Effectiveness of Community Smoking Prevention Education in Enhancing Adolescent’s Knowledge in Banyuwangi Indonesia

Introduction: Tobacco consumption increases the risk of chronic diseases and death. In Indonesia, the prevalence of active smokers is estimated to reach 27% of the population, or 70 million people, with 7.4% of them aged 10-18 years. The aim of this study is to assess the effectiveness of community smoking prevention education in enhancing adolescent knowledge in Banyuwangi, Indonesia. Methods: This study used a quasi-experimental research design with a pre- and post-test one-group approach. In this study, we employed total sampling as our sampling technique. The samples were students of class X SMA Negeri 1 Giri Banyuwangi, aged 14-16 years old. The intervention includes a presentation on long-term health consequences, the risk of addiction, and the adverse effects of smoking. Psychiatrists led our intervention, sharing general knowledge about smoking behavior and its risk for health outcomes. Results: The study ultimately employed a final sample of 49 participants. The paired t-test increased from the pre-test (53.47) to the post-test (63.47) score average. The standard deviation for the pre-test and post-test is 14.513. Eventually, the standard error mean for the pre-test and post-test is 2.073. The average learning outcome in the pre-test (53.47) is less than that of the post-test (63.47), and the p-value is 0.000, which is less than 0.05. Conclusion: The study’s results indicated that prevention education had a significant impact on increasing adolescents’ knowledge about smoking (p = 0.000). Regular prevention programs could further enhance adolescents’ understanding of the topic.

INTRODUCTION

Tobacco consumption can cause death, not only in direct tobacco use but also in indirect tobacco use, such as in passive smoking. As many as 8 million people die each year from tobacco exposure[1]. Based on WHO data, the prevalence of tobacco use worldwide is 22.3%, and tobacco use among people aged 15–24 is 14.2%. The Southeast Asia Region has the highest average tobacco use compared to other regions[2].

Smoking cigarettes is the most prevalent way to use tobacco[1]. In Indonesia, the prevalence of active smokers is estimated to reach 27% of the population, or 70 million people, with 7.4% of them aged 10-18 years[3]. Early initiation of smoking exposes a person to the harmful substances in cigarettes. Adolescents are still growing and more susceptible to the detrimental effects of smoking throughout this stage of life. The longer a person smokes in their life, the higher the risk of experiencing chronic diseases, such as lung cancer and chronic obstructive pulmonary disease. Adolescents who smoke are also more likely to continue smoking into adulthood[4][5].

Television and Indonesian media continue to regularly air cigarette commercials. Additionally, tobacco businesses continue to sponsor many sports and music events. Research has demonstrated that tobacco advertising, promotion, and sponsorship increase the risk of smoking behavior among Indonesian youths[6]. Regulations related to cigarette sales to adolescents in Indonesia are also weak. A study showed that schools in Banyuwangi are surrounded by many cigarette retailers whose prices are affordable for teenagers. Easy access to cigarettes and a lack of knowledge about the harmful effects and disadvantages of cigarettes can increase smoking behavior in teenagers[7][8][9].

An integrated strategy is required to address the problem of tobacco smoking among young adolescents in Indonesia. This strategy calls for tighter tobacco control laws to be put into place, as well as higher tobacco product taxes, better enforcement of age restrictions, a ban on tobacco advertising and promotion, and the launch of extensive public health campaigns to inform young people about the dangers of smoking[10]. The aim of this study is to assess the effectiveness of community smoking prevention education in enhancing adolescent knowledge in Banyuwangi, Indonesia.

METHODS

Study design

This study used a quasi-experimental research design with a pre- and post-test one-group approach. This design was chosen to evaluate the effectiveness of community smoking prevention education in enhancing adolescent knowledge in Banyuwangi, Indonesia. This research measured the student’s knowledge before and after the training session was carried out. The study was conducted on August 24th, 2024. Total sampling was used as a sampling technique in this study. The samples were students of class X SMA Negeri 1 Giri Banyuwangi, aged 14-16 years old. The inclusion criteria were students with the ability to communicate in Indonesian and a willingness to participate in the full sequence of the study. The exclusion criteria were students who did not complete the pre- and/or post-test. The ethics committee of Universitas Airlangga, Surabaya, approved this study. All participating students were informed about the purpose of the study and their rights and obtained written consent from their parents or guardians.

Measures and Data Analysis

The data obtained were analyzed using a paired t-test statistical test by SPSS 23.0 to see the significant difference between before and after the intervention.

RESULTS

A total sampling method was employed, initially enrolling 64 students; however, only 49 students were included in this study. 14 students were excluded because they did not complete the pre- and/or post-test.

Demographic Data

The data collected was analyzed to assess the impact of the educational interventions on the participants’ understanding of the risks associated with smoking and the importance of smoking prevention.Table 1.shows that the majority of respondents in this study are female (63%) and 37% male. Furthermore, based on age (years old), 53% of respondents in 15 years old, followed by 16 years old (39%), and 14 years old (8%). The ethnicity of the majority of respondents is Javanese (63%), followed by Javanese-Osing (16%), Javanese-Maduranese (6%), Javanese-Chinese (4%), Javanese-Balinese (2%), Javanese-Sundanese (2%), Javanese-Kalimantan (2%), Balinese (2%), Osing (2%), and Sundanese (2%). Based on religion, most respondents are Muslim (90%), Christian (8%), and Hindu (2%). For the history of chronic illness, most of the respondents have no chronic illness (65%), have digestive disorder (12%), have digestive disorder and allergy (12%), have allergy (6%), and have respiratory disorder (4%). Based on their smoking status, most respondents don’t smoke (98%), and there was 1 (2%) respondent who smoked.

Table 1.Characteristics of Research Respondents

Demographic Variable	Category	Total (n)	Percentage (%)
Gender	Male	18	37%
	Female	31	63 %
Age (years old)	14	4	8%
	15	26	53%
	16	19	39%
Ethnicity	Javanese	31	63%
	Javanese-Osing	8	16%
	Javanese-Maduranese	3	6%
	Javanese-Chinese	2	4%
	Javanese-Balinese	1	2%
	Javanese-Sundanese	1	2%
	Javanese-Kalimantan	1	2%
	Balinese	1	2%
	Osing	1	2%
	Sundanese	1	2%
Religion	Moslem	44	90%
	Christian	4	8%
	Hindu	1	2%
Chronic Illness	None	32	65%
	Digestive Disorder	6	12%
	Allergy	3	6%
	Respiratory Disorder	2	4%
	Digestive Disorder and Allergy	6	12%
Smoking status	Yes	1	2%
	No	48	98%

Program effects on smoking knowledge in students

The following segment details the analysis of the educational intervention’s effectiveness in enhancing adolescents' knowledge about smoking prevention. The analysis was conducted through the use of an anonymous questionnaire

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