Meta Analysis: The Effects of Parental Smokers, Peer Smokers, and Stress on Smoking Behavior in Teenagers


  • Riya Ulin Nuha Master's Program of Public Health, Universitas Sebelas Maret, Indonesia
  • Argyo Demartoto Faculty of Social and Political Science, Universitas Sebelas Maret, Indonesia
  • Hanung Prasetya Study Program of Acupuncture, School of Health Polytechnics, Ministry of Health Surakarta, Indonesia



Background: The habit of smoking is one of the health problems that the world is still facing today. The habit of smoking generally starts from youth, where it can have an impact on the health and cognitive behavior of adolescents that is sustainable. This study aims to estimate the influence of smoking parents, close friends of smokers, and stress on smoking habits in adolescents based on values obtained from several previous similar studies.

Subjects and Method: This study used a systematic review study design and meta-analysis. The primary articles used were obtained from online databases (Google Scholar, Elsevier, PubMed, Springer Link, and Science Direct) published in 2012-2022. Population: teenagers. Intervention: parents of smokers, close friends of smokers, and stress. Comparison: parents don't smoke, close friends don't smoke, and don't get stressed. Outcome: smoking habit. In searching for primary ar­tic­les, the researcher used the keywords “parents smoking” AND “peers smoking OR friends smo­k­ing” AND “stress” AND “adolescents OR youth” AND “smoking behavior” AND “cross-sec­tional study”. This study uses full text articles with a cross-sectional study design and contains aOR (adjus­ted odds ratio) values. The selection of articles is done using PRISMA flow diagrams. Pri­mary article analysis using the Review Manager 5.4 application.

Results: Articles with a sample size of 378,135 from Finland, Saudi Arabia, Brazil, Nigeria, South Korea, Taiwan, Malaysia, Turkey, Nepal, Ethiopia, Iran, Tunisia, France and Spain were selected for this meta-analysis. This study showed that adolescents whose parents smoked (aOR = 2.18; 95% CI = 2.12 to 2.25; p< 0.001), close friends smoked (aOR = 6.09; 95% CI = 2.71 to 13.70; p< 0.001), and stress significantly increased smoking behavior in adolescents (aOR = 1.41; 95% CI = 1.33 to 1.49; p< 0.001).

Conclusion: Parents of smokers, close friends of smokers, and stress may all increase the risk of smoking.

Keywords: parents, close friends, stress, smoking, teenagers.


Riya Ulin Nuha. Master’s Program, Universitas Sebelas Maret. Jl. Ir Suratmi No.36A, Jebres, Jebres, 57126 Surakarta, Central Java, Indonesia. Email: Telepon: +6281238710748.


Abosetugn AE, Zergaw A, Tadesse H, Addisu Y (2015). Correlations between risky sexual behavior and parental communication among youth in dilla town, gedeo zone, South Ethiopia. Biology and Med, 7(5). Doi: 10.4172/0974-8369.-1000253

Al-Zalabani A, Kasim K (2015). Prevalence and predictors of adolescent cigarette smoking in Madinah, Saudi Arabia: A school-based cross-sectional study, BMC Public Health, 15(1); 1–7. Doi: 10.1186/s12889-015-1363-8.

American Thoracic Society (2017). Why do I smoke dan why do I keep smoking? Am. J. Respir. Crit. Care Med., 196-(4); 7–8. Doi: 10.1164/rccm.1964p7.

Anhar, Arifin, Laily, Rahman, Ridwan, Bohari (2021). Analysis of smoking be-ha¬vior risk factors in adolescents through health belief model approaches, Open Access Maced. J. Med. Sci, 9(E); 192–197. Doi: 10.3889/oa-mjms.2021.5685.

Anjum MS, Srikanth, Reddy PP, Monica, Rao KY, Sheetal A (2016). Reasons for smoking among the teenagers of age 14–17 years in Vikarabad town: a cross-sectional study, J. Indian Assoc. Public Heal. Dent., 14(1); 80. Doi: 10.4103/2319-5932.178733.

Australia DHAC (2019). Smoking and tobacco dan young people, Australian Government. Available at: (Accessed: 29 August 2022).

Ayed H, Yaich S, Hmida M, Jemaa M, Triguy M, Karray R, Jedidi J et al (2021). Prevalence and factors associated with smoking among Tunisian secondary school-adolescents, Int. J. Adolesc. Med. Health 33(6); 379–387. doi: 10.1515/ijamh-2019-0088.

CDC (2014). Executive summary (the health consequences of smoking—50 years of progress: a report of the surgeon general), pp. 1–36.

CDC (2022). Youth and tobacco use, Available at: (Accessed: 23 August 2022).

CEBM (2014). Critical Appraisal of a Cross-Sectional Study (Survey) Appraisal questions, p. 1. Available at:

Derefinko KJ, Charnigo RJ, Peters JR, Adams ZW, Milich R, Lynam DR (2016). Substance use trajectories from early adolescence through the transition to college, J. Stud. Alcohol Drugs, 77(6); 924–935. doi: 10.15288/jsad.2016.77.924.

Duncan LR, Pearson ES, Maddison R (2018). Smoking preven¬tion in children and adolescents: a systematic review of individualized interventions, patient education dan counseling, 101(3); 375–388. Doi: 10.1016/j.pec.2017.09.011.

Goriounova NA, Mansvelder HD (2012). Short and long-term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function, Cold Spring Harb. Perspect. Med., 2(12); 1–14. doi: 10.1101/cshperspect.a012120.

Hossain A, Hossain QZ, Azzad-uzzaman, Rahman (2015). Factors influencing teenagers to initiate smoking in South-west Bangladesh, Univers. J. Public Heal, 3(6); 241–250. doi: 10.13189/-ujph.2015.030603.

Hurlock EB (2011). Psikologi perkembangan: suatu pendekatan sepanjang rentang kehidupan.Jakarta: Erlangga.

Kim DJ, Kim SJ (2018). Impact of nearby smoking on adolescent smoking behavior in Korea, Medicine (United States), 97(45). Doi: 10.1097/MD.00-00000000013125.

Kim K, Park H (2016). Gender differences in the association between self-reported stress and cigarette smoking in Korean adolescents, Tob. Induc. Dis. 14(1); 1–5. Doi: 10.1186/s12971-016-0084-9.

Kyoung HJ, Sung SC (2019). Factors affecting cigarette smoking among adolescents in South Korea, Vietnam, dan Thailand, J. Spec. Pediatr. Nurs., 24-(4); 1–10. doi: 10.1111/jspn.12267.

Lim H, Li L, Ghazali SM, Ling CY, Cheong KC, Pei HP, Huey TC et al. (2021). Influences of parents and peers on adolescent smoking initiation: findings from a longitudinal study in Kota Tinggi district, Johor, Malaysia, Malaysian J. Public Heal. Med., 21(2); 14–21. Doi: 10.37268/mjphm/vol.21/no.2/art.620.

Mulvihill C (2014). Parental and peer in-fluences on adolescent smoking: a literature review, Revue interdiscip-linaire des sciences de la santé - Interdiscip. J. Heal. Sci., 4(1); 33. doi: 10.18192/riss-ijhs.v4i1.1218.

Park MH (2022). Stress perception, smoking and drinking behaviors among adolescents, Adv. Soc. Sci. Res. J. 9(8); 425–428. doi: 10.14738/assrj.98.12971.

Park S (2011). Smoking dan adolescent health, Korean J. Pediatr, 54(10); 401–404. doi: 10.3345/kjp.2011.54.-10.401.

Reinaldo AM, Pereira MO (2018). Fatores associados ao tabagismo entre ado-lescentes do sexo feminino, Saúde em Debate, 42(spe4); 156–165. doi: 10.1590/0103-11042018s412.

Rozi S, Mahmud S, Lancaster G, Zahid N (2016). Peer pressure and family smoking habits influence smoking uptake in teenage boys attending school: multilevel modeling of survey data, Open J. Epidemiol, 06(03); 167–172. doi: 10.4236/ojepi.2016.¬63018.

Saari AJ, Kentala J, Mattila KJ (2014). The smoking habit of a close friend or family member-how deep is the impact of a cross-sectional study, BMJ Open, 4(2); 1–6. doi: 10.1136/bmj-open-2013-003218.

Scalici F, Schulz PJ (2017). Parents and peers normative influence on adolescents smoking: Results from a Swiss-Italian sample of middle schools students, Substance Abuse: Treatment, Prevention, dan Policy, 12(1); 1–9. doi: 10.1186/s13011-017-0089-2.

SEATCA (2021). The tobacco control atlas: ASEAN region, Southeast Asia Tobacco Control Alliance (SEATCA), (December). Available at: ASEAN Tobacco Control Atlas_5th Ed.pdf.

Shartle K (2021). Do high school friends still matter for health behavior in adulthood? variations in smoking trajectories by adolescent peer smoking networks, race/ethnicity, dan gender, SSM - Population Health, 16, p. 1009-25. doi: 10.1016/j.ssmph.-2021.100-925.

Sutrisno R, Melinda F (2021). The effects of cigarette advertisement and peer influence on adolescents smoking inten¬tion in Indonesia, Open Access Maced. J. Med. Sci, 9(T4); 291–295. doi: 10.3889/oamjms.2021.5809.

US Department of Health dan Human Services (2012). Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 43(RR-4), pp. 1–10.

US Department of Health dan Human Services (2014). The Health Consequences of Smoking—50 Years of Progress A Report of the Surgeon General, A Report of the Surgeon General.

WHO (2014). World Health Statistics 2014. Geneva: World Health Organization.

WHO (2022). Tobacco, Word Health Organization. Available at: 80%25 of the world’s, (WHO FCTC) in 2003. (Accessed: 18 August 2011).




How to Cite

Nuha, R. U., Demartoto, A., & Prasetya, H. (2023). Meta Analysis: The Effects of Parental Smokers, Peer Smokers, and Stress on Smoking Behavior in Teenagers. Journal of Health Promotion and Behavior, 8(3), 177–193.




Most read articles by the same author(s)

1 2 3 4 5 6 > >>