RESEARCH PAPER
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
,  
 
 
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1
Department of Public Health and Preventive Medicine, Universitas Udayana, Denpasar, Indonesia
2
The University of Sydney School of Public Health, Sydney, Australia
3
Udayana Center for NCDs, Tobacco Control and Lung Health (Central), Universitas Udayana, Denpasar, Indonesia
4
Department of Biostatistics and Population Studies, Universitas Airlangga, Banyuwangi, Indonesia
5
Prevention Research Collaboration (PRC), Charles Perkins Centre, The University of Sydney, Sydney, Australia
CORRESPONDING AUTHOR
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
KEYWORDS
TOPICS
ABSTRACT
Introduction:
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.

Methods:
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.

Results:
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.

Conclusions:
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.

ACKNOWLEDGEMENTS
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.
CONFLICTS OF INTEREST
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.
FUNDING
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.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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