POST C: Sitting down with Dhohri

After months of research, I finally witnessed Indonesia’s tobacco culture first-hand, after recently returning from a two week adventure to Java, Indonesia. From vivid billboards and consistent banner displays of tobacco advertising to the tourist attraction of Malioboro Street, covered with smokers who continue to contribute to the existing second-hand smoke within the area. The problem of tobacco in Indonesia is certainly one that is wicked and complex. I sat down with Dhohri, a Yogyakarta local and staff member at the hotel Jogja Village Inn to gain more insight on the issue and a supposed “way of life.”

I first met Dhohri when going out for lunch to Jogja Village Inn’s ‘Secang Bistro’ with a bunch of other individuals also on the university studio. His welcoming and friendly nature created an inviting presence and was a reflection of the kind-spirited and hospitable Indonesian folk I had already met across my travels. Shocked by the number of young tourists in front of him, he was interested in knowing about our visit to Yogyakarta. When I responded with “a project on tobacco” he looked in confusion and asked “why would you come to Indonesia to study tobacco?” After explaining how tobacco is a huge issue in Indonesia and our motive was to create design ideas that implement anti-smoking, he agreed that the majority of Indonesians are smokers and continued to add that “smoking pollutes the air”, highlighting smoking’s affect on others. To date, there are about 66 million active smokers and approximately 90 million passive smokers. (Afifa, 2019) Vital Strategies powerful campaign #SuaraTanpaRokok (Voices without Cigarettes) included a video of the recently deceased spokesman Pak Topo, who targeted smokers stating “I’m not a smoker. There are no smokers in my family. I also lead a healthy lifestyle… Maybe one of the causes [of my lung cancer] was that I’m a passive smoker…” (Topo, 2018)

In my conversation with Dhohri, I continued to ask him about his personal lifestyle. I learnt that he was a non-smoker and had a wife and two children. His 15 year old son also does not smoke because he attends an “educated and international school,” further implying that ones education and socioeconomic status correlates to the odds of smoking. A 2018 study has shown that adolescents in the poorest quintile had more than twice the odds of smoking compared with adolescents from the richest quintile (Global Health Action, 2018) When questioned as to why he doesn’t smoke he responded that “it is not healthy” and mentioned that Indonesians are ill informed of the health impacts. However, he went on to add that “smoking is a tradition…it is a way of life…many do it socially.” Laughing in response to my question of what could we could do to change the smoking scene, he said “it is too difficult to change…”

Dhohri in his element at Jogja Village Inn, 2019

Afifa, N., 2019, ‘Secondhand Smoke Is Much More Than Just a Smelly Nuisance’, Jakarta Globe, Jakarta, viewed 19th December 2019, <https://jakartaglobe.id/context/secondhand-smoke-is-much-more-than-just-a-smelly-nuisance>.

Cahya, G., 2019, ”I’m a passive smoker’: Sutopo leaves powerful warning against smoking before death’, The Jakarta Post, viewed 19th December 2019, <https://www.thejakartapost.com/news/2019/07/09/im-a-passive-smoker-sutopo-leaves-powerful-warning-against-smoking-before-death.html>.

Kusumawardani,N., Tarigan, I., Schlotheuber, A., 2018, ‘Socio-economic, demographic and geographic correlates of cigarette smoking among Indonesian adolescents: results from the 2013 Indonesian Basic Health Research (RISKESDAS) survey’, Global Health Action, vol.11, viewed 19th December 2019,<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990951/>.

POST B: Stoptober – a case study

In 2012 the English Department of Health designed a campaign called ‘Stoptober’, which focuses on the psychological principles underpinning tobacco use…

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Studies reveal the effectiveness of mass media anti-smoking campaigns (Bala et al., 2008, 2012) and studies that compare different message types find that harm focused messages have a higher impact than those with an ‘anti-industry or how-to-quit-themes’ (Durkin et al., 2012). In 2012 the English Department of Health designed a campaign called ‘Stoptober’, which focuses on the psychological principles underpinning tobacco use, aiming to create a positive mass quitting trigger, an area which Durkin et al. (2012) shows there has been little research done on the effectiveness. The name itself, ‘Stoptober’, was designed to build engagement with the public through the association with other popular national events such as ‘Movember’ and to increase awareness on social media. The campaign was seen in a combination of traditional media such as TV, print, radio, online advertising and digital platforms such as Facebook and Twitter with the aim to create a social movement around a specific activity, stopping smoking for 28 days.

The main psychological principles which the campaign underpinned its components included:

The campaign used both top-down strategies, with advertising and public relations as well as bottom-up strategies, with its peer networking and support services. The results of the campaign show that more than 300,000 people took part in the campaign in 2012 and the overall estimate of past-month quitting was calculated to be 4.15%, being most cost-effective for the modal 35-44 year-old group, with an ICER (incremental cost-effectiveness ratio) of £414.26 (Brown et al., 2014). As a public health campaign, the cost-effectiveness of Stoptober compared favourably with other estimates concerning UK anti-tobacco campaigns. The effectiveness of the campaign is shown through its continuation since 2012 (Brown et al., 2014).

Some interesting strategies such as the motivational text messaging programme is a particularly effective strategy with teens, as revealed in the Swiss study ‘Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults’ (Haug et al., 2012). Unique to this study is the use of personalised messages that changes depending on the users’ personal traits over an extended period of 24 months.

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An example of personalised text messages to participants. (Haug et al., 2012)

 

The Stoptober campaign reveals the effectiveness of national campaigns based on psychological motivations through positive messages and social behavioural movements over the common fear strategies utilised in anti-smoking campaigns.

 

Bala M., Strzeszynski L., Cahill K. Can tobacco control programmes that include a mass media campaign help to reduce levels of smoking among adults. Cochrane Database Syst. Rev. 2012;(6) Art. No.: CD004704.

Brown, J., Kotz, D., Michie, S., Stapleton, J., Walmsley, M. & West, R. 2014, “How effective and cost-effective was the national mass media smoking cessation campaign ‘Stoptober’?”, Drug and alcohol dependence, vol. 135, pp. 52-58, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929003/>.

Haug, S., Meyer, C., Dymalski, A., Lippke, S. & John, U. 2012, “Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial”, BMC Public Health, vol. 12, pp. 51, <https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-51>.

Durkin S., Brennan E., Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob. Control. 2012;21:127–138, <https://www.ncbi.nlm.nih.gov/pubmed/22345235>.