How to cite:
Radian Ilmaskal, Linda Wati, Rischa Hamdanesti, Alkafi, Helmanis
Suci. (2022). Adolescent Smoking Behavior In Indonesia; A
Longitudinal Study. Journal Eduvest. Vol 2(1): 41-47
E-ISSN:
2775-3727
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Eduvest – Journal of Universal Studies
Volume 2 Number 1, January 2022
p- ISSN 2775-3735 e-ISSN 2775-3727
ADOLESCENT SMOKING BEHAVIOR IN INDONESIA; A
LONGITUDINAL STUDY
Radian Ilmaskal
1*
, Linda Wati
2
, Rischa Hamdanesti
3
, Alkafi
4
,
Helmanis Suci
5
1,4
Public Health Study Program, STIKes Alifah Padang, West Sumatera Province,
Indonesia
2
Midwifery Study Program, STIKes Alifah Padang, West Sumatera Province, Indonesia
3,5
Nursing Study Program, STIKes Alifah Padang, West Sumatera Province, Indonesia
Email: radian.ilmas[email protected], lindawati.a[email protected],
rischa.hamdanesti@gmail.com, Mahealkafi@gmail.com, hel[email protected]om
ARTICLE INFO ABSTRACT
Received:
December, 26
th
2021
Revised:
January, 17
th
2022
Approved:
January, 18
th
2022
Adolescent smoking behavior in Indonesia is increasing
every year. This condition is dangerous threat to the
sustainability of a country. This study was aimed to analyze
determinant factors related to adolescent smoking in
Indonesia. The study is quantitative research with cross
sectional design. This study utilized IFLS 5 data. Sample was
unmarried adolescent aged 15-24 years with a total of
4,959 adolescents. Association between adolescent
smoking behavior status with parental smoking habits,
gender, age and residence were determined by using chi-
square test. We found that the majority (93%) of
adolescents were smokers who smoke a maximum of 10
cigarettes per day and most of them started smoking
regularly at the age of 12 to 17 years (66%). Parental
smoking habits significantly influenced adolescent smoking
behavior (p=0.000; OR=1.397; 95% CI=1.173<OR<1.663).
Gender and age group also affected smoking behavior in
adolescents. Meanwhile, the classification of residence has
no significant effect on adolescent smoking behavior
(p=0.337; OR=0.920; 95% CI=0.777<OR<1.090). These
findings suggested that efforts to prevent adolescent
smoking behavior should be more focused on children who
live with smoking parents.
KEYWORDS
Adolescents, Smoking, Behavior, Indonesia
Radian Ilmaskal, Linda Wati, Rischa Hamdanesti, Alkafi,
Helmanis Suci
Adolescent Smoking Behavior In Indonesia; A Longitudinal Study 42
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
Scientifically, smoking is a dangerous behavior for yourself and others, however,
many people still consume it. It was caused more than 8 million deaths and cost the world
economy about US$ 1.4 trillion annually (Organization, 2021). The use of tobacco
contributes to poverty with the aid of using diverting family spending from primary needs
consisting of safehouse and meals to tobacco. Approximal more than 80% of the 1.3
billion tobacco smokers in the world live in low-and middle-income countries, where
exposure to tobacco-related illness and death is the worst (WHO, 2021). By 2030, if
trends do not change, smoking mortality will increase 2.5-fold (Lim et al., 2017).
Globally, Indonesia is the third-largest number of smokers after China and India.
the number of tobacco smokers is predicted to increase by 24 million from 2015 to 2025
in Indonesia (Drope et al., 2018). Based on the Indonesian national health survey
(Riskesdas) showed that the proportion of smokers from 2017-2018 increased from
23.7% to 28.8%. It is not only that the total number of smokers keeps increasing, but also
the smoking behavior starts earlier. The age group with the highest smoking initiation
was the 10-14 years old and followed by the 15-19 years old. Prevalence of adolescent
smoking in the population aged 10-18 from 2013-2018 increased from 7.2% to 9.1%
(Ministry of Health of The Republic of Indonesia, 2013). Other research, from the Global
youth tobacco survey showed that 19.2% of students in Indonesia aged 13-15 years are a
smoker and 57.8% of them were contaminated with tobacco smoke at their homes (WHO,
Ministry of Health of The Republic of Indonesia, & CDC, 2019). Smoking behavior in
adolescents is a serious health problem since it increases the risks of various diseases
when they get older (Park, 2011). Finally, poor health in adolescence may present
challenges to educational and occupational success, which can have lasting impacts on
young people's life chances. It has an impact on the future sustainability of a country
automatically.
A meta-analysis of studies in China showed that smokers were at increased risk
of severity COVID 19 compared to nonsmokers (Patanavanich & Glantz, 2020).
Adolescents have a relatively lower risk of being infected with COVID 19 than older
people, but given the proportion of adolescents who use e-cigarettes, e-cigarette and
tobacco use among adolescents is an important risk factor for COVID 19 (Gaiha, Cheng,
& Halpern-Felsher, 2020).
Many factors were associated with adolescents smoking behavior. A study in
Central Java, Indonesia found that smoking behavior was directly influenced by strong
intention and weak perceived behavioral control and indirectly by weak exposure to
cigarette advertisement and availability, preventive subjective norm, negative attitude,
pocket money at least more than Rp.10.000, weak family support, and smoker peer-group
(Pandayu & Murti, 2017). The adolescents smoking-related factors included peer
pressure, the parents’ smoking status, masculinity, and curiosity too (Fithria, Adlim,
Jannah, & Tahlil, 2021). Other studies indicated that tobacco smoking among adolescents
was predictor by lower socioeconomic status (Green, Stritzel, Smith, Popham, &
Crosnoe, 2018)(Kuntz & Lampert, 2016). Aho et.al in Finland show that Parental daily
smoking predicted daily adolescent smoking, and this association was also observed in
adolescents when mothers and fathers quit smoking (Aho, Koivisto, Paavilainen, &
Joronen, 2018). The previous study has discussed a lot about adolescent smoking
behavior but only in a limited area and a small sample. Thus, objective the study to
Eduvest – Journal of Universal Studies
Volume 2 Number 1, January 2022
43 http://eduvest.greenvest.co.id
analysis caused adolescent smoking behavior from nationally representative data in
Indonesia.
RESEARCH METHOD
The study used secondary data from The Indonesian Family Life Survey (IFLS)
wave 5. IFLS is an ongoing longitudinal survey in Indonesia. It was conducted by RAND
Corp from the United States collaboration with Universitas Gadjah Mada in Indonesia. So
far, 5 waves of IFLS have been conducted, namely IFLS1 in 1993, IFLS2 in 1997, IFLS3
in 2000, IFLS4 in 2007, and finally IFLS5 in 2014. 2014. IFLS 5 succeeded in
interviewing 16,204 households and 50,148 individual samples. The survey was
conducted between October 2014 and Augustus 2015. The survey consists of 13
provinces and 30,000 individuals. With a 90% response rate, the IFLS-5 sample was
claimed to be representative of about 83% of the Indonesian population (Strauss J,
Witoelar F, 2016). The data are available at https://www.rand.org/well-being/social-and-
behavioral-policy/data/FLS/IFLS/ifls5.html. The sample of this study was adolescents
aged 15-24 years and status not yet married with number 4.959. The Independent variable
was smoking status and the dependent variable was the parents ‘smoking status, sex, age,
and residence. Data analyzed used univariate and bivariate.
RESULT AND DISCUSSION
The distribution of general characteristics of adolescent smoking behavior is
presented in Table 1 below:
Table 1 Characteristic of adolescence smoking in Indonesia (n=4.959)
Variable
Frequency
Percentage (%)
Ever tried Smoking
Yes
No
1.314
3.645
27
73
Smoking Status
Smokers
Non smokers
1.221
93
93
7
Types of cigarettes
Filter White Cigarettes
White Cigarettes without filter
Filter Kretek Cigarettes
Kretek Cigarettes without filter
Others
577
23
640
13
61
44
2
49
1
5
The age of starting smoking (years)
< 12
12-17
> 18
45
865
404
3
66
31
Number of Cigarettes per day
10
11-20
> 20
834
430
50
63
33
4
Eduvest – Journal of Universal Studies
Volume 2 Number 1, January 2022
Adolescent Smoking Behavior In Indonesia; A Longitudinal Study 44
Based on table 1, a total of 73% of adolescents has no smoking experience and
the percentage of adolescents who have smoking experience was 27%, of the total youth
who have smoking experience, most of them were continuing the habit of smoking at
92.92% until the time of interview, meanwhile only 7.08% of adolescents who have quit
smoking. Most adolescents smoked Kretek cigarettes filter (49%) and white cigarettes
filter (42%). The distribution of adolescents in terms of age the first time smoking
routinely was quite varied. Most of the respondents admitted that the age at first starting
smoking routine was in the age group 12 to 17 years, namely as many as 865 adolescents
(65.83%). Judging from the number of cigarettes smoked in a day, mostly teenagers was a
light smoker who smokes maximum of 10 cigarettes per day (63.47%).
Table 2 Distribution Frequency of Independent Variable (n=4.959)
Frequency
Percentage (%)
2.716
2.243
55
45
2.751
2.208
55
45
3.300
1.659
67
33
3.299
1.660
67
33
From table 2, when viewed from the gender of the respondents, the distribution of
adolescents is dominated by male adolescents, as many as 2,716 people (55%). Based on
the age group, most of the respondents in the unit of analysis were in the age group 15 to
18 years (55%), and based on the smoking habits of parents shows that most of the
respondents' parents have a smoking habit about 66.55%. Meanwhile, when viewed from
the classification of residence, the distribution of adolescents was dominated by
adolescents who live in urban areas, which are 3,299 adolescents (67%).
Variable
Smoking Behavior
Total
P
Value
OR (95%
CI)
Smoker
Non-
Smoker
n
%
n
%
N
%
Parental
smoking
habits
Smoker
Non-
smoker
370
948
22
29
1.289
2.352
78
71
1.659
3.300
100
100
0.000
1.397
(1.173-1.663)
Gender
189,456
Eduvest – Journal of Universal Studies
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45 http://eduvest.greenvest.co.id
Table 3 Bivariate Analysis of Adolescent Smoking Behavior
The results of the bivariate analysis based on Table 3 showed that there was a
relationship between parental smoking habits, gender, and age group with adolescent
smoking behavior. The experience of living with parents who have smoking habits would
increase the tendency of adolescents to become smokers by 1.397 times compared to
adolescents who live with parents without smoking habits (p=0.000; OR=1.397; 95%
CI=1.173-1.663). The male adolescents had a risk of smoking 189.456 times greater than
female adolescents. Meanwhile, adolescents in the age group over 18 years had a risk of
smoking 1,159 times greater than adolescents in the age group 18 years or less. Thus, the
residence classification variable had no effect on adolescent smoking behavior (p=0.337;
OR=0.920; 95% CI=0.777-1.090). This showed that there was no significant difference in
smoking behavior between adolescents living in rural areas and urban areas.
Based on this study, smoking behavior is the experience of adolescents in
smoking cigarettes or chewing tobacco. Several factors that influence adolescent smoking
behavior such as age, sex, educational attainment, economic status, family, and close
friends influence (Lim et al., 2017) (Pandayu & Murti, 2017) (Fithria et al., 2021) (Utami,
2020). The results of this study indicate that the smoking habits of parents significantly
affect the smoking habits of adolescents. This is consistent with research conducted in
Finland, Germany, and China (Aho et al., 2018)(Kuntz & Lampert, 2016)(Wang et al.,
2019). The role of the family, especially parents, is very important in shaping the attitudes
of children towards tobacco use. Commonly, children tend to imitate their parents’
behavior, parents smoking habits will increase the probability for their children to become
smokers. This finding is in conjunction with earlier studies in China (Wang et al., 2019).
Gender is significantly related to smoking behavior in adolescents. The
proportion of smokers for male adolescents was much higher compared to female
adolescents. The high risk of smoking behavior among adolescents based on gender was
caused by a bad stigma if a female has a smoking habit in Indonesia. There is a
relationship between gender and adolescent smoking behavior according to research
conducted by Laksono and Effendi which showed that there were differences in smoking
behavior between male and female adolescents (Laksono et al., 2021). However different
results were obtained in the research conducted by Aho et.al in Finland found that just
over one-third or 36% of all vocational school students reported smoking daily. Girls
were daily smokers (37%) slightly more often than boys (36%)(Aho et al., 2018).
Adolescent age was significantly related to smoking behavior. The results of this
study were in line with research conducted by Skulberg et.al in Pulau Weh, Indonesia,
Male
Female
1.306
12
1
48
2.231
1.410
99
52
2.243
2.716
100
100
0.000
(106.495-
337,044)
Age
group
(Years)
15-18
19-24
465
853
17
39
2.286
1.355
83
61
2.751
2.208
100
100
0.000
1.159
(1.120-1.199)
Residence
Rural
Urban
483
835
29
25
1.177
2.464
71
75
1.660
3.299
100
100
0.337
0.920
(0.777-1.090)
Eduvest – Journal of Universal Studies
Volume 2 Number 1, January 2022
Adolescent Smoking Behavior In Indonesia; A Longitudinal Study 46
which showed that there were differences in the proportion of smoking among
adolescents between age groups (Skulberg, Hamid, & Vaktskjold, 2019). The researchers
divided adolescents into two age groups, 14 years or less and more than 14 years of age.
The higher the adolescent age group, the greater the risk of smoking in adolescents.
This study found that the classification of residence has no significant effect on
smoking behavior in adolescents. The results of this study were also in line with a study
in Korea that the classification of residence in rural, urban, and metropolitan cities did
not affect adolescent smoking behavior (Kim et al., 2013). However, differences with the
study by Skulberg found that the odds of being an active smoker were 7.4 times higher
among students at the public rural school, as compared to the public school in town
(Skulberg et al., 2019).
CONCLUSION
The prevalence of smoking among adults and adolescents in Indonesia is still quite
high. The high prevalence of smoking among adults can affect the smoking behavior of
adolescents who have lived together. The behavior of parents is an example that their
children will easily imitate, including in terms of smoking habits. Researchers suggest
that efforts to prevent smoking behavior in adolescents are more focused on children who
live with smoking parents.
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