IMPLEMENTATION ANALYSIS OF THE NO SMOKING AREA POLICY: BRIDGING THE GAP BETWEEN NORMATIVE GOALS AND FIELD REALITIES IN URBAN AND RURAL CONTEXTS
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Abstract
The No Smoking Area (KTR) policy is one of the efforts to control the health effects of exposure to cigarette smoke. Its implementation shows a gap between normative goals and reality in the field. Implementation disparities between urban and rural areas indicate that the local context plays an important role in the effectiveness of the policy. This study aims to evaluate the effectiveness of KTR implementation in Indonesia through a Systematic Literature Review approach with a focus on comparison between urban and rural contexts. The review procedure was conducted based on the PRISMA protocol by screening scientific literature from the Scopus database. KTR implementation faces multidimensional challenges ranging from weak cross-sectoral supervision and coordination, low public awareness, and social resistance to regulations. Compliance is higher in health facilities, but still low in other public spaces, especially in areas with limited institutional capacity. This paper emphasizes the importance of a policy implementation approach that is adaptive to local characteristics and actively involves community actors. This paper also offers practical implications for strengthening KTR policy governance in a more participatory and sustainable manner to support public health development goals.
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References
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Muazzinah, Zakki Fuad Khalil, Cut Zamharira, and Rauzatul Rahmah. 2023. “Implementation of Smoke Free Area Policy in Banda Aceh City : Analysis of the Concept of Collaborative Governance.” (5): 217–32.
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Rayens, Mary Kay et al. 2016. “Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities.” Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 18(5): 1340–47.
Rethlefsen, M et al. 2021. “PRISMA-S: An Extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews.” Journal of the Medical Library Association : JMLA 109: 174–200. https://consensus.app/papers/prismas-an-extension-to-the-prisma-statement-for-reporting-koffel-moher/bba52ebe26e758bcafd98dccdaa195d5/.
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Septiono, Wahyu. 2024. “Quasi-Experimental Study on the Impact of Local Smoke-Free Policies on Smoking among Indonesian Adults: Evidence from Repeated National Health Surveys.” International Journal of Drug Policy 124(January): 104307. https://doi.org/10.1016/j.drugpo.2023.104307.
Sina, Lennart, and Kawa Nazemi. 2022. “Visual Analytics for Systematic Reviews According to PRISMA.” 2022 26th International Conference Information Visualisation (IV): 307–13. https://consensus.app/papers/visual-analytics-for-systematic-reviews-according-to-nazemi-sina/a8a17d8648455851ade9ffa2d5071983/.
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Sulistyo, Mochammad Remy, Endang Sutrisno, and Sri Primawati Indraswari. 2025. “IMPLEMENTATION OF SMOKE-FREE AREA POLICY TO FULFILL THE RIGHT TO PUBLIC HEALTH.” HERMENEUTIKA : Jurnal Ilmu Hukum. https://consensus.app/papers/implementation-of-smokefree-area-policy-to-fulfill-the-sulistyo-sutrisno/695bc9c0f30d583ba1627f0a92499045/.
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Syukur, M, S Hattab, and N Mangngasing. 2024. “Implementation of No Smoking Area Policy in Palu City.” Khazanah Sosial. https://journal.uinsgd.ac.id/index.php/ks/article/view/42958.
Torres, Gian et al. 2024. “Adherence to PRISMA 2020 Reporting Guidelines and Scope of Systematic Reviews Published in Nursing: A Cross-Sectional Analysis.” Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing. https://consensus.app/papers/adherence-to-prisma-2020-reporting-guidelines-and-scope-of-blodgett-relf/70c388f2fd9a51038bf9e6a3a0bdb15e/.
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Trisnowati, H, D Kusuma, A Ahsan, and ... 2019. “Smoke-Free Home Initiative in Bantul, Indonesia: Development and Preliminary Evaluation.” Tobacco Prevention …. https://pmc.ncbi.nlm.nih.gov/articles/PMC7205119/.
Verboom, Ben, and Aron Baumann. 2022. “Mapping the Qualitative Evidence Base on the Use of Research Evidence in Health Policy-Making: A Systematic Review.” International Journal of Health Policy and Management 11(7): 883–98. https://doi.org/10.34172/ijhpm.2020.201.
Wahyuti, Wahyuti et al. 2019. “Monitoring Compliance and Examining Challenges of a Smoke-Free Policy in Jayapura, Indonesia.” Journal of preventive medicine and public health = Yebang Uihakhoe chi 52(6): 427–32.
Widati, Sri et al. 2024. “Smoke Free Regulation for Clean and Healthy Environment in Blitar District, Indonesia.” JURNAL KESEHATAN LINGKUNGAN. https://consensus.app/papers/smoke-free-regulation-for-clean-and-healthy-evironment-in-siddiq-artanti/a26ca0fc81635e9687a41c8f99159dcf/.
Yunarman, Sepri et al. 2020. “Compliance with Smoke-Free Policy and Challenges in Implementation: Evidence from Bengkulu, Indonesia.” Asian Pacific journal of cancer prevention : APJCP 21(9): 2647–51.
Glor, E. 2022. “Can the PRISMA Protocol Be Used to Guide a Systematic Literature Review of Antecedents of Policy Innovation Trailblazing and Adoption?” https://consensus.app/papers/can-the-prisma-protocol-be-used-to-guide-a-systematic-glor/1f8efe74a2515453a272f4ab868ac874/.
Hahn, Ellen J et al. 2015. “A Controlled Community-Based Trial to Promote Smoke-Free Policy in Rural Communities.” The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association 31(1): 76–88.
Iriani, Atrika. 2018. “Implementation of Smoke Free Policy in the Workplace.” Journal of Public Administration Studies. https://consensus.app/papers/implementation-of-smoke-free-policy-in-the-workplace-iriani/89049261faa95d6b88d1cde509e33744/.
Ismaniar, Nur Inayah, Wahyudin Wahyudin, and Faradillah Paratama. 2025. “Organizational, Environmental, and Sustainability of Inputs to the Implementation of a Smoke-Free Area Policy: A Path Analysis of Makassar’s Health Facilities.” Svāsthya: Trends in General Medicine and Public Health. https://consensus.app/papers/organizational-environmental-and-sustainability-of-ismaniar-wahyudin/679d6b3d85c65c9d9ba54763213d37ba/.
Jones, Dina M et al. 2022. “Factors Associated with Smokefree Rules in the Homes of Black/African American Women Smokers Residing in Low-Resource Rural Communities.” Preventive medicine 165(Pt B): 107340.
Kahrass, Hannes et al. 2021. “PRISMA-Ethics – Reporting Guideline for Systematic Reviews on Ethics Literature: Development, Explanations and Examples.” https://consensus.app/papers/prismaethics-–-reporting-guideline-for-systematic-gastmans-graaf/e06077a03e0e5d04b980c4e874bf57c9/.
Kaiser, Daniel, Adrian Schuhmacher, and Klaus B�s. “Influencing Variables of Health: Dimensions and Their Determinants _ A Systematic Review.” Qeios. https://doi.org/10.32388/TH6SNL.
Karolina, Cut Meutia, and I Zarkasi. 2023. “Talking Cigarette in Cyberspace: Cyber Community Response to the Implementation of Smoke Free Area Policy in Bandung, Indonesia.” Public Health and Preventive Medicine Archive. https://consensus.app/papers/talking-cigarette-in-cyberspace-cyber-community-response-zarkasi-karolina/d5c73c3068da56128dc2d6a10cf3cb99/.
Kegler, Michelle C et al. 2019. “Implementation and Enforcement of Smoke-Free Policies in Public Housing.” Health education research 34(2): 234–46.
Kusumawati, Y, and F Africia. 2020. “The Implementation of A Smoke-Free Area Policy in SMA Negeri 2 Nganjuk.” INTERNATIONAL JOURNAL OF …. https://www.jknusantara.com/index.php/ijnms/article/view/311.
Lee, Kiyoung et al. 2015. “Secondhand Smoke Exposure Is Associated with Smoke-Free Laws but Not Urban/Rural Status.” Journal of the Air & Waste Management Association 65: 624–27. https://consensus.app/papers/secondhand-smoke-exposure-is-associated-with-smokefree-lee-hwang/5370e565e15f5e8f9bd8b4456d587b94/.
Made, I, Wirya Darma, Tjokorda Mirah, and Ary Mahadnyani. 2024. “EFFECTIVENESS OF CRIMINAL SANCTIONS FOR VIOLATORS OF SMOKE-FREE AREAS INDONESIA: CHALLENGES AND RESPONSIVE LAW SOLUTIONS.” Kanun Jurnal Ilmu Hukum. https://consensus.app/papers/effectiveness-of-criminal-sanctions-for-violators-of-made-darma/e2526733700950418a191eccb30e1fcf/.
Mantey, Dale S et al. 2022. “Home Smoke-Free Policies as Children Age: Urban, Rural, and Suburban Differences.” Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 24(12): 1985–93.
Maswita, Etti Sudaryati, and Juanita. 2020. “The Role of Health Promotion on Smoke Free Area Implementation at Regional Work Unit Langsa City.” 2: 298–303. https://consensus.app/papers/the-role-of-health-promotion-on-smoke-free-area-sudaryati-maswita/9af68ce61aed5b4b85bac786eda85902/.
McLeroy, Kenneth R. et al. 2012. “Reporting Guidelines and the American Journal of Public Health ’s Adoption of Preferred Reporting Items for Systematic Reviews and Meta-Analyses.” American Journal of Public Health 102(5): 780–84.
Muazzinah, Zakki Fuad Khalil, Cut Zamharira, and Rauzatul Rahmah. 2023. “Implementation of Smoke Free Area Policy in Banda Aceh City : Analysis of the Concept of Collaborative Governance.” (5): 217–32.
Nasution, F, F P Gurning, P A Siregar, and ... 2022. “Implementation of the Smoke-Free Policy in Medan City, Indonesia: Compliance and Challenges.” … Journal of Preventive …. https://journals.lww.com/ijom/_layouts/15/oaks.journals/downloadpdf.aspx?an=01439446-202213000-00030.
Padmawati, R et al. 2018. “Establishing a Community-Based Smoke-Free Homes Movement in Indonesia.” Tobacco Prevention & Cessation 4. https://consensus.app/papers/establishing-a-communitybased-smokefree-homes-movement-nichter-nichter/f485def9269459189c688bddb59640cb/.
Pati, Debajyoti, and Lesa Lorusso. 2018. “How to Write a Systematic Review of the Literature.” HERD: Health Environments Research & Design Journal 11: 15–30. https://consensus.app/papers/how-to-write-a-systematic-review-of-the-literature-pati-lorusso/1ac22a09df275a1eb3f2929f682fe3ba/.
Rayens, Mary Kay et al. 2016. “Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities.” Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 18(5): 1340–47.
Rethlefsen, M et al. 2021. “PRISMA-S: An Extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews.” Journal of the Medical Library Association : JMLA 109: 174–200. https://consensus.app/papers/prismas-an-extension-to-the-prisma-statement-for-reporting-koffel-moher/bba52ebe26e758bcafd98dccdaa195d5/.
Riker, Carol A et al. 2015. “Creating Effective Media Messaging for Rural Smoke-Free Policy.” Public health nursing (Boston, Mass.) 32(6): 613–24.
Rosmayanti, Desi, and Iman Permana. 2024. “Barriers and Facilitators to Implementation of Smoke-Free Area Policy in Public Places: A Scoping Review.” Journal of Public Health and Development. https://consensus.app/papers/barriers-and-facilitators-to-implementation-of-smokefree-rosmayanti-permana/b98e6c6dda0d5f4095a2d8cf118e28e4/.
Sakawati, Herlina, Hamrah Hamrah, and Didin Halim. 2023. “Implementation of the Smoke-Free and Limited Smoking Area Policy in Jeneponto Regency.” Jurnal Aktor. https://consensus.app/papers/implementation-of-the-smokefree-and-limited-smoking-area-sakawati-hamrah/c2a0115831f752d7a7e813a552d830f3/.
Sansone, Genevieve et al. 2019. “Secondhand Smoke Exposure and Support for Smoke-Free Policies in Cities and Rural Areas of China from 2009 to 2015: A Population-Based Cohort Study (the ITC China Survey).” BMJ open 9(12): e031891.
Septiono, Wahyu. 2024. “Quasi-Experimental Study on the Impact of Local Smoke-Free Policies on Smoking among Indonesian Adults: Evidence from Repeated National Health Surveys.” International Journal of Drug Policy 124(January): 104307. https://doi.org/10.1016/j.drugpo.2023.104307.
Sina, Lennart, and Kawa Nazemi. 2022. “Visual Analytics for Systematic Reviews According to PRISMA.” 2022 26th International Conference Information Visualisation (IV): 307–13. https://consensus.app/papers/visual-analytics-for-systematic-reviews-according-to-nazemi-sina/a8a17d8648455851ade9ffa2d5071983/.
Sugiyo, Dianita. 2020. “Engaging Community Participation for a Sustainable Smoke Free Initiative.” 9: 1160–65. https://consensus.app/papers/engaging-community-participation-for-a-sustainable-smoke-sugiyo/d63b0131fcb85f288aa8a145313a4286/.
Sulistyo, Mochammad Remy, Endang Sutrisno, and Sri Primawati Indraswari. 2025. “IMPLEMENTATION OF SMOKE-FREE AREA POLICY TO FULFILL THE RIGHT TO PUBLIC HEALTH.” HERMENEUTIKA : Jurnal Ilmu Hukum. https://consensus.app/papers/implementation-of-smokefree-area-policy-to-fulfill-the-sulistyo-sutrisno/695bc9c0f30d583ba1627f0a92499045/.
Sutantri, S et al. 2024. “A Qualitative Evaluation of Smoke-Free Policy Implementation among the Hospitality Industry in Yogyakarta, Indonesia.” Public Health of Indonesia. https://consensus.app/papers/a-qualitative-evaluation-of-smokefree-policy-wulandari-sutantri/0e997570dfc155ac840b7c15de78063a/.
Syukur, M, S Hattab, and N Mangngasing. 2024. “Implementation of No Smoking Area Policy in Palu City.” Khazanah Sosial. https://journal.uinsgd.ac.id/index.php/ks/article/view/42958.
Torres, Gian et al. 2024. “Adherence to PRISMA 2020 Reporting Guidelines and Scope of Systematic Reviews Published in Nursing: A Cross-Sectional Analysis.” Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing. https://consensus.app/papers/adherence-to-prisma-2020-reporting-guidelines-and-scope-of-blodgett-relf/70c388f2fd9a51038bf9e6a3a0bdb15e/.
Trirasetya, Mutiara Ulfa et al. 2024. “Effectiveness of Smoke-Free Campus Implementation on Smoking Behavior Control.” Jurnal Kesehatan. https://consensus.app/papers/effectiveness-of-smokefree-campus-implementation-on-suhartomi-trirasetya/cc79be6e4d62532483179c251c4a12d5/.
Trisnowati, H, D Kusuma, A Ahsan, and ... 2019. “Smoke-Free Home Initiative in Bantul, Indonesia: Development and Preliminary Evaluation.” Tobacco Prevention …. https://pmc.ncbi.nlm.nih.gov/articles/PMC7205119/.
Verboom, Ben, and Aron Baumann. 2022. “Mapping the Qualitative Evidence Base on the Use of Research Evidence in Health Policy-Making: A Systematic Review.” International Journal of Health Policy and Management 11(7): 883–98. https://doi.org/10.34172/ijhpm.2020.201.
Wahyuti, Wahyuti et al. 2019. “Monitoring Compliance and Examining Challenges of a Smoke-Free Policy in Jayapura, Indonesia.” Journal of preventive medicine and public health = Yebang Uihakhoe chi 52(6): 427–32.
Widati, Sri et al. 2024. “Smoke Free Regulation for Clean and Healthy Environment in Blitar District, Indonesia.” JURNAL KESEHATAN LINGKUNGAN. https://consensus.app/papers/smoke-free-regulation-for-clean-and-healthy-evironment-in-siddiq-artanti/a26ca0fc81635e9687a41c8f99159dcf/.
Yunarman, Sepri et al. 2020. “Compliance with Smoke-Free Policy and Challenges in Implementation: Evidence from Bengkulu, Indonesia.” Asian Pacific journal of cancer prevention : APJCP 21(9): 2647–51.