Health Promotion Model Not Smoking among Adolescents: A Path Analysis Evidence from Indonesia

Sujono Riyadi


Smoking behavior is a threat to public health. This study identified factors that influence non-smoking behavior among adolescents. The aim is to determine the effect of media exposure, knowledge of the dangers of smoking, social capital, access to cigarettes among adolescents by using Theory of Planned Behavior (TPB).

This cross-sectional study was conducted in Kulon Progo Regency, Yogyakarta Province, Indonesia, in April - May 2018. The dependent variable is non-smoking behavior. Independent variables were intention to not smoke, attitude to smoking, knowledge of tobacco use, subjective norms of not smoking, control of perceived behaviors for not smoking, media exposure to cigarette advertising, access to cigarettes and social capital among teenagers. Data were collected by questionnaire and analyzed by path analysis carried out in Stata 13.

This study resulted in an attitude towards not smoking (b = 1,15; 95% CI = 0,55 to 1,75; p< 0,001), subjective norm for not smoking (b = 1,56; 95% CI = 0,96 to 2,16; p <0,001), and perceived behavioral control for not smoking (b = 1,99; 95% CI = 1,39 to 2,60; p <0,001), which affects the intention of not smoking, and finally on non-smoking behavior. Exposure to tobacco advertising has an indirect impact on non-smoking behavior through attitudes toward non-smoking (b = -0,82; 95% CI = -1,28 to -0,37; p< 0,001) and the intention not to smoke. This exposure to cigarette advertising also has an indirect impact on non-smoking behavior through low knowledge about smoking (b = -0,45; 95% CI = -0,47 to -0,03; p = 0,037). Weak social capital has an indirect impact on non-smoking behavior through subjective norms of smoking (b = 0,64; 95% CI = 0,25 to 1,05; p = 0,001) and the intention not to smoke. Knowledge about tobacco smoking (poor) impact on perceived behavior control not to smoke (b = 1,59; 95% CI = 1,15 to 2,03; p <0,001) and influential to attitude positive toward no smoking (b = 1,60; 95% CI = 1,16 to 2,05; p <0,001).

Health promotion model with Theory of Planned Behavior (TPB) can be used to explain not smoking behavior among adolescents.



not smoking; adolescents; access to cigarettes

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Kementrian Kesehatan Republik Indonesia. Riset Kesehatan Dasar. 2018.

Sophia MSK, Nuriwani AR, Ahmad I, Ruzilawati. Assessment of Smoking Behavior Among Malay Male Smokers in Kelantan, Malaysia. Asian Journal Pharmaceutical and Clinical Research. 2017; 10 (2): 222-226.

Doss DSS, Lakshmi A, Rekha K, Antony K A. Effect of Smoking on Heart Rate Variability in Normal Healthy Volunteers. Asian Journal Pharmaceutical and Clinical Research. 2016; 9 (4): 230-234.

Bangash NSA, Hashim N, Ismail NL. Smoking Status Affecting Survival of Adenocarcinoma Lung Cancer Patients in Kuala Lumpur, Malaysia. Asian Journal Pharmaceutical and Clinical Research. 2017; 10 (9): 312-313.

Pothu R, Shayeda, Yamsani MR. Development and In-Vitro Evaluation of Nicotine Troches for Smoking Cessation. Asian Journal Pharmaceutical and Clinical Research. 2014; 7 (2): 68-75.

Hoyle RH (ed.). Structural equation modeling. Thousand Oaks, CA: SAGE Publications, Inc. 1995.

Riyadi S, Murti B, Akhyar M & Suminah. Predicting Tobacco Smoking among Adolescents Using Social Capital and Media Exposure with Theory of Planned Behavior: Path Analysis Evidence from Indonesia. Global Journal of Health Science. 2019; 11 (7): 18-28.

StataCorp LLC. Structural equation modeling (SEM). StataCorp LLC. 2018.

Crow JF. Sewall Wright. 1889—1988. Washington DC: National Academy of Science. 1994.

Ayuningrum IK dan Murti B. Aplikasi Path Analysis dan Structural Equation Model dengan STATA. 2019. Surakarta. Program Studi Ilmu Kesehatan Masyarakat UNS.

Islamuddin H. Psikologi Pendidikan. 2012. Yogyakarta: Pustaka Pelajar.

Karimy M, Zareban I, Araban M and Montazeri A. An Extended Theory of Planned Behavior (TPB) Used to Predict Smoking Behavior Among a Sample of Iranian Medical Students. Int J High Risk Behaviour Addict. 2015 September; 4 (3): e24715.

Ardini RF & Hendriani W. Proses Berhenti Merokok Secara Mandiri pada Mantan Pecandu Rokok Dalam Usia Dewasa Awal. Jurnal Psikologi Pendidikan dan Perkembangan. 2012; 1 (2).

Xu X, Liu L, Sharma M, Zhao Y. Smoking-related knowledge, attitudes, behaviors, smoking cessation idea and education level among young adult male smokers in Chongqing, China. Int J Environ Res Public Health. 2015; 12 (2): 2135–2149.

Latimer AE, Sarin SK, Cavallo DA, Duhig A, Salovey P and O’Malley SA. Targeted Smoking Cessation Messages for Adolescents. Journal of Adolescent Health. 2012. Elsevier.

Su X, Li L, Griffiths SM, Gao Y, Lau JTF and Mo PKH. Smoking behaviors and intentions among adolescents in rural China: The application of the Theory of Planned Behavior and the role of social influence. Addictive Behaviors. 2015. Elsevier.

Goldade K, Choi K, Bernat DH, Klein EG, Okuyemi KS and Forster J. Multilevel predictors of smoking initiation among adolescents: Findings from the Minnesota Adolescent Community Cohort (MACC) study. Preventive Medicine. 2012. Elsevier.

Alanazi NH, Lee JW, Santos HD, Job JS, Bahjri K. The use of planned behavior theory in predicting cigarette smoking among Waterpipe smokers. Tobacco Induced Diseases. 2017; 15: 29.

Lin YS, Wu DM, Lai HR, Shi ZP, Chu NF. Influence of knowledge and attitudes on smoking habits among young military conscripts in Taiwan. J Chin Med Assoc. 2010; 73(8): 411–418.

English LM, Hsia J and Malarsher A. Tobacco advertising, promotion, and sponsorship (TAPS) exposure, anti-TAPS policies, and students' smoking behavior in Botswana and South Africa. Preventive Medicine. 2016. Elsevier.

Do YK and Shin E. Bidirectional relationship between time preference and adolescent smoking and alcohol use: Evidence from longitudinal data. Addictive Behaviors. 2017. Elsevier.

Lindstrom M, Giordano GN. Changes in social capital and cigarette smoking behavior over time: a population-based panel study of temporal relationships. Nicotine & Tobacco Research, 2016; 18(11): 2106–2114.

Arun J, Srikant N, Suman E, Shenoy A, Baliga S. Effect of Tobacco Extract on Streptococcus Mutans: Possible Role in Modulating Carcinogenesis. Asian Journal Pharmaceutical and Clinical Research. 2018; 11 (7): 398-401

Levin KA, Dundas R, Miller M and McCartney G. Socioeconomic and geographic inequalities in adolescent smoking: A multilevel cross-sectional study of 15year olds in Scotland. Social Science & Medicine. 2014. Elsevier.

Wilson LM, Tang EA, Chander G, Hutton HE, Odelola OA, Elf JL, Stoddard BMH, Bass EB, Little EA, Haberl EB and Apelberg BJ. Impact of Tobacco Control Interventions on Smoking Initiation, Cessation, and Prevalence: A Systematic Review. Journal of Environmental and Public Health. 2012.



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