian Commonwealth Government, during the conduct of the study. P.A.S. Astuti reports grants from Indonesia Endowment Fund for Education (LPDP), and other from the Australia Indonesia Centre, outside the submitted work. B. Freeman reports personal fees from WHO, grants from Australia Department of Health, from the NSW Department of Health, from the Cancer Institute NSW, and from NHMRC Australia, and personal fees from the Asian Center for WTO & International Health Law and Policy, National Taiwan University, College of Law, and from Department of Health of The Government of Hong Kong Special Administrative Region, outside the submitted work.
The study was funded by Australia Indonesia Centre (AIC)-Health Cluster and the support of Australian Commonwealth Government. P.A.S. Astuti received an Indonesia Endowment Fund for Education (LPDP) scholarship for her PhD.
Not commissioned; externally peer reviewed.
Freeman B, Burton S. Tobacco retail density: still the new frontier in tobacco control. Med J Aust. 2018;208(5):203-204. doi:10.5694/mja17.01239.
Cohen JE, Anglin L. Outlet density: a new frontier for tobacco control. Addiction. 2009;104(1):2-3. doi:10.1111/j.1360-0443.2008.02389.x.
Henriksen L. The retail environment for tobacco: a barometer of progress towards the endgame. Tob Control. 2015;24:e1-e2. doi:10.1136/tobaccocontrol-2014-051884.
Gartner C and McNeill ANN. Options for global tobacco control beyond the Framework Convention in Tobacco Control. Addiction. 2009;105(1):1-3. doi:10.1111/j.1360-0443.2009.02720.x.
Lipperman‐Kreda S, Grube J, Friend K, Mair C. Tobacco outlet density, retailer cigarette sales without ID checks and enforcement of underage tobacco laws: associations with youths’ cigarette smoking and beliefs. Addiction. 2016;111(3):525-532. doi:10.1111/add.13179.
Schleicher NC, Johnson T, Fortmann S, Henriksen L. Tobacco outlet density near home and school: Associations with smoking and norms among US teens. Prev Med. 2016;91:287-293. doi:10.1016/j.ypmed.2016.08.027.
Marsh L, Ajmal A, McGee R, Robertson L, Cameron C, Doscher C. Tobacco retail outlet density and risk of youth smoking in New Zealand. Tob Control. 2016;25(e2):e71-e74. doi:10.1136/tobaccocontrol-2015-052512.
Lipperman-Kreda S, Mair C, Grube J, Friend K, Jackson P, Watson D. Density and Proximity of Tobacco Outlets to Homes and Schools: Relations with Youth Cigarette Smoking. Prev Sci. 2014;15(5):738-744. doi:10.1007/s11121-013-0442-2.
Leatherdale ST, Strath JM. Tobacco retailer density surrounding schools and cigarette access behaviors among underage smoking students. Ann Behav Med. 2007;33(1):105-111. doi:10.1207/s15324796abm3301_12.
Scully M, McCarthy M, Zacher M, Warne C, Wakefield M, White V. Density of tobacco retail outlets near schools and smoking behaviour among secondary school students. Aust N Z J of Public Health. 2013;37(6):574-578. doi:10.1111/1753-6405.12147.
Mennis J, Mason M, Way T, Zaharakis N. The role of tobacco outlet density in a smoking cessation intervention for urban youth. Health Place. 2016;38:39-47. doi:10.1016/j.healthplace.2015.12.008.
Chan WC, Leatherdale ST. Tobacco retailer density surrounding schools and youth smoking behaviour: A multi-level analysis. Tob Induc Dis. 2011;9(July):9. doi:10.1186/1617-9625-9-9.
Lee JGL, Sun DL, Schleicher NM, Ribisl KM, Luke DA, Henriksen L. Inequalities in tobacco outlet density by race, ethnicity and socioeconomic status, 2012, USA: results from the ASPiRE Study. J Epidemiol Community Health. 2017;71(5):487. doi:10.1136/jech-2016-208475.
Loomis BR, Kim AE, Goetz JL, Juster HR. Density of tobacco retailers and its association with sociodemographic characteristics of communities across New York. Public Health. 2013;127(4):333-338. doi:10.1016/j.puhe.2013.01.013.
Rodriguez D, Carlos H, Adachi-Mejia A, Berke E, Sargent J. Predictors of tobacco outlet density nationwide: a geographic analysis. Tob Control. 2013;22(5):349. doi:10.1136/tobaccocontrol-2011-050120.
Kite J, Rissel C, Greenaway M, Willliams K. Tobacco outlet density and social disadvantage in New South Wales, Australia. Tob Control. 2014;23(2):181. doi:10.1136/tobaccocontrol-2012-050648.
Marashi-Pour S, Cretikos M, Lyons C, Rose N, Jalaludin B, Smith J. The association between the density of retail tobacco outlets, individual smoking status, neighbourhood socioeconomic status and school locations in New South Wales, Australia. Spat Spatiotemporal Epidemiol. 2015;12:1-7. doi:10.1016/j.sste.2014.09.001.
Ribisl K, Luke D, Bohannon D, Sorg A, Moreland-Russell S. Reducing Disparities in Tobacco Retailer Density by Banning Tobacco Product Sales Near Schools. Nicotine Tob Res. 2017;19(2):239-244. doi:10.1093/ntr/ntw185.
Coxe N, Webber W, Burkhart J, et al. Use of tobacco retail permitting to reduce youth access and exposure to tobacco in Santa Clara County, California. Prev Med. 2014;67:S46-S50. doi:10.1016/j.ypmed.2014.01.023.
Campaign for Tobacco-Free Kids. The global cigarette industry. https://www.tobaccofreekids.or.... Published August, 2018. Accessed May 2, 2019.
PT HM Sampoerna Tbk. Annual Report 2015. Jakarta: 2015; PT HM Sampoerna Tbk. resources/docs/default-source/sampoerna-marketdocuments/ annual-reports/laporan-tahunan-2015. pdf?sfvrsn=19ce7bb4_2. Accessed May 2, 2019.
World Health Organization. Tobacco Free Initiative (TFI): MPOWER. Accessed April 15, 2019.
Pemerintah Republik Indonesia. Peraturan Pemerintah Republik Indonesia No 109 Tahun 2012. Pengamanan Bahan Yang Mengandung Zat Adiktif Berupa Produk Tembakau Bagi Kesehatan. Jakarta: Pemerintah Republik Indonesia; 2012. Accessed May 2, 2019.
World Health Organisation, Regional Office for South-East Asia. Global Youth Tobacco Survey (GYTS). Indonesia Report, 2014. New Delhi: WHO-SEARO; 2015. Accessed May 2, 2019.
Kementerian Kesehatan Republik Indonesia. Hasil Utama Riskesdas 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan; 2018. Accessed May 2, 2019.
Wang L, Lu B, Wewers M, Foraker R, Xie M, Ferketich A. Are retailers compliant with zoning regulations that ban tobacco sales near schools in Changsha, China? Tob Control. 2017;26(4):446-451. doi:10.1136/tobaccocontrol-2015-052787.
San Fransisco Tobacco-Free. Tobacco Density. http://sanfranciscotobaccofree.... Updated June, 2016. Accessed March 15, 2018.
Ministry of Law and Justice of India. The cigarettes and other tobacco products (Prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) Act, 2003. Act No 34 of 2003. Published 2003. Accessed May 2, 2019.
Gong T, Lv J, Liu Q, Ren Y, Li L, Kawachi I. Audit of tobacco retail outlets in Hangzhou, China. Tob. Control. 2013;22(4):245. doi:10.1136/tobaccocontrol-2011-050038.
Valiente R, Sureda X, Bilal U, at al. Regulating the local availability of tobacco retailing in Madrid, Spain: a GIS study to evaluate compliance. Tob Control. 2018;28. doi:10.1136/tobaccocontrol-2018-054269.
Walikota Denpasar. Peraturan Daerah Kota Denpasar Nomor 7 Tahun 2013. Tentang Kawasan Tanpa Rokok. Denpasar: 2013. Accessed May 2, 2019.
Walikota Denpasar. Peraturan Walikota Denpasar No 14 Tahun 2013. Penundaan Sementara Pemberian Izin Reklame di Kota Denpasar. http://perijinan.denpasarkota..... Accessed May 2, 2019.
Sebayang S, Dewi D, Lailiyah S, Ahsan A. Mixed-methods evaluation of a ban on tobacco advertising and promotion in Banyuwangi District, Indonesia. Tob Control. 2018. doi:10.1136/tobaccocontrol-2018-054443.
Lentera Anak Indonesia (LAI), Smoke Free Agent (SFA), Yayasan Pengembangan Media Anak (YPMA). Serangan Iklan Rokok di Sekitar Sekolah. Jakarta: Lentera Anak Indonesia (LAI), Smoke Free Agent (SFA),Yayasan Pengembangan Media Anak (YPMA); 2015.
Astuti PAS, Kurniasari N, Mulyawan K, Sebayang S, Freeman B. From glass boxes to social media engagement: an audit of tobacco retail marketing in Indonesia. Tob Control. 2019. doi:10.1136/tobaccocontrol-2018-054833.
Donovan RJ, Jancey J, Jones S. Tobacco point of sale advertising increases positive brand user imagery. Tob Control. 2002;11(3):191-194. doi:10.1136/tc.11.3.191.
Badan Pusat Statistik Kota Denpasar. Statistik Daerah Kota Denpasar 2017. Denpasar: 2017. https:// f027b0fed0089573b43006b8/statistik-daerah-kotadenpasar- 2017.html. Accessed May 2, 2019.
Kementerian Pendidikan dan Kebudayaan. Data Referensi Kementerian Pendidikan dan Kebudayaan. Jumlah data peserta didik per Kabupaten/Kota: Kota Denpasar. Accessed February 12, 2018.
Open Data Kit. ODK Tools [computer program]. Accessed November 15, 2017.
ArcGis Desktop 10.5. Data classification method. http:// layers/classifying-numerical-fields-for-graduatedsymbols. htm. Accessed January 12, 2019.
Henriksen L, Schleicher N, Feighery E, Fortmann S. A Longitudinal Study of Exposure to Retail Cigarette Advertising and Smoking Initiation. Pediatrics. 2010;126(2):232. doi:10.1542/peds.2009-3021.
Kementerian Perdagangan Republik Indonesia. Peraturan Menteri Perdagangan Republik Indonesia Nomor: 46/M-DAG/PER/9/2009 Tentang Perubahan atas Peratuan Menteri Perdagangan Republik Indonesia Nomor 36/M-DAG/PER/9/2007 Tentang Penerbitan Surat Izin Usaha Perdagangan. Jakarta: Kementerian Perdagangan Republik Indonesia; 2009.
Finan LJ, Lipperman-Kreda S, Abadi M, et al. Tobacco outlet density and adolescents’ cigarette smoking: a meta-analysis. Tobacco Control. 2018. doi:10.1136/tobaccocontrol-2017-054065.
Tan Y, Dorotheo U. The Tobacco Control Atlas. ASEAN Region. 3rd ed. Bangkok, Thailand; Southeast Asia Tobacco Control Alliance (SEATCA); 2016.
Ackerman A, Etow A, Bartel S, Ribisl K. Reducing the Density and Number of Tobacco Retailers: Policy Solutions and Legal Issues. Nicotine Tob Res. 2017;19(2):133-140. doi:10.1093/ntr/ntw124.
Pemerintah Indonesia. Nomor 36 tahun 2009 tentang kesehaltan. Accessed May 2, 2019.
Pemerintah Republik Indonesia. Peraturan Presiden Republik Indonesia No. 74 Tahun 2013 tentang Pengendalian dan Pengawasan Minuman Beralkohol. Jakarta: 2013. Accessed May 2, 2019.
Badan Penelitian dan Pengembangan-Kementerian Kesehatan Republik Indonesia. Riset Kesehatan Dasar: Riskesdas 2013. Jakarta: Kementerian Kesehatan Republik Indonesia; 2013. resources/download/general/Hasil%20Riskesdas%20 2013.pdf. Accessed May 2, 2019.
American Cancer Society, Vital Strategies. The Tobacco Atlas. Indonesia. Accessed May 22, 2018.
Wooten H, McLaughlin Ian, Chen L, Fry C, Mongeon C, Graff S. Zoning and Licensing to regulate the retail environment and achieve public health goals. Duke Forum For Law and Social Change. 2013;5:70-88.
Southeast Asia Tobacco Control Alliance. Indonesia: Tobacco industry merges retailer incentives with brand promotions. https://tobaccowatch.seatca.or.... Published July 28, 2017. Accessed June 1, 2018.
Batu SL. Big tobacco woos small shops. The Jakarta Post. July 25, 2017. Accessed May 2, 2019.
Hitchman S, Calder R, Rooke C, McNeill A. Small Retailers’ Tobacco Sales and Profit Margins in Two Disadvantaged Areas of England. AIMS Public Health. 2016;3(1):110-115. doi:10.3934/publichealth.2016.1.110.
Presiden Republik Indonesia. Peraturan Presiden Republik Indonesia No 112 Tahun 2007 Tentang Penataan dan Pembinaan Pasar Tradisional, Pusat Perbelanjaan dan Toko Modern. https://sipuu.setkab. TH%202007.pdf. Accessed May 2, 2019.
Pemerintah Republik Indonesia. Undang-Undang Republik Indonesia No 26 Tahun 2007 tentang Penataan Ruang. 26-2007.pdf. Accessed May 2, 2019.
World Health Organization. Tobacco Free Initiative (TFI). Taxation. Accessed May 28, 2019.
Kementerian Kesehatan Republik Indonesia. MENKES: Apresiasi Tinggi Bagi Daerah Yang Mengimplementasikan KTR dengan baik. Published May 31, 2018. Accessed May 29 2019.
Zebua DJ. Pemkab Kulon Progo Semakin Perketat Iklan Rokok di Dalam Toko. Published December 4, 2018. Accessed May 29, 2019.
Nurdiansyah R. Pemkot Depok Larang Display Rokok. Published November 2, 2018. Accessed May 29, 2019.
Redaksilensa. Kota Bogor Pertama di Indonesia Yang Larang Display Produk Rokok. Published May 5, 2018. Accessed May 29, 2019.