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Research Article
Revised

Predictors Of Tobacco Smoking Initiation Among Indonesian Teenagers: The 2019 Global Youth Tobacco Survey

[version 3; peer review: 1 approved with reservations, 2 not approved]
PUBLISHED 06 Mar 2025
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Abstract

Introduction

We examined the predictors of tobacco smoking initiation considering factors such as age, gender, pocket money, exposure to smoke in public outdoor places, anti-tobacco media, smoking parents, smoking teachers, and smoking friends among adolescents in Indonesia.

Methods

Using data from the 2014–2019 National Youth Tobacco Survey grades 7–12, data from 9,655 teenagers were analyzed. The research used the Global Youth Tobacco Survey (GYTS) questionnaire. The analysis used univariate, chi-square and logistic regression with the STATA application version 15.

Results

In total, 9655 adolescent respondents participated. Multivariate tests indicated that teenagers aged 13-15 years (AOR: 1.34, 95% CI: 1.08-1.66) and teenagers aged> 15 years (AOR: 1.65, 95% CI: 1.25-2.17), teenagers who were male (AOR: 13.99, 95% CI: 11.11-17.63), teenagers who were exposed to cigarette smoke in public places outside the room (AOR: 2.00, 95% CI: 1.74-2.29), teenagers who had never seen anti-tobacco messages in the mass media (AOR: 1.23, 95% CI: 1.02-1.48), Teenagers who had parents who smoke (AOR: 1.26, 95% CI: 1.08-1.46), teenagers who saw teachers smoking in the school area (AOR: 1.42, 95% CI: 1.18-1.71), and teenagers who accepted offers of cigarettes from friends (AOR: 15.11, 95% CI: 10.33-22.11).

Conclusion

The initiation of tobacco smoking among teenagers in Indonesia can be predicted by various factors such as age, gender, exposure to smoke in outdoor public places, exposure to anti-tobacco media, and influence of parents, teachers, and friends.

Keywords

Indonesia, Initiation, Smoking, Tobacco use

Revised Amendments from Version 2

In this revised version, we have made several key improvements. In the Introduction, we updated the section to include the latest adult tobacco use prevalence statistics in Indonesia and provided a demographic breakdown of tobacco consumption. In the Methods section, we explicitly stated that this study is a secondary analysis of the 2019 GYTS dataset, elaborated on the variable selection process, and clarified the categorization of key variables, particularly exposure to secondhand smoke and teacher smoking visibility. In the Results section, we refined ambiguous wording in key findings and provided a clearer rationale for variable classifications. Finally, in the Discussion and Conclusion, we added a statement on the limitations of the cross-sectional design and its inability to establish causality. We also expanded the discussion on self-reporting bias, particularly regarding potential underreporting among younger adolescents and female respondents. These revisions enhance the clarity and rigor of the manuscript.

To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table.

Introduction

The adverse health effects linked to tobacco have been thoroughly documented. Nevertheless, cigarette smoking remains the primary contributor to untimely and preventable deaths worldwide.1,2 Indonesia currently exhibits the highest prevalence of smoking globally, indicating a potential upward trend. Consequently, a significant number of Indonesian individuals, amounting to over 660 daily or exceeding 240,000 annually, succumb to ailments associated with tobacco consumption, with a particular emphasis on the adolescent demographic.35 According to a survey conducted by the Global Youth Tobacco in Indonesia, prevalence of smoking among teenagers aged 13-15 years rose from 33.9% in 2014 to 38.3% in 2019, indicating a significant increase. This percentage is notably high when compared to global statistics.6 Additionally, national data in 2021 indicate that approximately 60.5% of adult men and 3.3% of adult women in Indonesia smoke, making it one of the highest smoking rates among males globally.1 The most commonly used tobacco product in Indonesia is the kretek, a clove-flavoured cigarette.2 Other tobacco products, such as electronic nicotine delivery systems and heated tobacco products, have also seen rapid market growth since their legalization in 2018.3 These products are widely available and often marketed without health warnings, making them easily accessible.3 Tobacco use also varies by demographic factors, including gender, age, socioeconomic status, and geographic location, similar to those in rural areas compared to urban regions.46

Tragically, in 2016, 0.8% of girls and 1.2% of boys reported starting smoking at an early age when they were 5-9 years old.7 Health data research in 2018 showed that 77.7% of novice smokers in Indonesia started smoking before the age of 19.7 The results of research conducted by the 2018 Campaign for Tobacco Free Kids (CTFK) in 23 countries including Indonesia showed that the cigarette industry targeted children by advertising and promoting cigarette products in school environments.8 This contrasts with government programs during the 2015-2019 period, namely reducing smoking initiation by 1% per year.7

The age at which an individual begins smoking has been found to have a significant impact on their smoking habits in adulthood, as well as serving as an indicator of other problematic behaviors such as substance abuse, school disengagement, sexual risk-taking, and violent conduct.9 The current body of literature does not provide any forecast regarding the onset of smoking initiation in individuals. The findings of an Indonesian ministry study show that higher taxes on tobacco products have a very significant impact on reducing tobacco consumption among teenagers, especially by reducing smoking initiation, as well as among individuals with low socioeconomic status.7 However, alternative research posits that pricing strategies may not serve as a significant motivator for smokers to cease their habit, nor do they appear to act as a deterrent for young individuals who are considering initiating smoking.10

Several research studies have investigated determinants that contribute to the initiation of smoking behavior globally. A study conducted with Jordanian students revealed that a decrease in availability of financial resources, an increase in educational attainment, and heightened awareness of the adverse health consequences of tobacco consumption were significant factors that contributed to reduction of smoking prevalence among the student population.10 Likewise, in in Canada, a positive correlation was observed between the smoking behaviors of parents, siblings, and peers and the prevalence of smoking among university students.1 Furthermore, a research investigation into initiation of smoking behavior among young adults in the Korea observed that although education exhibited a negative correlation with smoking, exposure to smoking and tobacco use demonstrated a positive correlation with smoking behavior among this demographic.11 Despite extensive research on the determinants of smoking initiation, there remains a dearth of specific studies pertaining to developing countries in Southeast Asia, particularly Indonesia. Given the compelling evidence regarding determinants of tobacco smoking, the Indonesia-based investigation offers valuable perspectives on the factors that underlie tobacco smoking in the area and proposes policy interventions that emerging economies could implement to deter student smoking.12

Teenagers in Indonesia may also find it easy to access cigarettes, which can be bought anywhere at affordable prices for teenagers in Indonesia.13 Smoking initiation in teenagers is an important problem to be addressed because the younger the age at starting smoking, the stronger the smoking habit and the more difficult it is to quit smoking.12 The results of this study are expected to particularly inform theory development in community nursing. Knowledge of tobacco smoking initiation factors can be used as material for health promotion, as well as protection and prevention of diseases caused by tobacco smoking.14 The study findings can also provide additional information and overview of initiation factors of tobacco smoking in teenagers, and information for government to support development of health policies and programs aimed at preventing initiation of tobacco smoking in teenagers in Indonesia. Hence, the purpose of this study was determining predictors of tobacco smoking initiation among teenagers in Indonesia.

Methods

Research design

The present investigation employed a cross-sectional research design, utilizing secondary data sources obtained from the 2019 Indonesia Global Youth Tobacco Survey (GYTS). The Global Youth Tobacco Survey (GYTS) is a component of the Global Tobacco Surveillance System (GTSS) that serves as a worldwide benchmark for the methodical monitoring of tobacco consumption (both inhalation and chewing) among young individuals, as well as the tracking of tobacco control metrics.9 This study conducted a secondary analysis of the existing dataset, with no primary data collection. The selection of variables was guided by their relevance to smoking initiation, and the specific GYTS survey questions used in this study are detailed in the subsequent sections.

Population and sample

This survey was given to a total of 9,992 students in grades 7-12 spread throughout Indonesia, yielding a total response rate of 91.0%. The methodology employed by GYTS conforms to a global standard and involves a two-stage sample design. The present study employed a purposive sampling method, whereby participants were selected based on specific inclusion criteria. Specifically, the sample consisted of students in grades 7-12 who had completed the survey. The final study comprised a sample size of 9,655 participants.

Data collection

First, the researcher downloaded the dataset needed in the study from the Global Youth Tobacco Survey (GYTS) in 2019. Then downloaded it on the website https://nccd.cdc.gov/GTSSDataSurveyResources/Ancillary/DataReports.aspx?CAID=2. after being downloaded, the respondent data recruited based on the inclusion criteria were grade 7-12 students who had completed the survey. Then, data cleaning was carried out to re-check the data for the possibility of missing data, which was found to be as many as 225 data elements. Then, we identified variables to determine the final variables to be used in the study. The selection of variables was guided by their theoretical and empirical relevance to smoking initiation as suggested in the literature. The variables were grouped into independent and dependent variables based on prior research and public health frameworks related to tobacco use. We specifically included demographic factors (age, gender, pocket money), environmental influences (exposure to smoke in public outdoor places, anti-tobacco media exposure, and smoking behavior of parents, teachers, and friends), and behavioral factors that are commonly associated with smoking initiation.

The dependent variable, smoking initiation, was defined using the GYTS question: “Have you ever tried smoking, even one or two puffs?” Respondents who answered “Yes” were classified as having initiated smoking, while those who answered “No” were considered non-smokers. We explicitly defined the term “smoking initiation” as “having ever tried smoking, even one or two puffs” to ensure consistency in classification. Independent variables were also derived from specific GYTS survey questions. Exposure to secondhand smoke was assessed through the question: “During the past 7 days, on how many days were you exposed to tobacco smoke in public places?” Responses were categorized into “Never” and “1-7 days to align with prior research on youth smoking behavior and to maintain statistical power. While a more detailed categorization (e.g., 1-3 days, 4-7 days) was considered, it was not used due to potential sample size limitations in each subgroup.” Anti-tobacco media exposure was measured using the question: “During the past 30 days, have you seen or heard any anti-tobacco messages in the media (TV, radio, internet, billboards, etc.)?” The influence of parents, teachers, and friends was determined using questions such as “Do any of your parents smoke?”, “Do you often see teachers smoking in school?”, and “Have any of your friends ever offered you a cigarette?”

To identify the variables, a recoding process was carried out, in which the variables contained in the dataset were categorized into variables in accordance with the research without changing the original data and were given new code names. To improve clarity, we moved the categorization of variables from the Results section to the Methods section, ensuring that readers could understand variable classifications before analyzing the findings.

Data analysis

We used multivariate logistic regression to measure the association between age, gender, allowance, exposure to smoke in public outdoor places, anti-tobacco media, parents’ smoking, teacher smoking and peer smoking, while controlling for the previously mentioned potential confounders. In analyzing data from the four survey rounds, each round received equal weighting. This weighting was applied to address the complexity of the GYTS data. Additionally, the “svyset” or survey estimation command was employed to accommodate the survey sampling method.15 The analysis used the STATA 1516 application and carried out using univariate analysis to enable description of the variables, then bivariate analysis was carried out using chi square tests to determine relationships between variables. Multivariate analysis using logistic regression analysis testing which aimed to determine which independent variable had the greatest influence.

Ethical considerations

This study was reviewed and approved by the Institutional Review Board of the Ministry of Health (LB.02.01/2/KE.315/2019) date approval: 7 August 2019. Participation was voluntary, and all respondents were provided with information about the research. This study complied with the ethical principles of the Declaration of Helsinki.

Results

Univariate analysis results

Based on Table 1, from the total data of 9655 teenagers, the age of teenagers was categorized into 3 levels, namely <13 years, 13-15 years, and >15 years. Most were in the category of 13-15 years (n=4965, 51.43%). Most teenagers were women, as many as 5429 (56.23%). Pocket money was categorized into 4 levels, namely no pocket money, pocket money <1 USD, pocket money 1-5 USD, and pocket money >5 USD, with most teenagers in the Rp.11,000-50,000 category (n=4876, 50.50%). A total of 6,501 teenagers (67.33%) reported being exposed to cigarette smoke in public outside the room. Teenagers who reported seeing anti-tobacco messages on mass media such as television, radio, internet, billboards, posters, newspapers, magazines, or films were 7567 (78.37%). Most teenagers do not have smoking parents, 5546 (57.44%), less than half of teenagers who often see teachers smoking in the school environment are 4533 (46.95%). Among all surveyed teenagers, 89.56% (n=8647) reported refusing offers to smoke from their friends. The number of teenagers who said they had never tried or experimented with smoking was 6128 (63.47%).

Table 1. Characteristics of Respondents in Teen Tobacco Survey (GYTS Indonesia 2019) (n=9655).

VariableFrequency (n) Percentage (%)
Age
 <13 Years157216.28
 13-15 Years496551.43
 >15 Years311832.29
Gender
 Female542956.23
 Male422643.77
Allowance
 None4744.91
 <1 USD200220.74
 1-5 USD487650.50
 >5 USD230323.85
Exposure to smoke in public outdoors places
 0 day (Never seen)315432.67
 1-7 day (Seen)650167.33
Anti-tobacco media
 Yes756778.37
 No208821.63
Parents’ smoking
 No554657.44
 Yes410942.56
Teachers’ smoking
 Never seen512253.05
 See often453346.95
Friends’ smoking
 No864789.56
 Yes100810.44
Smoking initiation in teenagers
 No612863.47
 Yes352736.53
TOTAL 9655100%

Table 2 indicates that based on the results of bivariate analysis there were 7 independent variables that showed significant results on initiation of tobacco smoking in teenagers (p-value<0.05). These included: age (p-value=0.0053), gender (p-value=0.0000), smoke exposure in open public places (p-value=0.0000), anti-tobacco media (p-value=0.0029), parents who smoked (p-value=0.0108), teachers who smoked (p-value=0.0000), and friends who smoked (p-value=0.000). Meanwhile, the allowance variable (p-value=0.2636) did not show significant results on the dependent variable with p-value>0.05.

Table 2. Bivariate and multivariate analysis result of predictors of tobacco smoking initiation (n=9655).

VariableDependent
IndependentSmoking initiation in teenagers
YesNoBivariate analysisMultivariate analysis
N%N% p-value X2AOR95% CI p-value
Age 0.005330.62
 <13 Years52133.77105166.23Ref
 13-15 Years181538.46315061.541.341.08-1.660.008
 >15 Years119142.31192757.691.651.25-2.170.000
Gender 0.00003196.64
 Female64311.47478688.53Ref
 Male288467.52134232.4813.9911.11-17.630.000
Allowance 0.26368.16
 None18541.5528958.45
 <1 USD72039.32128260.68
 1-5 USD182539.2305160.8
 >5 USD79736.25150663.75
Exposure to smoke in public places outdoors 0.0000389.03
 0 day (Never seen)72424.59243075.41Ref
 1-7 day (Seen)280345.43369854.572.001.74-2.290.000
Anti-tobacco media 0.002914.51
 Yes268937.63487862.37Ref
 No83842.2125057.81.231.02-1.480.028
Parents’ smoking 0.010817.69
 No192936.84361763.16Ref
 Yes159841.06251158.941.261.08-1.460.004
Teachers’ smoking 0.0000236.36
 Never seen152631.72359668.28Ref
 See often200147.03253252.971.421.18-1.710.000
Smoking friends 0.00001488.92
 No259331.96605468.04Ref
 Yes93493.48746.5215.1110.33-22.110.000

Based on Table 2 also indicates that based on the results of multivariate analysis there were 7 independent variables that showed significant results on initiation of tobacco smoking in teenagers (p-value <0.05). Teenagers who were >15 years old were 1.65 times more likely to start smoking than those who were 15 and 13–15 years old. Teenage males were 13.99 times more likely to start smoking than teenage girls. Teenagers who were exposed to secondhand smoke outside in crowded areas were twice as likely to start smoking. Teenagers were 1.23 times more likely to start smoking if they had never encountered anti-tobacco messaging in the media. Teenagers who had smoking parents were 1.26 times more likely to start smoking. Teenagers were 1.42 times more likely to start smoking if they observed instructors smoking in the schoolyard. Accepting cigarettes from friends increased a teenager’s chance of starting to smoke by 15.11 times.

Discussion

The predictor of initiation of tobacco smoking among teenagers in Indonesia is in accordance with the 2018 Basic Health Research which showed 77.7% of first-time smokers in Indonesia started smoking before the age of 19 years.8 from ordering children under the age of 18 (eighteen) years to sell, buy, or consume tobacco products. Another policy that is quite effective in preventing the emergence of novice smokers is to implement a 100% non-smoking area policy. The Main Provisions of Non-Smoking Area Regulations in Indonesia are rooms or areas that are declared prohibited for smoking activities or for producing, selling, advertising, and/or promoting tobacco products in the applicable places.17 Because there are already regulations and policies regarding this, the government can carry out more supervision regarding the policies that have been implemented to prevent the initiation of smoking in teenagers in Indonesia.

Age has been shown to have a significant relationship with smoking initiation among teenagers in Indonesia. The results of research on age showed that the older the teenager, the risk to start smoking increases. This is consistent with research conducted in Samoa at 202118 and Korea at 202019 that age increases problems in life and their use of smoking is a coping mechanism. For this reason, health education is needed about the dangers of smoking, especially for older teenagers. Research has showed that a person is at risk for smoking initiation if they have insufficient knowledge about tobacco-related problems.20 Another study also found that discussions within the family about the harmful effects of smoking had a negative relationship with the adoption of tobacco smoking among students. This health education aimed to prevent teenagers from initiating smoking.21

Sex was found to have a significant relationship with smoking initiation in teenagers in Indonesia. The study’s results on gender showed that males were more at risk for initiating smoking. These results concur with studies in Africa,22 Nigeria,23 Samoa,18 and Korea.19 Adolescent males in Indonesia were found to be more likely to initiate smoking because the prevalence of smoking among the male population in Indonesia was higher than that of females. According to the 2018 Basic Health Research, the dominant gender is male in smoking initiation.8 Therefore, it is necessary to educate all genders about the dangers of smoking, especially male and female adolescents, which aims to prevent Indonesian youth from starting smoking. The study did not find a statistically significant correlation between receiving pocket money and smoking initiation among adolescents in Indonesia. This is in contrast to previous research conducted in Canada.24 While pocket money may not play a significant role in smoking initiation among adolescents in Indonesia, this should not be ignored because it has been identified as a causative factor for smoking initiation in other countries. Pocket money is not related to smoking initiation because smoking initiation in Indonesia is the low price of cigarettes.7 The 2019 GYTS data shows that most teenagers buy cigarettes in shops, stalls, street vendors and convenience stores. The cheap price of cigarettes makes it easier for teenagers to buy them. Although Government Policy 109/2012 prohibits the sale of cigarettes to youths under 18 years of age, most admit that they have never been prevented from buying cigarettes based on their age.25 Policies are needed regarding the increase in cigarette prices and re-monitoring of shops, stalls, street vendors and small shops selling cigarettes. Thus, they do not sell cigarettes in retail if the buyer is not over 18 years.26

Research has demonstrated a noteworthy correlation between outdoor exposure to smoke in public areas and onset of smoking behavior among teenagers in Indonesia. According to research findings, adolescents who are exposed to secondhand smoke in public places outside closed spaces are found to have a higher risk of starting smoking.27 The findings of this study are consistent with previous studies conducted in Nigeria23 and Samoa18 regarding adolescents who are accustomed to cigarette smoke and often start smoking. Researchers in Nigeria and Samoa demonstrated a positive correlation between external exposure and smoking initiation.18,23 Adolescents who are exposed to individuals who smoke in outdoor public areas, including playgrounds, roadsides, building entrances, parks, beaches, and sports fields, show a higher likelihood of initiating smoking behavior due to their high curiosity. and want to imitate what they have seen. There were already regulations in Indonesia prohibiting smoking indiscriminately, but supervision was still lacking. Hence, many people smoked haphazardly.28 Therefore, as community nurses, they provide education about smoking-free areas and the dangers of smoking, which aims to prevent young people from starting smoking.29

Anti-tobacco media has a significant relationship with smoking initiation among teenagers in Indonesia. According to research on anti-tobacco media, teenagers who had never seen anti-tobacco messages in the mass media were more at risk for smoking.22,23,30 This was in line with Widyaningsih’s research that the mass media campaign against tobacco marketing had effectively reduced smoking initiation.31 However, this result contrasted with a study in Samoa, where the media did not have any impact on cigarette consumption.18 Teenagers in Indonesia already have adequate access to mass media and social media.32 Many teenagers today use the telephone to communicate. Anti-smoking media messages on television, radio, internet, billboards, posters, newspapers, magazines, or films are easy for teenagers to access.33 Technology development has integrated the lives of children and teenagers with social and digital media on the internet.34 Children and adolescents who are still in their infancy are reported to be interested in trying new information or something, even if they see famous people or their idols smoking.9 They can use social and digital media to educate themselves about the dangers of smoking to reduce smoking initiation.35

Parents who smoked had a significant relationship with smoking initiation in teenagers in Indonesia. This study was in line with research in Nigeria,23 Swedia,20 Samoa,18 and Africa.22 These results indicated that teenagers saw their parents as role models and prominent influencers.36 The influence of advertisements, cigarette advertisements that often appear on television which are packaged with gentlemen like men completely make teenagers or children feel attracted to be considered adults and even more so if the advertisement model is an idol.37 Targeting parents who smoke tobacco through various health interventions such as health education is suggested to be likely to reduce smoking initiation in their children.38

Teachers who smoked had a significant relationship with smoking initiation in teenagers in Indonesia. The study’s results on teachers who smoked showed that teenagers who saw teachers smoking in the school area were more at risk for initiating smoking.38 According to a study in Beijing, China, there was a positive correlation between smoking and teachers who smoked.39 However, this result contrasted with a study in Samoa, where factors such as smoking among teachers were insignificant in smoking initiation.18 Teenagers’ parents regarded teachers as role models.40 Hence, targeting teachers who smoke tobacco in school areas through various health interventions such as health education is likely to reduce smoking initiation in students or teenagers.41

Friends who smoked had a significant relationship with smoking initiation in teenagers in Indonesia. The results indicated that teenagers who accepted cigarette offers from friends were more at risk of initiating smoking. Research in Swedia suggested that the influence of smoking friends on boys and girls in the sample was in line with a theory that emphasizes the power of peer modeling in developing health behaviors among teenagers.20 This was consistent with research in Samoa,18 Nigeria,23 and Africa22 that curiosity and peer pressure are the most contributing factors to the formation of the intention to smoke. This is in line with Indonesia where most teenagers are starting to dare to try cigarettes because they see other friends smoking. Therefore, it is necessary to supervise teenagers and educate parents to reduce the initiation of smoking.42

Nevertheless, this study is not without its limitations. First, as a cross-sectional analysis, this study can only assess associations between factors and smoking initiation but cannot establish causality; longitudinal studies are needed to confirm the temporal relationships between these variables and smoking initiation in adolescents. Additionally, this study relies on self-reported data, which may introduce response biases. Adolescents, particularly those under 13 years old and female respondents, may be more likely to underreport smoking behaviors due to social desirability bias or fear of judgment, potentially leading to an underestimation of smoking prevalence among these subgroups. Future research should consider using biochemical verification methods, such as cotinine tests, to validate self-reported smoking status. Furthermore, several factors related to smoking initiation, including the type of cigarette product used, frequency, age of onset, and motivation for smoking initiation, were not examined in this study. Further research efforts should aim to investigate these factors to provide a more comprehensive understanding of adolescent smoking initiation.

Conclusion

In conclusion, this study sheds light on predictors of tobacco smoking initiation among teenagers in Indonesia. The results suggest that several factors play a significant role in the initiation of smoking behavior, including age, gender, exposure to smoke in outdoor public places, exposure to anti-tobacco media, influence of parents, teachers, and friends. The findings highlight the need for interventions and policies targeted at reducing tobacco use among teenagers in Indonesia. Nurses and healthcare professionals can use these findings to develop effective smoking prevention and cessation programs for teenagers. Furthermore, policymakers can utilize these insights to design and implement health policies and initiatives to curb smoking behavior among Indonesian teenagers.

Authors’ contributions

All authors edited and approved the final manuscript.

Provenance and peer review

Not commissioned; externally peer reviewed.

Ethics and inform consent statement

This study was reviewed and approved by the Institutional Review Board of the Ministry of Health (LB.02.01/2/KE.315/2019 date approval: 7 August 2019). Participation was voluntary, and all respondents were provided with information about the research. This study complied with the ethical principles of the Declaration of Helsinki.

The data used in the study were collected by a reputable survey (Global Youth Tobacco Survey), and it is assumed that ethical considerations, including obtaining informed consent, were addressed during the original data collection process. The researchers adhered to any regulations, guidelines, or ethical standards set forth by the organization or authority that provided the data. Compliance with these standards may obviate the need for individual consent for secondary data analysis.

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Deva HS, Efendi F, Asmoro CP et al. Predictors Of Tobacco Smoking Initiation Among Indonesian Teenagers: The 2019 Global Youth Tobacco Survey [version 3; peer review: 1 approved with reservations, 2 not approved]. F1000Research 2025, 13:410 (https://doi.org/10.12688/f1000research.147006.3)
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Reviewer Report 26 May 2025
Gea Melinda, Center for Indonesia's Strategic Development Initiatives, Jakarta, Indonesia 
Not Approved
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Thank you for this important work. 
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Melinda G. Reviewer Report For: Predictors Of Tobacco Smoking Initiation Among Indonesian Teenagers: The 2019 Global Youth Tobacco Survey [version 3; peer review: 1 approved with reservations, 2 not approved]. F1000Research 2025, 13:410 (https://doi.org/10.5256/f1000research.178930.r376716)
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Andrea Leinberger-Jabari, Public Health Research Center, New York University Abu Dhabi, Abu Dhabi,, United Arab Emirates 
Approved with Reservations
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I reviewed a revision to the original article submission. I can see that the authors have made several minor corrections to the original article; however, there are still several revisions that are needed for clarity. 

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Leinberger-Jabari A. Reviewer Report For: Predictors Of Tobacco Smoking Initiation Among Indonesian Teenagers: The 2019 Global Youth Tobacco Survey [version 3; peer review: 1 approved with reservations, 2 not approved]. F1000Research 2025, 13:410 (https://doi.org/10.5256/f1000research.175543.r354568)
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Wahyu Septiono, Universitas Indonesia, Depok, West Java, Indonesia 
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Septiono W. Reviewer Report For: Predictors Of Tobacco Smoking Initiation Among Indonesian Teenagers: The 2019 Global Youth Tobacco Survey [version 3; peer review: 1 approved with reservations, 2 not approved]. F1000Research 2025, 13:410 (https://doi.org/10.5256/f1000research.161139.r278564)
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