The Influence of Non Smoking Area Policy on the Proportion of
Active Smokers in Student Groups
Neshia Nurindah Alifianti
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keywords: Non smoking area policy, Active smoker, Students, School, Tobacco control.
Abstract: Cigarettes contain harmful chemicals such as tar, nicotine and formalin. These chemicals can be a risk
factor for lung cancer, coronary heart disease and other chronic diseases. The prevalence of active smokers
is increasing every year in Indonesia. Teenagers contribute to the considerable cigarette consumption and 1
in 4 teenagers become active smokers. Therefore, people need to be protected from the hazards of cigarette
smoke in the environment. The non-smoking area policy aims to reduce the number of smokers and to
realise the potential of healthy air. The policy has seven targets; one of them is an educational institution.
The purpose of this study was to explain the impact of non-smoking area policy on the proportion of active
smokers in teenage groups in the school environment. This study was conducted using the descriptive
method. The data was collected from a secondary data source. The results showed that the proportion of
active smokers in junior and senior high school students following the enactment of the non-smoking area
policy has increased mainly in male students. In addition, active smokers who are junior high school
students located in districts and cities alike have increased in number. The proportion of smokers who are
high school students located in districts and cities has tended to decrease since the policy implementation.
1 INTRODUCTION
Cigarettes contain 4,000 components that are
hazardous chemicals. These chemicals can be toxic
or change the nature of the body’s cells in to
becoming malignant. There are 43 chemicals in
cigarettes that can cause cancer such as tar, nicotine
and carbon monoxide (Depkes RI, 2013b). Some
chemicals should not be used in cigarettes such as
arsenic as used in pesticides, toluene in paints,
formaldehyde in corpse preservatives, and benzene
used in addition to fuel oil (Depkes RI, 2017). One
of the substances that causes a person to become
addicted to cigarette consumption is nicotine. The
addiction of a smoker is not only physical, but it is
also psychological in nature.
Indonesia is the fifth highest cigarette consuming
country in the world of 215 billion (WHO, 2017).
The number of Indonesians in 2011 who smoked
was as many as 59.9 billion (34.8%) (WHO, 2012).
The proportion of active smokers who smoked daily
and were aged >10 years experienced an increase of
0.6% in 2007 & 2013 (Depkes RI, 2013a).
Indonesian teenagers aged <19 years old becoming
new smokers amounting to 16.4 million per year in
the period 1995-2013 (Menkes RI, 2016). 1 in 4
Indonesian adolescents become active smokers who
smoke every day (BNN, 2017). The high number of
adult smokers is of particular concern as they are at
risk of chronic disease later on in life.
A smoker is at risk of suffering from various
chronic degenerative diseases such as chronic
obstructive pulmonary disease, pulmonary tumours,
mouth and throat tumours, stroke and coronary heart
disease. In 2013, lung, bronchial and tracheal lung
disease had the most prevalent cigarette disease in
Indonesia. Cerebrovascular disease, ischemic heart
disease and tuberculosis are the three most common
causes of death from smoking (Menkes RI, 2016).
Various diseases appear in line with the increase in
the number of cigarettes consumed.
One of the government's efforts to protect people
from exposure to tobacco smoke that is dangerous is
through the policy of having area without any
smoking. The definition of a non-smoking area is a
non-smoking area or a place that does not produce,
sell or advertise tobacco products (Presiden RI,
128
Alifianti, N.
The Influence of Non Smoking Area Policy on the Proportion of Active Smokers in Student Groups.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 128-131
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

2012). The legal basis governing the non-smoking
area is UU no. 36 year 2009 about health and PP no.
109 year 2012 about securing materials containing
addictive ingredients such as tobacco products. The
public spaces targeted by non-smoking areas include
health care, teaching and learning, children's
playgrounds, places of worship, public transport,
workplaces etc.
The school environment is one of the target non-
smoking areas where the area is smoke-free, and
there are no cigarette products or cigarette
advertisements. The purpose of non-smoking area is
to reduce the number of smokers. Target areas
without cigarettes in schools include school leaders,
teachers, students, and other employees at the
school. The non-smoking area policy is expected to
create a 100% non-smoking learning area (Depkes
RI, 2010).
The policy about non-smoking area has been
going on for nine years and school has become one
of its targets. Therefore, this study aims to explain
the impact of the non-smoking area application on
the proportion of active smokers in the student
group.
2 METHOD
This study using descriptive method that will
describe a situation objectively. The type of data
used is secondary data. The data analysis was done
by comparing the prevalence of smoking in 2006
and 2016 in students from BNN. The data comes
from students who are in junior high and high
school. Furthermore, the results of the analysis are
also supported by the exploration of other research
results with related themes.
3 RESULT
The table below shows the results of a survey of
cigarette consumption by the National Narcotics
Agency (BNN) on students in 18 provinces of
Indonesia. Table 1 shows that the proportion of
active smokers who are junior high school students
has increased in 2000-2016 by 5%. The proportion
of high school students who smoke has decreased
from 33% to 31%.
Table 1: The proportion of active smokers in junior
and senior high school students in 2006 and 2016
(%)
Students Year
2006 2016
Junior High School 22 27
Senior High School 33 31
Source : BNN, 2017
In Table 2, it can be seen that the distribution of
active smokers by sex has a difference evident
within the results. Male junior high school students
experienced a significant increase of 44.8%. The
female SMP smokers decreased from 21.5% to
4.6%. Similarly with the high school students, male
high school smokers experienced a significant
increase of 49.2% while female high school female
smokers decreased by 26.8%.
Table 2: The proportion of active smokers in junior
and senior high school students in 2006 and 2016 by
sex (%)
Sex Junior High School Senior High School
2006 2016 2006 2016
Male 4,7 49,5 11,6 60,8
Female 21,5 4,6 32,7 5,9
Source : BNN, 2017
The data in Table 3 shows that there is a
difference between active smokers in junior and
senior high school students in cities and districts.
Junior high school students in the city experienced
an increase of 7.8% and in the district also
experienced an increase of 3.6%. The proportion of
smokers in high school students in the city decreased
by 2.6% and districts decreased by 0.8%.
Table 3: The proportion of active smokers in junior
and senior high school students in 2006 and 2016 by
location (%)
Location Junior High School Senior High School
2006 2016 2006 2016
City 20,1 27,9 33,1 31,7
District 23,2 26,8 32,1 31,3
Source : BNN, 2017
The Influence of Non Smoking Area Policy on the Proportion of Active Smokers in Student Groups
129

4 DISCUSSION
The Government of Indonesia has instructed on the
policy making of non-smoking areas since the
issuance of UU no. 36 tahun 2009 on the health
mandate to the local government in order to
implement areas without smoking in their respective
regions. Schools are one of the areas that must apply
the area without smoking policy and students have
become one of the targets. Students are expected not
to become new active smokers and to assist in
reducing the smoking rates among adolescents.
Based on the table presented, the proportion of
active smokers among junior high school students
has increased after the implementation of the non-
smoking area policy. This is in contrast to high
school students who showed a 2% decline rate in the
number of active smokers after the implementation
of a non-smoking area policy. The facts show that
junior high school adolescents are an increasingly
widespread target of the tobacco industry. The
tobacco industry proved that it has expanded its
marketing to an early age of only 10-14 years
(Afiati, 2015). In addition, junior high school is also
a vulnerable age group because it is in a critical
period of searching for their identity. Cigarettes are
considered to be a symbol of maturity and coolness
by teenage groups (BNN, 2017).
The proportion of smokers in junior and senior
high school students of the male sex tends to
increase considerably. Junior and senior high school
students of the female gender decreased after the
implementation of the policy of non-smoking areas.
The difference in the proportion of smoking is
because men smoke more than women, which can
be caused by stress factors. How stress is dealt with
in men tends to lead to negative things such as
smoking while women only tend to react with
feelings of anxiety. In addition, cigarettes are also
used as a social tool to forge friendships with other
men around them (Afiati, 2015).
Active smokers in the junior high school student
context in both cities and districts alike has
increased after the adoption of the non-smoking area
policy. High school students who are in the city or
districts have decreased the proportion of active
smokers. The proportion of active smokers in junior
high school students increased as the age of 10-14
years old has become the dominant first age of
starting to smoking (Afiati, 2015). At that age,
teenagers start trying to smoke because they want to
learn due to peer pressure (Rachmat, Thaha and
Syafar, 2013).
Judging from the implementation of the non-
smoking area policy, schools that have been smoke-
free and areas that are without cigarette
advertisements in Indonesia total only 90 (Yayasan
Lentera Anak, 2017). Tens of thousands of other
junior and senior high schools have not implemented
a comprehensive or consistent non-smoking area
policy in the school environment. Factors that
hamper the implementation of a non-smoking area
policy in some schools includes socialisation from
the local government to the school not being
optimal. There is no special team to oversee the
implementation of an area without cigarettes, the
availability of facilities and infrastructure of non-
smoking areas is not sufficient, and the school’s
commitment in the form of sanctions to the
offenders is still low (Argameli, 2017 dan Panjaitan,
2015). The optimal application of cigarette smoking
areas in every school is actually very important for
better growth and development in the younger
generation. This is evidenced by research that
explains that adolescents in schools with non-
smoking areas have a 3.2 times better chance of
having a positive attitude and are 2.6 times more
likely to quit smoking than teenagers in schools that
have not implemented an area without smoking
(Rachmat, Thaha and Syafar, 2013).
5 CONCLUSIONS
The results showed that the proportion of active
smokers in junior and senior high school students
following the enactment of a non-smoking area
policy has increased, mainly in the male students. In
addition, active smokers in relation to the junior high
school students located in districts and cities alike
has also increased in number. The proportion of
smokers of high school student age located in the
districts and cities has tended to decrease.
The increase in the proportion of active smokers
in students following non-smoking area policy was
due to less intensive dissemination of non-smoking
area policy, no special team of non-smoking area
policy, and lack of facilities or supporing
infrastructure. In addition, further research is needed
on the causes of an oncrease in the proportion of
active smokers among adolescents.
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
130

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