Understanding Determinants of Smoking Behavior Among Young Males in Rural Indonesia

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From Indonesia’s 264 million population, around 61.4 million are tobacco smokers, the 67% are smokers or tobacco users are men over 15 years of age. The negative health effects associated with smoking are well known, including premature death due to heart disease, lung disease, stroke, cancer, and diabetes. In Indonesia, smoking tobacco is a direct cause of more than 225,000 deaths per year. Tobacco smoking is an important indicator in the goals of sustainable development (SDGs) and also the mission of the World Health Organization (WHO). Given the high prevalence of male smoking in Indonesia, the target of reducing WHO in the prevalence of smoking target 30% by 2025 will be difficult to achieve.

Indonesia is ranked as the fifth largest tobacco producing country in the world and simultaneously has the highest smoking prevalence in the Southeast Asian region in 2015. In Indonesia, the average smoking behavior starts between the ages of 15 and 19, and men are 9 times more likely to smoke than women. Smoking behavior is also associated with social norms and masculinity for men, especially in rural areas of Indonesia. Smoking is often seen as a fundamental part of Indonesian men’s lives, especially those who live in rural communities where men gather at coffee shops to socialize with their friends and use the free WiFi provided to access the internet.

Responding to the high rates of smoking and death and disability associated with smoking, the Indonesian government has developed a coordinated strategy to control the consumption of tobacco products through public policies. These include restrictions and prohibitions on direct and indirect smoking advertisements, increases in tobacco taxes and prices, promoting public areas that are free of smoking and displaying health messages on product packaging. Despite these regulations, their implementation and effectiveness have not been optimal and the prevalence of smoking among young people continues to increase in Indonesia.

Understanding the factors associated with smoking behavior is important to identify key high-risk population and to inform government policies and design appropriate smoking cessation programs. Therefore, we conducted a study to identify the factors associated with smoking among young men (aged 15-24 years) living in rural Indonesia.

This research is a quantitative study using secondary data from the 2012 Indonesia Demographic and Health Survey: Adolescent Reproductive Health (DHS ARH). It was conducted by the Central Statistics Agency in collaboration with the Indonesian National Population and Family Planning Agency and the Ministry of Health.

Our study was carried out on 4811 adolescents aged 15-24 years who were not married and living in rural areas of Indonesia using the 2012 ARHS IDHS questionnaire. This instrument collected demographic characteristics including age, employment status, highest level of education, economic status, and data on knowledge participants on human reproduction and family planning use, tobacco and drug use, alcohol consumption and experience in dating and sexual relations. We use descriptive analysis to describe respondents’ demographic data and smoking behavior. We performed bivariate analysis using the chi-square test (χ2) to compare the characteristics of respondents who smoke and who don’t smoke. Factors related to smoking status were identified through binary logistic regression.

Education level, employment status, economic status, and access to media are determinants of smoking behavior among young men in rural Indonesia. Our analysis shows that rural young men with lower levels of education, exposed to the media (and cigarette advertisements) are more likely to smoke. While the Indonesian government has enacted regulations to limit smoking and access to cigarettes, the current smoking rate is still high enough that program evaluations and innovations are needed.

Our study highlighted the need for a comprehensive smoking cessation program targeted at young men who live in rural areas in Indonesia. To prevent the long-term health consequences associated with smoking, special smoking cessation programs for this population need to be developed. The findings from this study indicate that eliminating cigarette advertisements might be beneficial in the long run. For example, giving men the opportunity to socialize with restrictions on smoking (eg making coffee shops with free WiFi and also smoking free).

Author: Ferry Efendi, S.Kep., Ns., M.Sc., Ph.D.

Details of this research available at:

https://www.degruyter.com/view/j/ijamh.ahead-of-print/ijamh-2019-0040/ijamh-2019-0040.xml

Ferry Efendi, Fitriana Nur Aidah, Eka Misbahatul M. Has, Linlin Lindayani, Sonia Reisenhofer. (2019) “Determinants of smoking behavior among young males in rural Indonesia”, International Journal of Adolescent Medicine and Health. De Gruyter.

doi: 10.1515/ijamh-2019-0040.

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