Multilevel Analysis of the Biopsychosocial Determinants and Contextual Peer Groups on Smoking Habit in High School Students in East Lampung, Lampung, Indonesia
Abstract
Background: Smoking is still one of the greatest public health threats faced by citizens of the world. Data from the Central Statistics Agency in 2018 shows that smoking behavior in Lampung Province has a prevalence of 35.95%. The World Health Organization (WHO) states that smoking kills more than 8 million people per year worldwide. This study aimed to analyze the determinants of adolescent smoking behavior at the individual level and at the school level.
Subjects and Method: This was a cross sectional study conducted in East Lampung Regency, Indonesia, from October to November 2020. A number of 200 male adolescents were selected by random sampling. The dependent variable was smoking behavior. The independent variables were the influence of parents, peers, media exposure, pocket money, cigarette price, intention, attitude, and contextual effect of school. The data were collected by questionnaire and analyzed using a multiple multilevel logistic regression with Stata 13.
Results: The influence of family (b=2.88; 95% CI= 0.73 to 3.85; p= 0.004), peers (b= 2.85; 95% CI= 0.65 to 3.52; p= 0.004), media exposure (b= 3.04; 95% CI= 0.78 to 3.62; p= 0.002), money pocket (b= 3.22; 95% CI= 0.87 to 3.59; p= 0.001), cigarette price (b= 2.73; 95% CI= 0.54 to 3.28; p= 0.006), intention to smoke (b= 2.80; 95% CI= 0.69 to 3.95; p= 0.005), attitude toward smoking (b=3.83; 95% CI= 1.80 to 5.58; p<0.001) increased the likelihood to smoke in male adolescents. School had strong contextual effect on smoking in adolescents with ICC= 21.83%.
Conclusion: The influence of family, peers, media exposure, money pocket, cigarette price, intention to smoke, attitude toward smoking increase the likelihood to smoke in male adolescents. School has strong contextual effect on smoking in adolescents
Keywords: smoking behavior, adolescents, contextual effect of school
Correspondence: Retno Sulistiani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: retnosulistiani91@gmail.com. Mobile: +6285867006699.
Journal of Health Promotion and Behavior (2021), 06(01): 9-20
https://doi.org/10.26911/thejhpb.2021.06.01.02
References
Aggarwal J, Kumar M (2014). Prevalence of microalbuminuria among rural North Indian population with diabetes mellitus and its correlation with glycosylated haemoglobin and smoking. J Clin Diagnostic Res. 8(7): 11-13. https://doi.org/10.7860/jcdr/2014/9758.4613.
Alsubaie ASR (2018). Prevalence and determinants of smoking behavior among male school adolescents in Saudi Arabia. Int J Adolesc Med Health. 32(4). https://doi:10.1515/ijamh-2017-0180.
Alves J, Perelman J, Soto-Rojas V, Richter M, Rimpela A, Loureiro I, Federico B, et al. (2016). The role of parental smoking on adolescent smoking and its social patterning: A cross-sectional survey in six European cities. Journal of Public Health. 39(2): 339–346. https://doi.org/10.1093/pubmed/fdw040.
Amorha KC, Jiburu EM, Nduka SO, Okonta MJ (2017). Cigarette smoking prevalence and awareness amongst undergraduate students of the University of Nigeria, Nsukka. J Basic Clin Pharm. 8: 239-244. https://www.jbclinpharm.org/articles/cigarette-smoking-prevalence-and-awareness-amongst-undergraduate-students-of-the-university-of-nigeria-nsukka-3934.html.
Ariani RD. 2011. Hubungan antara iklan rokok dengan sikap dan perilaku merokok pada remaja (Studi kasus di SMAN Semarang). The relationship between cigarette advertising and smoking attitudes and behaviors in adolescents (Case Study at SMAN Semarang). Artikel ilmiah Semarang: Progam Studi Sarjana Kedokteran Fakultas Kedokteran Universitas Diponegoro.
Arifiyanti T, Soemato RB, Prasetya H (2019). The contextual effect of school on smoking behavior among male high school students. J Health Promot Behav. 4(1): 76-84. https://doi.org/10.26911/thejhpb.2019.04.01.08.
Atmojo JT, Soemanto RB, Murti B (2017. Determinants of successful smoking cessation in Surakarta, Central Java. J Health Promot Behav. 2(4): 332-342. https://doi.org/10.26911/thejhpb.2017.02.04.05.
Cui Y, Forget EL, Zhu Y, Torabi M, Oguzoglu U (2019). The effects of cigarette price and the amount of pocket money on youth smoking initiation and intensity in Canada. Canadian J Public Health. 110: 93–102. https://doi.org/10.17269/s41997-018-0123-9.
Delpia YV, Murti B, Suryani N (2016). Theory of planned behavior: Analysis of factors affecting the preventive behaviors of alcohol consumption and smoking among students from West Kalimantan, in Yogyakarta. J Health Promot Behavi. 1(2): 62-69. https://-doi.org/10.26911/thejhpb.2016.01.02.01.
Duncan LR, Pearson ES, Maddison R (2017). Smoking prevention in children and adolescents: a systematic review of individualized interventions. Patient Educ Couns. 101 (3): 375- 388. https://doi:10.1016/j.pec.2017.09.011.
Ganley BJ, Rosario DI (2013). The smoking attitudes, knowledge, intent, and behaviors of adolescents and young adults: Implications for nursing practice. Journal of Nursing Education and Practice. 3(1). http://dx.doi.org/10.5430/jnep.v3n1p40.
Heo J, Oh J, Subramanian S, Kawachi I (2014). Household and school-level influences on smoking behavior among Korean adolescents: A multilevel analysis. PLoS ONE. 9(6). https://doi.org/10.1371/journal.pone.0098683.
Isa L, Lestari H, Afa JR (2017). Hubungan tipe kepribadian, peran orang tua dan saudara, peran teman sebaya, dan peran iklan rokok dengan perilaku merokok pada siswa SMP Negeri 9 Kendari tahun 2017 (The relationship of personality types, the roles of parents and siblings, the role of peers, and the role of cigarette advertising with smoking behavior in Junior High School 9 Kendari students in 2017). Jurnal Ilmiah Mahasiswa Kesehatan Masyarakat. 2(7): 2.
Kemenkes RI (2015). Infodatin: Perilaku merokok masyarakat Indonesia (Indonesian Community Smoking Behavior). Jakarta: Kemenkes RI. ISSN: 2442-7659.
Kemenkes RI (2018). Rokok: Akar masalah jantung dan melukai hati keluarga (Cigarettes: Roots of heart problems and heartbreaking families). Jakarta: Kemenkes RI.
Kusumasari R (2017). Rokok ancam kita dan pembangunan (Cigarettes threaten us and development). Jawa tengah: Dinas Kesehatan Jawa Tengah.
Liem A (2014). Influences of mass media, family, and friends towards adolescents’ smoking in Yogyakarta. Makara Hubs-Asia, 18(1): 41-52. https://doi:10.7454/mssh.v18i1.3460.
Mangunsong RRD, Murti B, Wijaya M (2016). Association between cigarette package warning messages, self-efficacy, and smoking behavior among students at health polytechnic in Surakarta, Indonesia. J Health Policy Manage. 1(1): 44-52. https://doi.org/-thejhpm.2016.01.01.07.
Mcgee CE, Trigwell J, Fairclough SJ, Murphy RC, Porcellato L, Ussher M, Foweather L (2015). Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9–10 year old children from deprived neighbourhoods: A cross-sectional study. BMC Public Health. 15(225). https://doi10.1186/s12889-015-1513-z.
Mulvhill C (2014). Parental and peer influences on adolescent smoking: A literature review. Interdisciplinary J Health Sci. 4(1). https://doi.org/10.18192/riss-ijhs.v4i1.1218.
Murti B (2018). Teori promosi dan perilaku kesehatan. Edisi ke-satu (Promotion Theory and Health Behavior 1st Edition). Karanganyar: Bintang Fajar Offset.
Pandayu A, Murti B, Pawito (2017). Effect of personal factors, family support, pocket money, and peer group, on smoking behavior in adolescents in Surakarta, Central Java. J Health Promot Behavior. 2(2): 98-111. https://doi.org/10.26911/thejhpb.2017.02.02.01.
Panduwinata AW, Murti B, Pawito (2018). Multilevel analysis of the effect of school and peer group on smoking behavior in adolescents in Banjarnegara. J Health Promot Behav. 3(3): 166-178. https://doi.org/10.26911/thejhpb.2018.03.03.04.
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. https://doi.org/10.26911/thejhpb.2016.02.02.05.
Riyadi S, Murti B, Akhyar M, Suminah (2019). Predicting tobacco smoking among adolescents using social capital and media exposure with Theory of Planned Behavior: Path analysis evidence from Indonesia. Global J Health Sci. 11(7). https://doi.org/10.-5539/gjhs.v11n7p18
Robalino JD, Macy M (2018). Peer effects on adolescent smoking: Are popular teens more influential?. PLOS ONE. 13(7). https://doi.org/10.1371/journal.pone.0189360.
Roupa Z, Vasilopoulos A, Hatzoglou C, Gourgoulianis K, Kefaliakos A, Mechili EA, Archangelidi O, Mentzakis E, Diomidous M (2016). The effect of family and social environment on smoking behaviour in adolescence. European Scientific Journal. 12(2). https://doi:10.19044/esj.2016.v12n2p62.
Soesyasmoro RA, Demartoto A, Adriani RB (2016). Effect of knowledge, peer group, family, cigarette price, stipend, access to cigarette, and attitude, on smoking behavior. J Health Promot Behav. 1(3): 202-211. https://doi.org/10.26911/thejhpb.2016.01.03.07.
Thomas M (2016). Was television responsible for a new generation of smokers? Journal of Consumer Research. 46. https://doi:10.1093/jcr/ucz024.
Yang F, Salmon CT, Pang JP, Cheng WJY (2013). Media exposure and smoking intention in adolescents: A moderated mediation analysis from a cultivation perspective. SAGE. https://doi:10.1177/1359105313501533.
Yoo W, Yang J, Cho E (2016). How social media influence college students’ smoking attitudes and intentions. Comput Human Behav. 64: 173–182. https://doi:10.1016/j.chb.2016.06.061.
