Smoking Prevalence among Head of Household in Medan

Juanita

and Maya Fitria

Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Smoking, Head of Household, Medan City.

Abstract: Background: Smoking is an important public health problem in Indonesia. Smoking prevalence among

males and female is 66 % and 6,7 % (2013) increased from 53.4% and 1.7% (1995). Medan City has issued

Regulation on Non-Smoking Area No. 3/2014 which became effective since January 2014. Although Medan

already has regulation but data on the number of smokers has not been available, especially related to

smoking behaviour of household heads. The aims of this study were to analyze and identify smoking

prevalence in Medan. Methods: A cross sectional study was conducted using questioner among 400 head of

household in Medan City. Results: The overall prevalence of smoking was 57,25 % (97,8 % among males

and 2,2 % among females). About 47,2 % of smokers smoke 5–14 sticks per day, and 41,5 % smoke 15 or

more sticks per day. Average age at smoking initiation is 19 years; 46,7 % smoker was Senior high school

graduates, 20,5 % junior high school and 10,9 % Primary school compare to 21,4 % with university. About

75,5 % smokers are The National Health Insurance participant, age of initiation of smoking was 19 years.

Conclusions: The prevalence of male smokers in Medan is higher than the national prevalence, while

women smokers is lower than the national prevalence, this needs to be a concern. Most smokers are national

health insurance participants, so this behaviour is very risky to cause preventable diseases. Health centre

should prioritize promotive and preventive services for smokers.

1 INTRODUCTION

Smoking cigarette is the single, most important

preventable cause of death and the most important

public health issue. WHO described tobacco

smoking as an epidemic with an estimated three

million deaths annually worldwide because of

smoking. This figure is expected to rise to 10 million

by the year 2020 or early 2030, if the current trends

of smoking continue. Seventy percent of these

deaths will occur in the developing countries

Cigarette consumption in Indonesia is rising

more rapidly than anywhere else in the world.

Prevalence of active smokers was increasing from

1995 to 2013 in both males and females and in

almost all age groups. The prevalence of smoking

among male’s population age 15 years and above

increased from 53.4% in 1995 to 66% in 2013 and

from 1.7% in 1995 to 6.7% in 2013 in females

Medan has issued Regulation on Non-Smoking Area

No. 3/2014 which became effective since January

2014.

Although Medan already has regulation but data

on the number of smokers has not been available,

especially related to smoking behaviour of

household heads. Be advised that papers in a

technically unsuitable form will be returned for

retyping. After returned the manuscript must be

appropriately modified. Research Objectives: To

determine the prevalence of smoking among head’s

household in Medan.

2 METHODS

This research is a cross sectional study was

conducted among head of household in Medan City.

A total of 400 head of respondent were investigated

using a structured questionnaire. Descriptive

statistics which included frequency, % distribution,

average.

Sampel Size :

(1)

Information :

α = 5%, 1,96

2/1

PQZ







Juanita, . and Fitria, M.

Smoking Prevalence among Head of Household in Medan.

DOI: 10.5220/0010083806790683

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

679-683

ISBN: 978-989-758-449-7

679

P = Proportion smokers in Indonesia= 66,0%

(Riskesdas, 2013)

Q = 1-P, 1-0,66 = 0,34

d = estimated difference proportion = 5%

Number of sampel = 400 household

Table 1. Distribution of Sample.

No Districts

Numbe

r of hh Sampel

1 Medan Amplas 28364 22

2 Medan Area 22380 18

3 Medan Barat 17022 13

4 Medan Baru 11071 9

5 Medan Belawan 21898 17

6 Medan Deli 41235 32

7 Medan Denai 32587 26

8 Medan Helvetia 33460 26

9 Medan Johor 30342 24

10 Medan Kota 17684 14

11 Medan Labuhan 26131 21

12 Medan Maimun 9485 7

13 Medan Marelan 35780 28

14 Medan Perjuangan 23188 18

15 Medan Petisah 15705 12

16 Medan Polonia 12727 10

17 Medan selayang 28104 22

18 Medan Sunggal 27149 21

19 Medan Tembung 31048 24

20 Medan Timur 26104 20

21 Medan Tuntungan 20051 16

Total 511515 400

3 RESULTS

Prevalence of smokers by demographic

characteristics. The respondents were the head of

household in Medan who were willing to participate

in the study with a total of 400 people. The smoking

status in this study was grouped into 2 categories

namely smoking and not smoking. The results

showed that about. 57.25% were smokers, with

97.80% in males compare 2.2% to female. The

prevalence of male smokers is higher than female

smokers, with the number of stick per day averaged

5 to 14 stick (47.2%) and 15 - 25 sticks by 41.5%.

Based on the level of education, 46.7% of SMU-

educated smokers, 20.5% SMP and 10.9% SD

compared with those with an educated PT of 21.4%.

About 75.5% of smokers are JKN participants. The

following table is the distribution of respondent

characteristics.

Table 2. Demographic Characteristics of head’s household

in Medan.

Demographic Characteristics n %

Smoking status (n=400)

Yes 229 57,25

No 171 42,75

Gender

Males 224 97,8

Females 5 2,2

Education level

Primary school graduates 25 10,9

Junior high school graduates 47 20,5

Senior high school graduate 107 46,7

University graduates 50 21,4

JKN status

Yes 173 75,5

No 56 24,5

Number of stick per day

1 – 4 stick 17 7,4

5 – 14 stick 108 47,2

15 – 25 stick 95 41,5

>25 stick 9 3,9

Total 229 100,0

Table 3. Descriptive Data about age, age of smoking and

household expenditure cigarette of respondents.

Min Max

Mea

Std.

Deviation

Age of

responden

19 70

41.5

10.617

Age of

smoking

initiation

0 55

19.0

7.359

expenditur

e on

cigarette

36.000 1890000

574.

000

264140.8

The average age of smokers is 41.5 years with a

minimum of 19 years and a maximum of 70 years,

with a mean age of smoking initiation 19 years.

While the average cigarette expenditure is

Rp. 574,000.

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

680

4 DISCUSSION

4.1 Smoking Prevalence

The analysis shows that smoking prevalence in

Medan was 57.25% higher than the national rate of

54% in 2016. It means that from 100 heads of

households there were 57 people who smoked, more

than half of the heads of households were smokers.

The epidemic of cigarette consumption in Indonesia

is very worrying, where the number of smokers in

Indonesia shows a tendency to increase from the

previous year. In 2013 the prevalence of smokers by

36% increased to 54% by 2016. More than half of

Indonesia's population is categorized as permanent

smokers. This condition is very apprehensive for the

health of the people of Indonesia

4.1.1 Smokers by Gender

The results also indicate that there is a sharp

difference in the prevalence of male and female

smoking, where this habit is rarely done by women.

Smoking behavior in men is considered part of

normal behavior and acceptable to society

. which is

widely promoted through cigarette advertisements

In contrast, smoking behavior in women is

considered a deviant behavior and unacceptable to

society

6-4

. The dominance of male smokers and at

least female smokers can be attributed to a culture

that does not accept the behavior of women who

smoke. Promotion of the cigarette industry that

connects smoking with young women, singset and

beautiful, can be said to fail or still have not

succeeded in facing this cultural resistance. The

cultural view of women smoking is considered

discriminatory and as a stigma is something that

ultimately has a positive impact on women's health,

since the cultural outlook has made the prevalence

rate of smoking among women to be low

The psychological literature concludes that

gender diﬀerences in tobacco consumption are

mainly due to diﬀerent behavior, having its roots in

traditional sex roles. Waldron (1991 identiﬁes three

main reasons for gender diﬀerences in smoking

behavior: (i) general characteristics of traditional sex

roles lead to social pressure against female smoking,

(ii) traditional sex role norms cause diﬀerences in

personal characteristics leading to more or less

acceptance of smoking (e.g. rebelliousness among

males is more accepted than among women and

causes higher smoking rates), (iii) sex roles

inﬂuence the assessment of costs and utility of

smoking (e.g. a thin women’s beauty ideal makes

weight control more important for women and

therefore increases the beneﬁts of smoking

4.1.2 Smokers and Education Level

US surgeon general's report, upon a thorough review

of the literature, concluded that education is the best

sociodemographic predictor of cigarette smoking

patterns

. The general consensus has been that the

fewer years of education one has, the more likely

this person is to smoke. Good health is positively

associated with never starting to smoke, quitting

smoking, and choosing low levels of tar in cigarettes

and this is in line with expectations one would have

for these behaviours, because smoking is considered

to damage health

, higher levels of education may

lead to greater levels of knowledge, if this effect

exists it is actually likely to act through the greater

capacity of those with higher education to both

absorb and use information, education may have an

indirect affect through its impact on the structuring

of perceived risk and future orientation. lower

educated individuals being more likely to smoke

than higher educated individuals, have been widely

documented

10-14

The economic literature discusses at least three

partly related reasons why high educated individuals

smokeless

. First, education is an investment

raising future income, which increases the marginal

return to health capital and leads to a higher optimal

health stock

16-19

. Second, education can change the

inputs into health production itself

20-21

. For

instance, higher educated individuals may be more

likely aware of the harmful of smoking or better able

to process health information, such as following

medical advice, higher education and healthier

behaviour simultaneously

22-23

4.1.3 Smoker by Initiation of Smoking

Most smokers started smoking at the age of 19

years, it means that most beginner smokers come

from teenagers. If at a young age a person does not

start to learn to smoke then he will never become a

smoker. Most beginner smokers are teenagers who

do not yet have the ability to properly assess the

effects of smoking and they are unaware of the

powerful addictive effects of nicotine that will bind

and cause people to stop smoking. In order for the

public to make the right choice, appropriate

information is needed. There are still many

community members in Indonesia who do not

understand correctly about the dangers of smoking

for health. One difficulty to communicate health

risks is the 20-25 year grace period required since a

Smoking Prevalence among Head of Household in Medan

681

person starts smoking until the onset of various

diseases caused by cigarettes, such as lung cancer.

However, the existing evidence is sufficiently

convincing that the use of tobacco kills one of two

users and causes a large number of serious health

effects.

Two main strategies may be used to develop

preventive efforts against adolescent smoking: (i) to

identify the determinants of smoking initiation, and

(ii) identifying determinants of smoking cessation,

which includes smoking reduction

4.1.4 Household Expenditure on Tobacco

Data from Indonesia Statistic shows that tobacco and

betel is the third highest expenditure per capita

during 2014, after prepared foods and rice grains.

5 CONCLUSIONS

The analysis shows that the prevalence of smokers is

high among head of household in Medan males, less

educated and JKN participant, thus those population

are mostly affected by the ill impact of smoking.

Under a decentralized government system, local

authorities have more power to prevent negative

economic and social impact of tobacco consumption

with intensive supports from the central government.

Stronger pro-health leadership is required in central

and local government to support programs to prevent

hazardous impact of tobacco consumption.

ACKNOWLEDGEMENTS

This study was supported by the Research Institute

University of North Sumatra In accordance with the

contract of TALENTA Research Implementation

University of North Sumatra 2018 Fiscal Year No:

2590 / UN5.1.R / PPM / 2018 dated March 16, 2018.

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