What is the current picture of secondhand smoke exposure among never-smoker adolescents in Indonesia?

Introduction: Although Indonesia is not a signatory to the World Health Organization Framework Convention on Tobacco Control, 84% of local governments have adopted Smoke-Free Areas (SFAs) as a national policy. This study examines exposure to secondhand smoke (SHS) in adolescents who have never smoked after 8 years of SFA implementation. Methods: We used data from the 2019 Global Youth Tobacco Survey and a cross-sectional research design to find 6121 students from 148 schools in 30 provinces in Indonesia who met the research inclusion criteria. To identify risk factors regarding SHS exposure, multivariable logistic regression analysis was performed. Results: Although the local government had adopted an SFA policy, 61.1% of adolescents aged 11-17 years, especially middle and high school students, have relatively high exposure to SHS. School environments had the highest prevalence of SHS exposure (50.5%), followed by public places (49.9%) and at home (46.2%). A significant risk factor for exposure to SHS in the school environment is observed in teachers smoking inside school buildings (odds ratio [OR] =4.32, 95% confidence interval [CI]: 3.81-4.89); exposure to SHS at home and in public place (OR = 3.29, 95% CI: 2.93-3.70), and exposure to tobacco advertising, promotion, and sponsorship on offline and online media (OR = 2.07, 95% CI: 1.70-2.52). Conclusion: SFA policies must be evaluated and strengthened before they can be implemented to reduce smoking-related illnesses and economic losses. In addition, it is important to educate families and society about implementing SFA in school environments, public places, and at home.