Multilevel Analysis of the Biopsychosocial Determinants and Contextual Peer Groups on Smoking Habit in High School Students in East Lampung, Lampung, Indonesia

Abstract

Background: Smoking is still one of the great­est public health threats faced by citizens of the world. Data from the Central Statistics Agency in 2018 shows that smoking behavior in Lampung Province has a prevalence of 35.95%. The World Health Organization (WHO) states that smoking kills more than 8 million people per year worldwide. This study aimed to ana­lyze the determinants of adolescent smoking beha­vior at the individual level and at the school level. Subjects and Method: This was a cross sec­tional study conducted in East Lampung Re­gency, Indonesia, from October to November 2020. A number of 200 male adolescents were selected by random sampling. The dependent variable was smoking behavior. The indepen­dent variables were the influence of parents, peers, media exposure, pocket money, cigarette price, intention, attitude, and contextual effect of school. The data were collected by question­naire and analyzed using a multiple multilevel logistic regression with Stata 13. Results: The influence of family (b=2.88; 95% CI= 0.73 to 3.85; p= 0.004), peers (b= 2.85; 95% CI= 0.65 to 3.52; p= 0.004), media expo­sure (b= 3.04; 95% CI= 0.78 to 3.62; p= 0.002), money pocket (b= 3.22; 95% CI= 0.87 to 3.59; p= 0.001), cigarette price (b= 2.73; 95% CI= 0.54 to 3.28; p= 0.006), intention to smoke (b= 2.80; 95% CI= 0.69 to 3.95; p= 0.005), attitude toward smoking (b=3.83; 95% CI= 1.80 to 5.58; p<0.001) increased the likeli­hood to smoke in male adolescents. School had strong contextual effect on smoking in adoles­cents with ICC= 21.83%. Conclusion: The influence of family, peers, media exposure, money pocket, cigarette price, intention to smoke, attitude toward smoking increase the likelihood to smoke in male adolescents. School has strong contextual effect on smoking in adolescents Keywords: smoking behavior, adolescents, contextual effect of school Correspondence: Retno Sulistiani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: retnosulistiani91@gmail.com. Mobile: +6285867006699. Journal of Health Promotion and Behavior (2021), 06(01): 9-20 https://doi.org/10.26911/thejhpb.2021.06.01.02