Indonesia has a higher percentage of young smokers than any other country, but ignorance and a powerful tobacco lobby are making it difficult to stamp out nicotine addiction, say health workers and the government.
With a population of 230 million, Indonesia ranks third in the world according to the number of smokers, after China and India, whose respective populations are more than one billion, according to the former head of Indonesia's Medical Association, Kartono Mohamad.
While China and India may have more smokers given their larger populations, Indonesia has a higher prevalence among youngsters, he added.
According to the Indonesian Health Ministry's 2008 health profile, 29 percent of Indonesians aged 10 and above smoke an average 12 cigarettes a day.
Some 10 percent started smoking at between 10 and 14 years while 0.1 percent started as young as five, according to the report, which was released in 2010.
"Three in four adult males in Indonesia smoke and the worst thing is they smoke in the presence of children and pregnant women," said Mohamad, now a campaigner for the Indonesian Tobacco Control Network, an NGO.
"The epidemiology of smoking in Indonesia isn't fully established but cases that have been reported in the media indicate that the situation is serious and worrying because they aren't only confined to one region," he told IRIN.
A video of a two-year-old from the western Indonesian island of Sumatra chain-smoking has been viewed more than one billion times after it was posted on the internet last May.
The child has since been treated for cigarette addiction under the care of the country's child protection commission.
The commission said last September that the boy, Aldi Rizal, had overcome his nicotine addiction, but experts believe the case points to larger problems in regulating tobacco.
A 2009 health law lists tobacco as an addictive substance but farmers from one of the country's most fertile tobacco-growing regions, Central Java, are fighting this label in a constitutional court, citing the threat to their livelihoods.
Mohamad said the government had been reluctant to regulate tobacco strictly because of pressure from the tobacco industry. Nevertheless, it is preparing national tobacco regulation that seeks to restrict cigarette advertising and sponsorship to enforce the 2009 health legislation, said Lily Sulistyowati, director for health promotion at the Health Ministry.
"It is impossible to close down cigarette factories but we seek to inform the public that smoking is dangerous to their health and people who can't stop smoking [should] understand that and not put their families in danger," she said.
But the country's youngsters have little understanding of those dangers.
Dimas Riyadi, a 15-year-old street child, said smoking helped him to mix with his peers. "All my friends smoke so it's natural that I smoke too," said Riyadi, who makes a living doing street performances for motorists at a busy intersection in the centre of the capital, Jakarta.
"I have not been sick because of smoking," he added.
According to 2005 government research, almost US$20 billion was spent annually on health treatments related to smoking, three times more than what the state receives in cigarette taxes, said Mohamad.
There is no insurance for the treatment of smoking-related diseases.
The 2008 government health profile showed 60 percent of deaths in Indonesia were caused by non-communicable diseases - including smoking - an increase from 48.5 percent in 2001.
Worldwide, non-communicable diseases caused almost 60 percent of deaths and 43 percent of the disease burden a decade ago, according to the World Health Organization (WHO).
Based on current trends, by the year 2020 these diseases are predicted to account for 73 percent of worldwide deaths and 60 percent of the disease burden, estimates WHO.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions