Rural Indonesian adolescents' smoking behaviours during the COVID-19 pandemic: rapid survey and cotinine test of school-attend adolescents in Gunung Kidul, Yogyakarta.

The COVID-19 pandemic is predicted to affect adolescent smoking behaviours. We aim to map profiles of adolescents' smoking behaviours in a rural district in Indonesia during the COVID-19 pandemic and validate their smoking exposures using cotinine tests. This study applied an online survey followed by cotinine tests for high-school students in Gunung Kidul, Yogyakarta. The participants were asked to complete the survey and participate in a cotinine test. Univariate and multivariate regressions were performed to seek potential determinants of the smoking status and diagnostic accuracy of the cotinine test. A total of 281 participants completed the survey, with 19.6% (n = 55) and 22.8% (n = 64) being ever-smokers and current smokers. The impacts of the pandemics on their smoking behaviours were found in the urgency and numbers of daily smoked cigarettes. Univariate regression analysis revealed age, gender, learning mode, and whether father/friend smokes correlate with the adolescents' smoking behaviours. Multivariate regression analysis revealed that the odds of planning to stop smoking were 0.01 (95% CI 0.001-0.22, p-value 0.003) for having positive attitudes towards cigarettes compared to none. Of the 65 cotinine tests, 19 tested positive, with the sensitivity and specificity of the cotinine test at 94.7% and 95.6%. The prevalence of adolescent smoking during the COVID-19 pandemic in Gunung Kidul is high, with the impacts of the pandemic on the urgency and number of cigarette smoke. There are opportunities to help them stop smoking by providing reliable quit-tobacco access and advocacy in collaboration with schools, parents, and health providers.

Tobacco Use among School-Age Adolescents in Indonesia: Findings from the 2015 Indonesia Global School-Based Student Health Survey.

BACKGROUND: Although Indonesia has a considerable proportion of adolescent smokers, nationally representative studies of its determinants remain limited. The 2015 Indonesian Global School-Based Student Health Survey (GSHS) was conducted with school-age adolescents and provided information about smoking behavior. This study aimed to examine the prevalence, determinants, and correlates of tobacco use among adolescents in Indonesia using the GSHS survey. METHODS: A secondary data analysis of a cross-sectional study was conducted using data from the 2015 Indonesian GSHS. Multivariate logistic regression was used to assess the determinants and correlates of tobacco use. RESULTS: Our analysis showed that 9.1% of school-age adolescents had used tobacco products in the past 30 days. Most were 13-15 years (61.7%) and had attempted to stop smoking (92.4%). After adjusting for covariates, significant risk factors associated with tobacco smoking were older age groups (prevalence odds ratio [POR], 3.01-9.40; 95% confidence interval [CI], 1.71-23.1), male (POR, 13.7; 95% CI, 8.71-21.5), psychological distress (POR, 1.41; 95% CI, 1.05-1.90), smoking exposure (POR, 1.98-2.15; 95% CI, 1.35-3.42), and when both parents smoked (POR, 2.96; 95% CI, 1.78-4.94). In addition, tobacco use was associated with other risky behaviors, including sex with multiple partners, using drugs, drinking alcohol, and being involved in physical fights. CONCLUSION: Tobacco use is high among Indonesian adolescents. This prevalence highlights the need for a more stringent tobacco control policy and tailored cessation programs for adolescents by considering important modifiable determinants of tobacco use among adolescents, including risky smoking-related behaviors.

The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample.

BACKGROUND: Indonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia. METHODS: Secondary analyses were conducted of cross-sectional data from adults aged ≥ 40 years (n = 12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity. RESULTS: Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p < 0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p < 0.05) and work absenteeism (21% increase, P < 0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p < 0.05), being overweight was negatively associated with CHE incidences (50% decrease, p < 0.05). CONCLUSION: Combined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for individuals and the wider society in Indonesia.