FAMILY INFLUENCE ON SMOKING BEHAVIOR

OF ELEMENTARY SCHOOL STUDENTS

IN BANDAR LAMPUNG CITY IN 2019
Retno Ariza S Soemarwoto1, Marisa Anggraini2, Hetti Rusmini2, Sidik Rahman Hakim2
1
Departemen of Pulmonology and Respiratory Medicine, Faculty of Medicine, Lampung
University
2
Fakultas Kedokteran Universitas Malahayati
ABSTRACT
Background: Smoking is an activity that have been main and biggest cause of death in
society and difficult to prevent. Motives or driving factors for why children smoke are
friend factors, personal factors, family factors, and advertising factors. Adolescent attitudes
are shaped by the role of the family which includes family structure, family smoking
behavior and family upbringing. Objective: Knowing the influence of the family on the
smoking behavior of elementary students in Bandar Lampung City in 2019. Methods: This
research was in the form of observational analytic with cross sectional approach. The
sample of this study was 901 students obtained using cluster sampling. Data analysis using
chi square. Results: There was a significant relationship between family smoking
behaviour towards smoking behaviour of students p = 0.003. There was a relationship
between family structure and family parent care on smoking behaviour of students with
their respective values namely p = 1,000 and p = 0.069). Conclusion: There was a
relationship between family smoking behavior and smoking behavior. However, there is no
relationship between the integrity of the family structure and permissive family caring for
smoking behavior. Keywords: Smoking, family structure, family smoking behavior,
family upbringing.

1
INTRODUCTION
Smoking is the main and biggest
causes of the death in society wich
difficult to prevent. Cigarettes can kill
up to half of the users, even more than 7
million people was die each year by
smoking. (World Health Organization,
2017).
World Health Organization
(WHO)estimates that there are at least
346 million smokers in the world with
amount of children aged 13-15 years
estimated at around 25 million children.
In the Association of South East Asia
Nations (ASEAN), the countries with
the highest adolescent smokers are
Timor Leste with 15.7% followed by
Butha with 14.0% then Indonesia
occupies the third position with 11.5%
(WHO, 2017).
Based on data from the Riset
Kesehatan Dasar 2013(Riskesdas), the
proportion of smokers in Indonesia has
been alarming. There are smokers who
smoke from an early age, namely age 5-
9 years at 0.7%; 10-14 years old at
9.5%; age of 15-19 years is 50.3%; age
of 20-24 years is 26.7%; age of 25-29
years is 7.6%; and ≥ 30 years old at
5.2% (RI Kementerian Kesehatan,
2013). In addition, WHO also states that
in Indonesia there are 25.6% of smokers
aged 10-11 years, 10.9% of smokers
aged 8-9 even there are smokers aged
less than 7 years as much as 8.9%
(WHO, 2014).
According to the Riskesdas of
Lampung Province in 2007 it was stated
in Lampung Province that smokers aged
10 years and over were 28.8% with 90%
smoking inside the house. The highest
percentage was found in Tanggamus
District 33.6% followed by West
Lampung 33.3%, and Bandar Lampung
City 24.8% (RI Ministry of Health,
2009).
Taryaka and Hurriyati found that
the motives or driving factors for why
children smoke are friend factors,
personal factors, family factors, and
advertising factors (Taryaka &
Hurriyati, 2011). In addition, Komasari
and Helmi found that three factors
causing smoking behavior in
adolescents were psychological
satisfaction, parental permissiveness
towards adolescent smoking behavior,
and peer influence (Komasari & Helmi,
2000).
Family plays a strategic role in
shaping the attitudes of adolescents,
especially parents. Parents are role
models for children, deep interactions
between parents and children, giving
birth to similar characters. So that
families who have smoking behavior
will influence the smoking behavior of
adolescents (Kustanto, 2015).
Control and supervision require
the role of parents to apply the right
parenting style for their children. The
right style of parenting done by parents
will have an impact on the behavior of
children to adulthood. Father's role,
especially in father's permissive
parenting style, influences the desire for
smoking in children (Husna & Hastuti,
2015).
The integrity of the family can
also influence the desire to smoke
because there is a vacancy that will
cause children to become less attentive
and less in control (Septiana et al.,
2016). Family structure can affect
children's development. Children from
divorced parents have a risk twice as
likely to behave naughty than children
who come from intact families.
Teenagers who do not live with both
parents also have a risk of smoking
(Loke, 2013).
METHOD
2
 The design of this study is
analytic observative with cross sectional
approach. The population used is
elementary school students in the
Bandar Lampung city in 2019, there
was 94,796 students in 177 elementary
schools which are divided into 20 sub-
districts.
The number of samples used in
this study were 900 samples, which
were calculated based on formulas
(Notoatmodjo, 2010). The sampling
technique used is cluster sampling. This
research was conducted in 20
Elementary Schools in Bandar
Lampung City, spread across 20 sub-
districts. Data were obtained by
distributing questionnaires containing
questions about students' smoking
behavior, family structure, family
smoking behavior, family upbringing.
This research was conducted during
January 2019.
RESULTS
Characteristics of the samples can
be seen in table 1.
3
 Tabel 1. Characteristics of the samples (n=899)
No Demographic N %
1 Sex
Male 475 52,8
Female 424 47,2
2 Age
10 18 2,0
11 462 51,4
12 346 38,5
13 60 6,7
14 11 1,2
15 2 0,2

4
 Table 1 shows that the highest age
of respondents was at the age of 11
years, namely 462 (51.4%), where the
youngest age was 10 years and the
oldest was 15 years. Table 1 also shows
Tabel 2. Variables Distribution and Frequency (N=899)
No Variable
1 Respondents' Smoking Behavior
Smoking
Not Smoking
that the majority of respondents were
male as many as 475 (52.8%).
Respondents' smoking behavior,
family structure, family smoking
behavior and family upbringing in this
study can be seen in table 2 below:
N %
456 50,7
443 49,3

2 Family Smoking Behavior

Smoking 736 81,9
Not Smoking 163 18,1

3 Family Upbringing
Permisive 55 6,1
Non-Permisive 844 93,9

4 Family Structure
Non-Intact Family
Intact Family
Based on Table 2, that the
smoking behavior of the majority of
respondents is in the smoking category,
which is 456 people (50.7%). In this
study the smoking behavior of
respondents was divided into categories
of Smoking and No Smoking.
In Table 2, that the majority of
respondents have a family with smoking
behavior as much as 736 smoking
categories (81.9) and family care
patterns obtained by the majority of
respondents are Non-Permissive as
72 8,0
827 92,0
many as 844 (93.9%) and family
structures owned by respondents the
majority in the whole family category
were 827 (92.0%).
From the results of the chi square
analysis, it was found that the variables
of family smoking behavior were
related to students' smoking behavior (p
<0.05). Whereas for family structure
variables and family upbringing are all
not related to students' smoking
behavior (p> 0.05). For more details can
be seen in table 3.

Tabel 3. Family Influence on Smoking Behavior (n=899)

5
 Smoking Behavior
NO Family Factors Smoking Not Smoking p
N(%) N(%)
1. Family Smoking Behavior
Smoking 391(50,1%) 345(46,9%)
0,003
Not Smoking 65 (39,9) 98(60,1)

2. Family Upbringing
Permisive 35(63,6%) 20(39,4%)
0,066
Non-Permisive 421(49,9%) 423(50,1%)

3. Family Structure
Non-Intact Family 37(51,4%) 35(48,6%) 1,000
Inctact Family 419(46,7) 408(49,3%)
DISCUSSION
There are many reasons that
trigger the emergence of students'
smoking behavior. In general, smoking
behavior is a function of the
environment and individuals. That is,
smoking behavior is caused by internal
factors, not only caused by
environmental factors.
Family Smoking Behavior
The chi square test results of
family smoking variables with smoking
behavior showed relationships between
family smoking behavior with smoking
behavior (p = 0.003), where as many as
50.1% of students from smokers
families had smoking behavior. This
shows students with smokers families,
such as father smoker, one brother of oe
one of the family members who behaves
smoking, then will had the risk of
smoking behavior.
The results of this study are
supported by research conducted by
Wahyudi (2014) who found that the
majority of parents of smokers had
children who had a smoking habit of
36.9%. So there is a relationship
between parents of smokers and
smoking habits in children. Another
supportive research result is the results
of research from Andrade (2017) which
found that respondents with mothers or
fathers of smokers had 2.0 and 2.5 times
more risk of becoming smokers.
This is in line with the theory put
forward by Durkin and Helmi cited by
Wahyudi (2014) that the concept of the
first socialization developed from
sociology and social psychology which
is a process of transmitting values,
belief systems, attitudes and behaviors
from previous generations to
generations after that.
Smoking in the family is a serious
problem, because it occurs from
generation to generation. The majority
of family heads in Indonesia have a
smoking behavior, besides that male
family members who are considered
mature enough such as older siblings,
uncles or grandfathers have similar
habits so smoking behavior is
considered normal for adult men. In the
elementary school group, which
included the early adolescents who had
a great desire to know the taste of
cigarettes, supported by the smoking
behavior of the father and siblings, they
would make the students smoked
(Wulan, 2012).
Family Upbringing
The chi square test results of
family parenting variables with smoking
behavior showed no relationship
between family structure and smoking
behavior (p = 0.066), where only 35
(63,6%) of students who came from
families with permissive parenting had
smoking behavior. This shows that
students with permissive family care
have no risk of smoking behavior.
The results of this study are in line
with the results of research conducted
by Pramintari, Hastuti and Djamaludin
(2013) on high school students who
showed that there was no significant
relationship between the role of parents
both parents' parenting style and
parental example with adolescent
cigarette consumption behavior.
However, the results of this
study are different from the results of
research conducted by Kharie (2014)
which shows that the type of parenting
that is most widely applied by parents to
children is permissive parenting. In
addition, another study from Husna and
Hastuti (2015) found a significant
relationship (p <0.05) between father's
role especially in the father's permissive
parenting style (r = 0.364, p <0.05) with
the smoking tendency of students.
In fact the results of this study
indicate that there is no relationship
between family caring for adolescent
smoking behavior which can be caused
by the adolescent's internal factors,
namely self-esteem, self-control, and
self-efficacy. Teenagers who have self-
esteem, self-control, and self-efficacy
tend not to be involved (Pramintari,
2013).
Famiy Structure
Family structure, especially non-
intact families is one of the factors in
the occurrence of smoking behavior in
students (Septiana, 2016). Family is a
very influential environment for
children's development. Place for
planting values and norms and
establishing behavior in children.
Without a complete family structure,
there can be a vacancy that results in the
emergence of smoking behavior in
children.
Chi square test results of family
structure variables with smoking
behavior showed no relationship
between family structure and smoking
behavior (p = 1,000), where only 8.1%
of students from non-intact families had
smoking behavior. This shows that
students with an incomplete family
structure, such as having a divorced
parent, or not living with both parents,
have no risk of smoking behavior.
This study has different results
from the study conducted by Septiana
(2016) which found that family
structure will influence smoking
behavior by 2.95 times, so that the more
intact the family is, the higher the
behavior for not smoking.
Family structure does have a role
in shaping students in determining
attitudes and behavior. But with the
presence of communication and giving
good attention to students it will provide
good control for students. The
application of family communication
patterns as a form of interaction
between parents and children and
between family members has
implications for the child's emotional
development process (Setyowati, 2005).
CONCLUSION
The results showed a correlation
between family smoking behavior and
smoking behavior in elementary school
students in Bandar Lanpung City in
2019. However, there was no
relationship between family structure
and family upbringing with smoking
behavior in elementary school students
in Bandar Lampung City in 2019.
Suggestions for parents not to
consume cigarettes in front of their
children and to supervise with non-
permissive parenting so that the level of
control of students' smoking behavior
can be monitored so as not to enter into
smoking behavior. In addition, if the
family structure turns out not to be
intact, it is hoped that it will continue to
provide good attention and
communication for the development of
children's behavior.
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