Effects of Peers and Family Members on Smoking Habits in Adolescents: A Meta-Analysis

Florida Betty Apriliyani, Agus Kristiyanto, Bhisma Murti


Background: Nowadays, smoking is one of the biggest public health problems worldwide. It is a major cause of disease and mortality that can be prevented early. One out of 10 deaths worldwide is caused by tobacco use. 40 million people died each year due to tobacco. Adoles­cents start smoking in response to social effects, imitating the behavior of friends, family members, and others they admire. This meta-analysis study aimed to analyze the effect of peers and family members who smoked on smoking habits in adolescents.

Subjects and Method: Meta-analysis was conducted by searching for articles from data­bases such as PubMed, SpringerLink, Elsevier, Science Direct, and Google Scholar. The key­words were "peers" OR "parenting style" OR "family influence" AND "smoking" AND "beha­vior" AND "adolescents" AND "cross-sectional". The inclusion criteria were full-text articles with a cross-sectional design, English and Indo­nesian languages, students aged 14-24 years as the study subjects. The final results of the study were presented using the adjusted odds ratio (aOR). The articles were analyzed using Revman 5.3 software.

Results: 17 articles were analyzed. The results showed that peers and family members increased smoking habits in adolescents; the result was statistically significant with peers (aOR= 2.77; 95% CI= 1.67 to 4.60; p <0.001; I2= 96%) and family members (aOR= 1.69; 95% CI= 1.35 to 2.13; p<0.001; I2=65%).

Conclusion: Peers and family members affects smoking habits in adolescents. It is statistically significant.

Keywords: Peers, family members, smoking habits, adolescents, cross-sectional

Correspondence: Florida Betty Apriliyani. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: ridhaflorida@gmail.com. Mobile: 0813­29329417.

Journal of Health Promotion and Behavior (2020), 05(04): 248-263


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Aho H (2018). The relationship between peer relations, self rated health and smoking behaviour in secondary vocational schools. Nurs Open. 6(3): 754–764. https://dx.doi.org/10.1002%2F-nop2.260.

Akl EA (2010). The effect of waterpipe tobacco smoking on health outcomes: A systematic review. Int J Epidemiol, 39(3): 834-857. https://doi.org/10.1093/ije/dyq002.

Alves J, Parelman J, Rojas VS, Richter M, Rimpela A, Loureiro I, Federico B, et al. (2016). The role of parenting smoking on adolescents smoking and its social patternin: A cross-sectional survey in six European Cities. J Public Health Dent, (39)2: 339-346. https://doi.org/10.1093/pubmed/fdw040.

Aminuddin MI (2018). Analisis faktor-faktor perilaku merokok di Sekolah Menengah Pertama Sunan Ampel: Skripsi.

Aryal UR (2014). Predictors of smoking suscepbility among adoescents findings from a Peri-urbaan Nepalese Community. Department of Internal Medicine and Nutrition Sahlgrenska, ISBN 978-91-628-8985-2 169-176.

Ayalu AR, Asmamaw MBY (2019). Determi-nants of cigarette smoking among adolescents in Ethiopia: A cross-sectional study. Top Induc Dis, (17)9: 2-7. doi: 10.18332/tid/110800.

Backhaus I, D’Edigio V, Grassucci D, Gelar-dini M, Ardizone C, Torre GL (2017). Link between perceived smoking behaviour at school and students smoking status: a large survey among Italian adolescents. J Public Health, 151(2017): 169-176. http://dx.doi.org-/10.1016/j.puhe.2017.07.004.

Bakhruji EA, Tantawi MME, Gaffar BO, Al-Khalifa KS, Al-Ansari AA (2017). Carious lesions of permanent molars and oral health practices of parents and peers in Saudi male adolescents. Saudi Med J, (38)7: 748-754. doi: 10.15537/smj.2017.7.17601.

Ball J, Sim D, Edwards R (2018). Why has adolescents smoking declined drama-tically? Trend analysis using repeat cross-sectional data from New Zeland 2005-2015. BMJ Open. 8(10): 1-8. doi: 10.1136/bmjopen-2017-020320.

Balogun SK, Famakinde PO (2019). Paren-tal involvement, parentyng style and peer pressure as determinant of adolescents attitude towards cigarette smoking. Nigerian J Soc Psychol 2(1). https://nigerianjsp.com/index.php/NJSP/article/view/25/24.

Bee JA, Jere ML, Britton J (2011). Exposure to parental and sibling smoking and the risk o smoking uptake in child-hood and adolescence: A systematic review and meta analysis. Thorax, 66: 847-855. doi:10.1136/thx.2010.153379.

Frieden TR, Centers of Disease Control He-alth and Inequalities Report (2013). Morbidity and mortality weekly report. Surveillance summaries, 62 (3): 1-2. Centers for Disease Control & Prevention (CDC).

Gaffar AM, Alsanosy RM, Mahfous MS (2013). Sociodemographic factors associated with tobacco smoking intermediate and secondary school students in Jazan region of SAUDI Arabia. Subst Abus. 34(4): 381-8. https://doi.org/10.1080/08897077.2013.779361.

Hashmi R, Pulok MH, Tannous K, Alam K (2014). Family and peers effect on young and adolescent smoking in Bangladesh. Research Square, http:-//orcid.org/0000-0002-1733-5216.

Hiemstra M, Otten R, Engels RCME (2012). Smoking onset and the time-varying effects of self-efficacy, environmental smoking, and smoking-specific parenting by using discrete-time sur-vival analysis. J Behav Med, 35(2): 240-251. doi: 10.1007/s10865-011-9355-3.

Hiscock R, Bauld L, Amos A, Fidler JA (2012). Socioeconomic status and smoking: a review. Ann N Y Acad Sci. 1248(1): 107-123. doi: 10.1111/j.1749-6632.2011.06202.x.

Huang HL, Hsu CC, Peng WD, Yen YY, Chen T, Hu CY, Shi HY, et al. (20112). Analysis of influential factors associated with the smoking behavior of Aboroginal Schoolchildren in remote Taiwanese mountainous area. Journal of school health, 82(7): 318-327. https://doi.org/10.1111/j.1746-1561.-2012.00705.x.

Humskey JL (2010). Are adolescents with high socioeconomic status more likely to engage and illicit drug use in early adulthood?. BioMed Central, 5(19). doi:10.1186/1747-597X-5-19.

Illahi F (2015). Hubungan antara self-esteem dengan strategi coping 2.

Kementerian Kesehatan RI (2015). Perilaku merokok masyarakat Indonesia ber-dasarkan Riskesdas 2007 dan 2013. Pusat data dan informasi Kemen-terian Kesehatan RI. 2-12. doi: 2414-7659.

Kementerian Kesehatan RI (2011). Profil Kesehatan Indonesia 2010. Retrieved from http://www.depkes.go.id

Leatherdale ST, Cameron R, Brow KS, Jolin MA, Kroeker C (2010). The influence of friends, family, and older peers on smoking among elementary school students: Low-risk students in high-risk schools. Prev Med. 42(3): 218-22. https://doi.org/10.1016/j.ypmed.2005.11.019.

Lee KJ (2014). Current smoking and secondhand smoke exposure and depression aamong Korean adoles-cents: Analysis of a national cross-sectional survey. BMJ Open, 4(2): 1-7. doi: 10.1136/bmjopen-2013-003734.

Lehtren AE, Joronen K, Simila T, Rantanen A, Virtanen JI (2020). School achieve-ment and oral health behaviour among adolescent in Finland: A National survey. Oral health Prev Dent, 18(2): 125-132. doi: 10.3290/-j.ohpd.a43349.

Li LH, Pei HP, Huey TC, Cheong KC, Ghazali SM, Hock LK, Hui LJ (2020). Prevalence of smoking and its asso-ciated risk factors among secondary school students in Kelantan, Malaysia. Malaysian J Med Health Sci. 16(1): 44-50. https://medic.upm.edu.my/-upload/dokumen/2020011611573107_MJMHS_0417.pdf.

Lindstrom M, Sundquist J (2002). Ethnic differences in daily smoking in Malmo, Sweden. Eur J Public Health, 12(4): 287-294. https://doi.org/10.10-93/eurpub/12.4.287.

Manafe MWN, Lerrick YF, Effendy BS (2019). Determinan tingkatan peri-laku merokok remaja Kota Kupang. Jurnal Inovasi Kebijakan. 5(2): 51-59.

Moor I, Spallek J, Richter M (2015). Socio-economic inequalities in adolescent smoking across 35 countries: A multi-level analysis of the role of family, school and peers. Eur J Public Health, 25(3): 457-463. doi: 10.1093/eurpub-/cku244.

Nakaseko E, Kotera S, Nakazawa M (2020). Factors associated with smoking and dringking among early adolescents in Vanuatu: Across-sectional study of adolescents and their parents. Int J Environ Res Public Health. 17: 8412. doi: 10.3390/ijerph17228412.

Park MJ, Scoot JT, Adams SH (2014). Adolescent and young adult in the united states in the past decade: Little improvement and young adults remain worse off than adolescents. J Adoesc Health, 55(1): 3-16. doi: 10.1016/j.jadohealth.2014.04.003.

Purba GB (2019). Studi identifikasi faktor-faktor yang mempengarui perilaku merokok pada siswa kelas XI di SMA Parulian Medan. Fakultas Psikologi: Universitas Medan Area.

Purnaningrum WD, Joebagio H, Murti B (2017). Association between cigarette advertisement, peer group, parental education, family income, and pocket money with smoking behavior among adolescents in Karanganyar District, Central Java. J Health Promot Behav. 2(2): 150-160. http://doi.org/10.269-11/thejhpb.2016.02.02.05.

Putra HS, Rosemary R, Yanuar D, Ahsan A (2020). The effect of cigarette adver-tising on smoking behaviours of stu-dents in Banda Aceh city, Indonesia. Malaysian Journal of Communication, 36(2): 348-363. https://doi.org/10.-17576/JKMJC-2020-3602-21.

Ratna AP, Munawir YSL (2019). Hubungan antara konsep diri dan konformitas dengan perilaku merokok pada remaja. Jurnal Psikologi, 15(2): 20-26.

Reda AA, Moges A, Yazew B, Biadgilign (2012). Determinant of cigarette smoking among shool adolescents in Eastern Ethiopia: A cross-sectional study. Harm reduct J, 9(39): 1-6. doi: 10.1186/1477-7517-9-39.

Reidpath DD, Davey TM, Kadirvelu A, Soyiri IN, Allotey P (2014). Does one cigarette make an adolescents smoker, and is it influenced by age and age of smoking initiation? Evi-dence of association from the U.S youth risk behavior surveillance system. Preventive Medicine, 59(1): 37-41. doi: 10.1016/j.ypmed.2013.11.011.

Riadinata (2018). Hubungan keluarga dan teman sebaya dengan perilaku me-rokok pada remaja usia 18-22 tahun di Desa Gonilan Kartasura. Artikel publikasi, Universitas Muhammadiyah Surakarta.

Rostron BL, Chang CM, Pechacek TF (2014). Estimation of cigarette smoking attributable morbidity in the United States. JAMA intern Med. 20993(12): 1922-1928. doi: 10.1001/-jamainternmed.2014.5219.

Santrock JW (2007). Remaja jilid 2. Jakar-ta: Erlangga.

Saravan C, Attlee A, Sulaiman N (2019). A cross-sectional study on knowledge, beliefs and psycosocial predictors of sisha smoking among univerity stu-dents in Sharjah, United Arab Emi-rates. Asian Pac J Cancer Prev, 20(3): 903-909. doi: 10.31557/APJCP.2019.-20.3.903.

Septiana N, Syahrul, Hermansyah (2016). Faktor keluarga yang mempengaruhi perilaku merokok pada siswa sekolah menengah pertama. Jurnal Ilmu Kesehatan, 4(1).

Simbeee G (2012). Prevalence of substance use and psycosocial influencing fac-tors among secondary school students in Dodoma municipality gema Sim-bee. Dissertation Muhimbili Univer-sity of Health Aalied Science, 1-12.

Simetin IV, Kuzman M, Franelic IP, Pristas I, Benjak T, Dezeljin JD (2011). In-equalities in Croatian pupils un-healthy behaviours and health out-comes: Role of school, peers and family affluence. Eur J Public Health, 21(1): 122-128. doi: 10.1093/eurpub/skq002.

Skullberg KR, Hamid S, Vaktskjold A (2019). Smoking among adolescent males at Pulau Weh, Indonesia. Public Health J, 5(3): 62-70.

Smet B (2020). Determinant of smoking behaviour among adolescents in Semarang, Indonesia. BMJ Open, doi: 10.1136/tc.8.2.186.

Tapera R (2020). The Theory of planned behavior change for tobacco control strategies among adolescents in Bostwana. PLos ONE 15(6): e0233-462. https://doi.org/10.1371/journal.pone.0233462.

USDHHS (2014). Can we use them to make combusting of tobacco absoleteend the cigarette century and its prevent-able deathts? U.S Departement of health and human services. The health consequences of smoking 50 years of progress: A report of the surgeon general. U.S Department of health and human services centers for disease control and prevention, national center, 51.

Villanti A, Boulay M, Joun H (2011). Peer, parent and media influence on adolescents smoking by developmental stage. Addictive behavoiors. 36(1-2): 133-6. https://doi.org/10.1016/j.addbeh.2010.08.018.

Waziry R, Jawad M, Ballout RA, Akel MA, Akl EA (2017). The effects of water-pipe tobacco smoking on health outcomes: An updated systemtic review and meta-analysis. Int J Epidemiol, 46(1): 32-43. https://doi.org/10.1093/ije/dyw021.

World HealtH Organization (2011). Top 10 cause of death Switzerland.

World Health Organization (2017). Monitoring Tobacco use and prevention policies.


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