Exposure to outdoor cigarette advertisements and cigarette retailers near Indonesian schools: Density, proximity, and students' self-report of exposure.

Introduction: Adolescents are vulnerable to tobacco advertising, promotion, and sponsorships (TAPS). The presence of TAPS, specifically outdoor cigarette advertisements (OCA) and cigarette retailers (CR), impacts adolescent smoking behavior. This study examined the presence of OCA and CR near Indonesian schools and students' report of their TAPs exposure.

Methods: We conducted a cross-sectional study in the three diverse districts (Serang, Banyuwangi, and East Lombok) and a city district (Padang), Indonesia on September 2022-April 2023. In each district, we selected the three subdistricts with the most schools and the highest population density. Enumerators mapped all outdoor OCA and CR using Global Positioning System (GPS) devices. In selected schools within the study areas, we surveyed 6715 students about their TAPs exposure using face-to-face interviews. Students were selected using multistage cluster sampling. Data were analyzed descriptively using STATA 14.2.

Results: Of the 21460 retailers identified in the subdistricts, 30.4% were CR. The proportion of CR varied by district, between 24.8% and 40.7%. East Lombok had the highest percentage. Additionally, Banyuwangi had the highest density of CR. There were 13660 OCA points (district range 1918-6472). Around schools, banners were the most common OCA form (62.1%). Posters were second (32.8%). The retailers who sold the most cigarettes in the four districts were in kiosks. The density of CR and OCA per km² increased as the distance from schools decreased. Students' self-reported exposure to tobacco products was higher from OCA and CR than from the internet, television, and magazines/newspapers.

Conclusions: OCA and CR are ubiquitous around schools. The Indonesian government should assess OCA and CR regulations and limit OCA and CR close to schools.