Based on the results done in 2010, Java is the province with higher rates of an active smoker (Barkina, T., Dewi, V. K., Isnaniah. & Kirana, R. 2014). A survey conducted in East Java’s Surabaya – Indonesia’s second largest city, found that there was a significantly higher prevalence of depression in women in comparison to other cities (Byles, J., Christiani, Y., Dugdale, P. & Tavener, M. 2015). Women have turned to smoking as a form of a quiet self-medication, with the odds of a depressed woman being a smoker being twice that of a depressed man (Liew, H.P. & Gardner, S. 2016). In the same research study, the results of Indonesia was compared to the results attained in USA, South Africa, and Glasgow (UK), and it was found that the common aspects to the co-morbidity of depression and smoking is due to lack of strong social support networks caused by stigmas with mental health.
Statistical analysis showed that with better knowledge about mental health, the lower the tendency to have negative attitudes towards mental disorders. This recommends psychoeducational programs through a variety of methods to improve the understanding of mental health and the resources available to treat it (Ariana, A.D., Fardana, N.A., Hartini, N. & Wardana, N.D. 2018). In Surabaya, the highest concentration of Puskesmas (Community Health Centres) are greatly concentrated in the city centre. However, it is found that “current smoking behaviour was more frequent among the poor.” (Byles, J., Christiani, Y., Dugdale, P. & Tavener, M. 2015).
The support needed for these women and the community as a whole is greatly lacking. Indonesia possesses a Mental Health Law established in 2014, but its implementation is not yet optimal (WHO in Ayuningtyas, D., Maulidya, A.N., Misnaniarti, M. & Rayhani, M. 2018), with the causes being mainly due to limited resources and prevailing stigma against mental health. Although services in the field are increasing with 48 Mental Hospital and Drug Addiction Hospitals established in 26 of 34 provinces, there is still a low priority in the national budget for this area with only 1% dedicated to the cause (WHO in Ayuningtyas, D., Maulidya, A.N., Misnaniarti, M. & Rayhani, M. 2018). Where the mental health is low in exposure, a different industry is thriving with its voice in the community.
Indonesia ranks fifth highest in cigarette consumption, and “is the only country in the region that have not signed the WHO Framework Convention on Tobacco Control” (Barber et al. in Barkina, T., Dewi, V. K., Isnaniah. & Kirana, R. 2014 ). The tobacco industry has begun to feature more young women in cigarette advertisements. With 87% of the female population being Muslim in Surabaya, advertisements are marketing cigarette-use with female independence, portraying “young women in sleeveless tank tops in a country where many women dress modestly and wear hijabs.” (Cohen, J.E., Hardesty, J.J., Kaplan, S., Kennedy, R.D. et. al 2019 p. 42). This has resulted in a steady increase in female smokers in Surabaya since 2012 (Cohen, J.E., Hardesty, J.J., Kaplan, S., Kennedy, R.D. et. al 2019).
The battle now is between the efficacy of public health awareness and the aggressive advertising campaigns of the tobacco industry. With the rates of female smokers rising, it’s important to recognise that more power must be given to the support of mental health programs.
Ariana, A.D., Fardana, N.A., Hartini, N. & Wardana, N.D. 2018, ‘Stigma toward people with mental health problems in Indonesia’, Psychology Research and Behaviour Management, vol. 11, pp. 535-41.
Ayuningtyas, D., Maulidya, A.N., Misnaniarti, M. & Rayhani, M. 2018, ‘Implementation of mental health policies toward Indonesia free restraint’, Policy & Governance Review, vol. 2, no. 2, pp. 161-173.
Barkina, T., Dewi, V. K., Isnaniah. & Kirana, R. 2014, ‘ Smoking behavior and attitude towards cigarette warning labels among informal workers in Surabaya city – East Java, Indonesia’, Advances in Life Science and Technology, vol. 21, pp.1-2.
Byles, J., Christiani, Y., Dugdale, P. & Tavener, M. 2015, ‘Socioeconomic related inequality in depression among young and middle-adult women in Indonesia’s major cities’, Journal of Affective Disorders, vol. 182, pp. 76-81.
Cohen, J.E., Hardesty, J.J., Kaplan, S., Kennedy, R.D. et. al 2019, ‘Smoking among female daily smokers in Surabaya, Indonesia,’ Public Health, vol. 172, pp.40-42.
Liew, H.P. & Gardner, S. 2016, ‘The interrelationship between smoking and depression in Indonesia’, Health Policy and Technology, vol. 5, no. 1, pp. 26-31.