Factors Affecting Smoking Cessation Among Adolescents
An Application of Theory of Planned Behavior
Lingga Curnia Dewi, Laily Hidayati, Aria Aulia Nastiti and Nurul Istifaizah
Faculty of Nursing, Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
Keywords: Adolescents, Attitude, Subjective Norms, Self-Efficacy, Smoking Cessation, Theory of Planned Behavior
Abstract: Smoking has become one of the biggest problems facing adolescents. The Theory of Planned Behavior is
widely applied to predict and support behavior changes. Despite this, there is no sufficient study that considers
the factors influencing smoking cessation among adolescents. The purpose of this study was to investigate
attitudes, subjective norms, perception and self-efficacy relevant to smoking cessation through an application
of the Theory of Planned Behavior. This study design used a cross-sectional approach. A total of 139 school-
going adolescents completed a questionnaire to measure attitudes, subjective norms, perception, self-efficacy
and intention for smoking cessation. Data were analyzed by using the statistical test Spearmen rho. The study
showed that attitudes, subjective norms, perception and self-efficacy are significantly important regarding
intention of smoking cessation (p = 0.000). Smoking cessation by adolescents is affected by multiple factors.
In addition, understanding an application of the Theory of Planned Behavior helps adolescents quit smoking
effectively. Further research should involve the various influencing factors such as social environment and
attitudinal cognitions.
1 BACKGROUND
Smoking is a major phenomenon facing adolescents
that can be caused by stress, intrafamilial linkage,
perceptions of cigarettes and smoking by parents or
friends. In addition, smoking habits in adolescents are
not only the gateway to all kinds of substance abuse
but also cause various health problems (Park, 2011).
Worldwide, adolescents account for up to 30% of
smokers (Komalasari and Helmi, 2000). Indonesia
has a tendency towards an increasing number of
smokers, especially in adolescents. Based on data
from Riskesdas (2013), the Ministry of Health
indicated that the percentage of Indonesian smokers
over the age of 15 continued to increase from 2007 to
2013 from 34.2% to 36.3%. In 2014 smokers aged 16-
19 years reached 20.5% (Moh, 2016).
The intention to quit smoking in school-going
adolescents is an important subject to examine.
Providing information about the dangerous effects of
smoking is not effective in making people quit
smoking (Moan and Rise, 2005). The theory is that
explaining the formation of intention to quit smoking
and also the self-regulation process involves
converting the intentions into actions (Jones et al.,
2001).
The Theory of Planned Behavior (TPB) was
proposed by Icek Ajzen to predict a person's intention
to engage in behavior at a particular time and place.
The theory confirms that the intentions of individual
behavior are shaped by attitudes to one's behavior,
norms, and control of perceived behavior, which
indicate the individual perception that leads others in
the social environment to expect to behave in a
particular way (Ajzen, 2005; Armitage and Conner,
2001).
Attitudes towards behavior are defined as
individual positive or negative evaluations of specific
behaviors. It is established through an assessment of
one's beliefs about the consequences of behavior and
an evaluation of the desires of these consequences
(Ajzen, 2012). Attitudes, subjective norms and self-
efficacy simultaneously affect the intention. Each
individual has a level of self-efficacy or judgment
against their own ability to do different things
(Bandura, 1986).
Previous study has found support for assumption
in predicting smoking reduction among adolescents
(Moan and Rise, 2005). Obviously, there is no
sufficient study that considers the factors related to
the TPB contruct on smoking cessation among
school-going adolescents in Indonesia specifically.
532
Dewi, L., Hidayati, L., Nastiti, A. and Istifaizah, N.
Factors Affecting Smoking Cessation Among Adolescents.
DOI: 10.5220/0008328105320537
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 532-537
ISBN: 978-989-758-336-0
Copyright
c
 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

This study is to investigate attitudes, subjective
norms, perception and self-efficacy relevant to
smoking cessation through an application of the
Theory of Planned Behavior among adolescents at
Senior High School in Lamongan City, Indonesia.
The findings of this study can be used as guidelines
to develop an intention to quit smoking in
adolescents.
2 METHODS
This research used a descriptive correlational
research design with a cross-sectional approach. The
sample size was 139 students. The sampling
technique used in this research is convenience
sampling. The independent variables in this research
are attitudes, subjective norms, perception, and self-
efficacy. The dependent variable in this study is the
intention to quit smoking.
An attitude questionnaire was developed based on
the concept of the Notoadmodjo theory (2014). This
scale is made to measure attitudes in adolescents who
intend to quit smoking. A subjective questionnaire
comprises questions based on the concept of the
theory from Ajzen (2005), a perceptual questionnaire
is based on theoretical concepts from Soenaryo
(2004) and a self-efficacy questionnaire contains
questions based on the concept of a theory from
Alwisol (2009). The intention of quitting smoking
contains questions based on the theoretical concepts
of Ajzen (2005). Each questionnaire contains 10
statements. The scoring method on this gauge uses a
Likert scale with answers ranging from 1 to 4, that is,
4 to strongly agree, 3 to agree, 2 to disagree, and 1 for
strongly disagree.
The validity test showed that all questionnaires
were valid. While the reliability test results in all
questionnaires stated that they were very reliable.
This research was conducted at Private Senior
High School in Lamongan, Indonesia. Each data set
will be measured using a Spearman Rank Correlation
statistic test that sets a significance value at ≤0,05.
This study has been approved for ethical clearance
from the Faculty of Nursing Universitas Airlangga
(No. 504-KEPK).
3 RESULTS
Table 1 shows the characteristics of respondents’ age
who were 14-19 years old. Overall, the results show
that the attitudes, subjective norms, perception and
self-efficacy were in fair categories. Based on Table
2 most of the male adolescents have a fair attitude
(59%) to quitting smoking. Furthermore, in the
subjective norms aspect, most respondents also have
a fair score (61.9%) and indicated they are less able
to appreciate parents' advice to stop smoking.
Adolescents who have good perception of stopping
smoking can be self-directed to health and are able to
save money pocket (17.3%). While the fair category
showed that adolescents have less perception of the
dangers of smoking (58.3%). The aspect of self-
efficacy showed that 53.96 of respondents were in the
fair category and that indicated they are less able to
cope with stress.
The last aspect was the intention of smoking
cessation showing that most respondents (55.4%)
have a fair intention to quit smoking. Then, are
respondents with less perception who do not care
Table 1: The characteristic of respondents.
Respondent’s age
f
Percentage (%)
14
2
1.44
15
17
12.23
16
56
40.29
17
48
34.53
18
13
9.35
19
3
2.16
Total
139
100
Table 2: Attitudes, subjective norms, perception and self-
efficacy of respondents.
Variable
Category
F
Percentage
(%)
Attitude
Good
31
22.30
Fair
82
59.00
Poor
26
18.70
Total
100.00
Subjective
norm
Good
25
18.00
Fair
86
61.90
Poor
28
20.10
Total
100.00
Perception
Good
24
17.30
Fair
81
58.30
Poor
34
24.40
Total
100.00
Self-efficacy
Good
32
23.02
Fair
75
53.96
Poor
32
23.02
Total
100.00
Intentions of
smoking
cessation
Good
32
23.03
Fair
77
55.40
Poor
30
21.58
Total
100.00
Factors Affecting Smoking Cessation Among Adolescents
533

about the dangers of smoking and also do not care
about their health with a percentage of 24.4%.
Based on Table 3, it was found that adolescents
have fair attitude and intention to stop smoking
(36.7%). Meanwhile, the others have less attitude but
have the intention to stop smoking in the poor
category (11.51%). Table 4 showed that most
adolescents for subjective norms have good intention
to quit smoking in the fair category (12.23%).
Meanwhile, adolescents who have subjective norms
have sufficient intention to quit smoking in the poor
category (41.73%).
Table 5 found that most adolescents have good
perception of the intention to quit smoking in the
good category (10.07%). Meanwhile, adolescents
who have perceptions have enough intention to stop
smoking in the fair category (41.01%), for
adolescents who have less perception of the intention
to stop smoking in the poor category (13.67%).
4 DISCUSSION
Attitudes are individual positive or negative
evaluations of certain objects, persons, institutions,
behaviors or interests arising upon belief in the results
obtained from certain behaviors (Ajzen, 2005). The
results of the study show that most adolescents have
the attitude to quit smoking in enough categories, but
they still feel inferior and feel annoyed if they do not
smoke.
Attitudes are defined as favorable or unfavorable
feelings towards an object. From questionnaire results
based on attitude parameters in adolescents, it was
found that most respondents (82) have a value with
enough scoring categories.
In the questionnaire statements number 2 gained
the most answers ‘agree’, indicating that the majority
of adolescents remain confident despite quitting
smoking. And the questionnaire statement number 10
obtained the most answers ‘agree’ indicating that
concentration in adolescents was disturbed when
quitting smoking. The results of this study were
supported by Komalasari and Helmi's, (2000)
research on the factors causing smoking behavior in
adolescents. They stated that the concentration of
teenagers is disturbed if they stop smoking and they
will experience stress, dizziness, drowsiness and
mouth bitterness. Researchers argue that the attitude
of adolescents who have the intention to quit smoking
is sufficient, said to be enough because they can still
feel confident if not smoking. Subjective norm is a
person's perception of social pressure to engage in
behaviors that can be considered important for doing
cessation (intention to stop smoking) and the extent
of the individual intending to comply with such
suggestions and prohibitions (Ajzen, 1988).
The authors argue that the subjective norms of
adolescents who have an intention to quit smoking
indicate a sufficient category of subjective norms in
adolescents. This shows that adolescents have
concern for the environment, and for teachers’ and
parents’ advice.
Supported by the results obtained most
adolescents have enough perception to quit smoking.
Perception is the experience of objects, events or
relationships acquired with concluding information
and interpreted messages. In other words, perception
Table 3: The analysis of attitudes and intention of
smoking cessation.
Attitude
Intention of smoking cessation
Total
(%)
Good
Fair
Poor
Good
14
17
1
32
(10.07)
(12.23)
(0.72)
(23.02)
Fair
17
51
13
81
(12.23)
(36.7)
(9.35)
(58.28)
Poor
1
9
16
26
0.72%
(6.47)
(11.51)
(18.7)
Total
32
77
30
139
Uji statistik Spearman p = 0,000 r= 0.468
Table 4: The analysis of subjective norms and intention
of smoking cessation.
Attitude
Intention of smoking cessation
Total
(%)
Good
Fair
Poor
Good
14
11
0
25
(10.07)
(7.91)
(0.00)
(17.98)
Fair
15
58
13
86
(10.79)
(41.37)
(9.35)
(61.87)
Poor
3
8
17
28
(2.36)
(5.76)
(12.23)
(20.15)
Total
32
77
30
139
Uji statistik Spearman p = 0,000 r= 0.489
Table 5: The analysis of perception and intention of
smoking cessation.
Attitude
Intention of smoking cessation
Total
(%)
Good
Fair
Poor
Good
14
8
2
24
(10.07)
(5.76)
(11.43)
(17.26)
Fair
15
57
9
86
(10.79)
(41.01)
(6.48)
(58.28)
Poor
3
12
19
28
(2.16)
(8.63)
(13.67)
(24.46)
Total
32
77
30
139
Uji statistik Spearman p = 0,000 r= 0.471
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
534

is a process that involves the entry of messages or
information into the brain (Grace, 2011)
Researchers argue that the perception of
adolescents who have the intention to quit smoking
indicate that it is sufficient. This shows that
adolescents have enough frequency to be able to
overcome the symptoms of quitting smoking and also
have a good perception to maintain health and fitness.
Based on the results of this study most adolescents
have enough intention to quit smoking.
Self-efficacy is a person's belief that they are
capable of performing certain behaviors or achieving
a particular purpose or regarding their ability to carry
out and organize the series of tasks in their life
(Bandura, 1995). Self-efficacy is influenced by the
culture, gender, nature of the task at hand, the status
or role of the individual in the family and information
about self-efficacy (Bandura, 1986). Mood can also
influence self-assessment efficacy. A positive mood
helps improve self-efficacy rather than a negative
mood. For example, people with mood disorders such
as depression or anxiety have low self-efficacy. The
results of this study found that most adolescents have
enough intention to stop smoking. This indicates that
respondents have a moderate desire to quit smoking.
The intention to quit smoking is a strong desire from
within a person to stop smoking and stop consciously
(Sandek and Astuti, 2007).
The intention to quit smoking can also be
influenced by the norms that exist in the environment
of adolescent smokers. One such norm is school rules
that do not allow students to smoke in the school
environment, but the norm still cannot stop students
from smoking on the sidelines of learning activities at
school because during break time the students go out
to buy food and drinks at stalls outside school.
Analysis of the relationship between attitude and
intention to stop smoking in adolescents showed a
strong correlation between attitude and the intention
to stop smoking in adolescents. The relationship is in
moderate strength, where most teenagers have
sufficient attitude and the level of intention to quit
smoking in a category as well. The relationship can
also be seen based on the level of attitude, that is the
attitude to receiving (receiving), attitude to
responding (responding), respecting (valuing) and
responsible attitude (responsibility).
Every individual has an attitude where it reflects
all forms of behavior that arise, including taking a
stand on the decision to quit smoking. Attitudes
towards an attitude object will be accompanied by
tendency or interaction acts in accordance with
attitudes towards the object of that attitude (Gerungan
and Gerungan, 2000).
Based on the results of the above research the
researcher argues that adolescents who have good
attitude tend to have the intention to quit smoking the
good and sufficient category. Adolescents who have
enough attitude have the intention to quit smoking in
the enough category and adolescents who have less
attitude have intention to stop smoking in the enough
category. This shows that attitude is an aspect that
affects the intention to quit smoking. A positive
attitude to quit smoking and the belief that quitting
smoking will make smokers much better, healthier
and live longer is associated with a greater intention
to quit smoking (Komalasari and Helmi, 2000).
This research suggests enough attitudes in
adolescents among others, about self-confidence
despite quitting smoking. This is in line with the
intention to quit smoking in adolescents that shows
considerable results as well. Analysis of the
relationship between subjective norms with the
intention to stop smoking in adolescents in SMK
PGRI Sukodadi showed a moderate correlation
between them. The relationship is of moderate
strength, where most teenagers have sufficient
subjective norms and the level of intention to quit
smoking in the appropriate category as well. The
relationship can also be seen based on normative
beliefs and motivation to comply (individual
motivation to meet expectations)
This research is in line with the Devitarani study
(2015) which states that the subjective norm variable
is related to smoking cessation behavior, i.e. parents,
close friends, playmates, non-smoking close friends
and parents who have quit smoking. Belief on
subjective norms is formed based on invitations,
suggestions, and advice. The process of the
emergence of the beliefs of individual smokers shows
that the demands and expectations of parents can be
different from the belief in the demands and
expectations of friends. The relationship of subjective
norms with the intention to stop smoking shows the
greater value of subjective norms will strengthen the
intention to quit smoking. Also, the smaller the value
of subjective norms the weaker the intention to stop
smoking. According to Ajzen (2005), in the Theory
of Planned Behavior one of the factors that influence
the intention to quit smoking is normative belief. This
concept has the same meaning as the subjective norm,
which is the acceptance or rejection of a person to the
behavior embodied in a person.
Based on the results of the above study the
researcher believes that adolescents who have good
subjective norms tend to have the intention to quit
smoking in either category, subjective norms enough
with enough category. Whereas teenagers who have
Factors Affecting Smoking Cessation Among Adolescents
535

subjective norms less have the intention to stop
smoking in the category less. This shows that there is
a significant relationship between subjective norms
with the intention to stop smoking in adolescents.
This research finds enough subjective norms in
adolescents in SMK PGRI Sukodadi, among others,
about the belief in being punished when smoking in
school and also the belief that smoking will have a
negative impact. This is in line with the intention to
stop smoking in teenagers who showed results as
well.
The analysis of perception relationships with the
intention to stop smoking in adolescents showed a
moderate correlation between perception and the
intention to stop smoking. The relationship is of
moderate strength, where most teenagers have
sufficient perception and the level of intention to quit
smoking in a category as well.
This research is in line with Rahmi’s (2009)
research on the role of attitudes, subjective norms and
perceived behavioral control (PBC) on the intention
to stop smoking in smoker students uin syarif
hidayatullah Jakarta. It shows that perception is the
variable that has the most effect in influencing
intention to stop smoking. Behavioral control is the
control of the extent to which a person is able to
perform certain behaviors. Individuals do not form
the intention to conduct a behavior unless they feel
confident of have the ability to display the behavior.
Based on the results of the above study the
researcher argues that adolescents who have good
perceptions tend to have the intention to quit smoking
in either category, sufficient perception with
sufficient category whereas adolescents who have
perceptions lack the intention to stop smoking in the
category less. This research finds that enough
perception in adolescents about belief if not smoking
have benefit themselves and others. This is in line
with the intention of quitting smoking in adolescents
that shows considerable results as well.
Analysis of the relationship between self-efficacy
and the intention to stop smoking in adolescents
shows a moderate correlation between them. The
relationship is of moderate strength, whereas some of
the vicarious experiences of adolescents have
sufficient self-efficacy and the level of intention to
quit smoking in a sufficient category as well. Several
factors influence self-efficacy; that is experience of
success (mastery experiences), experience of others,
social persuasion, and physiological and emotional
state.
Based on the results of the above study the
researcher argues that adolescents who have good
self-efficacy tend to have the intention to quit
smoking in either category, self-efficacy enough with
enough category. Whereas teenagers who have less
self-efficacy have the intention to stop smoking in the
less category. Self-efficacy refers to one's self-beliefs
about their ability to carry out and organize the series
of tasks in their life (Bandura, 1995). Self-efficacy is
influenced by the culture, gender, nature of the tasks
encountered, the status or role of the individual in the
family and information about self-efficacy (Bandura
1997). Individuals need self-efficacy to remain
competent and effective in dealing with stressful
situations (Schwarzer et al., 1997). Individuals face
factor inhibitors with alternatives that strengthen self-
efficacy, so have the confidence that strengthens the
courage to implement the intention to quit smoking.
Self-efficacy also means believing oneself to be
successful. Individuals with high self-efficacy have a
commitment to solving problems and will not give up
when they realize the strategy being used is not
working (Reivich and Shatté, 2002). Individuals with
high self-efficacy will effectively face challenges,
have full trust with self-ability, quickly face problems
and be able to rise from failure.
5 CONCLUSIONS
Smoking cessation by adolescents is affected by
multiple factors. In addition, understanding an
application of Theory of Planned Behavior helps
adolescents quit smoking effectively. Further
research should involve the various influencing
factors such as social environment and attitudinal
cognitions.
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