KNOWLEDGE, ATTITUDE AND BEHAVIOR OF SMOKING HAZARD AND PREVENTION EFFORTS IN SENIOR HIGH SCHOOL ADOLESCENT BANJARBARU CITY

KNOWLEDGE, ATTITUDE AND BEHAVIOR OF SMOKING HAZARD AND PREVENTION EFFORTS IN SENIOR HIGH SCHOOL ADOLESCENT BANJARBARU CITY Fauzie Rahman, Anggun Wulandari 1, Dian Rosadi 2 and Fahrini Yulidasari 3 1 Health Policy Administration and Health Promotion, Public Health Study Program Medical Faculty Lambung Mangkurat University Banjarbaru, Kalimantan Selatan, Indonesia 2 Epidemiology Section, Public Health Study Program Medical Faculty Lambung Mangkurat University Banjarbaru, Kalimantan Selatan, Indonesia 3 Maternal and Child Health Section, Public Health Study Program Medical Faculty Lambung Mangkurat University Banjarbaru, Kalimantan Selatan, Indonesia Abstract- Based on data from Indonesia Global Youth Tobacco Survey (GYTS) in 2009 showed the prevalence of students who ever smoked by 30.4%, consisting of male by 57.8% and female by 6.4%, and 20.3% were students they use cigarettes. According to the characteristics of living, the prevalence of smokers in countryside of 37.4% and 32.3% in urban areas. Purpose of this study was to determine the knowledge and attitudes about dangers of smoke to smoking prevention in adolescent behavior. Type of research is observational analytic with cross sectional. The study population was students who were in senior high school Banjarbaru. Sample of 323 respondents. Data analysis using Chi Square test to see the correlation between knowledge, attitudes and behavior toward prevention of the effects of smoking. The results showed 38 adolescents (46.3%) had a good knowledge, 45 adolescents (54.9%) have a positive attitude, and 54 adolescents (65.9%) have a positive attitude. Based on the statistical test showed no correlation between knowledge smokers (pvalue=0.477), attitude of smokers (p-value=0.383) and smoking behavior. Therefore, need for increased knowledge through the establishment of a peer educator and empowering adolescents to early education that adolescents aware of the smoking effects and can prevent early. Keywords- Knowledge, attitudes, behaviors, smoking, adolescents Correspondent Author: Fauzie Rahman* I. INTRODUCTION Adolescence is a period of the most vulnerable to the influence of the environment (BPOM RI, 2011). Healthy teenager is adolescents productive and creative in accordance with the stages of development. Youth development is very susceptible to environmental influences, one of which is the social and cultural environment. Social and cultural environment that is negative is a factor for young people to get stuck in unhealthy behaviors, such as smoking, drinking, drug use, premarital sex, fights, criminal acts, and racing on the road (Tarwoto et al, 2009). The social environment affects a person and are related to smoking. Effect of friends and the group was very strong for a teenager decides to smoke or not. Teenagers would be try to follow the habit of a group or friends in order to be accepted in the group. It can also be caused confidence so low that tend to adopt the prevailing custom such as smoking (BPOM RI, 2011). Smoking is a problem that can not be resolved until today. Smoking has hit various communities in Indonesia, both children to the elderly, male and female. One of the program targets health behavior and community development is to reduce the prevalence of smokers as well as increased non-smoking healthy environment in schools, workplaces and public places. According to WHO (2008) every 6.5 seconds a person dies because of smoking. WHO (2008) estimates that people who begin smoking in adolescence (70% of smokers at an early age) and continuous smoking until two decades or more, will die 20-25 years earlier than people who have never touched a cigarette. @IJMTER-2016, All rights Reserved 119

Data Global Youth Tobacco Survey (GYTS) showed an increase adolescent smokers are quite worrying. The prevalence of smoking continues to increase both in men and female. The prevalence of smoking among women increased four-fold from 1.3% in 2001 to 5.2% in 2007. According to the Global Youth Tobacco Survey (GYTS) (2009) 30.4% of adolescents aged 13-15 years had never smoked (57,8% of men had never smoked and 6.4% of women never smoked), and 20.3% of adolescents aged 13-15 are active smokers. Indonesia was ranked the third by the number of smokers in the world after China and India and continue to occupy the 5th position after China, the United States, Russia and Japan in 2007 (WHO, 2008). More than 40.3 million Indonesian children aged 0-14 years of exposure to secondhand smoke (being active smokers and passive smokers). This causes development of the child's lung growth becomes slower and more prone to respiratory infections, ear infections and asthma (MoH RI, 2010). According Saprudin (2007) in Tarwoto et al, the reasons adolescents in Depok, West Java smoking is due to see friends (28.43%), saw the parents / family (19.61%), see figure on television artist (16.66 %), saw the teacher (9.8%), stress relief (3.92%), and because it was never informed about the dangers of smoking (10.79%). Smoking habit has become a culture in Indonesian society. Adolescents, adults, and even children are already familiar with these deadly objects. Smoking behavior committed by juveniles often we see in various places, for example in a shop near the school, the way to school, bus stop, private vehicles, public transport, even in the home environment. It has become a common sight and rarely gets public attention, but the behavior is harmful to adolescents and people in the vicinity (Kemenkes RI, 2012). Adolescents begin to smoking for a variety of reasons, such as imitating adult behavior, peer pressure, and imitate the properties of a famous person who usually smoke. Adolescents who is likely to have a low smoking behavior is teenage family and friends do not smoke, interested in academic activities or sports, and those who have plans to go into higher education (Wong, 2009). Smoking is a major factor causing diseases of the heart and blood vessels. Smoking behavior will affect health in the short term and long term, which will be borne not only by smokers themselves, but also others (Tarwoto, et al, 2010). Smoking will affect the environment, other people, or from people nearby. A non-smoker when constantly exposed to cigarette smoke can receive the same effect on smokers. Smoking can also lead to bad breath, brownish color of the nails and teeth, and an unpleasant smell on the hair and clothes, besides that the skin becomes more wrinkled early (Kemenkes RI, 2003). World Health Organization (WHO) issued a Framework Convention on Tobacco Control (FCTC) which is an international treaty that aims to protect the present generation and the coming of the dangers of smoking and smoke exposure. The Indonesian government has drawn up regulations that govern the protection of society due to the dangers of smoking, the Health Law No. 36/2009 on Tobacco Products Security as addictive substances for Health, the Draft Regulation of Tobacco Products Security As Addictive Substances for Health, the draft Law on Control of Tobacco Products Impact on Health (RUU-PDPTK) (Trihono et al, 2010). According to Wong (2009), adolescence is divided into the third stages, namely early teens, adolescents middle and late adolescence. In early adolescence, the percentage who know cigarettes may be smaller than the middle and late adolescents, but early adolescence is crucial to recognize young people in taking the act of smoking because of the influence of adaptation, and others. In this period the influence of peers on attitudes, interests and behavior outweigh the influence of family. The Government of the Republic of Indonesia has set a policy banning smoking in government regulations of the Republic of Indonesia Number 19 Year 2003 on cigarettes for health article 22 of the No Smoking (KTR). Public areas of health facilities, workplaces and places specifically as a teaching and learning, the arena of children's activities, places of worship and public transport are declared as a smoking area. Determination KTR in the region is basically a policy for the protection of passive smokers, adolescents, pregnant women and other vulnerable groups, to the health effects of cigarette smoke, as well as indoor air pollution (Ministry of Health, 2012). @IJMTER-2016, All rights Reserved 120

Tarwoto et al (2010) mentions the age of 11-13 years is an age which is categorized early teens. Adolescents at this stage begin to focus on the decision-making both in the home and outside the home. Adolescents can choose what you think is the teen well. Adolescents feel the need to collect new experiences and new knowledge and a knowledge test is for example by trying to smoke. Sarwono (2011) mentions the age of 12-15 years is an age which is identical to try, for example, try to smoke and possibly other deviant behavior. Such behavior is based on knowledge of adolescents about the effects of such behavior. Need appeal closest person to give instructions about the dangers perilau distorted. The prevalence of male smokers were in urban schools that never 65.6% and 71.2% at the elementary school. The prevalence of smokers in rural areas is higher than in urban areas. WHO (2010) states, in rural areas the number of cigarettes consumed a little more than urban areas, both in men and female. According to the characteristics of the place to stay, the prevalence of smokers in rural areas and in urban areas 37.4% 32.3% (Riskesdas, 2010). Urban areas is a village-level administrative areas / villages who meet certain requirements in terms of population density, percentage of agricultural households, and the number of urban facilities, formal education facilities, public health facilities, and so forth. While rural areas is a village-level administrative areas / villages who do not meet certain requirements in terms of population density, percentage of agricultural households, and the number of urban facilities, formal education facilities, public health facilities, and so on (CBS, 2010). Characteristics of the smoking population in rural locations as much as 55.8% and the smoking population in urban locations as much as 44.2%, while the prevalence of smoking is highest in the age group 10-14 years is 13.6%. Overall lower education in rural areas than urban areas (Riskesdas, 2010). Criteria for the urban village is a criteria using three indicators as a measure; population density per km2 (KPD), the percentage of agricultural households (PRT), and keberaaan or the access to urban facilities (Afu). East Java Province has categorized rural areas as much as 5670, and as many as 2836. urban Jember Regency has 166 territory categorized as rural and 82 urban areas categorized (CBS, 2010). Based on this background, the needed research to find out and explain the knowledge, attitude and behavior of smoking hazard and prevention efforts in senior high school adolescent Banjarbaru city. II. MATERIAL AND METHODS This type of research used in this study is observational analytic study using cross sectional approach. Cross sectional study is a cross-sectional study on the object of research is measured and collected simultaneously, instantaneous or just once in one time (the same time), and in this study there was no follow-up (Setiadi, 2007). The population in this study were all students / senior high school students in Banjarbaru. The samples are part of the overall object studied and considered representative of the entire population (Notoadmojo, 2010). Samples are elements selected population based on ability to represent (Setiadi, 2007). In this study, samples will be taken by 82 students. The sampling technique in this research is purposive sampling using multiple criteria for inclusion. The inclusion criteria are general characteristics of the study subjects an affordable target population to be studied (Notoatmodjo, 2010). Criteria for inclusion in this study are: Primary data is data collected through the first party, usually through questionnaires, interviews, polls, and others (Nazir, 2003). Primary data in this study is data derived from the answers to questions of researchers in the questionnaire about the dangers of smoking, the researchers conducted interviews on the smoking behavior of students and researchers are given a questionnaire containing questions about smoking and its dangers. Secondary data is data about teenagers from senior high school in Banjarbaru. Data collection tool used in this research is to use the technique of filling out the questionnaire. Mechanical filling out the questionnaire to do is to measure the level of knowledge, attitudes and behavior of adolescents about the dangers of smoking and prevention in adolescents SLTA Banjarbaru region. Assessment questionnaire about the level of @IJMTER-2016, All rights Reserved 121

knowledge of adolescents about the dangers of smoking using a type of right and wrong. A value of 1 is given if the answer is correct and the value 0 is given if the answer is wrong. A. Univariate Analysis III. RESULTS AND DISCUSSION 1. Knowledge The results showed that the respondents have bad knowledge of both numbers 44 (53.7%) of respondents. Based on the results of the questionnaire, 44 respondents who have less knowledge is good, there were 36 (81.81%) of respondents who do not know about the types of smokers. There are 3 types of smokers according to Nasution (2007), that light smokers, moderate, and severe. When a person consumes as much as 1-4 cigarettes per day are included in the rod-type light smokers. When a person consumes as much as 5-14 cigarettes per day are included in the rod-type moderate smokers. When a person consumes cigarettes more than 14 cigarettes per day are included in the type of heavy smokers (IK Nasution, 2007). Knowledge is a predisposing factor that influence a person's behavior, high knowledgeable teens are expected to behave positively. One way to improve the knowledge training on parenting adolescents anti-smoking. A study conducted to elucidate the effect of anti-smoking parenting training to the knowledge and behavior of adolescents to smoke to show the influence between knowledge and behavior of smoking. Implementation of anti-smoking parenting measured by the reaction of parents to smoke, rules applied at home, content and frequency of communication about smoking (Huver et al., 2008). In kamus besar Bahasa Indonesia (2002), knowledge (knowledge) is the result of "know" and this occurred after people perform sensing to a particular object. Sensing occurs through the human senses: vision, hearing, smell, taste and touch. Or cognitive domain knowledge is very important for the formation of a person's actions (over behavior) (Poerwadarmanto, 2006). This is consistent with that proposed by Notoatmodjo (2003) that the domain knowledge is very important in the formation of a person's actions (overt behavior). According Notoatmodjo (2003) states that one of the factors that determine the predisposing factors, including the knowledge. Meanwhile, the WHO in Notoatmodjo (2003) analyzed that knowledge is one of the principal reasons that cause a person to behave. In the case of smoking, can be explained that the respondents have sufficient knowledge related to smoking tend not to smoke, otherwise the respondents who have less knowledge about smoking tend to behave smoke. 2. Attitude The results showed that respondents who had a negative attitude amounted to 37 (45.2%) of respondents. Based on the results of the questionnaire, 37 respondents who had a negative attitude, there were 20 (54.05%) of respondents did not agree that it is not smoke, do not consume alcohol, the consumption of nutritious foods, and exercising can prevent diseases that arise from smoking. That is, the respondents did not know about the ways to prevent diseases resulting from smoking. According to research conducted by Wawan and Dewi (2010), the better a person's knowledge it will be more positive attitude toward an object, and conversely the lack of knowledge a person has the more negative attitude toward an object (Henry and Goddess, 2010). Therefore, it is necessary for proper health promotion media in order to enhance students' knowledge. According to Azwar (2011), in health promotion media, the message conveyed in an objective factual influence the attitude of (Anwar, 2010). Attitude is not an action or activity, but predisposes action behavior. That attitude is still a closed reaction, not an open reaction. Attitude is a readiness to react to certain objects in the environment as an appreciation of the object (Notoadmodjo, 2010). Attitude is not always consistent with the behavior because of the attitudes and behaviors no connecting factor is the intention. Intention is influenced by many things, both in themselves and because of external factors such as social pressure. Attitude is also influenced by the trust. If @IJMTER-2016, All rights Reserved 122

someone, in this case do not believe (either from observations or information received) that smoking is harmful to health, then it is likely to behave adolescents smoking is great. Attitude is one of the variables that influence the behavior and many other variables that also affect the incidence of a behavior (Novi, 2013). According Notoatmodjo (2003) analyzed the behavior with the starting point that the behavior is a function of its intention to act (behavior Intention), social support from surrounding communities (acessbility of Information), personal autonomy in decisions or actions (Personal Autonomy), and the situation menungkinkan to act (Action Situation). The attitude of a person affects the behavior of the person. attitudes inflicted on smoking behavior will affect the individual in taking the decision to behave. A positive attitude towards smoking means supporting the existence of a cigarette and the smoker then that person will participate as a smoker and vice versa if the negative attitude to smoking, people tend not to smoke. 3. Behavior Respondents who had a negative behavior amounted to 28 (34.1%) of respondents. Good behavior can usually be measured from knowledge. If knowledge better then expected behavior is also good, but sometimes the opposite someone who has a good knowledge may not be able to apply properly. Behavior is a real form of knowledge and attitudes that have been possessed. Once someone knows a stimulus or health object, then hold judgment or attitude, the next process is to be expected someone will practice everything he knew taking into account information and confidence about gains and losses obtained (Murdoko, 2006). According Murdoko (2006), the behavior is something that do as an embodiment of the attitude of the establishment. Behavior will support change if the attitude held by someone positive. Behavior will resist change if a person has a negative attitude. Smoking behavior usually begins in adolescence even though the process of becoming a smoker has started since childhood. Adolescence is also an important period of risk for the development of long-term smoking behavior. In addition, smoking is the entrance of other negative behaviors such as substance abuse and problem drinking (Tandra, 2009). B. Analysis Bivariat 1. The correlation between knowledge of smokers with smoking behavior Chi Square test results with a 95% confidence level, to see the connection between the perception of pictorial warnings on cigarette packs with the knowledge smokers found that, p-value = 0.477. P-value based on the statistical result obtained Ho received decision (p <0.05). This means that there is no significant relationship between knowledge of smokers and smoking behavior. In this case the respondent merely know but have not been able to understand, apply, analyze, synthesize and evaluate. This was supported by Tandra (2003) which says that the number of smokers among adolescents at higher despite knowing the adverse effects of smoking for health and mentions that 20% of smokers in Indonesia are teenagers aged between 15-21 years (Komalsari, 2005). This study is in line with research conducted by Purba (2009), entitled Relationship characteristics, knowledge, and attitude towards the Young Man Smoking Habit in SMU Parulian 1 Medan Year 2009 with a p- value = 0.234> 0.05, which means no the relationship between knowledge smokers with smoking behavior (Purba, 2009). 2. The correlation between attitudes of smokers with smoking behavior The results showed that from 45 (100%) of respondents who have a positive attitude, there were 15 (40.5%) of respondents who had a negative attitude. The results of this study also showed that out of 37 (100%) of respondents who had a negative behavior, there were 13 (28.9%) of respondents who had a negative attitude. In this research, it is known that the respondents who have a positive attitude tend to have a positive attitude. Chi Square test results with a 95% confidence level, to see the connection between the perception of pictorial warnings on cigarette packs with the attitude of smokers found that, p-value = @IJMTER-2016, All rights Reserved 123

0.383. P-value of the statistical test results obtained Ho received decision (p <0.05). This means that there is no significant relationship between the attitudes of smokers and smoking behavior, which, although the respondents' attitudes more in both categories, but still many who smoke. This is because the factors that influence adolescent smoking is not just an attitude alone but many other factors. According Komasari and Helmi (2000) states that almost all teenagers understand the harmful consequences of smoking, but they do not try to avoid such behavior. Smoking behavior is a function of the environment and the individual means that smoking behavior is attributed to the factors of the self is also caused by the environment in which adolescents began experiencing crisis psychosocial aspects of the future development period which was looking for its identity. This study is in line with research conducted by Purba (2009), entitled The correlation Characteristics, Knowledge, Attitude Youth Men Against Smoking Habit at SMU Parulian 1 Medan Year 2009 with a p-value = 0.657> 0.05, which means no correlation between knowledge smokers with smoking behavior (Purba, 2009). IV. CONCLUSION There was no relationship between knowledge smokers (p-value = 0.477), Attitude smokers (p-value = 0.383) and smoking behavior. Need for Improved Knowledge through Peer Educator Formation and Youth Empowerment for early education so that adolescents aware of the effects of smoking and can prevent early. REFERENCE Agustiani, Hendriati. 2006. Psikologi Perkembangan. Bandung: Refika Aditama Allender, et al. 2010. Community Health Nursing, Promoting & Protecting the Public s Health 7th Edition. Philadelphia: Lippincott, Williams & Wilkinss Alamsyah, Rika Mayasari. 2007. Faktor-faktor yang mempengaruhi Kebiasaan Merokok dan Hubungannya Dengan Status Penyakit Periodontal Remaja di Kota Medan Tahun 2007. Sumatra Utara : Universitas Sumatra Utara. Anderson & Mcfarlane. 2011. Community as Patner, Theory And Practice In. Nursing. 6th Edition. Philadelphia: Lippincott, Williams & Wilkins. Anto, Umbah, Joseph dan Datag. (Tanpa Tahun). Hubungan Antara Pengetahuan dan Sikap Tentang Bahaya Merokok Dengan Tindakan Merokok Remaja di Pasar Baserhati Kota Manado. Manado : Universitas Samratulangi. Arkan, Arnadi. 2006. Strategi Penganggulangan Kenakalan Anak-anak Remaja Usia Sekolah. Ittihad Jurnal Kopertis Wilayah XI Kalimantan. Vol. 4 (6). Badan Pusat Statistik. 2010. Klasifikasi Perkotaan dan Pedesaan di Indonesia Brockopp dan Tolsma. 2000. Dasar-Dasar Riset Keperawatan. Alih Bahasa oleh Yasmin Asih dan Anik Maryunani. Jakarta: EGC. Dempsey, Ann Patricia & Arthur D. Dempsey. 2002. Riset Keperawatan. Jakarta : EGC. Departemen Kesehatan. 2008. Anak dan Remaja Rentan Menjadi Perokok Pemula. Helmi, Alvin Fadila dan Dian Komalasari. (Tanpa Tahun). Faktor-faktor Penyebab Perilaku Merokok pada Remaja. Yogyakarta : UGM. Hernowo, 2007. Panduan Untuk Perokok. Jakarta : EGC. Jabbar, Abdul. 2008. Nge-rokok Bikin Kamu "Kaya". Solo: Samudera Kementerian Kesehatan R.I. 2010. Riset Kesehatan Dasar 2010. Jakarta : Badan Penelitian dan Pengembangan Kesehatan. Kementerian Kesehatan R.I. 2011. Pedoman Pengembangan Kawasan Tanpa Rokok. Jakarta : Pusat Promosi Kesehatan. Mubarak et al. 2010. Kesehatan Remaja problem dan solusinya. Jakarta: Salemba Medika Notoatmodjo. 2010. Ilmu Perilaku Kesehatan. Jakarta : Rineka Cipta. Notoatmodjo. 2010. Metode Penelitian Kesehatan. Jakarta : Rineka Cipta. Tarwoto et al. 2010. Kesehatan Remaja : Problem dan Solusinya. Jakarta : Salemba Medika @IJMTER-2016, All rights Reserved 124

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Table 5 Test Results Statistics between attitudes of smoker and smoking behavior No Behavior Attitude Negative Positive Total p-value 1. Negative 15 (40,5%) 22 (59,5%) 37 (100%) 0,383 2. Positive 13 (28,9%) 32 (71,1%) 45 (100%) @IJMTER-2016, All rights Reserved 126