Meta Analysis: Peer Influence on Smoking Behavior in Adolescents

Asri Wahyu Azzahro, Anse Putra, Isna Nur Rohmah


Background: Tobacco smoking is a direct cause of morbidity and mortality worldwide. Five million people die from smoking-related diseases every year in the world. If there is no change, then in the next 3 to 40 years the number of deaths and disabilities due to smoking will increase. This study aims to determine the magnitude of the influence of peers on smoking behavior in adolescents, with a primary study conducted by previous authors.

Subjects and Method: This study uses a systematic review and meta-analysis with PICO, population: adolescents. Intervention: having smoking friends. Comparison: has no smoking friends. Outcome: smoking habit. The articles used were obtained from several databases, namely Google Scholar, Pubmed, SpingerLink and Science Direct from 2014 to 2020. The search keywords for the article were “smoking behavior OR “smoking activity” AND “adolescent” AND “friend smoking status”. The inclusion criteria for research articles were full-text articles using a cross-sectional study design. The subjects of the study were adolescents and the results of the study were smoking habits. Multivariate analysis with Adjusted Odds Ratio (aOR) to measure the estimated effect. Data were analyzed using the Review Manager application (RevMan 5.3).

Results: A total of 9 articles with a total sample of 101,436 people, articles from Bangladesh, Sweden, Malaysia, Korea, Taiwan, Ethiopia, USA, Indonesia, and India, with selected cross-sectional studies for this systematic review and meta-analysis, Adolescents who have smoking friends are at risk of having smoking habits 13.74 times compared to adolescents who do not have smoking friends (OR= 13.74; 95% CI= 5.13 to 36.78; p< 0.001).

Conclusion: Having smoking friends can increase the risk of smoking in adolescents.

Keywords: peer, smoking, adolescents, behavior


Asri Wahyu Azzahro. Faculty of Medicine, Universitas Muhammadiyah Surakarta. Jl. Garuda Mas, Kampus 4 UMS, Gonilan, Kartasura, Surakarta 57102, Central Java, Indonesia. Email: asriwahyu­ Mobile: 081328543318.

Journal of Health Promotion and Behavior (2022), 07(02): 152-160

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Ahmed S, Sayeed A, Jahan I, Dewan F, Mali SK (2020). Prevalence and factors associated with cigarette smoking among resident university students: A crosssectional study from Bangladesh. Popul. Med. 2(February): 3. doi: 10.18332/popmed/118250.

Aryal UR, Max Petzold, Göran Bondjers, Alexandra Krettek (2014). Correlates of smoking susceptibility among adolescents in a peri-urban area of Nepal: A population-based cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site. Glob. Health Action. 7:24488. doi: 10.3402/gha.v7.24488.

Hock LK, Sumarni MG, Kee CC, Lim KK, Lim HL, Teh CH, Chan YY, et al. (2014). Prevalence and factors associated with smoking intentions among non-smoking and smoking adolescents in Kota Tinggi, Johor, Malaysia. APJCP. 15(10): 4359–4366. doi: 10.7314/APJCP.2014.15.10.4359.

Hwang JH, Park SW (2016). Association between peer cigarette smoking and electronic cigarette smoking among adolescent nonsmokers: a national representative survey. PLoS One. 11(10), e0162557. doi: 10.1371/journal.pone.0162557.

Liang YC, Jung YL, Charles Tzu CL, Chin ML (2022). Influence of Personal , Environmental, and Community Factors on Cigarette Smoking in Adole-scents: A Population-Based Study from Taiwan. Healthcare. 1: 534. doi: 10.3390/healthcare10030534

Roble AK, Mohamed OO, Om PL, Abdi-rashid AA. (2021). Prevalence of Cigarette Smoking and Associated Factors Among Adolescents in Eastern Ethiopia. Subst Abuse Rehabil. 12: 73–80. doi: 10.2147/sar.s331349.

Sidani JE, Shensa AYJ, Fertman C, Primack BA (2019). Waterpipe tobacco use in college and non-college young adults in the USA. Fam Pract. 36(2): 103-109. doi: 10.1093/fampra/cmy037.

Skulberg KR, Hamid S, Vaktskjold A (2019). Smoking Among Adolescent Males At Pulau Weh, Indonesia. Public Health of Indonesia. 5(3): 62–70. doi: 10.36685/phi.v5i3.287.

Thakur D, Gupta A, Thakur A, Mazta SR, and Sharma D (2014). Prevalence of cigarette smoking and its predictors among school going adolescents of North India. South Asian J Cancer. 3(04), 193-195. doi: 10.4103/2278-33-0X.142946.

Vitoria PD, M Fatima S, Silvia A, Hein dV (2014). Social influence, intention to smoke, and adolescent smoking behaviour longitudinal relations. Br. J Health Psychol. 16(4): 779–798. doi: 10.-1111/j.2044-8287.2010.02014.


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