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FACTORS RELATED TO SMOKING BEHAVIOR IN HIGH SCHOOL ADOLESCENTS IN AL-HASRA IN 2022
1Karimah Azzahra, 2Andriyani
Public Health Study Program, Faculty of Public Health, Universitas Muhammadiyah Jakarta K.H. Ahmad Dahlan St., Cireundeu, East Ciputat. South Tangerang, 15419
Email: karimah.azhr@gmail.com
ABSTRACT
Smoking behavior is widespread among teenagers and adults. This study examines factors associated with smoking behavior in adolescents at SMA AL-Hasra. The research design used is a quantitative method with a cross-sectional approach with a sample of 123 respondents. The sampling technique used in this study is total sampling with the Chi-Square test to see a relationship. The study showed that 43.1% of adolescents had smoking behavior. with the results of the P-Value statistical test p 0.000 in the knowledge category, p 0.003 in the attitude category, p 0.043 in the parental influence category, and p 0.000 in the influence category friend. It can be concluded that the analysis results show a significant relationship between respondents' knowledge , attitudes to respondents, the influence of respondents parents and the influence of peers a significant relationship on knowledge, attitudes, parental influence, and peer influence with smoking behavior in AL-Hasra Senior High school.
Keywords: Behavior, Adolescent, Smoking
ABSTRAK
Perilaku merokok adalah hal yang sangat biasa dilakukan kalangan remaja dan orang dewasa. Penelitian ini bertujuan mengkaji tentang faktor-faktor apa saja yang berhubungan dengan perilaku merokok pada remaja SMA AL-Hasra. Desain penelitian yang digunakan adalah metode kuantitatif dengan pendekatan cross sectional dengan jumlah sampel 123 responden.Teknik sampling yang di gunakan dalam penelitian ini adalah Total sampling dengan uji Chi-Square untuk melihat adanya hubungan.
Hasil penelitian menunjukan bahwa 43,1% remaja memiliki perilaku merokok dengan hasil uji statistik P-Value 0,000 pada kategori pengetahuan, p-Value 0,003 kategori sikap, p-Value 0,043 kategori pengaruh orang tua, dan p-Value 0,000 kategori pengaruh teman. Dapat disimpulkan bahwa terdapat hubungan yang bermakna antara faktor yang berhubungan dengan pengetahuan, sikap, pengaruh orangtua dan pengarauh teman sebaya dengan perilaku merokok pada remaja SMA AL-Hasra.
Kata Kunci: Perilaku, Remaja, Merokok.
INTRODUCTION
Smoking behavior is widespread among adults and teenagers. This refers to the number of cigarette users increasing yearly. The World Health Organization (WHO) states that in 2020 there will be a decrease in the number of cases of consuming cigarettes by around 1.30 billion from 1.32 billion two years ago. WHO estimates it will decrease to 1.27 billion people by 2025 (Anggela, 2020). The most male smokers in the West Pacific are 377 million people aged 15-24, at 14.2%. (Rizaty, 2021).
WHO also states that 38 million adolescents aged 13-15 are consuming cigarettes. The World Health Organization (WHO) survey in 2015 showed that 57% of Asian and Australian people consume cigarettes. In addition, 14% of Eastern Europeans and fractions of the Soviet Union, 12% of Americans, 9% of Western Europeans, and 8% of Middle Easterners. WHO also states that 10% of all smokers in the world and 20% of global deaths are due to smoking in countries in ASEAN. (Mirnawati et al., 2018)
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The Central Disease Control (CDC) page states that smoking is the leading cause of death in the United States, with more than 480,000 deaths yearly. In 2019, it showed that 14 out of 100 U.S.
Adults aged 18 currently smoked, of which approximately 34.1 million adults in the U.S. currently smoke. By gender, 15 out of every 100 adult men and 13 out of every adolescent woman. The CDC also states that the proportion of smokers who have quit has increased again (Cornelius et al., 2020).
The increasing number of teenagers who smoked cigarettes in 2019, the results of an analysis from the UNICEF organization stated that 35.5% of men smoked cigarettes with an age range of 13-15 years.
The gain in the attitude category of teenage boys is 16.3% because smoking can help comfort in social events. (UNICEF 2021)
Indonesia has the highest prevalence of smokers in ASEAN, which is more than 50% (Drope et al.
2018), so Indonesia is ranked 3rd in the category of smokers, with the highest number of 58 million men who consume cigarettes. The latest analysis from the University of Washington in the United States published the Global Disease Burden Study on smoking trends in 1990-2019 in 204 countries, the prevalence of smokers worldwide continues to increase by around 1.14 billion and smoking cigarettes cause 7.69 million deaths. (Simanjuntak, 2021).
Based on 2019 data, 38.3% of male students consume cigarettes (Global Youth Tobacco Survey 2020). The Central Statistics Agency (BPS) in 2020 reported that there were 23.21% of the population aged five years and over already consuming cigarettes, while in rural areas, it recorded that 24.36% of the population old five years and over had destroyed cigarettes, and 22.30 % in urban areas (BPS 2020).
The results of the research description from (Gobel et al. 2020) state that in the 15-year age category, namely 28.6%, 22.9% 16 years, 31.4% 17 years, 8.6% 18 years, 8.6% aged 19-year-old teenage boy who consumes cigarettes in interviews and the results of community service observations. According to (Damang, Syakur, and Andriani 2019), stated the reason for Depok adolescents who smoked was because they saw their peers consuming cigarettes namely 28.43%, the influence of parents 9.8%, relieving stress 3.92% and never getting a piece of information about the dangers of smoking 10.79%.
Based on the data described enviously, the higher a person's level of knowledge and an instant lifestyle, the more early and late teens consume cigarettes, both experimenting and dependent. Therefore, the problem of increasing smoking behavior in adolescents needs to be considered. Because adolescents are the next generation of the nation, based on this description, the researcher is interested in researching factors related to the smoking behavior of AL-Hasra senior High School adolescents.
METHOD
This study examines factors associated with smoking behavior in adolescents at SMA AL- Hasra. The research design used is a quantitative method with a cross-sectional approach where all related components are collected during the research to see a portrait of the condition of individual
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characteristics (knowledge, attitudes, peer influence, and parental influence). Primary data in this study were obtained from direct observations using google that will give to high school teenagers in Al-Hasra.
RESULTS AND DISCUSSION
Based on table 1. the category of class variables, it found that there were more respondents from class X with a score of 52 (42.3%) than those from classes XI and XII. The results showed more respondents in the 16-year age category for the age variable category. Namely, 38 respondents (30.9%) compared to 19 years old respondents, only one respondent (0.8%). In the category of smoking behavior variables, 53 respondents (43.1%) smoked, and 70 respondents (56.9%) did not smoke.
Table.1 Frequency Distribution of Smoking Behavior, Age, Class, Knowledge, Attitude, the Influence of Parents, the Influence of Friends on Adolescents at SMA AL-Hasra
The results obtained from the smoking knowledge variable were 73 (59.3%) respondents with poor knowledge and 50 (40.7%) with good knowledge. The smoking attitude variable category resulted in 94 (76.4%) respondents with a bad attitude and 29 (23.6%) with a good attitude. The variable category of parental influence obtained more significant results, namely 109 respondents (88.6%) said there was an influence from parents on adolescent smoking behavior, and in the variable category of peer influence, the results obtained were more significant than 63 respondents (51.2%) were affected than friends of peer to adolescent smoking behavior.
Variable Frekuensi ( n) Percentage ( %)
Class
X 52 42,3%
XI 29 23,6%
XII 42 34,1%
Age
15 31 25,2 %
16 38 30,9 %
17 29 23,6 %
18 24 19,5 %
19 1 0,8 %
Smoking behavior
Smoke 53 43,1 %
Not smoke 70 56,9 %
Knowledge
Not good 73 59,3%
Good 50 40,7%
Behavior
Not good 94 76,4%
Good 29 23,6%
Parental influence
There is 109 88,6 %
There is not 14 11,41 %
Friends influence
There is 63 51,2 %
There is not 60 48,8 %
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Based on table 2. The study’s knowledge and smoking behavior in AL-Hasra High School adolescents showed 12 teenagers (22.6%) with poor knowledge categories. In contrast, adolescents with good knowledge obtained 41 (77.4%). Based on the Chi-square test analysis obtained with a P-Value of 0.000, it can conclude that there is a relationship between the knowledge of AL-Hasra High School adolescents and smoking behavior. The analysis result also obtained an OR value of 0.043, meaning that adolescents with poor knowledge have a higher chance of having 4.12% smoking than adolescents with good behavior.
Table. 2 The Results of the Bivariate Analysis of Smoking Behavior with Knowledge, Attitudes, Parental Influence, and Peer Influence
Variable
Smoking Behavior
Total OR
P-Value Smoke Not Smoke
N % N % N % Knowledge
0,04 0,000
Not good 12 22,6 61 87,1 73 59,3
Good 41 77,4 9 12,9 50 40,7
Behavior
0,24 0,003
Not good 33 62,3 61 87,1 94 76,4
Good 20 37,7 9 12,9 29 23,6
Parental influence
5,27 0,043
There is 51 96,2 58 82,9 109 88,6
There is not 2 3,8 12 17,1 14 11,4 Friends influence
7,45 0,000
There is 41 77,4 22 68,6 63 51,2
There is not 12 22,6 48 31,4 60 48,8
The study’s result on attitudes and smoking behavior in AL-Hasra High School showed 33 teenagers (62.3%) with poor attitude categories. At the same time, teenagers with a good attitude obtained the results of 20 teenagers (37.7%) results. Based on the Chi-square test analysis obtained with a P-Value of 0.003, it can be concluded that there is a relationship between the attitudes of AL-Hasra High School teenagers and smoking behavior. The analysis’s result also obtained an OR value of 0.243, meaning that adolescents with a terrible attitude have a higher chance of smoking, 19.54%, than those with good behavior.
The results of the study on the influence of parents and smoking behavior in AL-Hasra High School teenagers showed that there were 51 teenagers (96.2%) in the category of parental influence.
In comparison, the results of 2 teenagers (3.8%) obtained no impact. Based on the Chi-square test analysis obtained with a P-Value of 0.043, there is a relationship between the influence of parents on teenagers at SMA AL-Hasra and smoking behavior. Analysis results also got an OR value of 5.27, meaning that influential adolescents have a higher chance of smoking at 84.06% compared to the absence of influence from parents on smoking behavior.
The results of the study on the influence of peers on smoking behavior in AL-Hasra High School adolescents showed that there were 41 adolescents (77.4%) with the category of peer influence on
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smoking behavior in adolescents. In contrast, the type of no peer influence with smoking behavior obtained the results of 12 adolescents (22.6%). Based on the Chi-square test analysis obtained with a P-Value of 0.000, it can be concluded that there is a relationship between the influence of peers on adolescents at SMA AL-Hasra with smoking behavior. The results of the analysis also obtained an OR value of 7.455, meaning that adolescents whose peers influence have a higher chance of smoking, 88.17%, than those who are not affected by their peer's smoking behavior.
Based on the research results from 123 respondents, 12 teenagers (22.6%) with poor knowledge categories. Meanwhile, teenagers have good knowledge are 41 teenagers (77.4%). Based on the Chi- square test analysis obtained with a P-Value of 0.000 or P-value <0.05, it can be concluded that there is a relationship between the knowledge of AL-Hasra High School adolescents and smoking behavior.
The analysis also obtained an OR value of 0.043 (95% CI 0.017-0.112), meaning that adolescents with poor knowledge have a higher chance of smoking by 4.12% than adolescents with good behavior. This study’s result aligns with research conducted by Zainul et al. in 2020 at SMA Negeri Tanjungsari that adolescents with poor knowledge obtained the results of 15 respondents (93.8%) compared to adolescents with good knowledge, namely 39 (62.9 %).
Statistical test results were obtained with a P-Value of 0.017 or <0.005, which means there is a significant relationship between knowledge and smoking behavior (Umari et al., 2020). Another study from Ati & Eyet in 2015 obtained a P-Value of 0.00 or <0.05.
A significant relationship between the knowledge of high school youth and smoking behavior.
(Rochayati and Hidayat 2015). Notoatmodjo (2012) states that knowledge is the result of knowing and often occurs after someone senses a particular object, while in the 2014 KBBI (Extensive Indonesian dictionary) dictionary, knowledge is something that can be concluded which is related to a learning process ( Agus, 2013). From the two descriptions above, knowledge results from knowing after someone does a specific object through their senses.
Based on the research results from 123 respondents, it is known that there are 33 teenagers (62.3%) with a lousy attitude category. In contrast, teenagers with a good attitude obtained the results of 20 teenagers (37.7%). Based on the Chi-square test analysis obtained with P-Value 0.003 or P-Value
<0.05, it can be concluded that there is a relationship between the attitudes of AL-Hasra High School teenagers and smoking behavior. Analysis results also obtained an OR value of 0.243 (95% CI 0.100 - 0.595), meaning that adolescents with bad attitudes have a higher chance of smoking, 19.54%, than those with good behavior. These studies align with previous research from Gani et al. in 2021 that the attitude P-Value is 0.002 or P-Value <0.005, which means that there is a relationship between attitude and smoking behavior in adolescents (Istyanto and Maghfiroh 2021). Other studies also state that the results of statistical test analysis obtained a p-Value of 0.025 or P-Value <0.05, which means a relationship between attitude and smoking behavior. (Handayani 2019).
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Bruno stated that attitude is a view or a relatively permanent tendency to react in a good or wrong way to a confident person or thing. (Syah Muhibbin, 2011) Meanwhile, according to Berkowitz, attitude is a feeling that supports or can take sides or not support or not take sides with a particular object. Other experts, according to Chave (1928), Bogardus (1931), and Lapierre (1934), stated that attitude is a kind of readiness to react to a type of object (Azwari, 2016). From the three descriptions above, it can be concluded that attitude is a person's readiness to imply an action or movement based on their convictions and beliefs.
Analysis results of this study from 123 respondents known, 51 teenagers (96.2%) with the category of influence from parents. At the same time, the class that does not have an effect is obtained by two teenagers (3.8%). Based on the Chi-square test analysis obtained with a P-Value of 0.043 or P- Value <0.05, it can be concluded that there is a relationship between the influence of parents on adolescents at SMA AL-Hasra with smoking behavior. Analysis results also obtained an OR value of 5.276 (95% CI 1.127 - 24.696), meaning that affected adolescents have a higher chance of smoking, 84.06%, compared to the absence of influence from parents on smoking behavior. Research conducted by Mellia & Putri in 2019, in line with this study, obtained a bivariate analysis with a P-Value of 0.039 or P-Value <0.05, which means that there is a significant relationship between the influence of parents and smoking behavior in adolescents (Fransiska and Firdaus 2019 ). The results of another study by Iceu et al. in 2014, which obtained a P-Value value of 0.043 or p <0.05, can be concluded that there is a relationship between the influence of parents and smoking behavior in adolescents (Yaslina and Amyuriani 2014).
(Baer & Corado in 2007) stated that the influence of parents on children is huge because parents are examples to be imitated by their children. If the parents are smokers, their children do not rule out the possibility of following or imitating their parents. (Program et al. 2017), while Ngalim Purwanto (2009) argues that parents play a prominent and very influential role. In their children, parents are also true educators for their children. The results of the description conclude that the part of parents greatly influences the mindset and actions of their children in the future. Suppose the role of the parents produces a positive step. In that case, the child will also set an example or implement it in themselves well or vice versa if the role If the parent gives a negative example.
Based on the research results from 123 respondents, it is known that peers influence 41 adolescents (77.4%) on smoking behavior in adolescents. The sort that does not have peer influence on smoking behavior is 12 teenagers (22.6%). Based on the analysis of the Chi-square test obtained with a P-Value of 0.000 or P-Value <0.05, it can be concluded that there is a relationship between the influence of peers on teenagers in SMA AL-Hasra and smoking behavior. The analysis results also obtained an OR value of 7,455 (95% CI 3,291 - 16,885), meaning that affected adolescents had a higher chance of smoking, 88.17%, compared to adolescents whose peers did not influence smoking behavior. Dwi
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Riya's research in 2018 is in line with this study, that the P-Value value of 0.000 or P <0.05 can be concluded that there is a relationship between peer influence and smoking behavior in adolescents (Riya et al., 2018). In another study by Hastin et al. (2019) that the results obtained a P-Value of 0.022 or P
<0.05, which means that there is a significant relationship between peer influence and smoking behavior in adolescents (Anggraeni, 2019). adolescents usually influence one of their peers, so they can do things that are not good, one of which is smoking behavior (Wulan, 2017). Refers to reinforced by (Poltekes Ministry of Health, 2010) that if a group member has smoking behavior, adolescents will affect by joining the group. Santrock (2011) states that the role of peers is influential in the form of a child's social development process, such as friends, physical support, and ego support, while, according to Yusuf (2010), peers can also provide opportunities to interact, control social behavior and exchange ideas. Based on this description, it can be said that peers also have a significant role in children’s social behavior development (Budi Kuncoro,2017).
CONCLUSIONS AND SUGGESTIONS
Based on the research findings that have been discussed in AL-Hasra High School adolescents regarding the factors related to smoking behavior from December 2021 to January 2022, it concluded that there are 53 respondents (43.1%) who smoke and 70 respondents (56, 9%) who did not smoke in the age category of 16 years are 38 respondents (30.9%) more than respondents in the age category of 19 years, only one respondent (0.8%). The statistical analysis results show a significant relationship between respondents' knowledge with a P-Value of 0.000. Attitudes to respondents with a P-Value of 0.003. The influence of respondents' parents with a P-Value value of 0.043 and the influence of peers with a P-Value value of 0.000 or P value <0.05.
Based on the conclusions that have been described previously, the researchers can provide the following suggestions: As the next generation, teenagers should be selective in choosing friendships to avoid dependence on cigarettes and not assume that cigarettes be used as friends in every difficulty. It is recommended that teenagers, both early and late, get used to managing a healthy lifestyle. They should have to choose friends and an excellent social environment so that teenagers can invite each other not to smoke and don't think that smoking is a form of loyalty between friends. The school should provide counseling, seminars, or talk shows every 3-6 months about the dangers of smoking and the application of a clean and healthy lifestyle. So, through these activities, it is hoped that teenagers can increase more profound knowledge regarding the dangers of smoking. Hopefully, this research can be used as a stepping stone to conducting further or deeper research on factors related to smoking behavior in adolescents.
255 ACKNOWLEDGMENT
In writing this journal, there are not a few obstacles experienced by researchers in solving them, but of the guidance, direction, and assistance from various parties, both moral and material, these obstacles are not too significant and can be overcome, the author expresses his deepest gratitude to the academic community. FKM UMJ, supervisors, parents, and research friends have helped a lot in writing this journal, both morally and materially.
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