Indonesian Family Life Survey Research Articles

Association between long-term PM2.5 exposure and mortality on Sumatra Island: Indonesian Family Life Survey (IFLS) 2000-2014.

The concentration of PM2.5 (particulate matter with a diameter < 2.5µm) on Sumatra Island has increased, mainly because of forest and peatland fires, transportation, and industry. Biomass burning releases partially burned carbon into the atmosphere, resulting in a smoky haze containing PM2.5. Air quality has deteriorated quickly, and PM2.5 has become a major health hazard in Indonesia. Studies on long-term exposure to PM2.5 have indicated its associations with both morbidity and mortality. Here, we measured long-term (2000-2014) exposure to PM2.5 on the basis of satellite-derived aerosol optical depth measurements (1 × 1 km2) used to predict ground-level PM2.5 concentrations. Additionally, population data on Sumatra Island residents from the fourth wave of the Indonesian Family Life Survey (IFLS) were obtained. We investigated the association between long-term PM2.5 exposure and mortality with a retrospective cohort study design. A total of 2409 subjects aged ≥ 40years participated in the IFLS-3 beginning in November 2000, and we examined mortality outcomes until the IFLS-5 in September 2014. We used Cox regression models to calculate hazard ratios (HRs) of mortality associated with PM2.5 exposure. According to the adjusted model, the mortality HRs per 10µg/m3 increase in PM2.5 concentration were 1.10 (95% CI 1.03, 1.17) for all natural causes, 1.17 (95% CI 1.05, 1.25) for cardiovascular causes, and 1.19 (95% CI 1.04, 1.36) for respiratory causes. Long-term exposure to PM2.5 was associated with all-natural, cardiovascular, and respiratory mortality on Sumatra Island, where PM2.5 levels exceed the WHO and US-EPA air quality standards.

Sleep quality and cognitive function on self-rated health status among the elderly: Findings from the Indonesian family life survey (IFLS-5)

Sleep quality and cognitive function on self-rated health status among the elderly: Findings from the Indonesian family life survey (IFLS-5)

Recurrent Flooding and Household Food Access in Central Java, Indonesia.

It is unknown how recurring flooding impacts household diet in Central Java. We aimed to assess how recurrent flooding influenced household food access over 22 years in Central Java by linking the Global Surface Water dataset (GSW) to the Indonesian Family Life Survey. We examined linear and nonlinear relationships and joint effects with indicators of adaptive capacity. We measured recurrent flooding as the fraction of district raster cells with episodic flooding from 1984-2015 using GSW. Food access outcomes were household food expenditure share (FES) and dietary diversity score (DDS). We fit generalized linear mixed models and random forest regression models. We detected joint effects with flooding and adaptive capacity. Wealth and access to credit were associated with improved FES and DDS. The effect of wealth on FES was stronger in households in more flood-affected districts, while access to credit was associated with reduced odds of DDS in more flood-affected districts. Flooding had more predictive importance for FES than for DDS. Access to credit, a factor that ordinarily improves food access, may not be effective in flood-prone areas. Wealthier households may be better able to adapt in terms of food access. Future research should incorporate land use data to understand how different locales are affected and further understand the complexity of these relationships.

The Relationship between Covid-19 and Consumption Patterns of Poor Households

Objective: This research aims to analyze the relationship between Covid-19 and Consumption Patterns of Poor Households. The phenomenon of the Covid-19 pandemic has caused various social and economic changes. Changes in behaviour and preferences are an important part of the research by emphasizing the analysis of changes in expenditure during the Covid-19 pandemic and post-Covid-19. Method:This research is in the form of quantitative descriptive, the type of data used by researchers is primary data using a questionnaire that refers to the IFLS (Indonesian Family Life Survey) questionnaire. Primary data includes questionnaires and poor people during and postpandemic in 2019 and 2022 in rural and urban areas. The research area includes several village comparisons of Bandar Lampung City, South Lampung Regency, and Pringsewu Regency. The multiple linear methods are performed with the t-test in pairs using the statistical tool Stata. Results: The results of the study concluded that in the different tests there was no difference in food expenditure during the Covid-19 and post-Covid-19 period, between urban and rural areas, because of the tendency to have both low food expenditures during the pandemic and increase in post- pandemic. The food consumption patterns of the two regions still tend to buy the same staples. There is a difference in non- food expenditures during the rural Covid-19 period is higher because health and urban costs are lower, in the post-Covid-19 rural areas are lower and urban areas are higher. Conclusion and suggestions: The advice to the government, as cases of the Covid-19 pandemic, rise again, is to focus on providing free health services to the poor, because the expenditure on health services is quite large during the covid-19 pandemic. The government is also expected to be able to provide prolonged food staples to poor households plus complementary ingredients such as fruits, vegetables, milk, meat, and foods with high nutrition and protein.

MODELING HYPERTENSION DISEASE RISK IN INDONESIA USING MULTIVARIATE ADAPTIVE REGRESSION SPLINE AND BINARY LOGISTIC REGRESSION APPROACHES

In the pursuit of the Sustainable Development Goals (SDGs), health-related challenges, especially hypertension, remain a significant global issue. The third goal of the SDGs aims to improve the quality of life and well-being of all individuals, but hypertension is a serious problem that can hinder these goals. Often referred to as the "silent killer" by the World Health Organization (WHO), hypertension is exacerbated by low awareness. Globally, more than 1.28 billion adults suffer from hypertension, with most cases in lower to middle-income countries, including Indonesia. Indonesia has an alarming rate of hypertension incidence, ranking fifth highest in the world. Riset Kesehatan Dasar (Riskesdas) 2023 and the Indonesia Family Life Survey (IFLS) are critical for understanding hypertension risk factors in Indonesia. The IFLS data, obtained from www.rand.org, includes observations from October 2014 to April 2015, totalling 85 observations. Despite being over 10 years old, this dataset was selected because it remains the most recent comprehensive data available from RAND, representing 83% of the Indonesian population. The IFLS is conducted every 7-8 years, with the next wave of data expected soon. Most studies on hypertension globally and in Indonesia use parametric regression methods. However, a research gap exists as no studies have used Multivariate Adaptive Regression Splines (MARS) on IFLS data to analyze hypertension risk factors. This study addresses this gap by comparing binary logit regression and MARS. The analysis shows the Apparent Error Rate (APPER) for MARS is 84.706%, while for binary logistic regression it is 80%, indicating MARS is better at classifying hypertension data in Indonesia. Using MARS offers a novel approach to understanding hypertension risk factors in Indonesia. Despite the data's age, it remains relevant as primary causes and risk factors for hypertension have not changed, making the findings valuable for current health policy and strategies.

Mechanisms linking prenatal environment and linear growth: the case of Ramadan during pregnancy.

Despite established links between prenatal nutritional deprivation and impaired offspring growth, the underlying dynamics and potential moderators remain largely unexplored. This study investigates the dynamics underlying Ramadan during pregnancy and its associations with children's linear growth, using data from the Indonesian Family Life Survey (1993 - 2015). We exploit Ramadan during pregnancy as a natural experiment, separating exposure from maternal background characteristics and season of birth effects. Employing OLS and logistic regressions, we explore two key mechanisms predicted by medical theory. First, the realization of health impairments in response to prenatal shocks is influenced by postnatal circumstances. Our results reveal significant growth impairments primarily in children raised under poor sanitary conditions, which is a risk factor for diminished linear growth by itself. Secondly, we assess whether prenatal Ramadan prompts epigenetic shifts towards earlier reproductive activity, potentially at the expense of height growth. Our data shows that prenatally exposed women tend to have their first childbirth at a younger age, though menarche onset remains unaffected. These results suggest that postnatal environments play a crucial role in mitigating sensitivity to prenatal shocks, highlighting the critical need for favorable living conditions for all children.

Factors Associated with Health-Seeking Behavior in Indonesia: Evidence from the Indonesian Family Life Survey 2014

Background and Objectives: Health-seeking behavior is a critical determinant of health outcomes, particularly in countries like Indonesia. Given the increasing burden of noncommunicable diseases, understanding the factors that influence health-seeking behavior in this context is essential for developing more accessible and effective public health strategies. This study aimed to identify various factors associated with health-seeking behavior among patients with chronic diseases across Indonesia, especially in formal facilities. Materials and Methods: This study used a cross-sectional research design, utilizing Indonesian Family Life Survey (IFLS)-5 data. The inclusion criteria included respondents aged 20–74 years old with at least one chronic disease based on self-reported data. Respondents who did not receive treatment, practiced self-medication, or provided incomplete data were excluded. We used multivariate logistic regression to identify factors associated with health-seeking behavior in formal facilities. Results: The results revealed that 80.7% (n = 1993) of the 2471 respondents sought treatment in formal facilities, whereas 19.3% (n = 478) opted for informal facilities. Respondents who were Bugis (OR 9.187, 95% CI 2.182–38.683; p = 0.002), retired (OR 2.966, 95% CI 1.233–7.135; p = 0.015), did not smoke (OR 1.604, 95% CI 1.126–2.285; p = 0.009), made less than IDR 1,500,000 a month (OR 1.466, 95% CI 1.174–1.831; p = 0.000), had to travel more than 3 km to reach a treatment facility (OR 1.847, 95% CI 1.41–2.42; p = 0.000), or had more than one comorbidity (OR 1.396, 95% CI; p = 0.01) were more likely to seek treatment at formal facilities. Conclusions: These findings are expected to provide recommendations for policymakers, healthcare providers, and researchers to contribute to the development of targeted interventions that can improve healthcare access and utilization, ultimately enhancing health outcomes and equity in Indonesia.

A growth curve model to estimate longitudinal effects of parental BMI on Indonesian children's growth patterns.

The global surge in childhood obesity is also evident in Indonesia. Parental body mass index (BMI) values were found to be one of the major determinants of the increasing prevalence of childhood obesity. It is uncertain if parental BMI during their offspring's childhood significantly affects their children's BMI trajectories into adulthood. We aimed to investigate the influence of parental BMI Z-scores on BMI trajectories of Indonesian school-aged children, with a focus on sex-specific effects. This study utilized data from the Indonesian Family Life Survey and tracked the same respondents over four time points, from wave 2 (1997-1998) to wave 5 (2014-2015). The sample of this study consisted of children aged 5-12 years in wave 2 for whom height and weight data were available. We utilized a two-level growth curve model to account for the hierarchical structure of the data, with time nested within individual children. Fathers' BMI Z-scores in wave 2 had a pronounced influence (β = 0.31) on female children's BMI Z-scores compared to the influence of mothers' BMI Z-scores (β = 0.17). Mothers' BMI Z-scores in wave 2 showed a stronger positive association with male children's BMI Z-scores (β = 0.22) than did the father's BMI Z-scores (β = 0.19). A significant interaction of fathers' BMI Z-scores and years of follow-up was found for male children. As male children's BMI Z-scores increased by year, this effect was stronger in those whose fathers' BMI Z-scores were at a higher level. In conclusion, we found that parental BMI values profoundly influenced their children's BMI trajectories.

Women’s Bargaining Power and Children’s Nutritional Status: Evidence from Indonesia

Child stunting is a serious challenge in Indonesia, one of the largest middle-income countries in the world. Beyond the influence of bio-behavioral determinants, mothers’ bargaining power in the household is expected to have an overarching contribution to stunting, particularly as the primary caregivers of their children. Using a dataset from the fifth wave of the Indonesia Family Life Survey (IFLS-5), this study examines whether and to what extent a mother’s bargaining power influences children’s nutritional status. The study uses the instrumental variables method to correct the potential endogeneity of the mother’s bargaining power. Results suggest that children of mothers with higher intrahousehold bargaining power have a lower prevalence of stunting and better anthropometric outcomes. However, other members of the household matter, in the sense that improved outcomes are evidenced when the mother exercises her choice in decision making in a more consensual manner, by consultation with other household members. HIGHLIGHTS In Indonesia, higher women’s bargaining power enhances child nutritional long-term outcomes. Child nutrition improves when women make decisions jointly with other family members. Boys appear to be the main beneficiaries of mothers’ higher bargaining power. Policies to increase women’s agency need to consider family support and social norms.

An Application of the Dagum Type III Model to Measure Household Net Wealth Inequality in Indonesia

Abstract This paper applies the Dagum Type III model to measure household net wealth inequality in Indonesia utilising data from the Indonesian Family Life Survey (IFLS) 1993–2014. The results are the distribution of household net wealth in Indonesia is right-skewed, with long-and sparse-hand tails that reflect a large proportion of households that have very low net wealth and a small proportion of households that have very high net wealth. Further, the inequality of household net wealth in Indonesia declined, as shown by the decrease in the Gini coefficient.

Work hours and the risk of hypertension: the case of Indonesia

BackgroundIndividuals working excessive hours is a worldwide phenomenon. In Indonesia, over 32 million people work more than 40 h per week, contributing to around 26% of the workforce. Excessive working may affect health, increasing the risk of cardiovascular diseases such as hypertension. Hypertension affected around 34% of Indonesian adults, approximately 63.3 million people and led to about 427,000 deaths in 2018, and the prevalence remains high at 29.2% in 2023. This study aims to analyze the relationship between work hours and the risk of hypertension among working individuals in Indonesia.MethodsThis study used a pooled cross-sectional data from the Indonesian Family Life Survey (IFLS) wave 4 (2007) and wave 5 (2014) and performed a logit regression analysis to examine the likelihood of a working individual having hypertension based on the individual’s work hours. A dummy variable of hypertension is created based on the result of blood pressure measurement. The sample consists of 22,500 working individuals in Indonesia. This study controlled for job characteristics, sociodemographic status and health-behavioral risk factors such as BMI and smoking behavior, and performed additional regression analyses for alternative models to check for robustness.ResultsOur findings showed that there is a higher probability of having hypertension for workers who work longer hours by 0.06% points for each additional hour of work (p < 0.01). Other factors such as physical activity and smoking behavior have also been demonstrated to be significantly correlated to the risk of hypertension.ConclusionsThis study revealed a positive relationship between work hours and hypertension. Although this study cannot suggest causality, the strongly significant correlation may provide an idea and an overview regarding the risk of hypertension among working individuals in Indonesia. The Indonesian government could consider conducting further studies to implement and promote flexible working arrangements initiatives and incentive programs to improve workers’ health outcomes.

Rural-urban Migration and Overweight Status in Low- and Middle-income Countries: Evidence from Longitudinal Data in Indonesia

With rapid urbanization and intensive rural-urban migration, being overweight has become an increasingly common source of health risks in low- and middle-income countries (LMICs). However, the impact of rural-urban migration on overweight status is understudied in the LMIC context. Previous studies primarily used cross-sectional data, failing to adjust for migration health selection. Furthermore, the potential gender pattern in the impact of rural-urban migration remained unclear, and the potential cumulative effect of the duration of urban residence among migrants was rarely examined with longitudinal data. Meanwhile, the mediating effects of health behavioral factors were poorly understood. Using data from the fourth and fifth waves of the Indonesia Family Life Survey (IFLS) and employing fixed-effects (FE) models (N=7267), this study provided new evidence on the impact of rural-urban migration on overweight status across time and gender. Findings suggest that rural-urban migration significantly and positively predicted being overweight, and the association was significantly stronger among women than men. The results also show that years lived in urban areas did not significantly predict overweight among migrants, and that mediating health-related behaviors did little to explain adverse weight outcomes of migrants. As the number of rural-urban migrants continues growing, LMIC governments should implement health interventions aiming for healthy weight status among migrant communities. Meanwhile, gender-specific programs targeting women should be considered. Future research should explore other potential mediators of the link between rural-urban migration and overweight.

Does conditional cash transfer deliver? The Indonesian evidence on PKH

Social protection programs aim to secure individuals’ incomes from socioeconomic shocks and provide access to social services for developing human capital and alleviating poverty. In Indonesia, the Family Hope Program (PKH – Program Keluarga Harapan) is a social protection program that focuses on human capital development that requires children’s school enrollment and mothers and toddlers’ health as the conditions of cash transfers. This study seeks to analyze the effects of the PKH program on consumption expenditure, children’s educational attainment, and prenatal visits in Indonesia. We use the 2007 and 2014 IFLS (Indonesian Family Life Survey) survey data analyzed by the difference-in-difference (DID) method. The results demonstrate that PKH has a significantly positive effect on food consumption expenditure. However, PKH has insignificantly negative effects on children’s educational attainment and prenatal visits. The results suggest that the government monitors and ensures that the targeted recipients receive the program’s benefits. As such, the government can enhance the recipients’ awareness of the program’s benefits and ensure the equal availability of supporting infrastructure that enables households to utilize education and health facilities optimally.

Sport and Mental Health among Indonesian Adults: Evidence from Indonesia Family Life Survey

Sport and Mental Health among Indonesian Adults: Evidence from Indonesia Family Life Survey

Incidence of Non-Communicable Diseases in Urban and Rural Areas of Indonesia

Introduction: NCDs were known of causing 74% of deaths worldwide, and 77% of all these deaths are in low- and middle-income countries. The prevalence of NCD in Indonesia has increased over the past five years as it has in the majority of other Low Middle-Income Countries (LMICs) in the Asia Pacific area. The objective of this study is to examine the incidence of non-communicable diseases (NCDs) in urban and rural areas. Methodology: This study used secondary data from the Indonesian Family Life Survey conducted in 2014-2015 (wave 5). A total of 16,204 households and 50,148 individuals were interviewed by the IFLS-5 in 2014-2015. The data reflects the entire country of Indonesia and was collected by stratified random sampling from province to residence level. We involved respondents between the ages of 18 and 64 as the inclusion criterion for this research. The exclusion criteria include those with unknown or incomplete data. A total of 26,437 participants were involved in this study. Result: People with CKD were nearly the same in urban and rural areas (55.91% and 44.09%); cholesterol disease (76.16% and 23.84%); CVD (63.38% and 36.62%); hypertension (62.57% and 37.43%); diabetes (74.42% and 25.58%); stroke (67.65% and 32.35%). Conclusions: Chronic kidney disease was nearly equal in both urban and rural; while cholesterol, cardiovascular, hypertension, diabetes, and stroke were higher in urban areas. This could be worthwhile to consider as part of improving NCD prevention and treatment. Keywords: non-communicable, rural, urban.

Parental socioeconomic status and adolescent development in Indonesia

ABSTRACT We examine the impact of parental socioeconomic status on adolescent cognitive and non-cognitive development using data on adolescents from the 2014–15 Indonesian Family Life Survey. The analysis is relatively new for a developing country, by including non-cognitive skills and by looking at adolescents rather than young children. Parental education has a greater cognitive skills effect than parental income and job status, especially for fathers. For non-cognitive skills, parental job status is important but only for mothers. Education policy could therefore focus especially on high school completion and higher education enrolment, while employment policy could improve women’s job flexibility.

Households' Debts Among Rural and Agriculture-based Households in Indonesia

Household debts reflect financial insecurity for households to maintain their standard of living because it reflects the financial commitment that must be paid to other parties. However, the share of debts among different household classes, especially among agriculture and rural households in Indonesia still needs to be discovered. This research investigates the distribution of households’ debts in rural areas in Indonesia by utilizing data from the Indonesian Family Life Survey (IFLS) Wave 5 (2014). This research shows that households in rural areas have lower average debts than those in urban areas. At the same time, households in rural areas outside Java Island have higher average debts than their counterparts in Java Island. Two significant contributors to households’ debts are household size and household head educational attainment, where both variables show a positive and significant effect. The government must focus on rural development, including agricultural-based households, creating small but financially strong households, and increasing food self-sufficiency. Keywords: agriculture, debts, households, rural

Sociodemographic Factors, Health-Risk Behaviors, and Chronic Conditions Are Associated with a High Prevalence of Depressive Symptoms: Findings from the Indonesian Family Life Survey-5

Depression is a significant public health challenge. However, limited research exists regarding the risk of sociodemographic factors, health-risk behavior, and chronic conditions in relation to the development of depression in Indonesia. This study assesses the prevalence of depressive symptoms in adolescents and adults, and identifies its potential associations with sociodemographic factors, health-risk behaviors, and chronic conditions. A national cross-sectional population-based survey was performed, using the Indonesian Family Life Survey (IFLS-5), to assess depressive symptoms in respondents aged 15 years and older. Depression was evaluated using the Center for Epidemiologic Studies-Depression (CES-D) scale, and potential associations with sociodemographic factors, health-risk behaviors, and chronic conditions were examined using logistic regression analysis. The study revealed a high prevalence of depressive symptoms, with the highest incidence observed in the age group of 25–34 years. Factors such as unmarried status, younger age, good physical activity, and having chronic conditions showed associations with depression. These findings have implications for developing public mental health strategies to reduce the prevalence of depression in Indonesia.

Access to Technology to Increase Food Resilience in Rural Households in Indonesia

Food resilience is intricately linked to household standard of living, human development, and economic growth. Higher food expenditure not only signifies improved living standards but also provides households with the necessary energy and nutrition for daily activities. The integration of technology holds promise for bolstering food resilience among households.However, there exists a gap in understanding how technology can enhance household food resilience across different socioeconomic classes, considering the diverse food expenditure patterns observed. This paper employs quantile regressions to examine the impact of technology on food resilience, accounting for heterogeneity across socio-economic classes.Utilizing data from the Indonesia Family Life Survey (IFLS) wave 5 dataset, our findings reveal varying effects of certain variables across different classes. Key contributors to food expenditure identified include income, household size, education, and engagement in agriculture as the primary source of employment. Consequently, policy interventions should prioritize expanding internet access for low-decile households residing in rural areas to effectively enhance food resilience.

The Features of Comorbidity of Stroke in The Indonesian Population: Findings from The Indonesian Family Life Survey (IFLS-5)

Background: Comorbidities are associated with a worse stroke prognosis and more challenging clinical management. However, population-based research related to stroke comorbidities in Indonesia is still limited. Objective: This study aims to evaluate the features of important comorbidities among stroke patients in the Indonesian population. Methods: The data was taken from the 2014–2015 Indonesian Family Life Survey (IFLS-5), which represents 83% of the Indonesian population. Data were analyzed by means of logistic regression models using statistical software for data science (STATA) 13. Results: There was a statistically significant relationship between stroke history and several comorbidities risk factors. The risk of stroke increases in individuals with hypertension (odds ratio (OR): 7.97, 95% confidence interval (CI): 5.19-12.26), diabetes (OR: 1.90, 95% CI: 1.14-3.15), heart disease (OR: 2.67, 95% CI: 1.47-4.85), and hyperlipidemia (OR: 3.68, 95% CI: 2.40-5.64). Of the 309 stroke patients, 41.9% had one comorbid condition; 24.1% had two; and 10.5% had three. Comorbidities increase with age, and 80.50% of stroke patients with comorbidities are aged 50 years or more. Conclusion: This study showed that the most common comorbidities in stroke patients in Indonesia are hypertension, hyperlipidemia, and diabetes.