COMPARATIVE STUDY: HEALTH RISK BEHAVIOUR IN URBAN AND RURAL INDONESIAN ADOLESCENTS

Introduction: In 2019, the prevalence of cigarette smoking among adolescents in Indonesia increased to 18.8%. Aim: To assess health risk behaviours among Indonesian students in both urban and rural areas. Methods: This study's survey items, were developed using items questionnaire that focuses on smoking, eating, socioeconomic status (SES), and social relationships among teenagers aged 14 to 18. The study used two separate, demographically and culturally varied school-based populations. Results: The study found that teenagers in urban areas were more likely to smoke cigarettes, whilst adolescents in rural areas were more likely to practice healthy eating habits. Significant disparities in socioeconomic level (P 0.05) and social interactions (P 0.05) were also discovered, which may have an impact on the health risk behaviours seen in teenagers. The development of focused therapies and public health initiatives to address teenage health risk behaviours will benefit from these findings. Conclusion: More study is necessary to further understand the relationship between risk factors and health behaviours in both urban and rural teenagers in Indonesia. This will make it possible to find efficient preventive techniques and plans adapted to pupils' particular environments and cultural backgrounds.
Angeles-Agdeppa, I., Toledo, M. B., & Zamora, J. A. T. (2021). Moderate and Severe Level of Food Insecurity Is Associated with High Calorie-Dense Food Consumption of Filipino Households. Journal of Nutrition and Metabolism, 2021, e5513409. https://doi.org/10.1155/2021/5513409
Bonino, S., Cattelino, E., & Ciairano, S. (2005). Risk Behavior in Adolescence. In E. Cattelino, S. Bonino & S. Ciairano (Eds.), Adolescents and Risk: Behavior, Functions, and Protective Factors (pp. 1–31). Springer Milan. https://doi.org/10.1007/88-470-0393-8_1
Brooks, F. M., Magnusson, J., Spencer, N., & Morgan, A. (2012). Adolescent multiple risk behaviour: An asset approach to the role of family, school and community. Journal of Public Health, 34(suppl 1), i48–i56. https://doi.org/10.1093/pubmed/fds001
Choi, W. S., Ahluwalia, J. S., Harris, K. J., & Okuyemi, K. (2002). Progression to established smoking: The influence of tobacco marketing. American Journal of Preventive Medicine, 22(4), 228–233. https://doi.org/10.1016/S0749-3797(02)00420-8
CodeBlue. (2023, March 3). Fast Food Environment And Obesity—Kimberly Wong & Prof Dr Moy Foong Ming. CodeBlue
Curtis, A. C., Waters, C. M., & Brindis, C. (2011). Rural adolescent health: The importance of prevention services in the rural community. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 27(1), 60–71. https://doi.org/10.1111/j.1748-0361.2010.00319.x
Dartanto, T., Moeis, F. R., Nurhasana, R., Satrya, A., & Thabrany, H. (2018). Parent smoking behavior and children’s future development: Evidence from Indonesia Family Life Survey (IFLS). Tobacco Induced Diseases, 16(3). https://doi.org/10.18332/tid/94561
Dyer, O. (2022). Groundbreaking anti-smoking laws advance in Malaysia and New Zealand. BMJ, 378, o1967. https://doi.org/10.1136/bmj.o1967
Haye, K. de la, D’Amico, E. J., Miles, J. N. V., Ewing, B., & Tucker, J. S. (2014). Covariance among Multiple Health Risk Behaviors in Adolescents. PLOS ONE, 9(5), e98141. https://doi.org/10.1371/journal.pone.0098141
Hoe, C., Cohen, J. E., Yang, T., Peng, S., & Zhang, W. (2022). Association of cigarette production and tobacco retailer density on secondhand smoke exposure in urban China. Tobacco Control, 31(e2), e118–e125. https://doi.org/10.1136/tobaccocontrol-2021-056655
Kim, S., & Selya, A. (2022). Rural disparities in adolescent smoking prevalence. The Journal of Rural Health, 38(2), 360–363. https://doi.org/10.1111/jrh.12610
Leatherdale, S. T., & Strath, J. M. (2007). Tobacco retailer density surrounding schools and cigarette access behaviors among underage smoking students. Annals of Behavioral Medicine, 33(1), 105–111. https://doi.org/10.1207/s15324796abm3301_12
Levin, K. A. (2014). Urban–rural differences in adolescent eating behaviour: A multilevel cross-sectional study of 15-year-olds in Scotland. Public Health Nutrition, 17(8), 1776–1785. https://doi.org/10.1017/S1368980013002127
Lim, K. H., Teh, C. H., Pan, S., Ling, M. Y., Yusoff, M. F. M., Ghazali, S. M., Kee, C. C., Lim, K. K., Chong, K. H., & Lim, H. L. (2018). Prevalence and factors associated with smoking among adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015. Tobacco Induced Diseases, 16, 01. https://doi.org/10.18332/tid/82190
Littlecott, H. J., Moore, G. F., Evans, R. E., Melendez-Torres, G. J., McCann, M., Reed, H., Mann, M., Dobbie, F., Jennings, S., Donaldson, C., & Hawkins, J. (2023). Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: A systematic review and meta-ethnography of qualitative research. BMC Public Health, 23(1), 424. https://doi.org/10.1186/s12889-022-14727-z
Maxwell, K. A. (2002). Friends: The Role of Peer Influence Across Adolescent Risk Behaviors. Journal of Youth and Adolescence, 31(4), 267–277. https://doi.org/10.1023/A:1015493316865
Mayhew, K. P., Flay, B. R., & Mott, J. A. (2000). Stages in the development of adolescent smoking. Drug and Alcohol Dependence, 59, 61–81. https://doi.org/10.1016/S0376-8716(99)00165-9
McMillan, C., Felmlee, D., & Osgood, D. W. (2018). Peer influence, friend selection, and gender: How network processes shape adolescent smoking, drinking, and delinquency. Social Networks, 55, 86–96. https://doi.org/10.1016/j.socnet.2018.05.008
Megatsari, H., Astutik, E., Gandeswari, K., Sebayang, S. K., Nadhiroh, S. R., & Martini, S. (2023). Tobacco advertising, promotion, sponsorship and youth smoking behavior: The Indonesian 2019 Global Youth Tobacco Survey (GYTS). Tobacco Induced Diseases, 21, 163. https://doi.org/10.18332/tid/174644
Mohd Hanim, M. F., Md Sabri, B. A., & Yusof, N. (2021). Online News Coverage of the Sugar-Sweetened Beverages Tax in Malaysia: Content Analysis. JMIR Public Health and Surveillance, 7(8), e24523. https://doi.org/10.2196/24523
Murayama, N. (2015). Effects of Socioeconomic Status on Nutrition in Asia and Future Nutrition Policy Studies. Journal of Nutritional Science and Vitaminology, 61(Supplement), S66–S68. https://doi.org/10.3177/jnsv.61.S66
Nargiso, J. E., Becker, S. J., Wolff, J. C., Uhl, K. M., Simon, V., Spirito, A., & Prinstein, M. J. (2012). Psychological, Peer, and Family Influences on Smoking Among an Adolescent Psychiatric Sample. Journal of Substance Abuse Treatment, 42(3), 310–318. https://doi.org/10.1016/j.jsat.2011.07.010
Nurhayati, N., Kusuma, D., Tarigan, A., Siregar, P., Hasibuan, R., & Ahsan, A. (2022). Exposure to Outdoor Tobacco Advertisements Near Home is Associated with Smoking among Youth in Indonesia. Asian Pacific Journal of Cancer Prevention, 23(7), 2179–2183. https://doi.org/10.31557/APJCP.2022.23.7.2179
Nurwanti, E., Hadi, H., Chang, J.-S., Chao, J. C.-J., Paramashanti, B. A., Gittelsohn, J., & Bai, C.-H. (2019). Rural–Urban Differences in Dietary Behavior and Obesity: Results of the Riskesdas Study in 10–18-Year-Old Indonesian Children and Adolescents. Nutrients, 11(11), 2813. https://doi.org/10.3390/nu11112813
Perera, I., & Ekanayake, L. (2011). Influence of oral health-related behaviours on income inequalities in oral health among adolescents. Community Dentistry and Oral Epidemiology, 39(4), 345–351. https://doi.org/10.1111/j.1600-0528.2010.00606.x
Ramadas, A., Tham, S. M., Lalani, S. A., & Shyam, S. (2021). Diet Quality of Malaysians across Lifespan: A Scoping Review of Evidence in a Multi-Ethnic Population. Nutrients, 13(4), 1380. https://doi.org/10.3390/nu13041380
Robalino, J. D., & Macy, M. (2018). Peer effects on adolescent smoking: Are popular teens more influential? PLoS ONE, 13(7), e0189360. https://doi.org/10.1371/journal.pone.0189360
Roberts, M. E., Teferra, A. A., Keller-Hamilton, B., Patterson, J. G., & Ferketich, A. K. (2020). Shared and unique risk factors for tobacco use among rural versus urban adolescents. Preventive Medicine, 140, 106239. https://doi.org/10.1016/j.ypmed.2020.106239
Salvy, S.-J., De La Haye, K., Bowker, J. C., & Hermans, R. C. J. (2012). Influence of peers and friends on children’s and adolescents’ eating and activity behaviors. Physiology & Behavior, 106(3), 369–378. https://doi.org/10.1016/j.physbeh.2012.03.022
Sawyer, S. M., Afifi, R. A., Bearinger, L. H., Blakemore, S.-J., Dick, B., Ezeh, A. C., & Patton, G. C. (2012). Adolescence: A foundation for future health. The Lancet, 379(9826), 1630–1640. https://doi.org/10.1016/S0140-6736(12)60072-5
Shi, Z., Lien, N., Kumar, B. N., & Holmboe-Ottesen, G. (2005). Socio-demographic differences in food habits and preferences of school adolescents in Jiangsu Province, China. European Journal of Clinical Nutrition, 59(12), 1439–1448. https://doi.org/10.1038/sj.ejcn.1602259
Story, M., & Resnick, M. D. (1986). Adolescents’ views on food and nutrition. Journal of Nutrition Education, 18(4), 188–192. https://doi.org/10.1016/S0022-3182(86)80015-2
UNICEF. (2020). Education and Adolescents | UNICEF Indonesia.
Unicef. (2020). Education and Adolescents | UNICEF Indonesia.
Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). Adolescence and the social determinants of health. Lancet, 379(9826), 1641–1652. https://doi.org/10.1016/S0140-6736(12)60149-4
Vlismas, K., Stavrinos, V., & Panagiotakos, D. B. (2009). Socio-economic Status, Dietary Habits and Health-Related Outcomes in Various Parts of the World: A Review. Central European Journal of Public Health, 17(2), 55–63. https://doi.org/10.21101/cejph.a3475
Widiastuti, A. (2022). Analisis Sektor Ekonomi Unggulan di Kabupaten Lebak Periode Tahun 2016-2020. Jurnal Ekonomi-Qu, 12(1), Article 1. https://doi.org/10.35448/jequ.v12i1.16303
York, N. L., Rayens, M. K., Zhang, M., Jones, L. G., Casey, B. R., & Hahn, E. J. (2010). Strength of tobacco control in rural communities. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 26(2), 120–128. https://doi.org/10.1111/j.1748-0361.2010.00273.x
Yoshikawa, H., Aber, J. L., & Beardslee, W. R. (2012). The effects of poverty on the mental, emotional, and behavioral health of children and youth: Implications for prevention. American Psychologist, 67(4), 272–284. https://doi.org/10.1037/a0028015
Copyright (c) 2025 The Indonesian Journal of Public Health

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
- The authors agree to transfer the transfer copyright of the article to The Indonesian Journal of Public Health effective if and when the paper is accepted for publication.
- Authors and other parties are bound to the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License for the published articles, legal formal aspect of journal publication accessibility refers to Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA), implies that:
- Attribution ” You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial ” You may not use the material for commercial purposes.
- ShareAlike ” If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.