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Smoking affects human health and healthcare systems worldwide, particularly in Indonesia. We used secondary data from the 2021 Global Adult Tobacco Survey (GATS) to analyze Indonesian smoking cessation determinants.
Methods
We analyzed data from 2,877 individuals aged 15 years and older from the 2021 GATS Indonesia, selected through multistage clustering. We used multiple logistic regression analysis adjusted for the complex survey in STATA 17.0 to examine Indonesian smokers’ intention to quit including age, sex, education, occupation, household wealth, place of residence, perceptions that smoking causes serious illness, efforts to stop smoking in the past, abstinence days in the past, health-related reason, social reason, environmental reason, and financial reason).
Results
Weighted adult intention to quit smoking within 12 months was 17.8%. Factors associated with intention to quit smoking among current smokers in Indonesia included adults age 45 years or older (adjusted odds ratio [AOR], 1.69; 95% confidence interval [CI], 1.12–2.54), completed higher education (AOR, 1.85; 95% CI, 1.01–3.42), working status (AOR, 0.72; 95% CI, 0.55–0.96), perception that smoking causes serious illness (AOR, 2.88; 95% CI, 1.96–4.22), abstinence days in the past >30 days (AOR, 3.10; 95% CI, 2.18–4.41), social reason (AOR, 1.48; 95% CI, 1.05–2.09), and environmental reason (AOR, 1.67; 95% CI, 1.23–2.28).
Conclusion
Intention to quit smoking depends on several factors. Smoking cessation guidelines must be widely and often implemented, especially for high-risk smokers. Pharmacological and non-pharmacological smoking cessation strategies require cooperation among healthcare providers, public health actors, and the government.
Healthcare providers continue to prioritize efforts to improve tobacco control and treatment [1]. Smoking is a worldwide public health issue, with a substantial detrimental effect on human wellbeing and healthcare expenditure [2]. While the prevalence of current tobacco smoking was 34.8% in 2011 and 33.5% in 2021, the prevalence of overall current tobacco usage was 36.1% in 2011 and 34.5% in 2021 [3].
Tobacco consumption is the largest preventable cause of mortality worldwide. In the context of aging populations, increased chronic illnesses, and rising healthcare expenses, it is imperative to address this preventable risk. Tobacco dependency, a chronic and recurrent disorder, frequently necessitates continuous care, and evidence-based therapies can markedly enhance the success of quitting [4,5]. Seeking best-practice smoking cessation programs is a cost-effective approach to alleviate the heavy global economic burden imposed by smoking, while helping smokers quit is thought to be the most effective method to reduce the health burden [6].
Various strategies are available for treating smoking addiction, encompassing both non-pharmacological approaches, such as behavioral counseling, and pharmacological therapies [7]. Pharmacological approaches for the treatment of smoking dependence should be linked to non-pharmacological strategies such as behavioral counseling, which are established methods for facilitating the cessation process [7].
According to Ahluwalia et al. [8], quitlines are the least often mentioned cessation technique worldwide. These results, together with other data, imply that quitting smoking is a process that involves personal decisions—whether or not to seek help, type of assistance available and sought (medications, advice, and behavioral interventions), motivations, self-efficacy, and possibly a host of other factors, including precipitating health conditions. Access to treatment facilities and medications in low- and middle-income countries (LMIC) presents distinct challenges. Creating solutions tailored to the requirements of LMICs is essential for effective tobacco control [9]. In Indonesia, the proportion of individuals who attempted to quit smoking in the past 12 months increased significantly from 30.4% in 2011 to 43.8% in 2021. Nevertheless, receiving advice from healthcare providers to quit smoking has not varied significantly over the past 12 months (34.6% in 2011 vs. 38.9% in 2021) [3].
To the best of our knowledge, studies on factors associated with the desire to quit smoking are limited. Therefore, this study aimed to analyze these variables using secondary data from the 2021 Global Adult Tobacco Survey (GATS).
Methods
Study design and participants
We used data from the 2021 GATS Indonesia for analysis. The survey was conducted as part of the Global Tobacco Surveillance System, which involved interviewing adults aged 15 years and older who were selected using multistage stratified cluster sample designs. The survey collected information through household and individual questionnaires on respondents’ age, sex, smoking habits, and various aspects related to tobacco use, such as heated tobacco products, smokeless tobacco, smoking cessation, exposure to secondhand smoke, economic factors related to cigarettes, media influence, and attitudes and perceptions towards smoking [10]. This study analyzed 2,877 adults aged 15 years and older.
Study variables
The dependent variable was intention to quit smoking, which was defined as participants’ plan to quit smoking within the next 12 months. Independent variables consisted of participants’ age (15–24 years, 25–44 years, >45 years), sex (male, female), level of education (no or incomplete primary school, completed primary school, completed secondary school, completed higher education), occupational type (not working, working), household wealth (poorest, poorer, middle, richer, richest), place of residence (urban, rural), perceptions that smoking causes serious illness (no, yes), efforts to stop smoking in the past (no, yes), abstinence days in the past (0=less than 1 day, 1=1–7 days, 2=8–30 days, and 3=more than 30 days), health-related reason (no, yes), social reason (no, yes), environmental reason (no, yes), financial reason (no, yes).
Household wealth was estimated using a composite household wealth index through principal component analysis to assign weights to various consumer goods owned (such as electricity, flush toilets, telephones, and televisions). This index was adjusted for both urban and rural locations. The household wealth index was computed by adding these weighted scores and then categorizing them into five groups or quintiles [11].
Statistical analysis
Descriptive statistics was used to describe the characteristics of participants by reporting the frequency and proportion of study variables and intention to quit smoking. To examine the association of each factor with intention to quit smoking, we applied univariate logistic regression and reported crude odds ratios (CORs). To analyze factors associated with the intention to quit smoking, we used multiple logistic regression and reported the adjusted odds ratios (AORs). All analyses were performed using Stata version 17.0, adjusted for a complex survey design. The level of significance was set at P-value <0.05.
Ethical considerations
In 2021, written informed consent for GATS was obtained from all participants by the Health Research Ethics Committee at the National Institute of Health Research and Development (HRECNIHRD), Ministry of Health of Indonesia (reference number: LB.02.01/2/KE.451/2020).
Results
We included a total of 2,877 participants in this analysis. The weighted proportion of adults who had the intention to quit smoking within the next 12 months was 17.8%. The detailed characteristics of the study participants and the proportion of intentions to quit smoking are presented in Table 1. The intention to quit smoking was higher among participants aged >45 years (19.7%), female participants (23.2%), those who completed higher education (26.5%), those who were not working (22.8%), individuals in the richest group (21.4%), urban residents (18.0%), and those who perceived that smoking caused serious illness (20.7%).
Table 2 shows the COR and AOR for factors associated with the intention to quit smoking among adults aged 15 years or older in Indonesia. Compared to the youngest age group, those aged 45 years or older were 1.69 times more likely to have the intention to quit smoking. Adults who had completed higher education were 1.85 times more likely to plan to quit smoking compared to those with no formal education or who had not completed primary school. Those who were working had 28% lower odds of the intention to quit smoking within the next 12 months compared to those who were not working. Adults who perceived that smoking caused severe illness were more likely to have the intention to quit smoking than those who did not (AOR, 2.88; 95% confidence interval, 1.96–4.22). Abstinence days in the past for more than 30 days were 3.10 more likely compared to those 1 to 7 days or 8 to 30 days.
Discussion
This study explored factors associated with the intention to quit smoking using secondary data from the 2021 GATS including individuals aged 15 years and older. Intention to quit smoking was associated with older adults, higher educational levels, and perceptions that smoking caused severe illness. Those who were working had a lower chance of having an intention to quit smoking.
Older adults were more likely to have an intention to quit smoking. This can be attributed to several factors. As people age, they often experience more health issues, some of which are directly linked to smoking [12]. These findings align with those of previous research, indicating that older smokers who attempt to quit tend to achieve greater success [13]. Physicians often emphasize the health benefits of smoking cessation, particularly for older adults with existing health conditions [14]. Older adults, particularly those with a fixed income, might experience a financial strain and perceive quitting smoking as a means to save money [15]. Theoretical frameworks in public health emphasize the importance of preventive interventions and behavioral modification strategies in addressing smoking-related issues [16]. Older adults may have been exposed to these messages for a longer period of time, influencing their decision to quit. They might have access to better support systems, such as smoking cessation programs, community groups, and resources that encourage quitting smoking [17]. These combined factors can lead to a higher intention among older adults to quit smoking than among younger individuals.
Participants with a higher education were more likely to have an intention to quit smoking. This is supported by several studies that have found a correlation between education level and the intention to quit smoking. For example, Cao et al. [18] indicated that individuals with college or higher education exhibited the lowest initiation probabilities and the highest cessation probabilities, resulting in the lowest prevalence of current smokers across all ages and birth cohorts for both the sexes. Additionally, Yuliawati et al. [19] and Effendi et al. [20] demonstrated that individuals with higher education are more likely to have attempted to quit smoking. Furthermore, Ruokolainen et al. [21] reported that higher education levels are generally linked to smoking cessation among the adult population, particularly among males.
Those who were working tend to not have any intention to quit smoking. This trend may be attributed to various factors related to work environment and personal background. Employees facing pressure and demands from their jobs, such as long working hours, may use smoking as a coping method to manage stress, thereby decreasing their motivation to quit [22]. Additionally, having colleagues who smoke at work can discourage employees from attempting to quit smoking or quitting smoking entirely [23]. This suggests that social interactions reinforce smoking behaviors among workers [24]. Furthermore, non-work-related factors such as perceived cravings from quitting smoking and living in a household permissive of smoking can diminish employees’ motivation and efforts toward smoking cessation [25]. These factors collectively contribute to the reduced inclination to quit smoking among working individuals compared with their non-working counterparts.
Participants who perceived that smoking causes serious illness were more likely to have the intention to quit smoking. Lin et al. [26] in 2021 found that perceptions of harm from cigarettes were strongly associated with the intention to quit smoking, particularly among cigarette smokers and dual users. Low public knowledge regarding the risks of smoking has led to the perception that cigarettes are less harmful to health [26].
Since smoking information was based on self-reported information, the study may be subject to recall bias. Furthermore, the cross-sectional design of our study limits the ability to infer causality.
The results indicate a definitive dose-response correlation between the number of abstinence days before smoking and the intention to quit smoking. The duration of prior abstinence from smoking is positively correlated with the intention to quit smoking. This trend confirms the belief that previous cessation attempts, especially those of extended length, may increase self-efficacy and bolster the motivation to quit. Comparable associations have been documented in previous research, indicating that recent or recurrent abstinence experiences are associated with higher intentions and future quitting attempts [27]. These findings emphasize the need to recognize and facilitate all quitting efforts, as they may significantly influence the readiness to quit.
The significant associations between social and environmental factors and a stronger intention to quit smoking highlight the role of external influences in shaping motivation. Social disapproval and normative expectations may reinforce internal motivation, while environmental restrictions may reduce opportunities to smoke. These results support previous findings that social support and smoke-free policies facilitate cessation, suggesting that integrated interventions targeting both areas may be especially effective [28,29].
In conclusion, multiple factors, such as age, education level, employment status, and perceptions of the health consequences of smoking, influence the intention to quit smoking. Immediate execution of thorough, focused guidelines is crucial, especially for high-risk populations. Collaboration among healthcare professionals, public health organizations, and governments is essential for implementing effective quitting measures, including enhanced educational programs to raise awareness about the risks of tobacco smoking, and integrating both pharmaceutical and non-pharmacological methods.
Notes
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Data availability
Data of this research are available from the corresponding author upon reasonable request.
Author contribution
Conceptualization: all authors. Methodology: DAAK, BAP. Software: BAP. Validation: DAAK, BAP. Formal analysis: DAAK, BAP. Investigation: DAAK, BAP, TP. Resources: TP, DRF. Data curation: DAAK, BAP. Project administration: DAAK, BAP, TP, BR, DRF. Visualization: DAAK, BAP. Supervision: WPN, TP, BR, DRF. Writing–original draft: DAAK, BAP. Writing–review & editing: all authors. Final approval of the manuscript: all authors.
Table 1.
Distribution of variables and proportion of intention to quit smoking among current smokers in Indonesia
Characteristic
Total
Proportion of intention to quit smoking
No. (%)
95% CI
Age (y)
15–24
423 (17.8)
79 (18.7)
14.5–23.9
25–44
1,097 (45.8)
183 (16.1)
13.1–19.5
>45
1,357 (36.4)
246 (19.7)
17.2–22.4
Sex
Male
2,763 (96.1)
481 (17.6)
15.6–19.9
Female
114 (4.0)
27 (23.2)
14.7–34.7
Level of education
No or primary
508 (14.5)
63 (13.7)
10.4–17.8
Completed primary
832 (25.8)
150 (17.8)
14.6–21.5
Completed secondary
1,367 (52.8)
250 (17.9)
15.6–21.5
Completed higher education
170 (6.9)
45 (26.5)
18.4–36.5
Type of occupation
Not working
492 (18.2)
109 (22.8)
18.7–27.5
Working
2,385 (81.9)
399 (16.7)
14.7–19.1
Household wealth
Poorest
730 (22.7)
105 (14.5)
11.6–17.9
Poorer
666 (23.0)
115 (17.9)
14.7–21.8
Middle
535 (20.1)
94 (17.1)
13.7–21.3
Richer
564 (19.8)
110 (19.8)
16.1–24.1
Richest
382 (14.2)
84 (21.4)
16.0–28.0
Place of residence
Urban
1,221 (55.1)
213 (18.0)
15.2–21.3
Rural
1,656 (44.9)
295 (17.6)
14.9–20.8
Perceptions that smoking causes serious illness
No
672 (21.1)
48 (7.3)
5.3–9.9
Yes
2,205 (78.9)
460 (20.7)
18.2–23.3
Efforts to stop smoking in the past
No
1,831 (61.6)
201 (10.9)
9.1–12.9
Yes
1,046 (38.4)
307 (29.0)
25.4–32.9
Abstinence days in the past (d)
<1
1,789 (59.6)
183 (10.0)
8.3–12.1
1–7
310 (12.1)
71 (22.4)
17.4–28.4
8–30
316 (11.4)
85 (27.4)
21.7–34.0
>30
462 (17.0)
169 (35.7)
30.0–42.0
Health-related reason
No
1,899 (63.9)
204 (10.8)
8.9–12.9
Yes
978 (36.1)
304 (30.4)
26.7–34.3
Social reason
No
2,292 (77.5)
299 (13.02)
11.1–15.2
Yes
585 (22.6)
209 (34.4)
29.2–39.6
Environmental reason
No
2,535 (86.4)
378 (14.6)
12.6–16.9
Yes
342 (13.6)
130 (38.3)
32.8–44.1
Financial reason
No
2,511 (86.0)
397 (16.0)
14.0–18.1
Yes
366 (14.0)
111 (29.6)
24.1–35.8
Values are presented as number (%) or 95% CI unless otherwise stated.
CI, confidence interval.
Table 2.
Factors associated with intention to quit smoking among current smokers in Indonesia
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