The Relationship Factors of Peers and the Role of Parents in Adolescent Smoking Behavior

: One of the problems that often occur in adolescents is smoking-related problems. Smoking, seen from any point of view, is very harmful, both for oneself and those around one. Peer factors and the role of parents can influence adolescent smoking behavior. This study aimed to determine the relationship between peer factors and the part of parents and teenage smoking behavior at SMPN 3 Menggala, Tulang Bawang Regency, in 2023. The type of research in this research is quantitative, using analytic methods with a cross-sectional approach. The population in this study were all male students at SMPN 3 Menggala, Tulang Bawang Regency, in 2023, with a total of 127 students. The sampling technique used is total sampling. This research instrument uses a questionnaire. Data analysis used univariate and bivariate (chi-square). The results of this study indicate that 80 (63%) of respondents have positive behavior, 84 (66.1%) of respondents get support from peers, and 86 (67.7%) of respondents have a parental role. The chi-square test results found a relationship between peer factors (p-value 0.011 and OR = 2.875) and the part of parents (p-value 0.036 and OR = 2.423) with adolescent smoking behavior at SMPN 3 Menggala, Tulang Bawang Regency in 2023. Suggestions need to be supervised by strict regulations by the school regarding students' smoking habits and the provision of severe sanctions for those who are caught smoking.


Introduction
Health development is one of the national development efforts aimed at achieving awareness, will, and ability to live healthily for every resident to realize the highest degree of public health. The high and increasing number of smokers in Indonesia will increase the risk of diseases that threaten active and passive smokers. This will cause a burden of illness with tremendous losses in the development of public health and the quality of human resources in national development .
Non-Communicable Diseases are the most significant cause of death worldwide. Noncommunicable diseases are generally known as chronic diseases related to lifestyle. Based on the top ten NCD causes of death in Indonesia, 6 of them are stroke 21.1%, coronary heart disease 12.9%, diabetes mellitus with complications 6.7%, pulmonary tuberculosis 5.7%, hypertension with complications 5.3%, chronic obstructive pulmonary disease 4.9%, which is caused by risk factors for smoking behavior (Direktorat Jenderal Pencegahan dan Pengendalian Penyakit, 2019).
Cigarettes are one the tobacco products intended to be burned, smoked, and inhaled. Tobacco products can be in clove cigarettes, white cigarettes, cigars, or other conditions. This product is processed from nicotiana tobacco, nicotiana, and other species. Cigarette smoke contains nicotine, tar, carbon monoxide (Co), radicals, and other chemicals. Cigarette smoke is dangerous and can cause disease. Besides being harmful to the smoker (active smoker), cigarette smoke also harms those around him who inhale the smoke (passive smoker). Cigarette smoke inhaled by passive smokers contains five times more carbon monoxide and four times more contains tar and nicotine (Permenkes RI, 2017).
World Health Organization (WHO) states that Tobacco kills more than 8 million people annually. More than 7 million deaths result from direct tobacco use, while around 1.2 million results from second-hand smoke. Indonesia is ranked first in the world with the highest cigarette consumption, with active smokers reaching 33% (WHO, 2021).
The percentage of smoking behavior in the population aged ≥ 15 years in Indonesia is 28.6% in 2020, and in 2021 it will increase to 28.96%, then in 2022, it will decrease to 28.26%. Whereas in Lampung province, it was found that the percentage of smoking behavior in the population aged ≥ 15 years in 2020 was 33.43%, in 2021, it increased to 34.07%, and in 2022 it rose again to 33.81% (BPS, 2022).
Tulang Bawang Regency is the fifth lowest district regarding smoking behavior in residents aged ≥10 years, namely 27.7%. The highest prevalence of smoking behavior occurred in West Lampung Regency, which reached 32.38%, and the lowest district was in Metro City, which was 23.53% (Dinkes Provinsi Lampung, 2021).
The large population of the youth age group is an asset and has potential for the nation in the future. However, to realize this hope, the state and society must be able to guarantee that Indonesian youth can grow and develop positively and are free from various threatening problems. Efforts to realize these goals are not accessible. The importance of the child as the future asset of human civilization is shown by several indicators set by the United Nations (UN) as the Millennium Development Goals directly related to youth and young people .
The development of adolescents characterized by high curiosity does not always have good results. Some of them are too great a teenager's interest and can cause them to imitate behavior like adults. One thing that is often a problem for teenagers is a problem related to smoking. Smoking, seen from any point of view, is very harmful, both for oneself and those around one. The latest data from the 2019 Global Youth Tobacco Survey (GYTS) shows that 40.6% of students in Indonesia (age 13-15 years), 2 out of 3 boys and almost 1 out of 5 girls have used tobacco products: 19.2% of students currently smoke and of these, 60.6% are not even prevented from buying cigarettes because of their age, and two-thirds of them can purchase cigarettes in retail (WHO, 2020).
Smoking behavior in adolescents is caused by internal factors associated with personality characteristics which can be a source of deviant behavior (Oktawati, 2017). In addition, smoking behavior is triggered by external factors or the social environment. The social environment is one of the reinforcing factors to encourage smoking behavior. Parents and peers are the social environment significantly influencing smoking (Gaga et al., 2017). Families who smoke, peers who smoke, and the mass media or cigarette advertisements play an essential role in smoking behavior in adolescent boys (Windahsari et al., 2017).
In line with the research of Daniati et al., (2022) said that there is a relationship between peers and the role of parents in smoking behavior in adolescents in Kapuas Kanan Hulu Village 2022. In addition, Bina et al., (2022) show a relationship between support family and peer support with smoking behavior in young men in RW 004 and RW 005 Kayu Putih Village, Kupang City.
Berdasarkan studi pendahuluan yang dilakukan Based on a preliminary study conducted by researchers during the pre-survey, it was found that there were 29 students at SMP N 3 Menggala who were smokers. Meanwhile, in SMP N 4 Menggala, there were only 17 students who had the habit of smoking. After conducting interviews with 29 students at SMP N 3 Menggala, 18 students (62.0%) stated that the initial reason students started smoking was that they joined associations where they felt they were considered more excellent by smoking and were more masculine, then tried to try it because they are curious about the taste and sensation of smoking and 11 other students (38.0%) by seeing their parents' smoking habits trigger them to want to do the same thing with their parents.

Method
This type of quantitative research uses a crosssectional approach. The population in this study were all male students at SMPN 3 Menggala, Tulang Bawang Regency, in 2023, with a total of 127 students. The sampling technique used is total sampling. Data analysis in this study using the chi-square test.

Result and Discussion
The table 1 shows that out of 127 respondents, 47 (37%) had smoking behavior in the harmful category, and 80 (63%) had smoking behavior in the positive class. Meanwhile, based on interviews with respondents, it was found that 87 children had never smoked. Smoking behavior is an activity carried out by someone in the form of burning and smoking either tobacco cigarettes or pipes that cause smoke so that many people can live the smoke. Smoking behavior is a habit that occurs as a result of addictive effects (Nelwan et al., 2016).
Smoking behavior in adolescents generally increases over time according to the stage of development, which is marked by increasing frequency and intensity of smoking, eventually leading to dependence on nicotine. The effect of nicotine in cigarettes can make a person addicted or addicted to cigarettes. Adolescents addicted to smoking generally cannot resist the urge not to smoke, and they tend to be sensitive to the effects of nicotine (Novariana et al., 2022).
This research is in line with a study conducted by Daniati et al., (2022) which showed that there were 33 (62.3%) adolescents with smoking behavior and 20 (37.7%) non-smokers.
According to the researchers' assumptions, negative adolescent behavior tends to choose cigarettes as an escape when there is a problem. In addition, this negative smoking behavior is also because students have a habit of smoking. Teen smoking habits are influenced by their friends and the role of parents at home. Outside the house, teenagers tend to imitate what their friends do in groups. When a teenager refuses to follow a friend's advice about smoking, the teenager is ridiculed or branded "not gentle", this is what causes the desire to try cigarettes. In addition, parental factors also influence smoking behavior in adolescents. Parents who smoke will be more at risk of being imitated by their children. The table above shows that out of 127 respondents, 43 (33.95) respondents did not receive peer support, and 84 (66.1%) received permission from peers. Interaction with peers is the beginning of a friendly relationship in which there is a reciprocal relationship. Peers are structured interactions between individuals with other individuals of the same age and with a relative level of closeness in the group. In peer relationships, it is usually someone who has social support that can be felt from the appreciation or attention given within the circle of friends to establish a closer relationship (Budikuncoroningsih, 2017).
Peer interaction can influence, change, or improve individual behavior between two or more people with conditions or developmental levels at the same age level that does not have to be the same. Peers play an essential role in the lives of adolescents. Teenagers want to be accepted and seen as members of their peer group, both in and out of school. Therefore, adolescents tend to behave like their peers' behavior (Amin et al., 2019).
This research is in line with research conducted by Amelia & Sunarti (2017) which showed that 33 respondents with a percentage (67.3%) received support from strong peers, while 16 respondents with a percentage (32.7%) received weak peer support.
According to researchers, peers play an essential role in children's personal and social development. Peers act as socialization specialists who shape children's behavior and beliefs. People with positive behavior support their friends to act positively and vice versa. If peers have negative behavior, it will affect their friends negatively. The table above shows that out of 127 respondents, 41 (32.3%) respondents had no parental role, and 86 (67.7%) had a parental role. The family has a significant role in maintaining the health of all family members. Supervision and prohibition carried out by the family is an effort to control adolescent smoking behavior (Etrawati, 2014). There are several roles that parents can play to prevent smoking behavior in adolescents, namely the role of educator, the role of motivator, the role of role model, the role of a friend, the role of supervisor, and role of counselor so that smoking behavior does not continue to increase (Octaviani & Fithria, 2018).
This research is in line with research conducted by Isa et al. (2017) which showed that out of 100 respondents, the majority of students with good parental and sibling roles were 96 respondents (96%). At the same time, students who have bad parental and sibling roles are four respondents (4%).
According to researchers, the role of parents is significant in shaping adolescent behavior. Parents are examples of their children. The better the role of parents, the better the behavior carried out by adolescents. Vice versa, if parents set a bad example, it will impact children's behavior. The table above shows that of the 43 respondents with peers in the non-supportive category, 23 (53.5%) respondents had smoked in the harmful category, and 4413 20 (46.5%) had smoking behavior in the positive category. Meanwhile, from 84 respondents who received support from peers, 24 (28.6%) respondents had smoking behavior in the harmful category and 60 (71.4%) in the positive category. The chi-square test results obtained a p-value of 0.011 <0.05, meaning that there is a relationship between peer factors and adolescent smoking behavior at SMPN 3 Menggala, Tulang Bawang Regency in 2023. OR = 2.875 means that adolescents who do not get peer support to prevent and avoid cigarettes are at risk of 2.875 times having negative behavior (smoking).
The influence of peers is considerable on the formation of adolescent perceptions. This is because perceptions are also influenced by social pressure. Adolescents starting to smoke is related to a psychosocial aspect of the crisis in adolescent development. Smoking can be a way for adolescents to appear accessible and mature when adjusting to their peers who smoke (Vitória et al., 2020).
Teenagers always try to match their peers and accept all influences from their peers. The influence exerted by peers can be either positive or negative (Novariana et al., 2022). Peers with negative behavior tend not to support their friends when they want to avoid smoking. Instead, they will support their friends to smoke. Teenagers who follow things about smoking from their friends will most likely imitate it because the adolescent phase has entered the imitating phase. In addition, support from peers is a factor that causes adolescents to have smoking behavior. When a teenager joins a peer group, the teenager will be required to behave the same way as the group. So if there is peer rejection, the effect is enormous because if peers do not follow the wishes or invitations of friends, most of their peers will feel isolated (Amalizar et al., 2023).
Students think smoking is a tool that shows they look free and mature when adapting to the social environment. Smoking is also one of the things that are mandatory when they get together with their friends.
Smoking students are likelier to be with their friends when forming groups or groups. The status of peers who smoke can influence adolescent smoking behavior because most teenagers are curious about smoking activities by the people around them (Goa & Bossa, 2020).
In line with research conducted by Novariana (2022) which showed a relationship between peer influence and smoking behavior in class VII and VIII students at Public Middle School in Way Kanan (p-value 0.012, OR 6.4).
According to researchers, there is a relationship between the role of peers and smoking behavior in students. This is because young smokers engage with fellow smokers for reasons of togetherness and even feel happy and satisfied when they can smoke together. The existence of peers can bring negative support for adolescents, and adolescents are easily influenced by the behavior shown by their peers. Adolescents who associate with peers who misbehave will also tend to lead adolescents toward harmful behavior. There is a relationship between smoking behavior in parents and smoking behavior in adolescents, and this is because parents are the first environment that can help anticipate smoking behavior in adolescents. The family environment can also support adolescent development. Adolescents who live with families under one roof or house can influence better adolescent development because families often interact and communicate so that adolescent social roles can be created properly (Marliani, 2016).
Parenting is an interaction given by parents in interacting and communicating with adolescents in applying discipline and teaching values or norms as well as providing affection and attention so that parents' attitudes and behavior can be used as role models for children. The most influencing cause of smoking behavior is the parental factor because parents are the closest environment to an individual. In line with research conducted by Mojallal (2017), shows that parenting style is a significant predictor of smoking status among students. A more instrumental family environment can protect adolescents from stressful events and help them manage their problems using more efficient coping strategies (Mojallal et al., 2017).

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The role of the family is significant for adolescents. Parents with a good role in teaching their children to avoid smoking will think that smoking is terrible and that no family supports their children's smoking. Teenagers can listen to these directions when the family tells them not to smoke. However, when teenagers are around friends who smoke, the teenager automatically has the desire to try smoking. The family is the first environment that is generally very influential in the development of adolescents. The family environment should be where adolescent values and norms are formed in behavior. The role of parents is, of course, a matter that needs attention in adolescent smoking behavior. However, other things show that the influence of peers in their environment is more significant when compared to the influence of parents (Wahyuningsih et al., 2023).
This research is in line with research conducted by Pertiwi et al. (2022) which shows parental involvement significantly influences smoking behavior in adolescents in the city of Bandung, and the greater the involvement of parents in adolescent behavior, the less smoking behavior is carried out by adolescents.
According to researchers, the role of parents is significant to improve children's behavior, especially the behavior of adolescents in terms of smoking, because adolescence is a transitional period where there is more imitating. There is a feeling of wanting to avoid being outdone by their friends, so they try to do new things. Therefore, the role of parents in providing education and motivation is essential to protect them. Therefore the role of good parents is significant to support children's behavior in a positive direction.

Conclusion
The conclusion of this study indicate that 80 (63%) of respondents have positive behavior, 84 (66.1%) of respondents get support from peers, and 86 (67.7%) of respondents have a parental role. The chi-square test results found a relationship between peer factors (pvalue 0.011 and OR = 2.875) and the part of parents (pvalue 0.036 and OR = 2.423) with adolescent smoking behavior at SMPN 3 Menggala, Tulang Bawang Regency in 2023.