Divergent temporal patterns in adolescent behavioural risk factors across sex, age, and region in Indonesia: a national repeated cross-sectional study, 2007–2023

BACKGROUND: National surveillance evidence describing long-term changes in adolescent behavioural risk factors in Indonesia remains limited. OBJECTIVE: To examine changes in tobacco use, alcohol use, insufficient physical activity, and insufficient fruit and vegetable intake between 2007 and 2023. METHODS: We analysed nationally representative Indonesian surveys from 2007, 2013, 2018, and 2023, comprising 653,700 adolescents aged 10-18 years. Survey-weighted estimates described population prevalence, and Poisson regression with robust standard errors estimated temporal differences adjusted for sex, age, and region. RESULTS: Tobacco use increased to 2018 before returning to baseline by 2023. Alcohol use prevalence was broadly comparable in 2007 and 2018, but substantially lower in 2023. Insufficient physical activity was markedly lower in 2013 than in other years; the 2018 and 2023 estimates were closer to 2007. Insufficient fruit and vegetable intake declined to 2018, before rising above baseline by 2023. Tobacco and alcohol use were higher among males and older adolescents. Insufficient physical activity was higher among females and younger adolescents, whereas insufficient fruit and vegetable intake was higher among females and older adolescents. Papua had the highest combined tobacco prevalence from 2013 onward, largely reflecting higher chewing tobacco use; Kepulauan Nusa Tenggara had the highest alcohol prevalence. Temporal changes varied by age and geographic region across all outcomes. CONCLUSION: Adolescent behavioural risk factors showed divergent changes, with persistent demographic and regional differences. Findings support targeted tobacco and alcohol prevention for high-risk groups and regions, alongside population-based strategies through schools, families, and communities to improve physical activity and diet.