SANTRI’S PERCEPTION OF CIGARETTES ON SMOKING BEHAVIOR IN LIRBOYO ISLAMIC BOARDING SCHOOL, EAST JAVA

Indonesia Basic Health Research Data in 2018 shows that smokers in the 10-18 years age group increased to 9.1%. Smoking in adolescents experienced by students on educational institutions such as Islamic Boarding School (Pesantren). Students/santri has experienced smoking from an early age. This study aims to review the santri's perceptions of cigarettes based on smoking habits, cigarette advertisements and the image of cigarette companies in the relations to the smoking behavior at Lirboyo Islamic Boarding School. This research is a quantitative study with a cross-sectional study design using 40 students as research samples. We use modified structured questionnaire from the Smoke-Free Agents. Research shows 62.5% of students are active smokers. Based on the bivariate test, we found a relationship between perceptions of smoking habits and perceptions of cigarette advertising (p-value <0.05) to the smoking behavior. In addition, we found that there is no relationship to the perception of the image of the cigarette company (p-value >0.05). This study found a high percentage of students who smoked at Lirboyo Islamic Boarding School. Santri's perceptions of smoking habits and cigarette advertisements are related to santri’s smoking behavior. Using this finding, the management of Islamic boarding school needs to do tobacco control to control smokers among santri and prevent adolescent’s smokers.


INTRODUCTION
The transition from childhood to adulthood is known as adolescents. In this period, adolescents are looking for self-identity. 1 Many of adolescents imitate the adult's behavior, to show that they can do something similar with adult's behavior. 2 The example of this deviations and irregularities committed by adolescents, is smoking. Smoking in adolescents is often considered normal and common, even when they know the consequences of smoking. The number of smokers in adolescents continues to increase. 2 The Indonesian Ministry of Health's Basic Health Research Data 3 shows the number of smokers in the 10-18 years age group increased from 2013 by 7.2% to 9.1% in 2018. 3 The Mid-Term National Development Plan target (RPJMN) 2019 of child's smokers 5.4% was not successfully met. 4 Adolescent's smoking has been experienced by students at educational institutions, where students are found smoking while in school or out of school. The 2014 Global Youth Tobacco Survey (GYTS) data published by WHO 11 shows that there are 18.33% of students in Indonesia who have a smoking habit, 33.9% are in the male group and 2.5% are female. The results of the study also showed that 47.2% of students who smoked in Indonesia were addicted. 5 In educational institutions such as Islamic Boarding School (Pesantren), this habit is considered normal. Many students are found smoking while doing relaxing activities such as sitting and chatting with friends, or when in meetings in organizations within pesantren, even while reading books and The Holy Quran. 6 The results of the study at Darut Taqwa Islamic Boarding School in Semarang shows that the smoking behavior of students was high at 63.5%. 7 Adolescents who have been addicted to cigarettes, will continuously smoking. This has negative impacts on health, both for smokers as well as to those around them (passive smokers). Cigarette consumption increases the risk of death from several diseases, such as ischemic heart disease, cancer, stroke and respiratory illnesses. The Tobacco Atlas 2018 data shows in 2016, cigarette consumption results more than 7.1 million deaths worldwide (5.1 million in men, 2 million in women). Deaths also occurred in 884,000 passive smokers. 8 Cigarette consumption not only has an impact to health, but also to poverty, education, women and children, social and economic impacts, and environmental damage. 9 Research conducted by the Universitas Indonesia Center for Social Security Studies/PKJS-UI in 2018 by exploring 2014 Indonesia Family Life Survey (IFLS) data using econometrics analysis shows that children who come from families whose parents are chronic smokers have a weight of 1.5 kg lower and height 0.34 cm shorter than children from families whose parents are non-smokers. 10 The data above shows that cigarette consumption has a negative impact on various aspects of life, so that concerns arise if cigarette consumption is not controlled, then the future children and adolescents, including students, will not easily reach the golden generation in a country. High smoking rates in adolescents can be resulted from their perceptions about smoking. Their perceptions can be a stimulus for someone to do something. 11 If you accept this perception of smoking as normal activity or good, then it will affect the person to smoke. 12 Factors influence a person to smoke can be caused by several things such as perception of smoking habits. Smoking is often considered to be able to provide pleasure for smokers. 13 The results of research at the Roudlatut Thalibin Islamic Boarding School shows a negative perception (not in accordance with the rules in force in the community) on smoking habits, where students are motivated to smoke because of trial and error because they want to be recognized as an adult. 14 In adolescents, smoking has become a habit, they burn the cigarettes after finishing lunch or dinner. 15 Some people think that smoking is a pleasant and luxurious behavior. 15 This usually arise because of the image of the smoker displayed through cigarette advertisements. Cigarette advertisements always show a positive image when the effects in reality are the opposite. The regulation of banning cigarette advertisements and sponsors are not strictly enforced in Indonesia has caused many cigarette advertisements and sponsorships to be found in public places and can be seen by children and adolescents. Cigarette advertisements and promotions target adolescents. Cigarette marketing and promotion activities by the cigarette industry are a consistent with the aim of recruiting children and adolescents to become permanent smokers. 16 17 There is one of the large cigaretteindustry in Indonesia standing in Kediri, East Java.18 This city is also known as a city of santri/students due to the abundant number of santri at an Islamic boarding school. Data from the Ministry of Religion of East Java Province (2013) shows that the City of Kediri has 38 (thirty-eight) Islamic boarding schools, and Kediri Regency has a total of 225 Islamic boarding schools.19 Some research shows that smoking behavior among santri has become a habit and considered as normal behavior. Some of the descriptions above indicate that it is necessary to examine students' perceptions of cigarettes with their smoking behavior.
Lirboyo Islamic Boarding School is one of the largest Islamic boarding schools in Kediri and has several branch units. The smoking habit's rate among santri is very high, and smoking behavior is common in the pesantren area. In addition, there has been no previous research related to the perceptions of smoking behavior in Lirboyo Islamic Boarding School. Furthermore, the results of the study can be used by boarding school management to implement a policy to reduce smoking prevalence among students.

MATERIAL AND METHODS
This research is a quantitative study with a cross sectional study design. We determine the relationship between students' perceptions of cigarettes from the aspects of smoking habits, cigarette advertisements and images of cigarette companies on smoking behavior among santri at Lirboyo Islamic Boarding School. This research was conducted in July 2019.
We took a minimum number of samples with an additional 10 samples. 20 As many as 40 students who live in Lirboyo Islamic Boarding School are used as research samples which are collected randomly. Data was collected using a structured questionnaire designed by Smoke-Free Agents agency questionnaire (Table 1) with several adjustments.
The univariate and bivariate analysis process were carried out through data processing (editing, coding, entry, cleaning and saving). We use descriptive analysis to know the distribution of smoking behavior in students and the explanation of some variables related to smoking behavior. We tested the relationship between variables with smoking behavior using chi-square analysis. Chi-square test was conducted to analyze the relationship between independent variables. We noted that the independent variables are: the perception of smoking habits, cigarette advertisements, image of cigarette companies, and the dependent variable is the smoking behavior among students ( Figure 1).

RESULT
Based on the results of the study, 25 santri/students (62.5%) of the total sample claimed that they smoked actively until the last 30 days when the data was taken (table 2). Table 3 shows 25 santri buy cigarettes for themselves very often.  Table 4 shows the frequency distribution of independent variables consisting of perceptions of smoking habits, cigarette advertisements, and the image of cigarette companies. Whereas in Table 5, it shows students who have negative perceptions of smoking. The students who believe smoking doesn't have a bad impact (contrary to existing norms) and also smokers are 13 students out of 15 students (86.67%). Statistical test results show a probability value of 0.035 meaning that at 5% alpha which shows relationship between students' perceptions of smoking habits and smoking behavior.
Students who have negative perceptions (contrary to existing norms) on cigarette advertisements and smokers as many as 15 students out of 18 students (83.3%). Statistical test results show a probability value of 0.033 meaning that at 5% alpha indicates a relationship between students' perceptions of cigarette advertising and smoking behavior. Students who have negative perceptions (contrary to existing norms) on the image of cigarette companies and also smokers are 10 students out of 15 students (66.7%). Statistical test results show a probability value of 0.933 which means that in alpha 5% there is no relationship between students' perceptions of the image of cigarette companies with smoking behavior.

DISCUSSION
Smoking behavior is something that is considered risky from all points of view, both for the smokers themselves and the people around them. 21 According to Levy in Fikriyah & Febrijanto (2012) burning to smoking cigarettes, as well as producing cigarette smoke that can spread to people around, are included in smoking activities. 21 The prevalence of smokers among students in Lirboyo Islamic Boarding School shows high results. The high prevalence of smokers among students is also experienced by the Darut Taqwa Islamic Boarding School in Semarang, which is 63.5%. 7 Perceptions of adolescents about smoking habits, can be one of the causes of high smoking behavior in adolescents. 22 Perception is a process with the purpose of looking, defining or valuing something that is obtained by human senses and produces a view of what is obtained. 23 Students' perceptions are divided into negative and positive perceptions, where positive perceptions are interpreted as respondents having the view that smoking will cause harm both from health, economy and so on, it means that it does not conflict with the existing norms. On the other hand, negative perceptions are interpreted as students' view that smoking does not have bad impacts, it means that it is contrary to existing norms/rules. 23 Perceptions about men who smoke will have more friends, or women who smoke will be cooler than other women who don't smoke are some of the reasons someone has smoking behavior. 24 This perception is also in accordance with the perception of students in Lirboyo Islamic boarding school. Based on the results of the questionnaire, 55% answered that smoking is great/cool/stylish. Even Lirboyo Islamic Boarding School students agree that smoking is an adult lifestyle. These results are aligned with the research at Roudlatut Thalibin Islamic Boarding School, which shows that the students' behavior of trying to smoke is because they want to be recognized as adults. It is motivated by students' perception that male masculinity is marked by smoking and having mustache. 14 Adolescent perceptions of smoking habits, especially masculinity, is one indication of adolescents to smoke. Smoking perceived as a real male identity that is considered by teenagers. 25 We found a relationship between perceptions of smoking habits with smoking behavior in students at Lirboyo Islamic Boarding School. This is aligned with the Septia's study (2014) that shows the relationship between perceptions of smoking behavior in high school students in Bandar Lampung. 22 It means more students had negative perceptions of smoking behavior than students who had positive perceptions (31.28%). This also aligns with Trihandini and Wismanto in Nurmayunita, et al., (2014), which shows that teenagers smoke due to modern lifestyle. 26 We found a contradiction study result about this. Susilowati (2015) shows that there is no relationship between smokers' perceptions about smoking with smoking behavior in the city of Yogyakarta. 27 Smoking behavior in adolescents can also cause by their perceptions of cigarette advertisements that visualize fun, cool, and respectful activities. 26 This is align with this study which shows that more than a half of the respondents/students (62.5%) at Lirboyo Islamic Boarding School stated that cigarette advertisements look great/cool/stylish. Cigarette companies often advertise their products through billboards or signboards on the sides of the road to grab the attention of everyone who passes through the place, not only through billboards, they also advertised on various cigarette packets, newspapers, and televisions. 28 Santri in Lirboyo Islamic Boarding School answered that cigarette advertisements can be freely advertised on television, on the streets, in sponsors/sports, minimarkets and stalls. In addition, the majority of students answered that cigarettes could be advertised on scholarships or educational institutions. Tobacco Control Support Center of the Indonesian of Public Health Experts Association (2012) found similar finding that 51% of the study sample expressed their supports for cigarette companies displaying advertisements or sponsors in the school/educational area. 29 It gives the sense that cigarette products are considered common and normal in marketing their products in the environment of children and adolescents.
The impressions on the color of the image, creativity, tone of voice and image effects on cigarette advertisements can produce a perception, both positive and negative. 30 Based on hypothesis testing, there is a relationship between perceptions of cigarette advertisements with smoking behavior in students at Lirboyo Islamic Boarding School. This is align with Afif & Astuti (2017) which showed a probability value <0.001, it means that a positive relationship is found between perceptions of cigarette advertisements with smoking behavior. 2 In addition, the results of Tobacco Control Support Center of the Indonesian Public Health Experts Association (2012) also shows 29.63% of respondents who are smokers, 15% of respondents had quit smoking, and 9% of respondents who are nonsmokers stated that cigarette advertisements cause respondents to have a desire to smoke when they are not burning cigarettes. Cigarette advertisements create a strong sensation for someone to try cigarettes again. Even for someone who has never tried to smoke, cigarette advertisements induce them to try smoking. 29 This shows that negative perceptions (contrary to existing rules) on cigarette advertisements can cause stimulants for students to smoke. Negative perceptions on cigarette advertisements can be interpreted as adolescents' impressions about advertisements as very attractive, and the visualizations of the men are masculine and great/cool/stylish. In addition, advertisements also share explanations about the quality of cigarettes from other brands. 2 The cigarette industry in its development in Indonesia has fluctuated every year, including the number of companies or the total annual production. 31 In Indonesia, several Islamic boarding schools are closely related to the cigarette industry and have been around for a long time. Perceptions of cigarette companies in this case include students' perceptions about cigarette companies can be the sponsor of sporting events, music, education or culture, cigarette companies contribute positively to the country's economy, cigarette companies have concern for the health of smokers, cigarette companies always try to provide correct information regarding the impact of smoking on consumers. The univariate results showed that many students had positive perceptions, it means that they disagree with the statement that have been given. The bivariate results showed that there is no relationship between students' perceptions of the image of cigarette companies with smoking behavior in students. This means that students who have negative perceptions of cigarette companies have no probability of smoking.
Perception of smoking behavior is a factor that can cause someone to smoke, because of this, the purpose of someone acting of course starts from the thoughts, feelings, and opinions of the person. 12 Soamole stated that a person starts smoking because there is a physiological and psychological urge. This means that there is a perception formed on smoking behavior from that urge to make someone smoke. Psychological impulse including to show pride, to divert anxiety and want to show an adult identity. In addition, it can also be encouraged with reasons to reduce stress and strengthen relationships. 12

CONCLUSIONS
The smoking behavior rate of students in the Lirboyo Islamic Boarding School shows a high number (62.5%). Several factors can influence a person to smoke. The results of the bivariate test showed a relationship between perceptions of smoking habits, perceptions of cigarette advertising with smoking behavior in students at Lirboyo Islamic Boarding School. This research shows the importance of controlling cigarette consumption, especially in educating students about the negative impacts of smoking. In addition, banning advertising, promotion, and sponsorship to underage children and adolescents also important. This study found that advertising, promotion, and sponsorship of cigarette products are having relationship to their smoking behavior. A high number of smokers in Lirboyo Islamic Boarding School is an indication of the need for adoption of policies that regulate smoking behavior and prevent santri to smoke.