Melinda Gea, Kamilah Fariza Zahra, Rizki Amelia Syifa, Nida Sofwatun, Kusuma Dian, Adrison Vid
Department of Research and Development, Center for Indonesia's Strategic Development Initiatives, Jakarta Pusat, DKI Jakarta, Indonesia
Department of Research and Development, Center for Indonesia's Strategic Development Initiatives, Jakarta Pusat, DKI Jakarta, Indonesia.
BMJ Open. 2025 Jan 21;15(1):e087786. doi: 10.1136/bmjopen-2024-087786.
To investigate the relationship between purchasing loose cigarettes and adolescent smoking habits in Indonesia.
This study employed a mixed-methods sequential explanatory design. We analysed the secondary data from a national survey, the 2019 Global Youth Tobacco Survey, using multivariable logistic regression models to examine the association between loose cigarette purchase and smoking frequency and intensity and nicotine dependence. Based on the quantitative findings, we arranged focus group discussions (FGDs) in junior and senior high schools located in South Jakarta, Indonesia. The qualitative data were analysed using thematic analysis with an inductive approach to explore experiences in purchasing loose cigarettes and how it affected their smoking initiation and current cigarette consumption.
For quantitative study, we included 785 samples after excluding the non-current smokers and those who had missing responses. For qualitative study, a total of 49 eligible students who met inclusion criteria (ever or current smokers, buying loose cigarettes and living with parents) and agreed to participate in FGD were later divided into 12 FGD groups.
Most students who smoked in the past 30 days are male (95%). More than half of the students (68%) reported buying loose cigarettes in the past 30 days, including 36% who smoked 1-2 days in a month and 34% who usually consumed one cigarette a day. One-third of the students had nicotine dependence (30%), with an average smoking duration of 3 years. Purchasing loose cigarettes in the past 30 days was significantly correlated with smoking for <20 days in the past month (adjusted OR (AOR)=1.56; 95% CI=1.17 to 2.07), consuming ≤5 sticks per day (AOR=2.15; 95% CI=1.54 to 3.00) and having lower nicotine dependence (AOR=1.55; 95% CI=1.08 to 2.22). Our qualitative findings further reported that affordability and accessibility were the main reasons that encouraged current student smokers to opt for loose cigarettes over other types of cigarettes (packs, cartons or rolled tobacco). Students reported the extensive selling of loose cigarettes and such a situation persuaded them to buy tobacco products more frequently, thus spending at least half of their weekly allowance on tobacco products, ranging from 30 000 to 200 000 Indonesian rupiah or equivalent to US$2-13 per week. Finally, our study highlighted that only a few students in this study either had to show their identity card or were denied when purchasing loose cigarettes in informal retailers.
Our study demonstrates that students purchasing loose cigarettes is significantly associated with non-daily smoking, consuming five or fewer sticks per day, and lower addiction which could be interpreted as smokers in the experimental phase. They possessed a higher risk of becoming regular smokers. Our qualitative findings supported the quantitative study by shedding light on the role of loose cigarettes in smoking initiation and continuation among young people. In this case, we supported the notion of prohibiting loose cigarette sales in the country in order to reduce smoking uptake and tobacco consumption among the younger generation.
调查在印度尼西亚购买散装香烟与青少年吸烟习惯之间的关系。
本研究采用了混合方法的序贯解释性设计。我们分析了来自一项全国性调查（2019年全球青少年烟草调查）的二手数据，使用多变量逻辑回归模型来检验购买散装香烟与吸烟频率、强度以及尼古丁依赖之间的关联。基于定量研究结果，我们在印度尼西亚雅加达南部的初中和高中组织了焦点小组讨论（FGD）。定性数据采用归纳法进行主题分析，以探索购买散装香烟的经历以及这如何影响他们开始吸烟和当前的香烟消费情况。
对于定量研究，在排除非当前吸烟者和那些有缺失回答者后，我们纳入了785个样本。对于定性研究，共有49名符合纳入标准（曾经或当前吸烟者、购买散装香烟且与父母同住）并同意参加焦点小组讨论的合格学生，随后被分为12个焦点小组讨论组。
在过去30天内吸烟的大多数学生为男性（95%）。超过一半的学生（68%）报告在过去30天内购买过散装香烟，其中36%的学生一个月吸烟1 - 2天，34%的学生通常每天吸一支烟。三分之一的学生有尼古丁依赖（30%），平均吸烟时长为3年。在过去30天内购买散装香烟与过去一个月内吸烟少于20天（调整后的比值比（AOR）=1.56；95%置信区间=1.17至2.07）、每天吸食≤5支烟（AOR = 2.15；95%置信区间=1.54至3.00）以及尼古丁依赖程度较低（AOR = 1.55；95%置信区间=1.08至2.22）显著相关。我们的定性研究结果进一步表明，可承受性和可获取性是促使当前吸烟的学生选择散装香烟而非其他类型香烟（包装烟、条装烟或手卷烟丝）的主要原因。学生们报告说散装香烟大量售卖，这种情况促使他们更频繁地购买烟草制品，从而将每周至少一半的零花钱花在烟草制品上，金额从30000至200000印尼卢比不等，相当于每周2至13美元。最后，我们的研究强调，在本研究中只有少数学生在非正式零售商处购买散装香烟时需要出示身份证或被拒绝。
我们的研究表明，学生购买散装香烟与非每日吸烟、每天吸食5支或更少香烟以及较低的成瘾性显著相关，这可以解释为处于实验阶段的吸烟者。他们成为常规吸烟者的风险更高。我们的定性研究结果通过揭示散装香烟在年轻人开始吸烟和持续吸烟中的作用，支持了定量研究。在这种情况下，我们支持在该国禁止销售散装香烟以减少年轻一代的吸烟率和烟草消费的观点。
