ArticleThe Lancet regional health. Southeast Asia2026
Impact of district-level comprehensive tobacco control on smoking among adolescent boys in Indonesia: a synthetic control study (2013-2023).
Article in The Lancet regional health. Southeast Asia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Indonesia has one of the highest smoking prevalences globally, particularly among boys and men, yet national tobacco control implementation remains limited. We aimed to evaluate the impact of comprehensive district-level tobacco control measures on smoking prevalence among male adolescents in a decentralized policy environment. Methods: We applied a quasi-experimental synthetic control approach using panel data from 497 Indonesian districts between 2013 and 2023. Bogor City, which intensified local tobacco control measures from 2014 onward, served as the treated unit. Smoking prevalence data were drawn from nationally representative Riskesdas surveys (2013, 2018, 2023). Pre-intervention covariates measured in 2013-including socioeconomic, educational, and health service indicators-were used to construct synthetic controls. Robustness was assessed through sensitivity analyses and placebo tests. The primary outcomes were ever and current smoking among male adolescents; adult men were examined as a secondary outcome. Findings: Compared to synthetic controls, Bogor City experienced reductions in smoking prevalence among male adolescents: a 14.7 percentage point reduction in current smoking (43.4% relative reduction) and a 12.3 percentage point reduction in ever smoking (34.5% relative reduction). These gaps widened over time, suggesting sustained policy impact. Among adult men, the effect was more modest: ever smoking declined by 3.2 percentage points (3.9% relative reduction), whereas current smoking prevalence remained 11.3 percentage points higher than the synthetic control (19.5% relative difference), consistent with limited responsiveness among established smokers. Interpretation: District-level comprehensive tobacco control was associated with reductions in smoking among male adolescents in Indonesia, despite weak national enforcement. These findings underscore the potential of subnational action in preventing youth smoking and support the need for complementary national measures to strengthen tobacco control. Funding: Khalifa University of Science and Technology.
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