Smoking Patterns, Quitting Intentions and Associations with Pro- and Anti-smoking Messages: Insights from the Indonesian GATS Survey (2011 and 2021)

Introduction: Indonesia has one of the highest smoking prevalences globally. Although studies have examined the impact of pro- and anti-tobacco messaging on smoking behaviour and quitting intentions, research on these influences among Indonesian adults remains limited. This study investigates smoking prevalence trends over the past decade and the relationship between tobacco-related messaging and adult smoking and quitting behaviour in Indonesia. 

Methods: This repeated cross-sectional study analysed secondary data from the Global Adult Tobacco Survey (GATS) Indonesia (2011 and 2021). Participants were adults aged ≥15 years, selected through a multi-stage stratified cluster sampling. GATS 2021 included 9156 completed interviews, whereas GATS 2011 had 8305 completed interviews. Smoking prevalence was compared using the chi-square test. Multivariable analysis employed complex samples with multiple logistic regressions to assess associations between tobacco advertising, anti-smoking messaging, smoking behaviour and quitting intentions. 

Results: Male smoking prevalence slightly declined from 67.04% (2011) to 64.71% (2021), whereas female prevalence remained stable (2.66%–2.25%). Exposure to anti-smoking messages is significantly associated with a lower likelihood of being a current smoker (aOR = 0.84, 95% CI = 0.72–0.99) and is linked to higher odds of quitting attempts (aOR = 1.34, 95% CI = 1.06–1.7) and thoughts of quitting (aOR = 1.52, 95% CI = 1.21–1.92). Exposure to pro-tobacco messages is not associated with smoking behaviour (aOR = 1.05, 95% CI = 0.87–1.27). Among males only, the exposure to anti-smoking messages is associated with decreased odds of being current smoker (aOR = 0.82, 95% CI = 0.69–0.98); higher odds of quitting attempts (aOR = 1.28, 95% CI = 1.01–1.64); and higher odds of thoughts of quitting (aOR = 1.54, 95% CI = 1.21–1.95). 

Conclusions: Smoking prevalence remains high, with pro-smoking messages linked to higher smoking rates. Although anti-smoking messages promote quitting intentions, stronger policies and cessation support are needed to reduce smoking.