A Study of Adolescents' Perceptions of Smoking Cessation Efforts at SMK Negeri 2 Buton Utara, Wakorumba Utara District, Buton Utara Regency in 2025

 Corresponding author: Sartiah Yusran Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. A Study of Adolescents' Perceptions of Smoking Cessation Efforts at SMK Negeri 2 Buton Utara, Wakorumba Utara District, Buton Utara Regency in 2025 Rahma Fanti *, Sartiah Yusran and Fikki Prasetya Faculty of Public Health, Master of Public Health Program, Halu Oleo University, Kendari, Southeast Sulawesi, Indonesia. World Journal of Advanced Research and Reviews, 2025, 28(02), 2182-2191 Publication history: Received on 17 October 2025; revised on 22 November 2025; accepted on 25 November 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.28.2.3952 Abstract Background: Teenagers are a vulnerable group to smoking, which can lead to various health problems, both physical and psychological. Although some teens are aware of the dangers of smoking, their success rate in quitting is still relatively low. Environmental influences and social pressure are dominant factors in developing smoking habits in adolescents. However, some teens are able to quit due to motivation from personal experiences and awareness of the negative impacts of smoking on their health. Objective: This study aims to analyze adolescents' perceptions regarding smoking cessation efforts based on the Health Belief Model (HBM) components, namely perceived severity, triggers for action, and self-efficacy. Method: This study used a qualitative approach with a phenomenological method. Data were collected through in-depth interviews with 13 informants: 6 adolescents from SMK Negeri 2 Buton Utara who had quit smoking, 6 family members, and 1 guidance counselor using a purposive sampling technique. Data were analyzed using Nvivo software. Result: The research results show that the intensity of perception is formed from direct experience with health impacts such as shortness of breath, coughing, and decreased stamina, which fosters a desire to quit. The trigger for action arises from internal motivation, such as a desire to improve health, and external support from family, school, and peers. Meanwhile, self-confidence is a key factor determining adolescents' success and consistency in quitting smoking, through the ability to control urges, resist temptation, and replace behaviors with positive activities, such as choosing exercise. Conclusion: Data analyzed using the Nvivo program revealed that adolescents who quit smoking are influenced by perceived severity, triggers for action, and self-efficacy, all of which play complementary roles in the process of behavioral change. Emotional family support and strong self-awareness are key to maintaining a sustainable commitment to quitting. Keywords: Perception; Health Belief Model; Adolescents 1. Introduction Adolescence, generally between the ages of 14 and 19, is a crucial phase in an individual's development. During this stage, they experience significant changes, both physically, psychologically, and socially. These developmental transitions make adolescence a period of vulnerability to various environmental influences that can have both positive and negative impacts on their behavior patterns (Hendi et al., 2023). One of the behaviors that teenagers often do when interacting with their peers is the habit of smoking (Yanti et al., 2022). World Journal of Advanced Research and Reviews, 2025, 28(02), 2182-2191 2183 Smoking itself is a major risk factor contributing to a number of chronic diseases and potentially causing death. The WHO (2024) reports that one in ten adult deaths is caused by smoking, totaling nearly 2.5 million deaths annually. Globally, approximately 37 million adolescents aged 18 years and under (9.7%) are known to use tobacco products. In Indonesia, the prevalence of smoking among children and adolescents also shows an increasing trend. Based on BPS data (2024), the prevalence of teenage smokers in 2022 reached 1.45%. Furthermore, the 2023 Indonesian Health Survey (SKI) recorded approximately 70 million active smokers in Indonesia, with 7.4% of them being teenagers aged 10–18 (Kemenkes, 2024). At the regional level, the prevalence of smokers in Southeast Sulawesi increased to 24.80% in 2024 (BPS Sulawesi Tenggara, 2024), and in Buton Utara Regency it was 18.08% in the 15–24 year age group (BPS Buton Utara, 2024). This condition shows the importance of prevention efforts considering the large health risks caused by smoking. The Indonesian government has implemented various policies to reduce the number of smokers, including accelerating the implementation of Smoke-Free Areas (KTR) in accordance with Health Law Number 17 of 2023 (Lestari et al., 2025) and Government Regulation No. 28 of 2024 (Kemenkes, 2024). However, these efforts still face challenges because environmental factors remain the main trigger for smoking behavior in adolescents. Research by Purnamasari et al. (2023), shows that curiosity, peer pressure, and a permissive family environment are the main factors that lead adolescents to start smoking. Similarly, Cheng et al. (2022), also emphasized that peers play a significant role in shaping smoking habits among adolescents. However, some adolescents successfully quit due to growing awareness of the negative health impacts of smoking and personal experiences that motivated them to quit. Based on initial observations conducted at SMK Negeri 2 Buton Utara, smoking rates among adolescents are quite high, especially around the school area. Some of them view smoking as a common activity and part of socializing with peers. Interviews with one adolescent who has quit smoking revealed that the habit began in junior high school due to peer influence and curiosity. However, after experiencing health symptoms such as a persistent cough, shortness of breath, and decreased stamina, the adolescent began to realize the dangers of smoking, thus motivating him to quit for the sake of his health. This indicates that individual perception of risk and self-confidence in controlling behavior play a crucial role in the success of smoking cessation efforts. Thus, the findings suggest that adolescents' perceptions of the severity of smoking's impacts begin to form naturally based on their experiences. The greater adolescents' understanding of the dangers of smoking, the greater their likelihood of attempting to quit. Furthermore, cues to action and self-efficacy also influence their ability to cope with social pressure and maintain their decision to quit. However, research specifically examining the relationship between these three factors is still very limited, particularly among students at SMK Negeri 2 Buton Utara. Based on this background, researchers are interested in conducting research that aims to analyze Adolescents' Perceptions of Smoking Cessation Efforts at SMK Negeri 2 Buton Utara, Wakorumba Utara District, Buton Utara Regency in 2025. 2. Material and methods This type of research is qualitative research using a phenomenological approach that refers to the Health Belief Model (HBM) theory, Notoatmodjho theory and L Green theory. Data collection techniques using in-depth interviews and purposive sampling techniques with 6 teenagers who have stopped smoking, 6 mothers and 1 guidance counselor, then the data were analyzed using the Nvivo Software method. 3. Result and discussion This research, conducted on adolescents' perceptions of smoking cessation efforts at SMK Negeri 2 Buton Utara, was influenced by several indicators: perceived severity, triggers for action, and self-efficacy. As illustrated in the following exploratory Figure, this research will focus on its objectives. World Journal of Advanced Research and Reviews, 2025, 28(02), 2182-2191 2184 Figure 1 Exploration of Research Sub-Themes 3.1. Perceived Severity Perceived severity refers to the adolescent's perception of how serious the impact or consequences of a disease or health problem are. Based on the interview results, several indicators of perceived severity were identified, as shown in the figure below, which describes the findings from each informant: Figure 2 Exploration of the Severity Sub-Theme Based on the exploration Figure, it was found that the severity indicators of smoking effects in adolescents were formed through three main components, namely knowledge, direct experience, and responses to the impacts that affect their daily activities. The results of the knowledge study indicate that all informants have a good understanding of the dangers of smoking. They know that smoking can cause respiratory problems, lung damage, heart disease, and even cancer. This knowledge serves as an important cognitive foundation in shaping adolescents' perceptions of the severity of the dangers of smoking. Adolescents with better knowledge tend to recognize that smoking has serious long-term health impacts. This finding aligns with the research of Ferdy et al. (2025), which states that knowledge plays a role in shaping individual risk perceptions for certain diseases or health conditions. Information obtained from family, school, media, and health education can strengthen adolescents' awareness of the dangers of smoking. Furthermore, regarding the experience aspect, all informants admitted to having experienced various health symptoms while still smoking, such as a persistent cough, shortness of breath, fatigue, headaches, chest pain, and sleep disturbances. Some adolescents even reported more serious conditions such as vomiting blood and a drastic decrease World Journal of Advanced Research and Reviews, 2025, 28(02), 2182-2191 2185 in stamina that affected their physical appearance. This direct experience reinforced the perception of severity because adolescents experienced the negative consequences of smoking firsthand. WHO (2020), emphasized that the health impacts of smoking not only increase the risk of chronic disease but also reduce quality of life. This is reinforced by Thangeswaran et al., (2025), who showed that personal experience is a dominant factor in increasing risk perception regarding the dangers of smoking; the more severe the effects felt, the higher the individual's perception of the severity of the impact. However, in terms of their response to the impact, it appears that adolescents tend to only take temporary measures when experiencing health problems, such as resting or taking symptom-relieving medication. These actions are still reactive to emerging physical symptoms, rather than preventive measures aimed at permanently stopping smoking. This indicates that although adolescents have knowledge and negative experiences related to smoking, their awareness of the need to make positive behavioral changes is still suboptimal. In terms of its impact on daily activities, all informants stated that smoking interfered with their productivity and role in school and social settings. They experienced difficulties in physical activities, decreased concentration in learning, lack of focus, and decreased enthusiasm. Some adolescents even felt embarrassed by their declining physical condition and avoided social interactions. These impacts have implications for adolescents' academic performance and quality of life. Research by Zhou et al. (2023) supports these findings by stating that health problems caused by smoking are correlated with lower academic achievement and overall activity levels in adolescents. Thus, smoking not only threatens adolescents' physical health but also disrupts their activities, motivation, and social functioning. Perceptions of the severity of smoking's dangers are shaped by strong knowledge and experience, but have not yet been fully followed by adaptive responses in the form of consistent efforts to quit smoking. 3.2. Cues to Action Triggers for action are factors that encourage individuals to take health action, such as personal experiences or events that remind them of the importance of preventive measures. Based on the results of the interview research, several indicators regarding perceptions of triggers for action were identified, as shown in the following figure, which describes the findings from each informant: Figure 3 Exploration of Sub-Themes Cues To Action Based on the exploration Figure, it is known that the decision of adolescents to stop smoking is the result of a combination of self-awareness, internal motivation, social support, and positive experiences felt after quitting. Research on smoking cessation motivations revealed that the primary reason adolescents decided to quit was the perceived health impacts. Most respondents reported experiencing frequent shortness of breath, coughing, chest discomfort, and feeling weak or unwell, leading to fears of future serious illness. Internal triggers, such as self-motivation, encourage adolescents to take action to quit smoking. This condition, along with the fear of the possibility of serious future illnesses, such as lung disease, heart disease, or cancer, increases World Journal of Advanced Research and Reviews, 2025, 28(02), 2182-2191 2186 adolescents' motivation to change their smoking behavior. The more real and severe the symptoms felt, the higher the perceived threat and urgency to act. This aligns with research conducted by Feng et al. (2021), which found that physical symptoms experienced due to smoking can increase a person's intention to quit. This study demonstrates that direct experience of negative health impacts serves as an effective trigger for behavior change. Research examining the sources of influence on adolescents' decisions to quit smoking revealed that parental influence, particularly mothers, plays the most significant role in adolescents' decisions to quit. Most adolescents reported quitting due to advice, prohibitions, and firm actions from their mothers, such as threats of withholding pocket money, anger, and warnings about the risks of smoking-related illnesses. Furthermore, support from the school environment, such as strict regulations and reprimands from teachers, also strengthened their decision to quit. External factors such as social support play a significant role as triggers for action. Parental influence, particularly from mothers, plays a significant role in adolescents' decisions to quit smoking. Support from the school environment, such as strict rules and teacher reprimands, also strengthens the decision to quit. This phenomenon aligns with the Health Belief Model theory, where external cues to action, such as parental and teacher reprimands, act as triggers for taking health actions (Vionalita et al., 2023). This is in line with research conducted by Munawaroh & Isnaeni (2025), which found that family support, particularly the role of mothers, is a significant determinant of adolescents' smoking cessation. Research on the smoking cessation process revealed that all informants began with the most common method used by adolescents to begin the process of quitting smoking: gradually reducing the frequency and number of cigarettes until they were finally able to quit completely. Furthermore, health factors such as pain or discomfort also served as natural triggers that helped them get used to not smoking again. The process of quitting smoking is generally done gradually. By using a strategy of gradually reducing smoking, adolescents feel more able to control their urges to smoke while adjusting to the physical and psychological changes caused by quitting. This aligns with the research findings of Reskiaddin & Supriyati (2021), which states that a gradual approach allows the body time to adapt while strengthening adolescents' resolve. Furthermore, health factors, such as the emergence of uncomfortable symptoms, act as natural triggers that help adolescents further avoid smoking. When symptoms improve after quitting, positive reinforcement emerges, strengthening their decision not to return to smoking (Yenti & Putri, 2025). This phenomenon aligns with research by Meylani & Yuliana (2022), which shows that most adolescents quit smoking using a gradual strategy because it feels more realistic and easier to implement than quitting suddenly. Quitting strategies are closely related to the methods used by smokers. Research on the role of social support revealed that all informants received support and advice from their families, particularly parents, who play a crucial role in encouraging adolescents to quit smoking. This support included advice, supervision, encouragement, and positive behavioral examples, such as not smoking in front of their children. Peer support also played a significant role, particularly when they transitioned from socializing to non-smoking activities. Social support is also a crucial factor in maintaining a commitment to quitting smoking. Family support, particularly from parents, plays a significant role in adolescents' success in quitting smoking. This support extends beyond advice or prohibitions, to positive role models such as not smoking in front of children, creating a smoke-free home environment, and offering appreciation for quitting efforts. This support strengthens adolescents' resolve and fosters a sense of responsibility to uphold their parents' trust. Furthermore, peer support is crucial, as in adolescents' social lives, peers serve as a primary reference group that can encourage positive behavioral change. This is in line with research by Yenti et al. (2025), which revealed that mothers play a significant role in the smoking cessation process, as the emotional closeness between mother and child creates a strong moral influence. Advice, reprimands, and even firm action from mothers often trigger adolescents to reconsider and commit to quitting. Furthermore, a study by Aisyah & Riyanti (2024) showed that family and peer support are key protective factors in adolescents' success in quitting smoking. Families that demonstrate caring and good communication can increase adolescents' intrinsic motivation to quit smoking. Research on the positive impacts of quitting smoking revealed that all informants experienced various positive changes in their physical and psychological health after quitting. The most frequently mentioned changes were reduced shortness of breath, the disappearance of a persistent cough, and increased fitness and weight. Furthermore, some adolescents also experienced healthier skin and a sense of calmer and more comfortable feeling. Quitting smoking has positive physical and psychological impacts. Teenagers who successfully quit smoking generally begin to experience various positive effects as a result of their behavioral changes. The process of quitting smoking not World Journal of Advanced Research and Reviews, 2025, 28(02), 2182-2191 2187 only brings improvements in physical health but also has a positive impact on adolescents' psychological well-being. Physically, quitting smoking allows adolescents to recover quickly, marked by reduced shortness of breath and coughing, increased fitness and stamina, and a return to normal weight. Furthermore, positive changes in appearance are seen, such as brighter skin, fresher breath, and a less fatigued body. This is in line with the results of research by Abadiah & Purba (2022), which stated that quitting smoking has a positive impact on improving respiratory function and physical fitness within a few weeks of quitting smoking. Psychologically, quitting smoking provides a calming effect and emotional well-being. Adolescents feel calmer, less anxious, and more focused in their daily activities, especially in their studies. This indicates a recovery in mental health due to reduced dependence on nicotine, which previously triggered stress and anxiety when not smoking. This is in line with research by Kong et al. (2021), which also revealed that individuals who quit smoking tend to experience an improved overall quality of life, including emotional aspects, because they feel more confident and free from dependence. 3.3. SelfEfficacy Self-efficacy is an individual's belief in their own ability to successfully perform and maintain recommended health practices. Based on the results of the interview research, several indicators of self-efficacy perceptions were identified, as shown in the following figure, which describes the findings from each informant: Figure 4 Exploration of Sub-Themes Triggers for Action Based on the exploration Figure, it is known that self-confidence is influenced by efforts to maintain consistency, obstacles faced, experiences of failure and learning, efforts to control desires, and factors supporting consistency. Research findings on efforts to maintain consistency revealed that all adolescent informants who had quit smoking motivated themselves by remembering the negative effects of smoking, such as pain, shortness of breath, and the threat of serious illness. Furthermore, advice and warnings from family, especially parents, were also strong motivators for maintaining their commitment to not smoking. Self-confidence is a key component in determining an individual's success in maintaining smoking cessation. Most adolescents reported that self-motivation is a crucial factor in maintaining their commitment to quitting. Adolescents strive to instill the belief that quitting smoking is a step towards maintaining health and a better future. Strategies include recalling negative experiences while smoking, such as shortness of breath or fatigue, which serve as reminders to avoid returning to old habits. This aligns with research by Ilmaskal et al. (2022), which found that adolescent awareness of the dangers of smoking is a crucial factor in encouraging behavioral change. Most adolescents who quit smoking do so out of concern for the negative health effects. External support from family plays a significant role in maintaining consistent smoking cessation in adolescents. Adolescents feel motivated when their families show concern and confidence in their ability to quit smoking completely. World Journal of Advanced Research and Reviews, 2025, 28(02), 2182-2191 2188 Emotional support, such as praise or appreciation from parents, also strengthens adolescents' confidence in maintaining healthy behaviors. This is in line with research by Munawaroh & Isnaeni (2025), which found a significant relationship between family support and adolescent smoking cessation intentions. Active family support, supervision, and motivation have been shown to help adolescents maintain their non-smoking behavior. Research examining the challenges faced by adolescents who have quit smoking shows that most adolescents cite temptation from peers who still smoke as the biggest challenge, especially when gathering or being offered cigarettes. Furthermore, stress and mental pressure also trigger the urge to smoke again. The process of quitting smoking is not without its challenges. Adolescents tend to be more easily influenced by social pressure and emotional states, making the process of quitting smoking often a complex and multi-layered challenge. Peer influence is a major obstacle that can trigger the desire to smoke again. This is in line with the research findings of Inayah Ismaniar et al., (2025), which confirmed that peer influence is a strong determinant of smoking behavior among school adolescents, including during the phase of maintaining consistency in quitting smoking. Another obstacle faced by adolescents during the smoking cessation process is their personal emotional state. Most informants stated that emotional conditions such as stress, boredom, or mental pressure also trigger the desire to smoke again as a form of escape or coping mechanism. This is in line with the findings of Riya et al., (2023), which showed that peers and stress have a significant relationship with adolescent smoking behavior, where adolescents with friends who smoke are more likely to return to smoking after quitting. The research findings, from the perspective of failure and learning experiences, revealed that all adolescents had experienced failure. Previous failures in quitting smoking were generally caused by peer influence and a lack of personal willpower. Most informants admitted to frequently returning to smoking after being encouraged by friends, especially during social gatherings or in situations that encouraged them to smoke. Furthermore, stress and mental pressure also contributed to relapse. However, from these experiences of failure, adolescents learned the importance of maintaining strong determination, maintaining personal commitments, and respecting family trust. The experience of failure is also an important learning process for adolescents. Adolescents admitted to returning to smoking after being invited by friends, especially in social situations such as gatherings or hanging out together. Stress and psychological pressure are also strong triggers for the desire to smoke again. Several informants stated that when facing personal problems, such as family conflict, academic pressure, or feelings of anxiety, adolescents are more easily tempted to return to smoking as a temporary escape. This aligns with the results of a study conducted by Safitri, Avicenna, and Hartati (2013), which stated that stress and peer pressure are factors associated with smoking behavior in adolescents. These findings confirm that emotional conditions play a significant role in triggering relapse or failure in maintaining smoking cessation efforts (Laelya Shofa et al., 2024). Despite experiencing various failures, the adolescents in this study indicated that these experiences served as important learning experiences. They began to understand that successfully quitting smoking requires strong determination, consistent personal commitment, and emotional support from their families. Some adolescents noted that each failure reinforced the importance of respecting their families' trust and maintaining their commitment to their decisions. Research on smoking control efforts concluded that some teenagers chose physical activities like exercise or walking, while others distracted themselves by eating candy, playing games, or listening to music. Furthermore, some teenagers motivated themselves by remembering the negative impacts of smoking in the past or their parents' disappointment if they started smoking again. Adolescents use self-control strategies to overcome the urge to smoke by trying to divert their focus to other positive activities such as exercising, walking, playing games, listening to music, or eating candy. This strategy is used to suppress the urge to smoke by modifying behavior and creating distractions from the urge to smoke. This finding is in line with research by Maharani & Rohmadani (2024), which states that adolescents trying to quit smoking utilize diversionary strategies such as listening to music and increasing physical activity to reduce the urge to smoke. This strategy has been shown to help adolescents calm themselves and control their smoking impulses. Other strategies used by adolescents involve internal motivation, such as remembering the negative effects of smoking they have experienced, such as coughing, shortness of breath, or decreased stamina, as well as the disappointment of their parents if they return to smoking. This finding is in line with the results of a study by Indah Sari et al. (2020), which also reported that remembering the negative effects of smoking they have experienced and the disappointment of their parents if they return to smoking. This strategy has been shown to help adolescents calm themselves from the urge to smoke. World Journal of Advanced Research and Reviews, 2025, 28(02), 2182-2191 2189 Engaging in positive activities such as sports, studying, or social activities also strengthens self-perceptions as healthy and productive individuals. These activities not only serve as a distraction from the urge to smoke but also increase adolescents' perceived confidence in quitting. This is consistent with a study (Lathu Asmarani et al., 2022), which found that positive activities and self-control increase adolescents' perceived confidence in living without cigarettes. Research examining factors supporting consistency in adolescents who have quit smoking suggests that most informants cited parental attention and motivation, particularly from their mothers, as significant emotional support for maintaining their commitment to quitting. Furthermore, self-awareness of the importance of health and spending time with beneficial activities such as exercise or studying were also effective strategies for maintaining their commitment to not returning to smoking. Factors supporting adolescents' consistency in maintaining their decision to quit smoking include emotional family support, personal intention, and awareness of the importance of health. Adolescents need sustained motivation to avoid returning to smoking. Emotional support from family, especially mothers, provides moral encouragement and a sense of appreciation, thus strengthening adolescents' perceptions of their ability to maintain their decision to quit smoking. This finding aligns with research by Munawaroh & Isnaeni (2025), which confirms that family support strengthens adolescents' confidence in maintaining healthy behaviors. Furthermore, personal intention and self-awareness of the importance of health reflect internal beliefs (self-efficacy) in dealing with peer temptation and social pressure. Adolescents who are confident in their abilities are more able to resist invitations to smoke and control the urge to smoke again. This aligns with the concept of self-efficacy in the Health Belief Model, where belief in one's abilities drives healthy behaviors (Indah Sari et al., 2020). 4. Conclusion and further study The results of this study indicate that adolescents have a high perception of the severity of the dangers of smoking through direct experience of health problems, which fosters awareness and a desire to quit. The trigger for action arises from a combination of internal motivation, such as the desire to improve health, and external support from family, school, and peers, which reinforces the decision to quit smoking. Meanwhile, self-efficacy plays a crucial role in maintaining consistent smoking cessation behavior, where adolescents with high self-efficacy are able to resist temptation, replace smoking with positive activities, and maintain commitment with emotional support from their immediate environment. These findings can form the basis for developing school-based health interventions to increase adolescents' motivation and self-efficacy in quitting smoking. Further research is recommended to involve adolescents who are still actively smoking to compare differences in perceptions and factors influencing successful quitting. 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