BACKGROUND: Living near tobacco retailers (both conventional and electronic) is associated with smoking initiation and prolonged smoking behavior. While data on conventional tobacco retailer density exists, but there is limited evidence on electronic cigarette providers. Evidence on the spatial-temporal density of both conventional and electronic cigarette providers is crucial to strengthen tobacco control efforts at national and regional levels in Indonesia. This study examines tobacco retailer density, trends in their spatial distribution, and spatial factors influencing this density.
METHODS: This study employed a mixed-method approach, analyzing neighborhood-level data from Medan, Bogor, and Malang between 2015 and 2022. Retailer locations were identified through a virtual Google Street View survey, and data were analyzed using the Spatial Autoregressive Random Effect Model (SARREM). Additionally, in-depth interviews with health officials and store owners provided qualitative insights.
RESULTS: The findings indicate a significant increase in both traditional and electronic tobacco retailers from 2015 to 2022. Spatial dependency was observed for traditional retailers in all three cities in both years (p<0.001), while electronic cigarette retailers showed spatial dependency in 2022 (p<0.001). The number of schools positively correlated with tobacco retailer density in Bogor (Coef: 0.034, p<0.001), Medan (Coef: 0.015, p<0.001), and Malang (Coef: 0.047, p<0.001). Interviews confirmed that minors frequently purchase cigarettes at local stores, including near health facilities. Health offices reported challenges in enforcing sales restrictions, particularly in border areas compared to city centers.
CONCLUSIONS: This study highlights the importance of spatial factors in the increasing density of tobacco retailers in three Indonesian cities. Retailers were found to have spatial dependency, and proximity to schools is associated with the rise in the number of retailers. Local governments in Indonesia can use spatial mapping to prioritize enforcing cigarette sales restrictions especially near schools.