Association Between Symptoms of Common Mental Disorders and Adolescent Smoking: A Cross‐Sectional Study From Indonesia's Basic Health Research Survey

Background and Aims: Evidence on the association between common mental disorder symptoms and adolescent smoking in a large nationally representative sample remains limited. We investigated this relationship among Indonesian adolescents using national survey data. Methods: We analysed cross-sectional data from the 2018 Indonesian Basic Health Research survey, a two-stage stratified sample of 176,555 adolescents aged 10-18 years. Symptoms of common mental disorder were assessed in 70,969 adolescents aged 15-18 years using the Mini International Neuropsychiatric Interview (MINI) questionnaire and the Self-Reporting Questionnaire-20. We estimated the prevalence of adolescent smoking. We developed a directed acyclic graph (DAG) to identify the potential confounders and applied multivariable logistic regression models with survey weights to evaluate the association between common mental disorder symptoms and adolescent current smoking, controlling for measured confounders. Results: The prevalence of adolescent current smoking aged 10-18 years in Indonesia was 9.10% (95% CI: 9.03, 9.16). The prevalence of adolescent current smoking among those completing common mental disorder symptom assessment was 18.14% (95% CI: 18.00, 18.18). Both cohorts showed higher prevalence in male, older, and rural groups. Adolescents with symptoms of common mental disorder had increased odds of current smoking: estimated odds ratio of 1.59 (95% CI: 1.40, 1.81). Important measured confounders of the estimation obtained from DAG analysis and adjusted for in the final model were age, sex, current education, place of residence, working status, and health behaviours (alcohol use, physical activity, and dietary patterns). Conclusions: The prevalence of adolescent smokers in Indonesia is higher than reported previously. This study established the association between common mental disorder symptoms and adolescent current smoking. Incorporating mental disorder screening and support into prevention strategies could strengthen interventions and inform future policy to reduce the increased prevalence of youth smoking.