56 Aditama Med J lndones Smoking problem in Indonesia Tjandra Yoga Aditama Abstrak Kebiasaan merokok merupakan masalah kesehatan pentin g di Indonesia . Sampai 60% pria Indonesia dan sekitar 4% perempuan di 11egara kita punya kebiasaan merokok. Kadar tar dan nikotin beberapa rokok kretek ternyata juga cukup tinggi. Selain dampak kesehatan rokok juga punya dampak buruk pada ekonomi, baik tingkat individu maupun keluarga . Dari sudut kesehatan, kendati data morbiditas dan mortalitas berskala nasional sulit didapat, data dari berbagai kota menunjukkan timbulnya berbagai penyakit akibat rokok seperti kanker paru , PPOK, gangguan pada janin dan sebagainya. Masalahnya lagi, kebiasaan merokok telah dimulai usia sangat muda di Indonesia. Pada tulisan ini disampaikan ju ga hambatan-hambatan dalam prog ram penanggulangan masalah merokok serta hal-hal yang perlu dilakukan untuk meningkatkan program penanggulangan yang ada. (Med J lndones 2002; 11: 56-65) Abstract Smoking is an important public health problem in Indonesia. Up to 60% of male adult population as well as about 4% of femal e adult population are smokers. In fact, some of Indonesian kretek cigarettes have quite high tar and nicotine content. Besides health eff ect, smoking habit also influence economic status of the individuals as well as the family. In health point of view, even though reliable nation wide morbidity and mortality data are scarce, report from various cities showed smoking related diseases, such as lung cancer, COPD, effect of pregnan cy, etc. Other problem is a fact that smoking habit start quite in early age in Indonesia. This article also describe fa ctors complicate smoking control program as well as several things to be done to strengthen smoking control pro g ram in Indonesia. (Med J Indones 2002; 11: 56-65) Keywords: smoking, Indonesia, impact The Republic of Indonesia, which consists of 72%, with the highest percentage belong to the approxi mately 17,000 islands, had a population of 210 drivers of public buses in Jakarta. Among females, million; i t is the fourth most populous country in the the percentage ranges from 1.5% to 9.7%. world after China, India, and the United States with hundred s of ethnic groups and language I dialects The Indonesian Smoking Control Foundation ("LM being practices in the country. An estimated 55.4 3") compiled a meta-analysis study on smoking . I d . 14 million persons (31 % of the population) were living in patterns m n onesia . urban areas in 1990, compared with 73.4 million (36% of the population) in 1997.'-2·3 All of these factors The conclusions of the meta-analysis study performed complicate tobacco-control measures in Indonesia . by "LM3" included the following: 14 1. The studies found that 59.04% of males over ten years of age in the 14 provinces in Indonesia were Smoking Pattern currently smoking. Among females over 10 years of age, 4,83% were current smokers. Table I compiles the results from several studies on smoking behavior in Indonesia. The percentage of 2. There was a negative correlation between the level current smokers among males ranges from 30.2% to of education and the percentage of current smokers. 3. On average, current male smokers consume almost ten cigarettes each day, while female Pulmonolog y Department Faculty of Medicine University of current smokers consume around three cigarettes Indonesia I Persahabatan Hospital, Jakarta, Indonesia each day. Vol I I , No I , January - March 2002 Smoking problem in Indonesia 57 4. Among both current and former smokers, males 7. Clove-flavoured cigarettes ( kretek ) were the or females, the freq uency of smoking was still favourite choice of smokers in Indonesia. For fairly mild, less than 200 score indexed by male current smokers, 84,31% preferred kretek mu ltiplication of nu mber of cigarettes and length cigarettes, as did 79,42% of the female smokers. of smoki ng. Similar figures were found in former smokers, as 5. Ex-smokers generally reported smoking h igher 84,31% of the males and 72.94% of the females n u mbers of cigarettes than current smokers. In preferred the clove cigarettes. males i t was 1 3 versus 10 cigarettes daily, and in 8. For both current or former smokers, the age of females it was more significant at 6.2 versus 3 smoking initiation were quite you ng. Females cigarettes dai l y. tend to start to smoke at the older age. 6. The average of ounces of tobacco per week was 0.79 in cu rrent users, and 1 .42 in ex-users. Table I . Percentage of Current Smokers i n some studies i n Indonesi a No. Study -year -investigator Question N Ages Males Females Total Survey on Eye and ENT Heal th 1994- Do you currently 14071 J 0 years 48,34% 3,16% 22,68% 4 1996 i n 7 Provinces, MOH, R l smoke? and older Have you ever Indonesian Family Life Survey 1 993 m 14638 10 years 67,70% 9,70% 36,50% I 3 Provi nces smoked? and older 5 LD-FEU I, Rand Co National Household Survey, Module on Have you 65664 HH 10 years 45,00% 1 ,50% 22,90% Susenas, J 995, i n 5 Provinces, MOH, smoked in the and older R I" past month? 4 Does the head of Head of Prospecti ve Study on Public Health, 1 7349 30.20% Pasar Rebo , Cipayu ng & Ciracas, East your house- hold HH (adult) Jakarta 1 993/94, Fae of Public Health smoke? 7 - UI 5 Smoking And Its Socioeconomic NA 250 10 years 64.40% Aspects In Jakarta , 1981, Soekidjo, and older Siregar, Wi bowo. Fae. of PH - UI 6 Effect On Smoking Deceased Program NA 449 Adul t 48,00% 48,00% Among The Smoker -Workers In St.Carol us Hospital, Jakarta, 1 995, J udi n. Tanju ng, Fae. of PH - UI'' Relationshi p Between Habit On Cloves 7 Do you smoke? 3386 Ad ul t 72% 72% Smoking And Dental Destruction, A mong The Dri vers Of PPD Company I n Jakatta, 1992, 0 Soetiarto ' 8 Action on smoki ng, in: Compi btion of NA 1000 2,1 % 64,4% papers on Cancer Problem (Ku mpulan Naskah Masalah Kan ker), · 1 1 Hoepoedio, I 981 9 Proportion Of Smokers Among The Have you ever 1 86 Ad ult 50,0% 50,0% Male Employees In The Office Of smoked? Di tjen Bin kesmas, MOH, 1996 11 Syafranelsar, Fae. of PH - Ul 1 0 Study On Knowledge , Atti tude A nd Do you smoke? 431 Grade 5 12,76% Behavior On Smoking, Among The and 6 Pupi ls of Elemen tary School Grades V (Primary A nd Y I, In East Jakarta 1992, School) 13 Shebubakar, Fae. of Medicine - Ul (-) : Not avai lable I not calcul ated 58 Aditama Med J lndones The above data show no significant differences when smoked non-filtered k retek cigarettes, 0.3% compared with the WHO (1997) estimation, where in consumed cigars, 3.8% rolled their own cigarettes , Indonesia the prevalence of current smokers was and 0.1% smoked tobacco using a pipe. The reported to be 53.0% of the males and 4% of the comparative n umbers for the rural population are females. But it shou ld be noted that the WHO figures as follows: 1 1.6%, 2.8%, 33.7%, 24.9%, 0.6%, 15 were for people over the age of 15 years. 25.4% and 0.5% respecti vely. The Indonesia Household Health Survey in 1980 Most of the tobacco consumed in Indonesia is in the showed that about 54% of males and about 3% of the form of cigarettes, and between 85% and 90% of all females over ten years of age were regular (daily) cigarettes smoked in Indonesia are k reteks. The smokers. A similar survey carried out in 1986 cigarette market share of k reteks increased from about reported similar prevalence rates (53% of males, 4% 30% in 1974 to about 90% in the 1990s. Since the of females). Other surveys carried out during he 1980s early 1970s, the per-capita adult (over 10 years of in Lombok , Jakarta , and Yogyakarta reported male age) consumption of cigarettes (all forms) has more prevalence levels of 75%, 65%, and 61 %, than doubled , from 500 to 1 180 per adu lt. A survey respectivel y , and female prevalence levels less than carried out in Jakarta in 1981 estimated that each 5% (except for Jakarta where 9.8% of the females are smoker consumed (on the average) twelve cigarettes smokers) . Nationally , the prevalence of smoking is each day. About 5% of all smokers smoke more than 17 approximately 60% for men and 5% for women. 20 cigarettes a day. According to a 1 985 survey in Semarang, 36% of Table 2. Con sumption of manu factured cigarettes doctors smoked , as d i d 79% of paramedical person nel. Almost all (96%) of the "peddle rickshaw" drivers in Year Annu al average per adu l t (l5+) the survey smoked , as did over half (52%) of government civil servants. A 1992 survey of medical 1970 - 1 972 500 1 980 - 1982 950 students revealed that 8% of males and 1% of females 1 990 - 1992 1 180 were daily smokers, while 39% of males and 15% of females were occasional smokers. The Indonesian Hou sehold Heal th Survey in 1995 was Tar levels in domestically grown Indonesian tobacco one of the biggest health survey performed in 6 are high . In 1983, the average tar content of 1 8 brands Indonesia wi th over 200,000 responden ts. Among i ts of kretek cigarettes was 58.0 mg (range 41 - 71), findings were the followi ng: while the average n icotine con tent was 2.4 mg (range 1.