Loss of autonomy among active adolescent smokers in Indonesia and its associated factors: a cross-sectional study using GYTS 2019

Background: Indonesia has one of the highest smoking prevalence rates worldwide; smoking initiation often occurs during adolescence or childhood. This study aimed to identify factors associated with loss of autonomy among adolescent smokers in Indonesia. Methods: This cross-sectional study analyzed data from the 2019 Indonesia Global Youth Tobacco Survey (GYTS). The sample comprised students who reported smoking within the past 30 days. The primary outcome variable was loss of autonomy. Multivariate analysis utilized modified Poisson regression with backward elimination. Results are presented as adjusted prevalence ratios (APRs) with a significance level of P<0.05. Results: Among 1,129 student smokers, only 27.44% retained their autonomy. A total of 61.20% reported a strong urge to smoke and an inability to resist doing so. Factors significantly associated with loss of autonomy included electronic cigarette use (APR, 1.08; 95% confidence interval [CI], 1.01-1.17), cigarette accessibility near schools (APR, 1.11; 95% CI, 1.04-1.19), and peer cigarette offers (APR, 1.39; 95% CI, 1.23-1.57). Higher daily cigarette consumption was also associated with a greater likelihood of loss of autonomy. Conclusion: Loss of autonomy among adolescent smokers indicates nicotine dependence and difficulty quitting. Daily cigarette consumption, peer influence, cigarette accessibility near schools, and electronic cigarette use are key contributing factors. Essential policy recommendations include strengthening youth-focused tobacco regulations and incorporating smoking prevention and cessation programs into school curricula.