Perception and smoking status among primary healthcare center staffs as predictors of support for a 100% smoke-free policy in a mixed rural-urban area
Abstract
Purpose: Focusing on primary healthcare personnel at the district level in Indonesia and integrating behavioral theory and contextual tobacco-control factors, this study aims to analyze health staff attitudes toward implementing a 100% smoke-free policy in primary healthcare centers (PHCs).
Methods: This study utilized secondary data from Quit Tobacco Indonesia. The survey, conducted between 2011 and 2012, focused on staff employed at PHCs in Bantul District, Special Region of Yogyakarta. The study employed a cross-sectional design with 313 participants. The dependent variable in this study was attitude towards a 100% smoke-free policy in PHCs. The independent variables were beliefs regarding the effects of environmental tobacco smoke (ETS) and perceptions of ETS. Covariate variables included staff position, gender, educational level, training on the smoking problem, smoking status, knowledge level about the impacts of ETS, medical staff as role models, age, and length of working. Analysis was conducted using descriptive (proportion) and bivariable (chi-square) approaches, as well as multivariable (multiple logistic regression).
Results: Individuals who perceived ETS exposure negatively (OR 16.6; 95%CI: 6.59-42.1), and those with a non-smoking status (OR 20.3; 95%CI: 7.43-55.3) or former smoking status (OR 6.7; 95%CI: 1.73-26.0), were more likely to demonstrate a favorable attitude toward a 100% smoke-free policy in PHCs.
Conclusion: Stakeholders such as the district health office and PHC heads can strengthen smoking cessation efforts through education and financial strategies to help current smokers transition to former smokers.
References
Shi Y, Qin D, Wang H, Sun L, Gu K. Effectiveness of tobacco control policy interventions on tobacco use behaviours and health outcomes based on ITS research methodology: a scoping review. BMJ Open. 2025;15(11):e094148.
Ministry of Health Republic of Indonesia. Survei kesehatan Indonesia (SKI) 2023 dalam angka. Jakarta: Ministry of Health Republic of Indonesia; 2024. Available from: [Website]
Kondo T, Nakano Y, Adachi S, Murohara T. Effects of tobacco smoking on cardiovascular disease. Circulation Journal. 2019;83(10):1980–5.
Anthony D, George P, Eaton CB. Cardiac risk factors: environmental, sociodemographic, and behavioral cardiovascular risk factors. Family Practice Essentials. 2014;421:16–20.
Saeys F, Cammu H. GPs' attitudes on a healthy lifestyle: a survey of GPs in Flanders. British Journal of General Practice. 2014;64(627):e664–9.
Arno. Determinan perilaku merokok petugas kesehatan pasca penerapan kawasan tanpa rokok di Dinas Kesehatan Kabupaten Agam Provinsi Sumatera Barat [Thesis]. Yogyakarta: Program Studi Ilmu Kesehatan Masyarakat, Fakultas Kedokteran, Universitas Gadjah Mada; 2009.
Rosmayanti D, Permana I. Barriers and facilitators to implementation of smoke-free area policy in public places: a scoping review. Journal of Public Health and Development. 2024;22(3):289–304.
Cho H. Health communication message design: Theory and practice. New York: SAGE Publications; 2012.
Li Z, Yao Y, Han W, Yu Y, Liu Y, Tao Y, et al. Smoking prevalence and associated factors as well as attitudes and perceptions towards tobacco control in Northeast China. International Journal of Environmental Research and Public Health. 2015;12 (7):8606–8.
Giorgi E, Marani A, Salvati O, Mangiaracina G, Prestigiacomo C, Osborn JF, et al. Towards a smoke-free hospital: how the smoking status of health professionals influences their knowledge, attitude and clinical activity. Results from a hospital in central Italy. Annali di Igiene: Medicina Preventiva e di Comunita. 2015;27(2):447–59.
Ravara SB, Calheiros JM, Aguiar P, Barata LT. Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: A cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban. BMC Public Health. 2011;11(1):720.
Giraldi G, Fovi De Ruggiero G, Cattaruzza MS, Camilli F, Dionette P, Osborn JF, et al. Perception of smoke-free policies among workers in an Italian Local Health Agency: survey of opinions, knowledge and behaviours. Annali di Igiene: Medicina e di Comunita. 2013;25(5):397–409.
Fu M, Castellano Y, Tigova O, Mons U, Agar T, Kyriakos CN et al. Correlates of the support for smoke-free policies among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC EUROPE SURVEYS. Tobacco Induced Diseases. 2018;16(Suppl 2):A17.
Radwan GN, Loffredo CA, Aziz R, Abdel-Aziz N, Labib N. Implementation, barriers and challenges of smoke-free policies in hospitals in Egypt. BMC Research Notes. 2012;5(1):568.
Tildy BE, McNeill A, Perman-Howe PR, Brose LS. Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies. BMC Primary Care. 2023;24(1):32.
Pénzes M, Carnicer-Pont D, López Luque AM, Koprivnikar H, Kilibarda B, Vasic M, et al. Barriers and opportunities for the expansion of smoke- and aerosol-free environment policies in Europe. Tobacco Prevention and Cessation. 2024;10(November):52.
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