An Analysis Impact of No-Smoking Area Declaration Program in

Adolescents Smoking Behavior in Purworejo Hamlet, Wonolelo

Villages, Pleret, Bantul

Marsiana Wibowo

, Eriyani Khuzaimah

Faculty of Public Health, Universitas Ahmad Dahlan, Daerah Istimewa Yogyakarta, Indonesia

Keywords: Adolescent, Declaration, No-Smoking Area.

Abstract: Purworejo Hamlet has declared No-Smoking Area Program since 2010 to control people’s smoking

behavior. This study aims to determine the background and impact of the program in adolescents smoking

behavior, especially in places of worship, education, workplaces, homes, and community meeting places.

This study is qualitative research with a case study approach. Interviews and observations were employed as

data collection techniques and the researchers also selected the informants purposively. The background of

the program is the freedom of smoking, the encouragement and support of the public health services for the

application of no-smoking areas. The implementation of no-smoking areas has positive impacts. There are

no adolescents who smoke in places of worship, education, workplaces, homes and meeting places.

Adolescents only smoke at the locations in which they are allowed to smoke. The sustainability of this

program has been able to reduce the number of teenage smokers in the village. Adolescent compliance with

the regulations applied is also due to their role models, involved older people and regulatory compliance.

Programs that are carried out on an ongoing basis, maintaining compliance with the declaration agreement

and the existence of a good role model make the program produce a positive impact on changes in

adolescents’ behaviour in smoking.

1 INTRODUCTION

Smoking is one of the risk factors for non-

communicable diseases (Kementerian Kesehatan

Republik Indonesia, 2018). The act of smoking is

usually applied to tobacco/cigarettes (Baker and

Hooper, 2017). The number of adolescent smokers

aged 15 years and older increased from 2007 to

2013, from 34.2% in 2007 to 36.3% in 2013 with the

classification of 64.9% men and 2.1% women who

are still smoking. The data show that 1.4% smokers

were 10-14 years old, 9.9% of the smokers in the

Group didn’t work, and 32.3% was in the lowest

ownership index (Kementerian Kesehatan Republik

Indonesia, 2013). Special Region of Yogyakarta is a

province that is included in the top 15 highest

prevalence of smokers in Indonesia, which

amounted to 31.6%. Based on data from the

Department of Health Research and Development in

2016, the smokers aged 15 years old increases every

year. Based on data at the Ministry of Health,

27.2% of population are smokers. This number

increased in 2001 with 31.8% of smokers. The

number of smokers increased about 34.2% from

2007 to 2010. The previous research in 2013 shows

that the number of smokers increased amounted to

36.3% (Yogyakarta, 2013). Active smokers in

Special Region of Yogyakarta reached 21.2% per

day. The men smoking behaviour (>15 years)

reached 64.9%, and the first time for smoking is 15-

19 years old. The averaged of smoke consumption in

Indonesia is 12.3 stems (more than one packs) per

person (Kementerian Kesehatan Republik Indonesia,

2013)

No-Smoking Area is a regulation that support

peoples to maintain the health. This programme

needs supports and commitment from various

parties. No-Smoking Area programme can provide

protection for passive smokers and reduce the

number of active smokers (Azkha, 2013). A

supporting factor in implementing this policy is the

existence of adequate resources. While the inhibiting

Wibowo, M. and Khuzaimah, E.

An Analysis Impact of No-Smoking Area Declaration Program in Adolescents Smoking Behavior in Purworejo Hamlet, Wonolelo Villages, Pleret, Bantul.

DOI: 10.5220/0008370100050011

In Proceedings of the 1st International Conference on Social Determinants of Health (ICSDH 2018), pages 5-11

ISBN: 978-989-758-362-9

factors are more difficult to change smoking habits,

easy to get cigarettes, lack of commitment from the

implementer and the absence of SOPs (Monica and

Pambudi, 2017). Support for policy of area without

cigarettes is given by teenagers in Denpasar and

Yogyakarta. They are smokers and non-smokers.

Therefore, it is good to continue the intervention

with a sustainable programme (Mardhiati, Fatimah

and Andayani, 2017).

Governor of Special Region of Yogyakarta has a

regulation number 42 the year 2009 about No

Smoking Area. This regulation explained in article

number 1 clause 1 that No-Smoking Area is an area

which nobody can smoke, including public facilities,

health facilities, workplace, and another specific

place for study, children area, praying area, and

public transportation. The purpose of the No-

Smoking area is to protect peoples, both individual

and group to avoid all threats of diseases caused by

cigarettes. No-Smoking Area is implemented to

reduce morbidity and mortality due to smoking

(Pemerintah Daerah Isitimewa Yogyakarta, 2009). A

smoke-free village was formed as an effort to protect

those who do not consume tobacco from the dangers

of cigarettes. Intensive socialization and warning is

quite effective in controlling tobacco consumption

(Gunawan, 2016). In addition, if toddlers are

exposed to cigarette smoke, they will be exposed to

cigarette smoke twice more dangerous than active

smokers and smoke produced from the tip of a more

toxic cigarette butt (Perdana, 2014).

No-Smoking Area is a health campaign initiated

by Bantul Health Office as a form of Clean and

Healthy Behaviour Pattern in the community.

Purworejo Hamlet implements No Smoking Area,

this hamlet as a pilot hamlet 4. The purpose of this

programme is stated in article 3 of Bantul Regent’s

regulation number 18 the year 2016 about Healthy

Area Without Cigarette Smoke. It aims to protect a

community, especially vulnerability group, like

babies, toddlers, pregnant mothers, and elderly from

cigarette smoke and reduce morbidity also mortality

caused cigarette smoke in a way change community

behavior for the healthy life. Based on Self

Examination Survey 2016 in Pleret sub-district, the

incidence of smoking is considered as high.

Therefore, Pleret Public Health Service creates a

programme innovation in the form a smoking

regulation in education institutions and praying area,

then implemented in a declaration programme of

No-Smoking Area. Pleret Public Health Service also

creates a programme, namely MBS Pleret Pesat

Berkokok (Muhammadiyah Boarding School Pleret:

Healthy Pesantren Free Cigarette Smoke and Ok) to

reduce the prevalence of smokers. No-Smoking Area

Declaration has a framework about any places in

which peoples cannot smoke because smoking has

many negative impacts, both for active and passive

smokers. Passive smokers consisting of babies and

children have high risk because their organs such as

lungs growing. The aim of this study is to identify

the background and impact of the program in

adolescent smoking behavior, especially in places of

worship, education, workplaces, homes, and

community meeting places.

2 SUBJECTS AND METHODS

This is qualitative research with a case study

approach. The research subjects were purposively

selected, namely those who were directly involved

in the initiation and implementation of the no-

smoking area program in Purworejo hamlet. They

are Stakeholders, program founders, neighborhood

heads, youth leaders, representatives of family

welfare advisers, representatives of health cadres,

and youth smokers in the village, amounted to11

people. The data have been collected in two ways,

namely interviews and observations to get data about

the background of the declared and impact of the

program in adolescent smoking behavior, especially

in places of worship, education, workplaces, homes,

and community meeting places.

3 RESULTS

This study gathered information from 11

informants (table 1) to obtain information about the

background of the declared non-smoking area

program and its impact on adolescents’ behaviour

Table 1. The characteristics of Informants

Gender

Position

Male

The Chairman of the program

Male

The Head of Purworejo Hamlet

Female

The Head of Wonolelo Villages

Male

Adolescent

Male

Adolescent

Male

Adolescent

Male

The Chairperson of the

Neighborhood Association 01 of

Purworejo Hamlet

Female

Fostering family welfare Cadre

Female

Health Cadre

ICSDH 2018 - International Conference on Social Determinants of Health

Male

Public Figure

Male

The Chairperson of teenagers in

Purworejo Hamlet

3.1 The Background of No-Smoking

Area Program in Purworejo

Hamlet

The research showed that before the No-Smoking

Area was implemented, the smoking behavior was

not controlled. In addition, the residents refused to

implement the program. This condition caused some

residents to have a job as tobacco farmers.

Purworejo Hamlet has a suitable geographical

condition for tobacco cultivation. The smokers in

Purworejo Hamlet are mostly teenagers and adults.

This condition was described by informant 1 and 9.

“...sebelum adanya program itu masih pada

ngerokok semua, ning sekarang tidak...” (before the

program, residents were still smoking, but now they

were not)(by. Informant 1). “...kalo dulu sebelum

adanya kawasan dilarang merokok itu sebelum

adanya larangan seperti itukan sembarang mbak,

mau itu ada rewangan, ada pertemuan, mau disitu

ada anak balita mau ada disitu ada jagong bayi

tetep mereka itu merokok didalam rumah...”( "...

before the no-smoking area was implemented, many

people smoke carelessly, in the meeting or other

event, ladies and gentlemen, even though there are

toddlers and go to the baby's birth celebration, they

still smoke")(by informant 9).

On the other hand, the No-Smoking Area is

supported by residents for various motivational

reasons such as because the program is useful for

maintaining health, especially passive smokers.

The program was initiated in 2010, then it was

declared in 2013. On the way to the declaration

process, many preparations were made, including

educating residents about the program. One of the

aims of the education is to change the attitudes of

citizens who do not agree with the implementation

of the Non-Smoking Area Program in their hamlets.

General health services provide counseling about

Smoking and Non-Smoking Areas. This activity was

created with the aim of increasing motivation and

positive perceptions about the Non-Smoking Area

Program. Counseling has a role in increasing one's

knowledge and abilities through learning tactics or

teaching techniques with the aim of changing or

influencing human attitudes and practices so that

they can participate in these activities.

Another obstacle when starting the program was

the presence of residents who refused because they

were tobacco farmers. Residents have a group of

tobacco farmers called Sido Rahayu Tobacco Group.

However, due to the DIY Governor Regulation No.

42 of 2009, tobacco farmers stopped planting local

Kedu Silo tobacco which had high nicotine content,

so tobacco farmers chose Paiton Rasa tobacco which

had much lower nicotine content. Tobacco farmers

in Sido Rahayu have a long collaboration with one

of the cigarette factories in Klaten. However, since

the No Smoking Area program, residents of

Purworejo Hamlet committed to selling tobacco

plantation products and not consuming them. The

identified chemical content of tobacco reaches 2,500

components, while there are 4,800 types of

components. The nicotine levels are influenced by

variety, cultivation, and environment.

Residents participated in the implementation of

the No-Smoking Area program. It was done by

participating in the socialization at the beginning of

the introduction of the program, supporting the No-

Smoking Area program after being approved by the

Residents, helping to create facilities that supported

programs such as making a seminar or venue or

smoking and reading. After the declaration, the

residents continued to hold regular meetings and

remind each other of the No-Smoking Area

regulations with other fellow citizens. Teenagers are

also enthusiastic in supporting through young

people. The important people who played a role in

this program included the head of the farmer group,

the Chairperson of the Neighborhood Association 01

of Purworejo Hamlet, and community leaders.

In its implementation, the Non-Smoking Area

Program is supported by citizens for various

motivational reasons. Motivation is a benefit of the

program, a program that is useful for maintaining

health, especially passive smoking. All informants

strongly agreed that careless smoking would

endanger passive smokers such as vulnerability

groups, including women, children, infants and

toddlers.

3.2 Adolescent Smoking Behavior In

Places Of Worship, Educational

Institution And Work Place, Home,

And The Meeting Place After The

No Smoking Area Program

Non-smoking area programs have led teenagers to

have ethics in smoking. They no longer smoke in

prohibited places, such as places of worship,

workplaces, education, meetings, and residences.

An Analysis Impact of No-Smoking Area Declaration Program in Adolescents Smoking Behavior in Purworejo Hamlet, Wonolelo Villages,

Pleret, Bantul

Facilities that have been provided, such as "cakruk"

which have been used as a smoking area. “Mboten

onten seng ngerokok teng masjid blas. Paling teng

cakruk niko, mboten teng mriki tok, satu desa pun

hampir sama” ("Not everyone is in the mosque.

Most of the nuk cakuk niko, not in the village, one

village is almost the same ") (by informant 1)

Based on the results of observations, there is no

teenagers found smoking in places of worship,

workplaces, education, meetings, and residences any

longer. The results of observations conducted at one

of the workshops (iron welding machines) in the

village showed that none of the workers had smoked

while working. They did that during the breaks at

designated locations. The results of observations at

the residence also showed that they did not smoke at

home. Adolescents make use of the cigarette scans

that have been installed in front of the entrance door

to turn off cigarettes before entering the house. The

results of observations at the meeting place also

show the same thing. No ashtray was found as a

means of smoking in community meetings. Penalties

were also put in place to maintain the continuity of

the no-smoking area program. The neighborhood

leaders, program managers, and existing

stakeholders work together to monitor the

implementation of the program. Those who violate

will be given a penalty. “...apa lagi di pendidikan

mbak, kita kan sudah ada kita pasang-pasang

plakat, kita tekankan agar tidak ada yang merokok

disitu, dan mereka pun akan sadar dengan

sendirinya...” ("... what's more in the education of

mbak, we have already installed placards, we

emphasize that no one smokes there, and they will

realize themselves ..." (by Informant 9).). “...disaat

jam kerja sudah ada jamnya sendiri. Kalau perokok

mungkin jam istirahat untuk merokok, tapi kalau

yang tidak merokok dia manfaatkan yang lain...”

("... when working hours there is a time of its own.

Smokers may take a break to smoke, but if they don't

smoke, they use to the others activity... "(by

Informant 11) “...kalau ditempat usaha, kan disini

kan ada tempat pembuatan roti, batako, nah saya

survei itu mereka juga bisa membedakan jam-jam

kerja dan jam istirahat. Kalau mau merokok mereka

akan keluar” ("... if it is a place of business, right

here there is a bakery, brick making, now I survey it,

they can also distinguish between working hours and

rest hours. If you want to smoke they will come out

"(Informant 11).

Parents have set a good example for adolescents,

namely obeying the agreement on a no-smoking area

program. This example leads adolescents to also

obey the policy. Teenagers have a sense of

reluctance and respect for older people. This is a

strategy that needs to be emulated in developing

adolescent characteristics. Teenage peer support also

plays a role in running a no-smoking area program

for teenagers. For teens, peers have a strong urge to

do something. If a friend does not smoke in a place

that is prohibited then other teenagers will follow

him. If a teenager is obedient, it will encourage their

peers to obey the rules. Supports for social and

physical environment and peer support are factors

that play a role in adolescent adherence to

adolescent smoking behavior in non-smoking area

programs.

4 DISCUSSIONS

4.1 The Background of No-Smoking

Area Program In Purworejo

Hamlet

At first, Purworejo hamlet was a village that had a

behavior that has no policy and regulation about

smoking. This behavior is also reflected in

adolescents. The adolescents can smoke anywhere in

the desired place, such as a house, place of worship,

institutional education, meeting place, and

workplace. The nicotine effect in cigarettes causes

smokers to become addicted, even though most of

adolescents are high smokers. Teenagers are easy

targets for cigarette marketing because adolescents

are easily influenced because they are in a transition

era, have many problems, lack ability to manage

their life. They have many questions about who they

are, what their interests are, and many things (Liem,

2014). In that situation, teens need help from parents

and the environment (Ikatan Dokter Anak Indonesia,

2013).

Purworejo Hamlet realized the environmental

support for the declared Non-Smoking Area

Program. This program is intended to all residents,

including adolescents. Even though the program had

received rejection from a number of residents,

eventually the program could be carried out

sustainably because of the awareness of the

residents. The awareness of citizens to live healthier

and safeguard the rights of non-smokers is a good

start to initiate a smoking behavior control program

(Gunawan, 2016). This is because there is a

situational analysis and an appropriate and intensive

citizen approach. Without support from various

parties, the area without smoking is difficult to

implement (Azkha, 2013). Social environment has a

strong influence to smoking behaviour. The social

ICSDH 2018 - International Conference on Social Determinants of Health

environment includes family environment, peers,

teachers, idols, and cultural environment (Sutha,

2016). The empowerment process was carried out by

the community through three stages, namely the

awareness stage, this stage the community held

socialization by inviting human resource from the

health center to talk about the dangers of smoking

and the benefits of quitting smoking. Furthermore,

the capacity building phase is the effort to stop

smoking and not smoking in the area without

smoking and a limited area of smoking (Sadono,

2018).

4.2 Adolescents smoking behavior in

places of worship, educational

institution and work place, homes,

and the meeting place after the

program of No Smoking Area

The results of this study indicate that there might be

a change in behavior in adolescents by adhering to

the agreement to declare no-smoking areas in

Purworejo Hamlet. Teenagers do not show smoking

behavior in places of worship, meeting places,

workplaces, places of education, and homes.

Teenage smokers still exist in the village, but they

have ethics to perform their behavior. Adolescent

behavior is influenced by moral education from the

environment, namely the models of older people to

obey and discipline rules. The moral education can

be taught through conducting examples of good

behavior from the teacher or elders. The most

powerful factor that gives rise to moral emotion

consists of two factors, namely external (such as the

influence of parents, friends, and teachers) and

internal (such as values possessed, character and

moral identity) (Pratiwi and Adiyanti, 2017). No-

Smoking Area Program has a tendency to reduce

smoke behavior. Although it is not maximal to

reduce the number of smoking behavior, the

presence of No-Smoking Area Program increases

residents’ awareness about the dangers of smoking

and slightky reduce the number of smokers (Azkha,

2013). Adolescent smoking behavior is related to

environmental factors, such as parents, peer siblings

(Tristanti, 2016). Adolescent smoking behavior can

be formed by support from older peoples.

Adolescents tend to imitate what adults do. As adults

do not smoke in religious places, they imitate it.

Therefore, adolescents need guidance and mentoring

from adults in their daily behavior also obey the No-

Smoking Area Program.

The adolescents in Purworejo Hamlet show

better smoking behaviour in educational institution.

They comply to perform their behaviour in the

specified palce. Self-control and compliance with

rules have a relationship with smoking behaviour

(Ramdani, 2016; Rukmy, Dwirahayu and Andayani,

2018). The number of smoking behavior in

educational institution has decreased after the

implementation of No-Smoking Area Program. The

adolescents smoke in the place provided. There is a

relationship between the environment and the

smoking behavior of an adolescent, whether from a

family environment, peers, or advertisement. Peers

education is very influential (Windahsari,

Candrawati and Warsono, 2017). Educational

institution is a place for learning and teaching which

must implement No-Smoking Area Program. It is as

a country commitment to protect the citizens from

the dangers of smoke and create a healthy and strong

society. This program helps peoples to reduce

smoking people to smoking in public area

(Trisnowati and Sunarti, 2016). Application of No-

Smoking Area Program has been fully supported by

some parties who have an important role in their

place, such as call for appeal and verbal warning.

The warning must be carried out continuously, so

No-Smoking Area Program can be maintained.

After the declaration of no-smoking area

program, the adolescents show that they did not

smoke at home. They have better smoking

behaviour. They went to “cakruk”, a place that the

agreement alow people to smoke there. “Cacakan” is

a small container of sand that is hung on the wall.

This container is used to put out cigarettes before

entering the house. Adolescents obey this rule. This

is done to protect vulnerable groups from exposure

to cigarette smoke. There is a significant relationship

between cigarettes smoke exposure with primary

dysmenorrhoea (YS, Ermawati and Medison, 2016).

The older peoples in a family need to introduce

about what cigarette is, especially the dangers and

the negative impact. Parents have strong influence to

their children to avoid smoking behavior. Parents

must control continuously to maintain smoking

behavior at home. the role of parents and siblings

has a relationship with adolescent smoking

behaviour (Isa, Lestari and Afa, 2017).

Based on this study, adolescent smoking

behavior in meeting place is better. They do not

smoke at meeting places. If they want to smoke, they

went out and look for places to smoke that are

allowed. This behavior is implemented by

adolescent because they respect other peoples and

comply to the regulation. At meeting place, they

An Analysis Impact of No-Smoking Area Declaration Program in Adolescents Smoking Behavior in Purworejo Hamlet, Wonolelo Villages,

Pleret, Bantul

cannot find ashtray, it is as a commitment from

residents and the support to maintain the

implementation of declaration. The adolescent

behavior is formed due to some factors. They are the

environment and peers. Peers in Purworejo hamlet

have strong influence, especially smoking behavior.

This condition is applied in a positive control, if an

adolescent does not smoke in meeting place, the

others will do the same. Adolescents tend to smoke

if they have friends or family members who smoke.

Although in their environment many peoples do not

smoke, but in their relationship they will look

strangely to those who have an environment as

active smokers. This is the cause of adolescent

smoking habits to be fostered properly. Therefore, a

a good environment that supports the existence of

the No-Smoking Area program is needed, that

makes the adherence to smoking in place prohibited

from smoking can be adhered to by adolescents.

5 CONCLUSSION

Residents in Purworejo Hamlet have the habit of

smoking freely before the declared Smoking Area.

Residents were introduced to the Non-Smoking Area

Program in 2010. Pleret District Health Service

Center introduced this program to residents. The

socialization process is carried out by health

personnel. Barriers to program initiation are in the

form of disagreement by some residents to

implement non-smoking area programs. The

Community Health Center made various efforts to

change the attitude of the population to accept the

program. One of the conditions of the community is

the work of citizens as farmer groups. However.,

some residents who refused, now support and have

the motivation to succeed the program. Purworejo

hamlet boldly stated that the program will be

successful, even though many of its citizens were

tobacco farmers. The tobacco farmers group has a

commitment to support this program by changing

the type of tobacco that has low levels of nicotine.

Farmers do not consume tobacco, but they sell to

other industries. Purowrejo Hamlet has successfully

implemented a Non-Smoking Area Program. After

the declared non-smoking area program was

declared and implemented the program agreement,

the smoking behavior of adolescents in places of

worship, in education / educational institutions,

workplaces, and homes had changed. Teenagers

have not shown their smoking behavior in places

that are prohibited. They follow the rules and smoke

in a designated place. Parents create good models for

teens to adhere to policies for program

sustainability. The social environment has a great

power to support the ongoing program and achieve

program targets.

ACKNOWLEDGEMENTS

This research runs well and ends according to the

objectives of the researcher because of the support

of various parties, they are Faculty of Public Health

Universitas Ahmad Dahlan, the Head of Purworejo

Hamlet, The Head of No-Smoking Area Program in

Purworejo Hamlet, and all participants who support

this research. Your kindness means a lot.

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