De-normalising smoking among youths: a school-based smoking prevention program

The high rate of adolescent smoking has become one of the major concerns for tobacco control in Indonesia. The Global Youth Tobacco Survey (GYTS) indicated that Indonesia has one of the highest numbers of adolescent smokers in the world. Students’ exposure to smoking activity is very high, either in the home or in the school environment. Three out of five children aged 13 to 15 are exposed to cigarettes at home, with seven out of 10 children seeing smoking activity in their school environment. GYTS data also showed that three out of five children aged 13-15 years in Indonesia have seen cigarette advertisements in cigarette selling counters, and have been exposed to smoking activity at home or in public areas. The availability of tobacco products is also high in Indonesia, with three out of five children able to buy cigarettes in grocery stores and kiosks without being restricted. With such a high exposure and the ease of accessibility, it is no wonder that approximately 20 per cent of junior-high school teenagers, or one in five children aged 13-15 years in Indonesia, have ever smoked.

Due to the early age of tobacco uptake, youth is a critical period for targeting smoking prevention measures and beginning to decrease the high prevalence of tobacco use in Indonesia. In order to prevent youth tobacco use, a comprehensive tobacco control program requires a combination of educational, clinical, regulatory, economic and social strategies. School-based smoking prevention programs are considered to be among the most effective strategies for reducing initiation of adolescent smoking. Teachers have been shown to be a significant vanguard population for tobacco control; they are an epitome of community norms and can be instrumental in school-based tobacco control program.

The Center for Indonesia’s Strategic Development Initiatives have a strong focus on health and youth-related issues. Considering the problems of youth smokers can affect healthy populations, CISDI developed a program that aimed to integrate a tobacco-smoking harms education module into the current grade seven curriculum at two targeted schools in Jakarta. CISDI aimed to improve the knowledge of junior high school students about the adverse effects of smoking and to provide them several soft skills to influence attitudes, which may help to decrease their desire and intention to smoke.

This project consisted of a classroom management strategy, which provides an enhanced academic curriculum designed to improve knowledge about the health risks of smoking, as well as a youth-led workshop designed to build and improve soft skills among students in order to decrease early initiation smoking. The study found most students (78.4 per cent) started smoking when they were younger than 12 years old. The prevalence of self-reported tobacco or e-cigarette users in the current academic year was 26.05 per cent, with 8.45 per cent current smokers. Of past users, 12 per cent have tried an electronic cigarette (e-cigarette).

CISDI, in collaboration with volunteers and education consultants, conducted a literature review on the existing Junior high school education syllabus to formulate an integrative module. We analysed smoke-free issues that would best fit with the syllabus and based on this analysis, came up with five units of study and three smoke-free issues. The issues deemed relevant were smoke-free areas, the dangerous impact of tobacco, and tobacco advertisements. These issues were integrated into social studies, science, maths, language and civil education.

The module was implemented for five weeks at SMP 97 and SMP 7 in Central Jakarta. Nine teachers delivered smoke-free education through five units of study to 142 students in the seventh grade to build stronger knowledge and attitude towards smoke-free behaviour.

  • This project integrated the negative effects of smoking into the curriculum of junior high school students in grade seven. This content was integrated into five subjects.
  • The first stage was volunteer capacity building to assist the process of module preparation and implementation.
  • The second phase integrated the modules that have been prepared based on the topic of the subject. Modules were implemented by teachers who have been given previous training.
  • Third stage was soft skill training to improve students’ attitudes toward smoking behaviour.

Cigarette consumption in Indonesia has reached an epidemic level that threatens its population, particularly its younger generation. High exposure to cigarette advertisements and smoking from an early age plays a significant role in creating positive perceptions of smoking activity. While nearly 70 per cent of students are informed about the dangers of smoking in schools, there are a limited number of formal smoking prevention programs implemented within schools in Indonesia.

The broader impact of this project is the experience of integrating cigarette education information within the school curriculum in Jakarta. Previous approaches have only integrated the information into science subjects, whereas this project expanded the number of subjects embedding the tobacco information. The practice has brought new experiences and knowledge in tobacco control in Indonesia, both in methods and content. In May, the results of this project were presented at the Indonesian Conference on Tobacco Control or Health in Surabaya, where many delegates appreciated it and proposed collaborations for module development and subsequent implementation.

Outputs

Module

  • ‘Progresif’ Module : Integration of a tobacco-smoking harms education module into Junior high school (SMP) curriculum; 2018; CISDI: Jakarta

Presentations

  • Abstract entitled ‘PROGRESIF: An innovative approach on school-based tobacco control intervention through integrated module’ was presented to the 5th Indonesia conference on Tobacco or Health (ICTOH), May 2018, Surabaya, Indonesia
  • ‘Increasing student’s knowledge and attitude on smoking hazard through PROGRESIF’ presented to the 5th Indonesia conference on Tobacco or Health (ICTOH), May 2018, Surabaya, Indonesia, and Asia Pacific Conference on Tobacco or Health (APACT) 12, Bali, September 2018

People

  • Anindita Sitepu
    Programme Director
    Center for Indonesia’s Strategic Development Initiatives