DOI : https://doi.org/10.56338/mppki.v9i9.10123

Factors Associated with Screening-Defined Self-Reported Current Smoking among Senior High School Students in Semarang City

Dratia Eka Fajarani (1), Megah Andriany (2), Nur Setiawati Dewi (3), Vebby Amellia Edwin (4)
(1) Master of Nursing Program, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
(2) Department of Nursing, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
(3) Department of Nursing, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
(4) Department of Environmental Health, Poltekkes Kemenkes Padang, Padang, Indonesia
Fulltext View | Download
How to cite :
Fajarani, D. E., Andriany, M., Dewi, N. S., & Edwin, V. A. (2026). Factors Associated with Screening-Defined Self-Reported Current Smoking among Senior High School Students in Semarang City. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 9(9), 1753–1766. https://doi.org/10.56338/mppki.v9i9.10123
Citation Format :

Introduction: Adolescent smoking occurs within overlapping individual, interpersonal, school, and communication environments. Examining these domains together can show which associations persist after accounting for co-occurring measured exposures and can identify domains requiring closer surveillance and assessment in local health-promotion planning. This study examined factors associated with screening-defined self-reported current smoking among senior high school students in Semarang City.


Methods: This pooled cross-sectional secondary analysis included 8,230 unique senior high school students from routine school-based smoking screening conducted in 2023–2025. Before anonymisation and analysis, the research team performed data cleaning and cross-year record linkage using National Identification Number (NIK) and personal email address as the primary identifiers, with name and school used for additional verification when required, so that each student contributed only one observation. The outcome was screening-defined self-reported current smoking based on the routine screening question “Do you smoke?”, which did not specify a recall period; “yes, every day” and “yes, occasionally” were classified as current smoking. Population-averaged adjusted associations were estimated using generalised estimating equations with a binomial distribution and logit link, Puskesmas (community health centres) as the clustering unit (29 clusters), robust sandwich standard errors, all six prespecified explanatory variables, and screening year.


Results: Overall, 2,173 of 8,230 unique students (26.4%) met the screening definition of current smoking; the corresponding screening-defined prevalence was 25.6% in 2023, 26.9% in 2024, and 27.4% in 2025. After adjustment for all prespecified variables, screening year, and clustering within Puskesmas, higher odds were observed for male sex (aOR = 11.71; 95% CI: 8.89–15.45), reported observation of smoking at school (aOR = 1.37; 95% CI: 1.14–1.66), a family member at home who smoked (aOR = 1.97; 95% CI: 1.72–2.25), and reporting that many close friends smoked (aOR = 4.64; 95% CI: 4.01–5.36). The one-source category (aOR = 0.59; 95% CI: 0.40–0.86) and more than one source (aOR = 0.18; 95% CI: 0.13–0.26) were inversely associated with the outcome.


Conclusion: The observed adjusted associations identify measured school, household, peer, sex, and communication domains that warrant attention in local surveillance and further assessment, but they do not establish causal pathways or the effectiveness of any intervention. The inverse gradient for the number of smoking-related information sources should be treated as exploratory because message content, timing, frequency, intensity, and direction were not measured. Longitudinal studies using standardised smoking definitions and richer exposure measurement are needed.

  1. 1. World Health Organization. WHO tobacco trends report: 1 in 5 adults still addicted to tobacco. Geneva: 2025.
  2. 2. Reynolds LM, Faure P, Barik J. Adolescent nicotine exposure and persistent neurocircuitry changes: unveiling lifelong psychiatric risks. Mol Psychiatry 2025; 30:5534–45. https://doi.org/10.1038/s41380-025-03110-0 .
  3. 3. Badan Kebijakan Pembangunan Kesehatan. Indonesian Health Survey 2023 in numbers. Jakarta: 2024.
  4. 4. World Health Organization. Global Youth Tobacco Survey 2019 fact sheet. Geneva: 2020.
  5. 5. Putra A, Prasetya H, Murti B. Meta analysis: effects of peer, family, and school environment on smoking behavior in adolescents. Journal of Health Promotion and Behavior 2023; 8:316–28. https://doi.org/10.26911/thejhpb.2023.08.04.08.
  6. 6. Lin M, Chu M, Li X, Ma H, Fang Z, Mao L, Wang P, Chen T, Chiang Y-C. Factors influencing adolescent experimental and current smoking behaviors based on social cognitive theory: a cross-sectional study in Xiamen. Front Public Health 2023; 11:1093264. https://doi.org/10.3389/fpubh.2023.1093264.
  7. 7. Megatsari H, Astutik E, Gandeswari K, Sebayang SK, Nadhiroh SR, Martini S. Tobacco advertising, promotion, sponsorship and youth smoking behavior: the Indonesian 2019 Global Youth Tobacco Survey (GYTS). Tob Induc Dis 2023; 21:163. https://doi.org/10.18332/tid/174644.
  8. 8. Handayani S, Rachmani E, Saptorini KK, Manglapy YM, Nurjanah, Ahsan A, Kusuma D. Is youth smoking related to the density and proximity of outdoor tobacco advertising near schools? Evidence from Indonesia. Int J Environ Res Public Health 2021; 18:2556. https://doi.org/10.3390/ijerph18052556.
  9. 9. Rachmani E, Handayani S, Saptorini KK, Nurjanah, Kusuma D, Ahsan A, Kusuma EJ, Atique S, Jumanto J. Why do youths initiate to smoke? A data mining analysis on tobacco advertising, peer, and family factors for Indonesian youths. Computer Methods and Programs in Biomedicine Update 2024; 6:100168. https://doi.org/10.1016/j.cmpbup.2024.100168.
  10. 10. Saputri MSK, Mustofa SB, Lestantyo D. Meylida Analysis of determinant factors of smoking behavior in adolescents. Indonesian Journal of Global Health Research 2026; 8:1025–30. https://doi.org/10.37287/ijghr.v8i1.453.
  11. 11. De Waard A, Heris C, Barrett EM, Rickard E, Cohen R, Brinckley MM, Kennedy M, Calma T, Lyons L, O’Brien M, Thurber KA, Maddox R. Longitudinal study of indigenous children: adolescent never smoking and associations with individual, social, and environmental factors. Health Promot Int 2025;40: daaf022. https://doi.org/10.1093/heapro/daaf022.
  12. 12. Bigwanto M, Pénzes M, Kodriati N, Rachmawati E, Amalia N, Urbán R. E-cigarette use and susceptibility among Indonesian youth: the role of social environment, social media, and individual factors. BMC Public Health 2025; 25:2756. https://doi.org/10.1186/s12889-025-24013-3.
  13. 13. Roczen J, Bolte G, Reineke B, Kuhnert R, Starker A, Mena E. Gender equality and smoking among 15 to 25 year olds—a time-based ecological analysis of developments in Germany from 1960 to 2005. Front Public Health 2024; 12:1295050. https://doi.org/10.3389/fpubh.2024.1295050.
  14. 14. Seidenberg AB, Donovan EM, Liu M, Kreslake JM. E-cigarette use by female vs male high school students. Pediatrics 2024;154: e2024067767. https://doi.org/10.1542/peds.2024-067767.
  15. 15. Adebisi YA, Ogunkola IO, Alshahrani NZ, Jimoh ND, Ilesanmi OS. Determinants of knowledge of risks associated with cigarette smoking among adolescents in Scotland. Eur J Public Health 2025; 35:491–7. https://doi.org/10.1093/eurpub/ckaf024.
  16. 16. Xie J, Ma C, Yang H, Gong Z, Zhao M, Magnussen CG, Xi B. Proportions and trends of global adolescent knowledge and attitudes toward tobacco smoking from 1999 to 2019. Front Public Health 2025; 13:1546867. https://doi.org/10.3389/fpubh.2025.1546867.
  17. 17. Liu Y, Li L, Chen Z, Ren S, He R, Liang Y, Tan Y, Shao X, Chen S, Chen X, Tang J, Liao Y. Relationship between parental smoking and adolescent smoking: gender differences and mediation of resilience. BMC Public Health 2025; 25:434. https://doi.org/10.1186/s12889-025-21457-5.
  18. 18. DeLay D, Shen M, Cook RE, Zhao S, Logis H, French DC. Peers influence the tobacco and alcohol use of Chinese adolescents. J Res Adolesc 2023; 33:591–602. https://doi.org/10.1111/jora.12828.
  19. 19. Zhou A, Li X, Song Y, Hu B, Chen Y, Cui P, Li J. Academic performance and peer or parental tobacco use among non-smoking adolescents: influence of smoking interactions on intention to smoke. Int J Environ Res Public Health 2023; 20:1048. https://doi.org/10.3390/ijerph20021048.
  20. 20. Kim SY, Jang M, Yoo S, JeKarl J, Chung JY, Cho S Il. School-based tobacco control and smoking in adolescents: evidence from multilevel analyses. Int J Environ Res Public Health 2020; 17:3422. https://doi.org/10.3390/ijerph17103422.
  21. 21. Ba-Break M, Bewick BM, Elsey H, Huss R, Ensor T, Saleh M, Donnelly S, Osman DM. School-based smoking prevention strategies for adolescents in a conservative LMIC context: a qualitative study from Egypt. Front Public Health 2025; 13:1694729. https://doi.org/10.3389/fpubh.2025.1694729.
  22. 22. Slocum E, Xie Y, Colston DC, Emery S, Patrick ME, Thrasher JF, Elliott MR, Fleischer NL. Impact of the tips from former smokers anti-smoking media campaign on youth smoking behaviors and anti-tobacco attitudes. Nicotine and Tobacco Research 2022; 24:1927–36. https://doi.org/10.1093/ntr/ntac152.
  23. 23. Addo IY, Acquah E, Nyarko SH, Dickson KS, Boateng ENK, Ayebeng C. Exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among adolescents in Gambia. BMC Public Health 2024; 24:1041. https://doi.org/10.1186/s12889-024-18543-5.
  24. 24. Rifat MA, Orsini N, Qazi B, Galanti MR. Smoking prevention and cessation programs for children and adolescents focusing on parental involvement: a systematic review and meta-analysis. Journal of Adolescent Health 2025; 76:532–41. https://doi.org/10.1016/j.jadohealth.2024.10.032.
  25. 25 Hwang JH, Ryu DH, Park SW. Influence of school-based smoking prevention education on reducing gap in exposure to anti-tobacco media message among Korean adolescents. Int J Environ Res Public Health 2020; 17:8742. https://doi.org/10.3390/ijerph17238742.
  26. 26. Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/2015/2023 tentang Petunjuk Teknis Integrasi Pelayanan Kesehatan Primer. 2023.
  27. 27. Ismail R, Hassan SA, Shukor MS, Shafurdin NS, Hanafi N, Aljaberi MA, Lin CY, Griffiths MD. Prevalence, risk factors, and protective factors of tobacco use among school-going adolescents at drug-abuse hot-spots in Malaysia. Addictive Behaviors 2025; 171:108455. https://doi.org/10.1016/j.addbeh.2025.108455.
  28. 28. Chen T, Chen J, Wang MP, Cheung YTD, Lam TH, Ho SY. Smokefree home rules and susceptibility to cigarette and e-cigarette use in adolescents: the mediating role of attitudes. BMC Public Health 2025; 25:3665. https://doi.org/10.1186/s12889-025-24963-8.
  29. 29. Muangkote N, Wangchamhan AR, Wangkhamhan T. Exploring social and environmental factors contributing to smoking initiation among Thai adolescents using advanced feature selection techniques. Tob Prev Cessat 2025; 11:29. https://doi.org/10.18332/tpc/205065.
  30. 30. Sohn M, Moon D, Kim J. A longitudinal cohort study of adolescent social network positions and lifetime daily smoking and nicotine dependence. Youth Soc 2024; 56:217–38. https://doi.org/10.1177/0044118X231164742.
  31. 31. Khalil G, Ramirez E, Khan M, Zhao B, Ribeiro N, Balian P. Risk perception and knowledge following a social game-based tobacco prevention program for adolescents: pilot randomized comparative trial. JMIR Serious Games 2024;12: e63296. https://doi.org/10.2196/63296.

Downloads

Download data is not yet available.