Determinants of Smoking Relapse Among Indonesian Children: A National Cross-sectional Analysis Using Global Youth...

This study aimed to identify the determinants associated with 4 smoking trajectories (never smoking, current smoking, consistently quitting smoking, and smoking relapse) among Indonesian children using pooled national data.

This study analyzed children's smoking trajectories using pooled data from the Indonesian Global Youth Tobacco Survey (2006, 2009, 2014, and 2019). Multinomial logistic regression was applied to examine 4 categories of smoking behavior, and propensity score matching (PSM) was used to address potential selection bias related to advertising exposure.

Higher prices (>IDR31 000/USD1.87) (relative risk ratio [RRR], 0.527) were protective against relapse. This policy effect was systematically undermined by single-stick purchasing, which increased relapse risk by 57.41 times (p<0.01). Peer smoking (RRR, 3.696) and exposure to advertisements in sports events (RRR, 1.477) were also significant risk factors for relapse. Free cigarette distribution demonstrated the strongest association, corresponding to a 23.1 percentage-point increase in relapse probability.

The findings indicate that children's smoking relapse in Indonesia is shaped by distinct behavioral trajectories. Relapse was influenced by the widespread availability of single-stick cigarettes, pervasive marketing, peer dynamics, and relatively affordable prices. These results underscore the urgent need for a comprehensive strategy that includes substantially increasing excise taxes, eliminating single-stick sales, and fully banning tobacco advertising. Simultaneous implementation of these measures is crucial to prevent relapse and interrupt the progression toward lifelong nicotine addiction.