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.

Background
Indonesia faces significant maternal and child health challenges, including a high maternal mortality ratio. The country’s vast geography results in disparities in healthcare facility availability. This study aimed to identify factors influencing maternal delivery choices in health facilities across Indonesia’s rural and urban areas.
Methods
This cross-sectional study analyzed data from the 2017 Indonesia Demographic Health Survey. The study population included women aged 15–49 who had given birth within 5 years preceding the survey. A total of 14,162 women were included, with 6,339 from urban and 5,009 from rural areas. Logistic regression was performed to identify factors associated with maternal delivery locations.
Results
The findings showed that 91.37% of urban and 69.33% of rural mothers delivered in healthcare facilities. All analyzed variables were significantly correlated with maternal delivery in health facilities across both areas. In rural areas, the sex of the household head (adjusted odds ratio [AOR], 1.32; 95% confidence interval [CI], 1.02–1.71; P=0.031) and the absence of barriers to healthcare access (AOR, 1.31; 95% CI, 1.07–1.60; P=0.008) were significant factors. Conversely, in urban areas, only maternal age was significantly associated with delivering in health facilities.
Conclusion
Determinants of maternal delivery choices vary between rural and urban settings. In rural areas, healthcare access and household head sex are key factors, while maternal age is significant in urban areas. The government should prioritize equitable healthcare facility distribution, particularly in rural areas, and promote family involvement, especially among husbands, during antenatal care to encourage facility-based deliveries.

Citations

• Family medicine for all stages of life: turning knowledge into actionable care
  Joung Sik Son
  Korean Journal of Family Medicine.2026; 47(2): 95.     CrossRef