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Introduction
Indonesia is the world's fourth most populous country with the fifth largest cigarette market, and one-third (34%) of Indonesians smoke tobacco products. 1 2 Most Indonesian smokers smoke kreteks, hand-rolled or machine-rolled clove-flavoured cigarettes, which account for over 92% of retail sales volume 3 and, like all tobacco products, cause serious diseases and death. 2 Smoking is the cultural norm in Indonesia and plays a central role in social and political systems. 4 In December 2009, Indonesian governmental officials announced intentions to consider ratification of WHO Framework Convention on Tobacco Control (FCTC). 5 Although a hopeful sign for approximately 57 million Indonesian smokers and the millions of youth targeted by the tobacco industry, 6 major barriers to effective tobacco control exist in Indonesia.
First, Indonesia's tobacco control legislation is weak on taxation and price, tobacco advertising, promotion and sponsorship, and smoke-free public places. 7 8 Second, governmental policy protects and promotes the tobacco industry. Third, following the unsuccessful attempts to penetrate the Indonesian tobacco market in the 1990s, 9 transnational tobacco companies (TTCs) have now successfully invaded the country by purchasing domestic kretek manufacturers. This has created a westernisation of the Indonesian tobacco market, with the introduction of new kretek products, such as Marlboro Mix 9 and A-Volution.
To protect the future generations of Indonesia, we must advance understanding of the relationships between the Indonesian tobacco market and the TTCs. By analysing internal tobacco industry documents and public documents, we describe what and when the TTCs knew about the disease effects of Indonesian kretek products that they now own. We also describe the TTCs' successes at growing their Indonesian businesses through strategic acquisitions and transformation of kretek manufacturers and efforts to influence public policy.
Methods
Primary sources analysed include internal tobacco industry documents produced in response to US litigation settlements, corporate reports to investors relating to Indonesian operations, the tobacco trade press and Indonesian media.
Public accessibility and history of internal tobacco industry documents have been described. 8 Online searches of documents produced by British American Tobacco (BAT) and Philip Morris (PM) were conducted on the Legacy Tobacco Documents Digital Library at the University of California, San Francisco website ( http://www.legacy.library.ucsf.edu/ ). Searches of documents dating back to the 1960s were conducted between October...