Identifying determinants of tobacco smoking addiction in rural Indonesian communities

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Smoking is a health problem often found in Indonesia especially in rural communities. Previous studies have outlined the causes of smoking behaviour are lack of knowledge, socioeconomic factors, information through media, and stress or negative life-related events. However, majority of those studies were conducted in urban areas. Therefore, this study aims to analyze the determinants of tobacco smoking addiction in rural areas.

A cross-sectional study was conducted in February 2020 at Songgon sub-district, Banyuwangi regency, East Java. The respondents were male local villagers aged 15 year old and above who agreed to be subjects of this study. The respondents were requested to complete three questionnaires, consisting of tobacco addiction determinants, Perceived Stress Scale–10 (PSS-10), and WHO ASSIST v3.0 questionnaire for tobacco. The respondents’ responses were converted into points to be analyzed later. All questionnaires have been validated and presented in Bahasa.

There were 75 respondents participating for the study. The mean age of the respondents was 44.04 ± 13.10. Most of them worked as a self-employee/subsistence. Regarding the education level, most respondents were of senior high school levels or higher. It was also observed that most of them were married and living with 4–6 persons in their homes. Based on WHO ASSIST v3.0 questionnaire, the respondents’ were categorized with low, moderate and high risk of tobacco addiction, with 45, 23, 7 respondents respectively.

The result showed that the tobacco addiction risk did not significantly correlate with age (p=0.241), occupation (p=0.553), education level (p=0.940), marital status (p=0.593), and number of persons in each home (p=0.873).

The scores of each questionnaire sections and PSS-10 were compared based on the respondents’ addiction risk. It was found that the scores obtained by respondents with low risk of tobacco addiction were significantly higher than those with moderate risk and high risk of tobacco addiction. It showed that respondents with a low risk of tobacco addiction have better awareness of the dangers of tobacco, better social control abilities over tobacco use, and better awareness of mass media coverage of the dangers of tobacco use.

This research made some findings different from those of the previous studies that the stress level were not significantly related to addiction risk, since the stress level in rural areas is lower than that in the urban settlements. Besides environmental and socioeconomic aspects, rural areas tend to support each other through gotong royong. Therefore, it is assumed that the lower stress levels may lead to a stress-related smoking behavior,

This study has several limitations, such as (1) the limited time which restricted the sample size and method, (2), using only a single sub-district which may not represent rural areas in other provinces or islands in Indonesia. Therefore, further research is needed with a larger number of samples in several different places.

In conclusion, this study shows no significant association between high stress levels and the risk of tobacco addiction in rural areas. However, the higher awareness of the health hazards of tobacco, the ability to social control, and awareness of mass media coverage of the dangers of tobacco are significantly associated with a lower risk of tobacco addiction. This can be a recommendation for the government to pay more attention to the above factors rather than overcoming stress levels in the population.

Authors: Jovian Philip Swatan, Sulistiawati, dan Azimatul Karimah
Details of this research can be viewed on:

Swatan JP, Sulistiawati S, Karimah A. (2020). Determinants of Tobacco Smoking Addiction in Rural Indonesian Communities. Journal of Environmental and Public Health, vol. 2020. doi:

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