Impact of Indonesian subnational smoke-free policies on cardiovascular health outcomes: evidence from national health insurance (2019–2021)

SFP adoption at both the province and district levels was associated with reduced CVD burden. However, inconsistencies in impact, particularly at the district level, highlight potential challenges in the implementation and enforcement of these policies. Despite these challenges, these findings suggest the potential for tobacco control strategies implemented at a subnational level to reduce population harm, when implemented in settings with decentralised health systems.