BACKGROUND: The prevalence among adult men in Indonesia is among the highest in the world. Objective: Our study examines the hotspots and regional variation in smoking prevalence among 514 districts in Indonesia.

METHODS: Taking advantage of the latest national health survey (Basic Health Research, Riskesdas 2018), which included smoking prevalence representative at the district level. We assessed the smoking prevalence among male and female adults (15+ years) and youth (13-14 years). We conducted geospatial analyses, using ArcMap 10.6, including quintile analysis (mapping the smoking prevalence by quintile for each district) and hotspot analysis (using Getis-Ord Gi* statistics to produce the hotspots, areas with a significantly higher density of advertisements). We also conducted quantitative analyses, using Stata 15.1, on geographic disparity, including region and urbanicity.

RESULTS: We found huge disparity in smoking prevalence between districts, ranging from 9 to 81% for men, 0 to 50% for, 0 to 41% for women, and 0 to 50% for girls. We found up to 62 and 47 smoking hotspots among males and females, respectively. The poorest districts had significantly higher smoking prevalence among men but lower smoking prevalence among boys, and less educated districts had higher smoking prevalence among women.

CONCLUSION: There were significant hotspots and regional variations among 514 districts in Indonesia.