Determinants of Smoking Behavior in Junior High School (Sekolah Menengah Pertama) at Kabanjahe District

Frida Lina Br Tarigan1*, Santhna Letchmi Panduragan2, Faridah Mohd Said3, Mido Ester Sitorus4, Nurcahaya Nainggolan5

1,4Sari Mutiara Indonesia University, Sumatera Utara 20124, Indonesia

2,3,5Lincoln University College, 47301 Petaling Jaya, Selangor, Malaysia

*Corresponding Author’s Email: frida_tarigan@yahoo.co.id

ABSTRACT

Introduction: The age of smokers in Indonesia is now getting younger; it has even touched the age of children. The prevalence of smoking among school-aged adolescents, or those aged 10–18 years, has increased by 9.1%. An initial survey in several junior high schools in Kabanjahe District showed that many students smoked in several shops around the school after returning from school. This study aims to determine the determinants of smoking behavior in junior high school students in Kabanjahe District.

Methods: The type of research used is qualitative research with a phenomenological design. Data collection was carried out through in-depth interviews. The determination of informants used the purposive sampling method and obtained as many as four informants.

Results: According to the findings of this study, the determinants of smoking behaviour in adolescents are their peers who invite them to smoke, factors associated with parents who do not supervise and even smoke in front of their children, and advertising factors in the mass media that involve attractive and good-looking models. The living environment contributes to adolescent smoking behavior, as does the Karo cultural factor, where cigarettes are one of the important ingredients in every traditional event in the Karo Community.

Conclusion: The school should be able to provide efforts to prevent smoking behavior with training involving peer counselling by utilizing outstanding teenagers as peer educators in an effort to keep children away from the influence of smoking.

Keywords: Adolescent Smoking Behavior; Peers; Parenting; Advertising; Culture

INTRODUCTION

Smoking behavior is an action taken by a person related to the burning of tobacco and the inhalation of a substance. Smoking behavior has many factors or determinants and includes various things, for example, the act of choosing the actual smoking, smoking style, depth of inhalation, and the rate and frequency of smoking. In the government program of the Republic of Indonesia known as PHBS (Clean and Healthy Living Behavior), one of the indicators is the behavior of not smoking. Lessons for behavior should be given when children are at an early age; this is based on the belief that an early age, or the “golden age”, is the main foundation for the development of children's behavior (Pinilih & Margowati, 2016). The existence of various good experiences in children at this age will have an impact on the life of the next child. Smoking behavior in various studies is suspected to cause various diseases, namely those who conducted research at the Bali Sanglah Hospital were pulmonary TB disease as many as 46 cases (76.1%), COPD there were 16 cases (81.3%), pneumonia there were 9 cases (55.6%), and asthma there were 12 cases (41.7%) (Riyadi & Handayani, 2021)

Smoking has a very negative effect on minors, both from the physiological and psychological aspects (Johnston et al., 2012). Smoking can also affect child’s level of intelligence. A child who is proven to smoke will have a lower level of intelligence than a child who does not smoke. This has become serious considering the increasing number of cigarette advertisements, which have become the gateway to targeting young people, especially children (Lewerissa, Tarigan, & Hidayat, 2021).

The age of smokers in Indonesia is now getting younger; it has even touched the age of children. This condition causes Indonesia to be called the only country in the world with baby smokers or child smokers. The prevalence of smoking in school-age adolescents, or those aged 10-18 years, has increased by 9.1% (Riskesdas , 2018)

An initial survey in several junior high schools in Kabanjahe District showed that many students smoked in several shops around the school after returning from school. The results of interviews with three counselors in junior high schools found that some students who smoked secretly had decreased academic achievement and high absenteeism rates. Some students also stated that the reason they smoked was to join friends and not know the impact of tobacco on health.

METHODOLOGY

This study uses qualitative research methods based on phenomenological studies. Abdussamad & SIK, (2021). In this case, what will be studied is smoking behavior among junior high school students in Kabanjahe District. The informants in this study were five state high school students, community leaders, and school principals. The technique used in determining informants is purposive sampling. Data collection techniques were carried out through observation, in-depth interviews, and literature study.

Ethical Consideration

This research was approved by the Ethics Committee of Sari Mutiara Indonesia University with no No.1138/F/KEP/USM/IX/2021 dated September 8, 2021.

RESULTS

Based on the results of interviews with five (5) State Junior High School students in Kabanjahe District, the factors that influence students to smoke are as follows: the influence of friends, the influence of parents, the influence of advertising, and Karo culture.

Table 1: Analysis of Factors Associated with Adolescent Smoking Behavior

DISCUSSION

In the discussion section, the researcher will describe the results of the research that has been carried out in an effort to answer the problems that have been disclosed.

Student Smoking Factors Friends Influence

Families do have a hand in shaping behavior in children, but without us realizing it, peers have an even greater influence. (Siregar et al., 2021) In peer associations, there are several norms in the association that "force" its members (adolescents) to carry out certain activities or certain attributes to be accepted and recognized in the group. (Cunha et al., 2019) Often smoking is one of the media to be accepted and considered in a community. For teenagers or potential members of the community who do not smoke, they will be considered "stupid" or other names that make the teenager feel inferior. Only individuals who have high social skills and a strong identity do not need cigarettes and other media to mingle and be accepted by the group. (Huang et al., 2014).

Smoking tobacco is one of the main risk factors for oral cancer. (Pal et al., 2019) Smoking is currently considered a form of juvenile delinquency, but this is considered normal by some people. This is because most of the people (men) are also smokers, and smoking is done anywhere, both at home and in other public places. Many factors affect adolescent smoking, but the biggest factor is the environment. The environment is where they spend most of their time, where they learn, imitate, and practice all the experiences they have gained.

Playmates, who are the biggest contributors to this influence member, can be positive or negative influences. One of the negative influences influenced by friends is smoking. A sense of solidarity, as a participant, the fear of not being accepted in the community, or a sense of respect for friends are the reasons for teenagers to try smoking, and the results of trying can result in addiction. The results of the study generally show that students learn to smoke because they are influenced by friends. (Among adolescent smokers, 87% had at least one or more friends who smoked, as did adolescent nonsmokers).

Parental Influence

Parents are also very involved in causing students to smoke. Basically, children are good examples of what their parents do; he will easily follow what he sees. Parents who smoke at home will usually see their children becoming smokers. (Wilkinson, Shete, & Prokhorov, 2008).The results of this study indicate that the second factor that causes students to smoke is due to the influence of their parents. The attitude of parents who are less concerned about the behavior of their children makes them more free to smoke. Parents sometimes don't realize that their child has started to learn to smoke, so when the child becomes addicted, it will be very difficult to stop. Another very concerning attitude of parents is that they even ask their children to buy cigarettes, so that the shop owners can no longer distinguish which cigarettes will be consumed by children, which are actually for their parents. Families that are not harmonious are also very possible for teenagers to vent their disappointment on cigarettes. Smoking is thought to make them forget their problems, so they continue to do it until it becomes an addiction for them.

One of the findings about adolescent smoking is that young people who come from unhappy households, where parents pay little attention to their children and inflict harsh corporal punishment are more likely to become smokers than young people who do not. comes from a happy home environment.

Advertising Effect

The results also show that cigarette advertisements contribute to causing students to smoke. These ads usually appear on TV or on billboards that can be found anywhere around them. Even many billboards are close to their school environment (Bastonus & Herieningsih, 2017). Attractive advertisements become an attraction to ensnare new smokers, such as junior high and high school teenagers. Many teenagers are influenced by cigarette advertisements because the model looks very charming (Huang et al., 2014). Models appearing in cigarette advertisements seem to represent real men and ideals for women, giving the impression that smokers are real men. The attractiveness of the cigarette advertisements found on television and the large billboards installed on strategic streets are appealing enough to make everyone pay attention to them. Even though there are strong warnings on cigarette packages and advertisements that "smoking kills you," this is not a reason for smokers to stop smoking. There is even justification for smokers if they are reminded of the dangers of smoking that the danger only applies to those who already have a congenital disease.

Smoking culture in Karo people.

Cigarettes (sap: in Karo) are one of the important ingredients in every traditional event in the Karo people. At happy and sad events, rituals, and other traditional events, there are always cigarettes (for men) and Belo or betel leaves (for women). Before the event, usually the owner of the event has prepared cigarettes and betel leaves. There is a language that is often mentioned in starting events in the Karo community: "dudurkenlebe suck ndu, then bancisibenaipercepatenta" (give me your cigarette first, so we can start our conversation). This shows that there will not be any discussion if there are no cigarettes given, so the presence of cigarettes is very important in events in the Karo Community. The importance of the bargaining position of the existence of cigarettes finally gives the impression that cigarettes are not something that is harmful or dangerous.

The above fact is one of the reasons why children finally become more daring to try smoking or are interested in trying cigarettes. Children's daily lives are surrounded by smoking activities where cigarettes are not dangerous goods. When they participate in traditional events or other events in the Karo community, they are free to see how cigarettes play a role in society. In the neighborhood and even in the family, they see adults smoking freely. Although there have been many government recommendations about the dangers of smoking, it does not have a fearful effect on children who are getting to know about or start trying smoking.

Student Smoking Prevention Efforts

Based on the results of this study, it can be said that the school (principals and teachers) have provided guidance to students who smoke, actions and directions to overcome smoking in adolescents, especially schools at Kabanjahe State Junior High School, the smoking ban has become a school rule but there are still those who smoke because At the age of teenagers curiosity and group friends are very influential. on the school side, at the beginning of the year, they must emphasize school rules, especially the prohibition on smoking. The school also invites resource persons from the health office to provide counseling or socialization about health, especially the dangers of smoking.

The teacher will also call students who are caught smoking for guidance, and this is done by all teachers. If necessary the teacher will give punishment, such as cleaning the toilet, and other punishments that are educational to the student because smoking is a violation. The main thing that teachers do is provide students with the widest possible information about smoking. Furthermore, the teacher invites school residents to create a smoke-free environment by attaching anti-smoking slogans, instructing the prohibition of smoking in the school yard, which is very effective in preventing students from smoking by setting an example for that the teacher never smokes in front of students, and providing special material about the bad effects of smoking.

Increasing students' understanding of the dangers of smoking is very urgent to do to change students' smoking behavior. Besides that, the teacher invites students to do reforestation in the school garden so that the environment becomes cool and comfortable, and the students realize how important it is to maintain health. Teachers take steps to call students who are caught smoking for advice, punish smoking students because it is considered a violation, and provide guidance. The teacher held anti-smoking socialization and carried out reforestation in the school garden, invited spiritual teachers, and held communication with the guardians of students.

CONCLUSION

Based on the results of the research described above, the researchers concluded that students started smoking due to environmental incentives. For example, students feel they will not be accepted by their friends because they do not smoke. Students are firm not to smoke or indeed will stop smoking is very necessary to support efforts to quit smoking, with sufficient understanding of the various negative effects of smoking on health, will increase confidence and self-motivation to keep trying to stop smoking.

There have been several efforts made by the school to prevent student smoking behavior, such as providing information about smoking to students, collaborating with the health department, inviting spiritual teachers, and giving punishment to students who smoke. The preventive approach is an approach that is directed at anticipating common individual problems and preventing these problems from happening to individuals. The supervisor makes several efforts, such as providing information and skills, to prevent these problems.

Conflict of Interest

The authors declare that they have no conflict of interests.

ACKNOWLEDGMENT

Authors are thankful to Sari Mutiara Indonesia University and Lincoln University College for academic support.

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