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A qualitative study of factors influencing adolescent smoking behaviors
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One of the causes of the high rates of smoking amongst adolescents or novice smokers is that the adolescent wants to appear mature and show off.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1,2</span></a> An interesting finding of the present study is psychosocial development during elementary school affects smoking behavior in early adolescent development. The transition from primary school to junior high school is strongly linked to the transition from childhood to early adolescence. Often adolescents age 10–12 years will begin smoking, however, at this stage smoking is typically experimental and not habitual.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> In 2007, novice smokers or young smokers were carried out at the age above 15 years. Now shifted to be younger smokers were less than 15 years old.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> According to the Basic Health Research, the number of novice smokers in Indonesia is 45%. This shows that the number of novice smokers in developing countries such Indonesia is more than in developed countries. Such as the United States, where smoking decreased from 17% to 15% between 2015 and 2017. This is due to the extensive anti-smoking campaign and high cigarette taxes.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The number of daily smokers aged<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>10 years in Aceh Province was 25%, occasional smokers were 4.3%, former smokers 2.5% and non-smokers were as much as 68.2%. Based on gender, men smoke and 11.7% of women smoke. The amongst reported smokers, 18% report first trying cigarettes between ages 10 and 14 years and 55.4% between ages 15 and 19.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Based on the high incidences of adolescent smoking in Indonesia, this research was conducted in order to learn more about the factors that influence adolescents to try smoking in junior high school.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Research methods and sampling techniques</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research used a qualitative approach. The research was carried out in three junior high schools around the city of Banda Aceh from January 9-February 2, 2020. A total of 16 students (12 smokers and 4 non-smokers) were selected as participants. A quota sampling technique was used. After selecting 16 students from the 3 schools, the researchers proceeded to the data collection stages. The selection of the three junior high schools was based on the consideration that the three schools came from 3 sub-districts in Banda Aceh which were located far apart and could represent 9 other sub-districts.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The data was collected through interviews, documentation, and field observations. The collected data was validated using triangulation techniques.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6,7</span></a> The data was analyzed using qualitative research analysis, through the INVIVO 12 Plus program, by coding and assigning categories and themes.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7,8</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Research ethics</span><p id="par0030" class="elsevierStylePara elsevierViewall">The researchers met the participants at school and had them sign an informed consent form before the interview process. The researchers explained the purpose of the study to the participants, then the participants signed an informed consent waiver if they agreed. If the participants did not agree, the researcher took other participants who were willing. Before beginning each interview, the researcher provided a clear timeframe to the participant, which is also explained by the researcher. This study received approval form University of Indonesia Ethics Committee, with number SK-270/UN2.F12.D1.2.1/ETIK.FIK.2019.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Analysis and data collection procedures</span><p id="par0035" class="elsevierStylePara elsevierViewall">The data was collected and processed by using the INVIVO 12 Plus, and then the data was coded and assigned categories and themes.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7,8</span></a> From these themes, researchers analyzed qualitative themes related to previous theories and research. Based on the interview results, observations, and field notes, the data was validated using the source triangulation method. The data were processed qualitatively and analyzed with qualitative techniques.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6,7</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Result</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Characteristics of participants</span><p id="par0040" class="elsevierStylePara elsevierViewall">The participants were chosen from three junior high schools in Banda Aceh. Fourteen students were chosen from grade 8 and 2 students from grade 7.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on the data obtained from the 16 participants, there are 4 participants, namely the participant coded P1, P14, P15 and P16 who have never tried smoking. Meanwhile, the other 12 participants have all tried smoking. 12 participants in grade 8 have tried smoking while 2 people in grade 8 never tried smoking. While 2 people in grade 7 never tried smoking. Of those who had attempted to smoke before, many students tried to smoke in elementary school. 7 participants tried smoking in elementary school, 5 participants tried smoking in junior high school, and 4 participants have never tried smoking. 12 participants who have tried smoking, 8 participants say they have stopped smoking and 4 participants were still smoking until now.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Research findings</span><p id="par0050" class="elsevierStylePara elsevierViewall">Based on the results of interviews conducted with 16 Junior High School students from January 9-February 2, 2020, researchers identified five themes related to the research objectives. The themes consist of: Smoking urge, adolescent perceptions of smoking habit, information about the dangers of smoking, barriers to quitting smoking and smoking control strategies.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Based on the interview results, it was found that four participants said they never smoked, as the following participant statement:<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I have never tried smoking” (P1)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I never smoke” (P14), (P15) and (P16)</span></p></span></p><p id="par0060" class="elsevierStylePara elsevierViewall">Most participants said that they tried smoking between the ages of 9–14. Specifically in grade 3, grade 5, grade 6 in elementary school, grade 7 and grade 8 in Junior High School.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Early age adolescents start smoking expressed as follow:<span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I tried smoking when I was in grade 3 elementary school.” (P2) and (P3);</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0020"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I tried smoking when I was in grade 7 junior high school.” (P4) and (P5);</span></p></span></p><p id="par0070" class="elsevierStylePara elsevierViewall">The reason why adolescents smoke is because of curiosity around cigarette taste, as expressed by the following participants:<span class="elsevierStyleDisplayedQuote" id="dsq0025"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“The reason I smoke is that I see people smoking, it seems good, and I want to try it.” (P7)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“The reason I smoke is that my friends invite me after school during the day at the coffee shop,” but I don’t do it anymore. “(P10)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0035"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“The reason I tried smoking was that I was curious, seeing my friends smoking, so I wanted to know the taste of cigarettes.” (P5)</span></p></span></p><p id="par0075" class="elsevierStylePara elsevierViewall">The reason why adolescents not try to smoke, as the following participant statement:<span class="elsevierStyleDisplayedQuote" id="dsq0040"><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I have never tried smoking because cigarettes are dangerous.” (P1)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0045"><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I never smoke.” (P14), (P15) and (P16)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0050"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“Because it's not good for health.” (P14) and (P15)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0055"><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“My father also forbade me to smoke” (P15)</span></p></span></p><p id="par0080" class="elsevierStylePara elsevierViewall">Adolescents said the way to control smoking behavior, as expressed by the following participants:<span class="elsevierStyleDisplayedQuote" id="dsq0060"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I do worship to forget cigarettes.” (P3)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0065"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I don’t smoke anymore, because mom forbid me.” (P7)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0070"><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I do sports every afternoon with my friends” (P9)</span></p></span></p><p id="par0085" class="elsevierStylePara elsevierViewall">Adolescents experience various obstacles in controlling smoking behaviors, as expressed by the following participants:<span class="elsevierStyleDisplayedQuote" id="dsq0075"><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I sometimes feel addicted to smoking when hanging out with friends.” (P3)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0080"><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I find it hard to avoid friends who smoke (P2)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0085"><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I have a hard time refusing a friend's invitation to smoke.” (P13)</span></p></span></p><p id="par0090" class="elsevierStylePara elsevierViewall">The support needed by adolescents to control smoking behavior comes peers and from outside adolescents, as expressed by the following participants:<span class="elsevierStyleDisplayedQuote" id="dsq0090"><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I need the support of parents. My parents don’t agree that I smoke. My parents got angry to me.” (P10)</span></p></span><span class="elsevierStyleDisplayedQuote" id="dsq0095"><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I need support from my friends to stop smoking” (P3)</span></p></span></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Adolescent smoking trials</span><p id="par0095" class="elsevierStylePara elsevierViewall">The result showed that there were twelve participants who had tried smoking. Researchers found that many adolescents began smoking at a young age, in elementary school, or they tried smoking in junior high school.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> The urge to smoke for the first time began when adolescents were in grade 3, grade 5 and grade 6 in elementary school. Several other adolescents said they tried smoking when they were in junior high school in grade 7 and 8.</p><p id="par0160" class="elsevierStylePara elsevierViewall">A previous study found that smoking trials are mostly carried out by children 13–14 years old, during junior high school. They smoke for the first time together with friends.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> Adolescents divided into three categories, namely: early adolescents aged 12–13 years old, mid adolescents aged 14–16 years old, and late adolescents aged 17–12 years old.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> This study in line with the research in US found that male adolescents tend to experiment with smoking after school with their friends.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">The reasons</span><p id="par0100" class="elsevierStylePara elsevierViewall">Researchers found that adolescent smoking is largely influenced by peers. Early adolescent smoking is often due to the influence of peers who smoke. Adolescents who have peers who smoke exhibit persistent smoking behavior in adulthood.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Not only peers, but adolescents’ relationships with their parents also influences their smoking behaviors. This is because good communication at home can result in stronger bonds between adolescents and parents.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The results also showed that there were four adolescents who had never tried smoking. They said that they did not want to get sick, so they stayed away from smoking. They also said that their parents forbade smoking. Their parents said that smoking was dangerous so they should stay away from cigarettes and never try to smoke. This in line with a previous study that found that not only does smoking in peers have an influence on adolescents smoking, but also there is a relationship between parents who smoke an incidence of adolescent smoking. Parents have an effect on controlling adolescent smoking behavior. This is intended so that adolescents have strong core values, and are not easily influenced by a negative environment.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The view that parents affect adolescents smoking behaviors. Parents become agents of socialization for adolescents to stop smoking. The involvement of parents is also a factor that inhibits adolescent smoking trials from an early age.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Another interesting finding of the present study was adolescents smoking is driven by a desire to try something new, reduce stress, as well as the influence of peers, and negative behavior within their home environment (such as seeing people smoke).<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">These aforementioned desires and factors often cause adolescents to try smoking. Social factors greatly affect adolescent smoking. The social dimension is a strong predictor of smoking behaviors.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Adolescents who start smoking at a young age will likely become smokers in the future. This is because the initial experience of smoking produces an addictive sensory experience and can trigger adolescents to continue smoking in adulthood. However, the initial smoking experience may depend on the context of initiation such as who did the adolescent first try smoking with, where the adolescent first smoked, and what age the adolescent first, which all factor in to whether the adolescent would smoke or not in the future.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">In this study, the researchers also found that intentions and attitudes were caused adolescents to smoke. This is supported by previous research which found that smoking cessation by adolescents should come from the intention within themselves. Therefore, it is necessary to provide regular education to increase adolescent knowledge about smoking and its dangers.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">12,16</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The researchers argue that smoking behavior by adolescents is influenced by various factors such as: peers, parents, intentions and self-control. Lack of self-control will make it difficult for adolescents to avoid smoking behavior. Adolescents will less self-control will be easily persuaded by their peers without being able to consider the consequences of their behavior. Adolescents who start smoking at a young age will likely remain smokers in the future. This is because the initial experience of smoking produces an addictive sensory experience and can trigger adolescents to continue smoking well into adulthood. However, the initial smoking experience may depend on the context of initiation such as who the adolescent first tried smoking with, where the adolescent first smoked, and what age the adolescent first tried smoking.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Adolescent smoking behaviors can be managed with strong community value and positive environment and role models, such as peers, parents, siblings, and teachers. Adolescents with harmonious social relationships are more likely to avoid risky behavior.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Adolescents smoking behavior begins at an early age. This is influenced by peers, parents, intention and self-control. Adolescents who experiment with smoking behavior often begin in elementary school. The biggest factors that influences adolescent smoking is their peers. Their peers may persuade them to smoke when they hang out after school or in coffee shop. Therefore, adolescents need the support of their parents, peers, siblings and teachers at school. Adolescents need to be given support and information on the dangers of smoking in order to help them resist the desire to experiment with smoking in first place.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1613099" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1442277" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Research methods and sampling techniques" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Research ethics" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Analysis and data collection procedures" ] ] ] 4 => array:3 [ "identificador" => "sec0030" "titulo" => "Result" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Characteristics of participants" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Research findings" ] ] ] 5 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Adolescent smoking trials" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "The reasons" ] ] ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack568980" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-11-05" "fechaAceptado" => "2021-04-20" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1442277" "palabras" => array:3 [ 0 => "Factors influencing" 1 => "Smoking behavior" 2 => "Adolescent" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study was conducted in order to determine the factors that influence smoking behaviors in adolescents.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study used a qualitative approach at junior high school, from January to February 2020. The sampling technique used quota sampling. A total of 16 students) were selected as participants. Data was collected through interviews, documentation, and field observations. The data was analyzed through qualitative research analysis through the INVIVO 12 Plus Program.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study identified five themes: Smoking urge, adolescent perceptions of smoking behavior, information about the dangers of smoking, barriers to quitting smoking and smoking control strategies.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Factors that influence adolescent smoking behavior were peers, parents, intentions, and adolescent self-control.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the Riau International Nursing Conference 2020. 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