BACKGROUND: In 2018, Indonesia had the highest tobacco smoking prevalence (33.4% among adults) in the world, with kretek (clove cigarettes) being the most popular tobacco products. This study examines changes in kretek use among Indonesian adults (≥15 years) between 2011 and 2021 by selected sociodemographic and tobacco control factors.
METHODS: Data from the Global Adult Tobacco Survey (GATS) Indonesia in 2011 (n=8,305, response rate=95.4%) and 2021 (n=9,156, response rate=94%) were analyzed. GATS uses nationally representative, multistage cluster sampling. Multivariable logistic regression calculated adjusted prevalence ratios (aPR) for kretek use changes over time controlling for sociodemographic characteristics, knowledge of smoking harm, exposure to secondhand smoke, pro- and anti-tobacco messages.
RESULTS: Overall, crude prevalence of kretek use was 31.5% (95% CI, 29.8%–33.3%) in 2011 and 28.6% (95% CI, 27.1%–30.1%) in 2021. Adjusted prevalence decreased relatively by 8% (aPR, 0.92; 95% CI, 0.86–0.98), from 31.3% (95% CI, 29.9%–32.8%) in 2011 to 28.8% (95% CI, 27.5%–30.1%) in 2021. Notably, adjusted prevalence among men decreased by 8% (aPR, 0.92; 95% CI, 0.85-0.99), from 53.9% (95% CI, 51.1%–56.8%) in 2011 to 49.6% (95% CI, 46.9%–52.3%) in 2021, while adjusted prevalence among women remained consistently low, at 3.4% (95% CI, 2.4%–4.5%) in 2011 and 2.3% (95% CI, 1.5%–3.0%) in 2021. Significant reductions were observed among adults aged 45–64, rural residents, individuals without schooling or tertiary education, adults with a low or middle wealth index, individuals’ aware of the harms from smoking, those exposed to secondhand smoke or anti-tobacco messages, and adults without exposure to tobacco advertising.
CONCLUSIONS: While progress has been made in reducing kretek use, prevalence remains high, particularly among men. Comprehensive tobacco control policies, including stricter advertising regulations and expanded anti-tobacco campaigns, can help to address this issue.