The Relationship of Socio-economic Characteristics with

Chewing Tobacco Habits of Lactating Mother in Karo District

E. Aritonang and A. Siagian

Department of Community Nutrition, Universitas Sumatera Utara, Medan, 20155, Indonesia

Keywords: Socio Economy, Lactating Mother, Chewing Tobacco.

Abstract: Tobacco-related deaths worldwide are overwhelmingly concerned about 100 million during the 20th and the

21st century if no tobacco consumption prevents. Besides consumed as cigarettes, tobacco is consumed by

chewing on some people. The habit of chewing tobacco is mostly done Batak tribe. Chewed tobacco

thought to contain nicotine higher than tobacco in cigarettes so effects on chewing tobacco health are worse

than tobacco in cigarettes. This study analyzes the relationship of socio-economic characteristics with

chewing tobacco habits in breastfeeding mothers in Karo Regency. This research is analytic descriptive with

cross sectional study design. The population is all breastfeeding mothers with children 0 - 24 months, and

sample 40 people were determined purposively. Socioeconomic characteristics include parity, age and

occupational, child's age, sequence of children, and family income. Chi Square test used to analyze

relationship of parity, age and work of mother, child age, order of children, and family income with chewing

tobacco habit. The results showed that there was a significant correlation between mothers' age and chewing

tobacco consumption. There is no significant relationship of parity, toddler age, child sequence,

occupational, and family income with chewing tobacco consumption. This means chewing tobacco

consumption is not related to socioeconomic characteristics.

1 INTRODUCTION

Consumption of cigarettes and other tobacco

products is a worldwide health problem because it is

harmful not only to health that can result in death

but also socio-economic losses that have been

proven in various scientific studies. In addition to

smoking the habit of chewing tobacco with the term

inquiring also still found in several cities in

Indonesia, including in Karo District.

Consumption of substances or hazardous

materials includes caffeine, alcohol, and cigarettes.

Tobacco consumption through smoking habits in the

community is very high that can be seen from

several research results. The appeal for smoking

bans has been done as well as the impact of

cigarettes on health has been frequently socialized,

but the facts show that smoking is still quite high in

the community. The data of smokers in Indonesia is

still high especially in the adolescent population.

Based on Indonesia Health Survey in year 2013

known smokers who smoke cigarettes every day in

Indonesia for the age group above or equal to 10

years there are 24. 3% and for North Sumatra almost

equaled the national data of 24.2%.

WHO states that tobacco-related deaths around

the world have been very worrying about 100

million during the 20th and 1st centuries during the

21st century if there is no prevention of tobacco

consumption. Difficult to reduce smoking habit is

caused in the tobacco content that because pleasure

and addiction to the users of tobacco are nicotine,

and myosin.

Besides consumed in the form of cigarettes,

tobacco is also consumed by chewing on some

people as a habit that has lasted for a long time.

Tobacco chewing habit is mostly done by Batak

Karo tribe in North Sumatera province as smokeless

tobacco. This habit is considered normal (usual) and

does not have a negative impact on health. This is

what causes the habit persist and increasing. Chewed

tobacco is thought to contain higher nicotine than

tobacco in cigarettes so the adverse health effects of

chewing tobacco are worse than tobacco in

cigarettes.

Aritonang, E. and Siagian, A.

The Relationship of Socio-economic Characteristics with Chewing Tobacco Habits of Lactating Mother in Karo District.

DOI: 10.5220/0010082114611467

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

1461-1467

ISBN: 978-989-758-449-7

1461

The results revealed that nicotine in tobacco is a

carcinogen that causes an increased risk of bladder

cancer 400 percent higher in chewing tobacco

consumption than non-chewing tobacco consumers.

In addition, the effects of nicotine on tobacco

smoked through cigarettes, chewed or inhaled cause

narrowing of blood vessels, anorexia, increased

heart rate and blood pressure. Another effect

suggests that risk factors due to chewing tobacco

consumption will remain for years even after the

user actually stops chewing tobacco consumption.

Aritonang.E research (2017) shows that more

pregnant women who consume chewing tobacco

during pregnancy than those who do not consume

chewing tobacco are 57.4% consume and 42.6% do

not consume.

Based on this case, this study wanted to analyze

the relationship of socio-economic characteristics

(mother's age, parity, age of child, sequence child,

mother's occupational and family income) with the

habit of chewing tobacco in lactating mother in

Berastagi sub-district of Karo Regency.

2 RESEARCH METHOD

This is an analytical descriptive research with cross

sectional study design. The population is all

breastfeeding mothers who have children aged 0-24

months in Karo regency with the sample determined

by purposive that is 44 people. The types of data

collected are socioeconomic characteristics

consisting of mother's age, parity, child age,

sequence child, mother's occupational and family

income. The relationship between maternal age,

parity, child age, sequence child, mother age, mother

education, and family income with chewing tobacco

use Chi Square test.

3 RESULT AND DISCUSSION

3.1 Characteristics of Lactating Mother

The characteristics of lactating mothers by mother

age, parity, child age, sequence child, mother’s

occupational and family income in the results of this

study are described in Table 1. Grouping by age is

done according to the Ministry of Health (2015)

classification of safe reproduction (20-35 years),

reproduction at risk (<20 and> 35 years).

From the table 1, it was found that age of

breastfeeding mothers was 20-35 years old is 32

people (72.73%), age >35 years 9 people (20.46%)

and age <20 years were 3 people (6.81%).

Table 1: Characteristics of Lactating Mother.

Characteristic F %

Age (year)

 < 20

 20 – 35

 > 35

6.81

72.73

20.46

Parity

 1 – 2

 > 2

75.00

25.00

Child Age (month)

 0-6

 7-12

 13-24

50.00

34.10

15.90

Sequence Child

 First child

 Not first child

29.54

70.46

Mother’s Occupational

 Work In The House

 Work Outside Home

11.37

88.63

Family Income

 < Regional Minimum

Wage

 ≥ Regional Minimum

Wage

63.63

36.37

Total 44 100.0

Similarly, Ayuningtyas (2013) in Ngembat

Sragen Village showed that the proportion of

breastfeeding mothers aged 20-35 years is greater

than 80% compared to breastfeeding mothers aged

>35 years and <20 years.

Based on parity, the highest proportion was in

breastfeeding mothers who had 1-2, as many as 33

people (75%) compared with breastfeeding mothers

who had >2 as many as 11 (25%). The same thing

was obtained by the researcher Abdullah, et. a.l

(2013) that the parity of 1-2 more that is equal to

186 people (62%) and parity >2 of 114 people

(38%).

Based on the age of the children, the highest

proportion was in the age group 0-6 months is 22

people (50%), age 7-12 months as many as 15

people (34.10%) and the age of 13-24 months as

many as 7 people (15.90 %). Based on the

children to, the highest proportion is in children >1,

which is 31 people (70.46%) compared to the first

child of 13 people (29.54%). Based on the work of

the mother, mothers who work outside the home

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

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more as many as 39 people (88.63%) while the

mother working in the house for 5 people (11.37%).

This research is in line with the result of Haryanti

and Puspitaningrum (2016) research which stated

that the mothers who work outside the house are 11

persons (55%) while the housewives only 9 people

(45%). Based on family income, households earning

below of Regional Minimum Wage were 28 people

(63.63%) compared with families who received

upper Regional Minimum Wage, which was 16

people (36.37%). This study is in line with the

results of the Purba, B (2014) study which gained

the result that families with below of Regional

Minimum Wage revenues are greater than those with

income upper of Regional Minimum Wage.

3.2 Relationship of Maternal Age and

Tobacco Chewing Habits

Maternal age at the time of breastfeeding is one

indicator to determine its relationship with chewing

tobacco consumption

Table 2: Relationship of Maternal Age and Tobacco Chewing Habits.

Characteristic Category F Mean SD p 95% CI Median

(min-maks)

Age

Healthy Reproduction

(20 – 35 year)

1.48 0.821 0.003 1.73 1

Reproduction is at Risk

<20 and > 35 year

Based on the table 2, it can be concluded that the

proportion of maternal age in healthy reproduction

category (20-35 years) is 32 persons (72.72%)

compared to maternal age in risk reproduction

category (<20 years and >35 years) (27.28%). This

research is in line with the research result of

Abdullah, et a.l (2013) in Ujung Pandang Baru

Public Health Center and Kaluku Boddoa Public

Health Center Tallo District Makassar City, that the

age of mother is 36% (35%) while the age <20 year

and >35 years as many as 75 mothers (25%).

The average age of nursing mothers in chewing

tobacco consumption is still relatively young is 20-

35 years with standard deviation 0.821. Age 20-35

years is still categorized in the productive age group,

so the consumption of chewing tobacco nursing

mothers can affect the level of productivity of the

mother later. In the book The Public Disclosure

Authorized page 20 also mentioned that the average

age of much tobacco is 25 years old.

The existence of mother's age relationship with

chewing tobacco consumption due to age factor

influence in decision in acting. At the age of 20-35

years old mother consume more tobacco because the

mother already felt her adult and the way of thinking

is also ripe, so that the mother has her own decision

to act, and take care of herself.

Activities performed within this age group are also

more so that interaction with many people is also

more active. The habit of tobacco consumption in

the area is likely to be followed by other members.

Tobacco chewing habits are mostly done during the

party, social and religious activity, and others. This

will affect the mother in that age group to consume

chewing tobacco. In the group of women (mothers)

consume more chewing tobacco, while the male

group (fathers) smoking more. The number of

mothers consuming tobacco caused by the culture of

chewing tobacco at the time of carrying out formal

events and non formal in Karo District.

3.3 Relationship of Parity and Tobacco

Chewing Habits

The result of bivariate analysis of mother's parity

relationship with chewing tobacco consumption

habit showed no significant correlation. The result of

bivariate analysis of mother's parity relationship

with the habit of chewing tobacco consumption

obtained the following results.

Table 3: Relationship of Parity Mother with Chewing Tobacco.

Characteristic Category F Mean SD p 95% CI Median

(min-maks)

Parity

1-2 33

1.70 0.462 0.099 1.84 2

>2 11

The Relationship of Socio-economic Characteristics with Chewing Tobacco Habits of Lactating Mother in Karo District

1463

The highest proportion of chewing tobacco

consumption in breastfeeding mothers was found in

1-2 to 33 parity (75%) and for parity >2 for 11

people (25%). Maternal parity is still relatively low

with an average of 1.70 with standard deviation of

0.462. Parity is the state of women who once gave

birth to a living baby where women gain knowledge

from personal experience. Experience is a way of

obtaining the truth of knowledge. Therefore,

personal experience can be used as an effort to gain

knowledge. Whether obtained directly or indirectly,

but not all personal experience can lead one to draw

conclusions correctly (Haryati and Puspitaningrum,

2016). But in this study the opposite occurs because

there is no parity relationship with chewing tobacco

consumption. Mothers who have little or no

childbirth are not associated with their habit to

consume chewing tobacco. The consumption of

chewing tobacco is already a hereditary habit that is

difficult to remove in the area.

The more often the mother consumes chewing

tobacco will have an impact on the outcome of

pregnancy. This is stated in the study Purba (2014)

is the relationship of chewing tobacco consumption

with the incidence of LBW by making parity as an

effect modifier. The incidence of LBW increases

with the increase in chewing tobacco consumption in

the first parity. In this study, the average parity of

mothers who consumed tobacco was in the second

parity, this is because breastfeeding mothers already

have experience with parity to-1.

3.4 Relationship of Infant Age and

Tobacco Chewing Habits

The result of bivariate analysis of infant age

relationship with chewing tobacco consumption

habit showed no significant correlation. The result of

bivariate analysis of toddler age relationship with

chewing tobacco chewing habit obtained the

following result.

Table 4: Infant Age Relationship with Chewing Tobacco Lactating Mother

Characteristic Category F Mean SD p 95% CI Median

(min-maks)

Infant Age

0-6 month 22

50 0.50 1 1.65 1.5

7-24 month 22

Based on the table 4, it is known that nursing

mothers who consume tobacco have toddlers aged 0-

6 months by 22 people (50%) and toddlers aged 7-24

months by 22 people (50%). Nutrition needs of

breastfeeding mothers is important for mothers and

babies because nutrition needs of breastfeeding

mothers affect the production of breast milk

(Sudaryanto, 2014). Mothers who consume chewing

tobacco, mothers consume nicotine in tobacco so

that the nicotine will be consumed by the mother

through breast milk.

3.5 Relationship of Children Sequence

and Tobacco Chewing Habits

The result of bivariate analysis of children sequence

with chewing tobacco consumption habits showed

no significant relationship. The result of bivariate

analysis of children relationship to the habit of

chewing tobacco consumption obtained the

following results.

Table 5: Relationship of Children Sequence and Chewing Tobacco in Lactating Mother

Characteristic Category F Mean SD P 95% CI Median (min-

maks)

Children

First child 13

1.70 0.46 0.099 1.84 2

Not first child 31

Based on table 5 it was found that the proportion

of breastfeeding mother who consumed tobacco in

non-children first was 31 persons (70.45%) more

than the first child was 13 persons (29.55%). More

mothers consume tobacco in children to 2 or more

caused; when the first child is still very mother keep

the womb, so for food consumed was very guarded.

Unlike the second child and so on the mother

already has experience, so the mother felt no need to

take care of what will be consumed. Although

statistically, there is no age relationship of children

with chewing tobacco consumption habits.

The habit of chewing tobacco in which the main

ingredient is nicotine is at risk for the occurrence of

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

1464

health problems in breastfeeding mothers and also

breastfeeding infants. Tobacco can cause heart

damage, blood circulation, and lung and can cause

cancer (Ketaren and Hulu, 2014). Communities that

have consumed chewing tobacco will be difficult to

stop not to consume again because the longer a

person consumes tobacco then the brain cells more

enjoy the nicotine in the threshold of excitatory.

Once the level of nicotine in the blood decreases and

below the threshold value of the stimulus then, the

tobacco consumption will feel tortured so try to find

the tobacco back that causes addiction to nicotine

(Dharmasemaya, 2004).

3.6 Mother’s Working Relationships

with Chewing Tobacco Habits

The result of bivariate analysis of mother's work

relationship with chewing tobacco consumption

habit showed no significant relationship. The result

of bivariate analysis of mother's work relationship

with chewing tobacco habit obtained the following

result.

Table 6: Mothers Employment Relations with Chewing Tobacco

Characteristic Category F Mean SD P 95% CI Median

(min-maks)

Work

work in the

home

1.89 0.321 0.098 0.143 2

work

outside the

home

Based on the table 6, it is found that the

proportion of breastfeeding mothers with chewing

tobacco consumption habit that works outside the

home is higher that is 39 people (88.63%) and work

in house is 5 people (11.37%). This study is in line

with the results of Fernando (2011) research in Gerat

Village Biru Biru District Deli Serdang obtained the

result that the population consuming more tobacco

work outside the home is 68.1% than the inner

worker.

In general, the prevalence that chews tobacco is

higher in workers than does not work. This is

because the habit of chewing tobacco consumption

in research sites is generally done when gathering

with mothers outside the house in the event of

arisan, party, misfortune, and others. IAKMI also

stated that employment activities make others to

smoke (IAKMI, 2014).

From the results of the interview it is known that

nursing mothers who work more tobacco chewing to

reduce the level of stress the mother of the work

being done. In addition, the reason nursing mothers

eat chewing tobacco because it can relieve stress and

make the body refreshed again. Although

statistically there is no relationship of mother's work

with chewing tobacco consumption habit.

3.7 Relationship of Family Income with

Tobacco Tobacco Habits

Chewing tobacco showed no significant association.

The result of bivariate analysis of the relationship of

family income with chewing tobacco habits obtained

result as follows.

Table 7: Relationship of Family Income with Chewing Tobacco Habit

Characteristic Category F Mean SD P 95% CI Median

(min-maks)

Family Income

<Minimum Wage

Income in Karo

District

2.590.909 1.33 0.080 0.066 2.500.000

≥ Minimum Wage

Income in Karo

District

The Relationship of Socio-economic Characteristics with Chewing Tobacco Habits of Lactating Mother in Karo District

1465

The socioeconomic status of the mother is said to

be high if the income of the maternal family above

or same with minimum wage income and vice versa,

the socioeconomic status of the mother is said to be

low if the mother's family income below of

minimum wage income. Based on the table 7, it is

found that the highest proportion of family income

of nursing mother with chewing tobacco habit is

below of minimum wage income that is equal to 28

people (63,63%) while those with income above or

same with minimum wage income is 16 people

(36,37%).

This research is in line with research by

Fernando (2011) in Gerat Village Biru Biru District

Deli Serdang stated that the people who consumed

tobacco mostly come from families with <Minimum

Wage Income 51.1% income compared to those who

have income ≥Minimum Wage Income.

The prevalence of tobacco-consuming

populations is higher in people with lower income

levels than high income populations. This statement

is consistent with that contained in The

Publicdisclosure Authorized book on page 18:

"Currently, in many high-income countries, there is

a significant difference in the prevalence of tobacco

consumption among different socioeconomic

groups. In the UK, for example, only 10 percent of

women and 12 percent of men from the highest

socioeconomic group consume tobacco. In the

lowest socioeconomic group the percentage smoked

three times as much: 35 percent and 40 percent.

Higher chewing tobacco consumption in mothers

with lower incomes than mothers with high incomes

is attributable to higher life burdens in mothers with

low incomes that chewing tobacco that can give

calming effects encourages mothers to consume

chewing tobacco. In addition, the actual socio-

economic status in the community Karo Regency

associated with the level of education.

Tobacco chewing habits in breastfeeding

mothers are associated with education levels.

Mothers with low levels of education, consuming

more tobacco than mothers with higher education

levels. Mothers with low levels of education do not

yet know the impact of tobacco to the body and to

breastfeeding children, while mothers with higher

education, already know more about the negative

effects of tobacco.

The habit of using tobacco in which the main

component is nicotine is very high risk of health

problems to the users of tobacco. Nicotine contained

in tobacco leaf is a kind of toxic chemical elements,

similar to alkaline. One type of stimulants that can

damage the heart and circulation blood (Basyir,

2006).

4 CONCLUSIONS

1. The age of breastfeeding mothers who consume

chewing tobacco is dominated by the age of 20-35

years.

2. Breastfeeding mothers who consume chewing

tobacco are higher at parity to 1-2.

3. Breastfeeding mothers who consume chewing

tobacco, more in childhood to > 1.

4. Family income with nursing mothers who

consume chewing tobacco, the average is families

with <Minimum Wage Income Karo Regency

5. Breastfeeding mothers who consume chewing

tobacco who work outdoors more than nursing

mothers who eat chewing tobacco who work in the

house.

To the health workers at Karo Public Health

Center Can be input and further information with the

counseling about the effects of chewing tobacco

consumption. Health Workers can work with cadre

to motivate and feel important in monitoring all

mothers, especially nursing mothers who consume

chewing tobacco. To the mothers and children. For

information to nursing mothers not to consume

chewing tobacco.

ACKNOWLEDGEMENT

Thank you to the Directorate of Research and

Community Service, General Directorate of

Research Empowerment and Development, The

Ministry of Research, Technology, and Higher

Education as the source of research fund, DRPM

Kemenristekdikti with research scheme Applied

Superior University of Fiscal Year 2018 Number

255/UN5.2.3.1/PPM/KP-DRPM/2018.

REFERENCES

Abdullah, Muhammad Tahir, Alimin Maidin, and Andi

Dwi Lestari Amalia. 2013. Physical Conditions,

Knowledge, Education, Mother and Lifetime Jobs

Breastfeeding In Full. National Public Health Journal

8 (5). Makassar: Hasanuddin University

Ayuningtyas, Valentina Yonanda Takasita. 2013.

Relationship Between Mother Motivation With

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

1466

Exclusive Asi In Village Ngembat Sragen. Surakarta:

Faculty of Medicine, University of Surakarta

Haryanti, Rusiana Sri and Afif Puspitaningrum. 2016. The

Relationship Between Parity With A Maternal

Knowledge About Cord Baby Care. Profession 14 (1).

Surakarta: Stikes PKU Muhammadiyah Surakarta

Purba, Bahtera Bindavid. 2014. The Effect of Tobacco

Chewing Consumption on Low Birth Weight

Incidence In Simalungun Regency 2013. Thesis.

Medan: University of North Sumatera

Tobacco Control Support Centre. 2014. Tobacco Facts and

Problems in Indonesia. Bunga Rampai Books. Jakarta

: IAKMI

Basyir, Abu Umar. 2006. Bandung : Why Hesitate Leave

Cigarettes. Pustaka At-Tazkia

Sudaryanto, Gatot. 2014. Mother's Complementary

Complete Super Milk Food. Jakarta: Penebar Plus

Ketaren, Otniel S and Hulu. 2014. Characteristics Of

Tobacco Users Among Women in Sembahe Sibolangit

Village Deli Serdang Regency Year 2013. (7).

Mutiara Kesehatan Indonesia. Medan

Fernando, Efrato. 2011. Nicotine Content Analysis on

Tobacco (Nicotiana tabacum) Used As Chewing

Tobacco and Characteristic of the Users in Gerat

Village Biru Biru District Deli Serdang Regency Year

2010. Medan: Faculty of Public Health

The Public Disclosure Authorized. 2000. Meredam Wabah

Pemerintah dan Aspek Ekonomi Pengawasan terhadap

Tembakau. P (18-20).

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