Exposure to Outdoor Tobacco Advertisements Near Home is Associated with Smoking among Youth in Indonesia

BACKGROUND: The prevalence of cigarette smoking among adults is persistently high, and among youth is increasing in Indonesia. Objective: This study aims to examine the association between youth smoking behavior and outdoor tobacco adverts near home in Indonesia. METHODS: We conducted a cross-sectional survey of 3,557 students in North Sumatera during September-November 2020. The main independent variables include seeing tobacco advertisements near home, near school, on social media. The outcome variables included ever smoked and smoked in the last ten days. RESULTS: We found significant associations between exposure to outdoor tobacco adverts near home and youth smoking. High school students who reported seeing tobacco adverts near home were 1.42 times more likely to smoke and 2.29 times more likely to smoke in the last ten days. Moreover, students at private schools (a proxy for higher income) exposed to tobacco adverts near home were 1.56 times more likely to smoke and 2.93 times more likely to smoke in the last ten days. CONCLUSION: Exposure to outdoor tobacco advertisements near home is associated with smoking among youth in Indonesia. Comprehensive tobacco control efforts are needed, including through a ban of outdoor tobacco adverts.