To gain further information on tobacco use in Indonesia, I consulted 25-year-old Abdul Aziz Purnama Adi (2019, pers. comm., 14 January), a full time employee for Philip Morris International distributing tobacco products across Indonesia. This discussion determined how an individual’s surrounding environment significantly influences and manipulates their views on tobacco.

Aziz was first exposed to cigarettes in the home when his mother, father and uncle would smoke around him inside the house. He himself began experimenting with smoking in Junior High School and became a regular smoker in college. This behaviour seems to be considered normal as he stated many other students also smoked, supporting the statistic that “nearly nine out of ten adult daily smokers started smoking before they were 18 years old” (Scott 2018). He claimed he didn’t receive any education on the detrimental impacts and consequences of smoking, however the punishment if caught smoking on school premises was expulsion. He does believe that children should be educated about how to control their use of tobacco.

In addition to Aziz’s home and school environment, he has been exposed to cigarettes through pro-tobacco advertisements saturating Indonesia. These advertisements are detrimental to individuals – especially youth – as they mislead them to believe cigarettes are not harmful to health. Tobacco companies take advantage of this in their advertising (without explicitly saying so) by purposefully target youth as 37% of the Indonesian population (approximately 100 million people) are under the age of 20 (Tjandra 2018). The power of these companies is made evident when Aziz claimed that the “graphic visuals on cigarette packaging is a conspiracy” and the presented health problems are not a result of smoking.

Now as an employee for Philip Morris International – one of the largest tobacco companies globally – Aziz has become a “casual” smoker to calm his mind. He claims the company does not force the employees to smoke, although the majority do. He sees no harm in working for the company and promoting tobacco products as he believes “smoking half a pack of cigarettes a day is a good amount,” which directly correlates and supports the statistic from a recent study that “80% of physicians practicing in Indonesia believed that smoking up to 10 cigarettes a day was not harmful for health” (Haddock et al. 2007).

Abdul Aziz Purnama Adi (left of image).

References:

Haddock, C., Lando, H., Ng, N., Nitcher, M., Mahardinata, N., Muramoto, M., Okah, F., Padmawati, R., Poston, W., Prabandari, Y., Pyle, S. 2007, ‘Physician assessment of patient smoking in Indonesia: a public health priority’, Tobacco Control, vol. 16, no. 3, pp.190-196.

Scott, J.E. 2018, ‘17^th World Conference on Tobacco or Health’, Tobacco Induced Diseases, vol. 16, pp. 178, viewed 13 January 2019, <http://www.tobaccoinduceddiseases.org/-8220-Little-Lungs-8221-using-digital-platforms-innovative-creative-and-audience,84281,0,2.html&gt;.

Tjandra, N. 2018, ‘Disneyland for Big Tobacco’: how Indonesia’s lax smoking laws are helping next generation to get hooked, News, The Conversation, Victoria, viewed 9 January 2019, <http://theconversation.com/disneyland-for-big-tobacco-how-indonesias-lax-smoking-laws-are-helping-next-generation-to-get-hooked-97489&gt;.

“Cigarette butts are the most commonly discarded pieces of waste worldwide. It is estimated that 148705 tonnes of butts and packs wind up as toxic trash in Indonesia annually” (The Tobacco Atlas 2019) due to the country selling over 315 billion cigarettes (Tjandra 2018) and disposing of the same amount. This disruptive culture of tobacco disposal has been further explored through undertaking visual ethnography in Ambon.

Within Ambon’s city centre, it was discovered that approximately one quarter of waste came from cigarette butts and packaging (refer to figures one). The littering of cigarettes is seen most predominantly in the busiest parts of the city, around small shops and market stalls where people were selling the cigarettes (refer to figure two). Citizens disposed of their cigarettes by dropping them onto the ground or chucking them into waterways (refer to figure three and four). When moving east of the city centre towards the DRPD Provinsi Maluku, known for being a wealthier part of town, there was less cigarette disposal on the streets although some cigarette packets and butts could still be found outside of the Provinsi and along the adjacent streets.

Figure One: Close up evidence of rubbish in Ambon’s waterways, where cigarette butts and packets amount for approximately 25%.

Figure Two: Mapping the prevalence of cigarette disposal in Ambon.

Figure Three: Evidence of large amounts of cigarette butts disposed in Ambon street drains.

Figure Four: Evidence of large amounts of waste in Ambon’s waterways (Elliott 2019).

From these observations, speculations were made that cigarette disposal is much more prominent in the city centre as it is bustling with people in comparison to the quieter wealthier east. In addition, the social culture of smoking on the streets in large groups was only seen in the city centre and hence created more physical waste from tobacco products. However, bins for general waste and cigarettes are inconveniently placed and extremely hard to find around the city streets, the only spotting being in the centre of Merdeka Field (refer to figure five). This may conclude why smokers choose to drop their discarded cigarettes on the streets instead of putting them in provided bins.

Figure Five: Sighting of bins to dispose waste in Merdeka Field.

There are many solutions Indonesia could adopt to try and change smoker’s behaviour towards cigarette butt deposition. One way entails enforcing anti-littering laws as they have proved to be successful in countries such as the U.S. (Barnes 2011). In addition, imposing cigarette butt abatement fees on each pack of cigarettes would help to reduce the number of people buying cigarettes – as evidence has shown that younger people and people with low incomes are more responsive to tobacco price increases (Adioetomo et al. 2008) – and hence reduce the amount of waste. But simply, adding more bins around the city – specifically for cigarettes – would significantly benefit the detrimental tobacco dumping culture as “cigarette butts are [a] toxic, hazardous waste” (Barnes 2011) that contribute to the pollution of the beautiful ocean, rivers, drains and streets of Indonesia which in turn affect individuals health and the environment.

References:

Adioetomo, S.M., Ahsan, A., Barber, S., Setyonaluri, D. 2008, Tobacco economics in Indonesia, International Union Against Tuberculosis and Lung Disease, Paris.

Barnes, R.L. 2011, ‘Regulating The Disposal of Cigarette Butts as Toxic Hazardous Waste’, Centre for Tobacco Control Research and Education, vol. 1, no. 20, pp. i45-i48.

Elliott, J. 2019, Gotta Love Your Phone Disconnecting From The Drone Mid Flight and Having to Fly Blind 500m to the Top of your Hotel, Instagram, viewed 16 January 2019, <https://www.instagram.com/p/BsnA2-mhWpX/&gt;.

Tjandra, N. 2018, ‘Disneyland for Big Tobacco’: how Indonesia’s lax smoking laws are helping next generation to get hooked, News, The Conversation, Victoria, viewed 9 January 2019, <http://theconversation.com/disneyland-for-big-tobacco-how-indonesias-lax-smoking-laws-are-helping-next-generation-to-get-hooked-97489&gt;.

The Tobacco Atlas 2019, Indonesia, American Cancer Society Inc. and Vital Strategies, viewed 15 January, <https://tobaccoatlas.org/country/indonesia/&gt;.

A recent study has exposed tobacco companies paying young and popular social media influencers with large online followings to advertise their cigarettes as a part of a marketing strategy to target youth (Campaign for Tobacco-Free Kids 2018). These influencers are told what brands to promote, when to post pictures for maximum exposure, and how to take “natural photos” that do not look like staged advertisements (refer to figure one). In response to this study, the FDA (an agency within the U.S. Department of Health and Human Services) initiated the Little Lungs in a Great Big World campaign to deal with tobacco control among youth in the U.S.

Figure one: One example of a young social media influencer promoting cigarettes as a paid advertisement (Kaplan 2018).

Little Lungs in a Great Big World is a digital campaign including five short animated advertisements (refer to figure two) targeted at teens aged 12 to 18 who are open to smoking, are already experimenting with cigarettes, have a lower socioeconomic status, are surrounded by smokers, or live in a chaotic home environment (Shorty Awards 2019). Addressing and reducing teen tobacco use is essential as “nearly nine out of 10 adult daily smokers started smoking before they were 18 years old” (Scott 2018). The top-down initiative is designed to resonate with a teen audience (Jardine 2017) and target them on the same platforms as the tobacco companies, including YouTube, Facebook, Snapchat and Instagram (Oster 2017).

Figure Two: One video of five from Little Lungs in a Great Big World campaign (The Real Cost 2017).

As this campaign was released across social media, the engagement levels of the videos determine its success. Little Lungs in a Great Big World has currently been viewed over 65 million times on YouTube, and additional 8 million times on Facebook and Instagram (Shorty Awards 2019). The campaigns success was aided by its design as the visual style and humour engages youth whilst still educating them on the consequences of smoking. In addition, the number of youth using tobacco products has shown to decrease after the time the campaign was released. In 2013, about 17.7% of middle school students and 46% of high school students reported current use of some type of tobacco product. This has decreased to 7.2% of middle school students and 27% of high school students in 2018 (Centers for Disease Control and Prevention 2019), however it is not determined whether the Little Lungs in a Great Big World campaign has any influence in these figures.

Although the campaign didn’t receive any criticism, it still faces the challenge of fighting the influence of tobacco advertising on social media. “Posts advertising tobacco products on social media have been viewed more than 25 billion times globally and 8.8 billion times in the U.S.” (TakeAPart 2019). With the FDA continuing to make anti-smoking campaigns similar to Little Lungs in a Great Big World, the number of U.S. teenagers using tobacco products should continue to decrease.

References:

Campaign for Tobacco-Free Kids 2018, New Investigation Exposes How Tobacco Companies Market Cigarettes on Social Media in the U.S. and Around the World, Washington D.C., viewed 13 January 2019, <https://www.tobaccofreekids.org/press-releases/2018_08_27_ftc&gt;.

Centers for Disease Control and Prevention 2019, Youth and Tobacco Use, Atlanta, viewed 13 January 2019, <https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm&gt;.

Jardine, A. 2017, The FDA Targets Teen Smokers With Animations Featuring Unfortunate ‘Little Lungs’, AdAge, viewed 13 January 2019, <https://adage.com/creativity/work/little-lungs-pool/51220&gt;.

Kaplan, S. 2018, Big Tobacco’s Global Reach on Social Media, New York Times, News, New York, viewed 13 January 2019, <https://www.nytimes.com/2018/08/24/health/tobacco-social-media-smoking.html&gt;.

Oster, E. 2017, FCB New York Introduces ‘Little Lungs’ to Show ‘The Real Cost’ of Smoking for the FDA, Adweek, viewed 13 January 2019, <https://www.adweek.com/agencyspy/fcb-new-york-introduces-little-lungs-to-show-the-real-cost-of-smoking-for-the-fda/127638&gt;.

The Real Cost 2017, Little Lungs in a Great Big World: Birthday, Animation, YouTube, viewed 13 January 2019, <https://www.youtube.com/watch?v=fmKply2PfmI&gt;.

Scott, J.E. 2018, ‘17^th World Conference on Tobacco or Health’, Tobacco Induced Diseases, vol. 16, pp. 178, viewed 13 January 2019, <http://www.tobaccoinduceddiseases.org/-8220-Little-Lungs-8221-using-digital-platforms-innovative-creative-and-audience,84281,0,2.html&gt;.

Shorty Awards 2019, Little Lungs in a Great Big World, New York, viewed 13 January 2019, <https://shortyawards.com/2nd-socialgood/little-lungs-in-a-great-big-world-2&gt;.

TakeAPart 2019, Resources & Media, Campaign for Tobacco-Free Kids, Atlanta, viewed 13 January 2019, <https://www.takeapart.org/wheretheressmoke/resources/&gt;.

Although there are multiple factors contributing to the success of the tobacco industry in Indonesia, designers play a significant role in its success through the power of advertising. Indonesia has one of the highest rates of smokers in the world, selling over 315 billion cigarettes each year (Tjandra 2018). This explains why tobacco advertising in Indonesia is among the most aggressive and innovative in the world and is seen so predominantly around the country. Tobacco companies are politically and financially powerful because they are one of the largest sources of government revenue. As a result, there are few restrictions on tobacco marketing and advertising (Danardono et al. 2008), allowing for them to have complete control and freedom. The themes most commonly focused on in tobacco advertisements include control of emotions, smoking to enhance masculinity, smoking as a means to uphold traditional values while simultaneously emphasising modernity and globalisation (Danardono et al. 2008).

The major issue with tobacco advertising in Indonesia is the lack of awareness of the health risks. A recent study shows 80% of physicians practicing in Indonesia believed that smoking up to 10 cigarettes a day was not harmful for health (Haddock et al. 2007). Tobacco companies take advantage of this in their advertising (without explicitly saying so) by purposefully target a younger audience as 37% of the Indonesian population (approximately 100 million people) are under the age of 20 (Tjandra 2018). This is alarming as 76% of males aged 15 years and older are daily smokers (Tjandra 2018) which directly contributes to the estimation that the age-standardised mortality of respiratory tract cancer (primarily caused by smoking) in Indonesia among men is 68.5 per 100 000 (Haddock et al. 2007).

Video advertisement by the cigarette company Gudang Garam’s GG Mild targeting the younger demographic (GG Mild 2017).

Currently there is one restriction in place for tobacco advertising and promotion: they must only be played on TV and radio between the hours of 9:30pm and 5am (Tobacco Control Laws 2018). However this is not an effective measure as the tobacco companies are still able to sponsor large popular events and have thousands of billboards across the country. By placing stricter laws and eradicating tobacco advertisements all together like Australia, we can only assume it will help reduce the consumption of cigarettes in Indonesia. Though, the most effective way to reduce tobacco-related morbidity and mortality is to increase the price of tobacco. Globally, evidence has shown that younger people and people with low incomes are more responsive to tobacco price increases (Adioetomo et al. 2008), hence why we have seen a decline in tobacco sales in higher paying income societies such as Australia. Currently, Kretek cigarettes (the most popular brand in Indonesia) range in price from Rp 300 ($0.07 AUD) for a single cigarette to Rp 23 500 ($3.56 AUD) for a pack of 16 (Danardono et al. 2008). To purchase the equivalent in Australia, a pack of 20 cigarettes would cost Rp 253 000 ($25 AUD) (Tobacco Blends 2000).

References:

Adioetomo, S.M., Ahsan, A., Barber, S., Setyonaluri, D. 2008, Tobacco economics in Indonesia, International Union Against Tuberculosis and Lung Disease, Paris.

Danardono, M., Ng, N., Nichter, M., Padmawati, R., Prabandari, Y., 2008, Reading culture from tobacco advertisements in Indonesia, University of Arizona, Arizona.

GG Mild 2017, Iklan GG Mild 2017 Style of New Generation, Video Recording, YouTube, viewed 9 January 2019, <https://www.youtube.com/watch?v=_ulaZYgXzdM&feature=youtu.be&gt;.

Haddock, C., Lando, H., Ng, N., Nitcher, M., Mahardinata, N., Muramoto, M., Okah, F., Padmawati, R., Poston, W., Prabandari, Y., Pyle, S. 2007, ‘Physician assessment of patient smoking in Indonesia: a public health priority’, Tobacco Control, vol. 16, no. 3, pp.190-196.

Jha, P. & Chaloupka, F. 2000, Tobacco control in developing countries, Oxford University Press, Oxford.

Tjandra, N. 2018, ‘Disneyland for Big Tobacco’: how Indonesia’s lax smoking laws are helping next generation to get hooked, News, The Conversation, Victoria, viewed 9 January 2019, <http://theconversation.com/disneyland-for-big-tobacco-how-indonesias-lax-smoking-laws-are-helping-next-generation-to-get-hooked-97489&gt;.

Tobacco Blends 2000, Imported cigarettes, Victoria, viewed 9 January 2019, <https://www.tobaccoblends.com.au/products/imported-cigarettes/&gt;.

Tobacco Control Laws 2018, Legislation by country Indonesia, Washington, viewed 9 January 2019, <https://www.tobaccocontrollaws.org/legislation/country/indonesia/summary&gt;.