Smoking Behavior, Social Support, and Cessation Motivation in Smoking Among Health Sciences' Students

Smoking had been a phenomenal habit which we often found out as a shared custom so that many have been thinking that smoking is something healthy despite possible health threats – still, do they keep smoking (Mahendra, 2010). Cigarettes are specific products containing tobacco leaves that have been cut into pieces and chopped up (Waruwu et al., 2017). Cigarettes have been spread over the world. In the past, only Indian people used to consume cigarettes for ARTICLE INFORMATION ABSTRACT


Introduction
Smoking had been a phenomenal habit which we often found out as a shared custom so that many have been thinking that smoking is something healthy despite possible health threats -still, do they keep smoking (Mahendra, 2010). Cigarettes are specific products containing tobacco leaves that have been cut into pieces and chopped up (Waruwu et al., 2017). Cigarettes have been spread over the world. In the past, only Indian people used to consume cigarettes for

Methods
The design of the study is cross-sectional. The population of this research consisted of active smokers from the Faculty of Health Sciences. Further, the accidental sampling technique was employed to determine the sample out of the whole population. In total, there were 63 samples of students who smoke. Tthis research variable is quittance motivation and social support. An instrument about quittance motivation from smoking was adopted by the Richmond test questionnaire, with four questions based on University of Rodhe Island Change Assessment (UNRICA) scale consisting of three major categories: low, medium, and high (Garcia-Portilla et al., 2013). The lowest score from the total accumulation signified 0 or 1, while the highest score did at 1 or 3. Further, the maximum rating would be ten and the minimum one 0. Individually, quittance motivation from smoking was considered low in level only if the score showed 0-4, 5-6 for medium, and 7-10 for high.
Moreover, the instrument regarding social support was adopted from Interpersonal Support Evaluation List (ISEL) questionnaire by Cohen & Hoberman Harry (1983), with four tables or segmented types of questions, including Appraisal Support, Tangible Support, Selfesteem Support, and belonging Support. This kind of instrument was assisted by a Likert scale, with three main criteria, which were high, medium, and low. The assessment system showed that the respondents would make four scores (from 1-4 interval). If they went for "Always" choice on the positive questions and "Never" one for the negative questions; '3' for "Often" on the positive questions and "Sometimes" on the negative questions; '2' for "Sometimes" on the positive questions and "Often" on the negative questions; and '4' again for "Often" on the positive questions and "Always" for the negative questions. The instrument about smoking behavior with the help of a Likert scale consisting of three main criteria, namely severe, moderate, and mild. Further, the assessment system employed a 3-1 score interval, stating that '1' for "Often" choice, '2' for "Sometimes," and '3' for "Never." After receiving approval from the institution where the research was conducted, in march 2019, the researcher administered the questionnaire. First of all, the researchers confirmed that the respondent filled out the informed consent form. Secondly, the researchers explained the steps of questionnaire completion. Thirdly, sufficient time was given to the respondents for the questionnaire completion by providing them with acceptable guidelines. Fourthly, after the respondents were done with the completion, questionnaire sheets were collected to the researchers.
Finally, the researchers appreciated all the respondents for the cooperativeness and time allocated to the questionnaire administration. After all, the data of the questionnaire were tabulated, analyzed, and sorted out based on the set criteria. Descriptive data analysis was referred to as a statistical method of analysis on one single variable, with frequency distribution analysis that demonstrates the distribution in the forms of table, diagram, and narration (Riwidikso, 2012).

Results and Discussion
According to Table 1, it is shown that all of the 63 respondents (100%) were male students. Most of the respondents who were involved in this current research were dominated by those who had spent the 3-year length of study (n=26, 41.3%). Besides, conventional cigarettes are shown the most-consumed type among the respondents, indicating 94%. In the Table 2 was shown that the student's smoking habits were categorized into some criteria with the following distributions: moderate with 41 respondents (65%), mild with 14 respondents (22%), and severe with eight respondents (13%). Identified that 53 respondents (84%) were highly supported to quit smoking, while 10 (16%) other respondents were gaining low social support. Concerning Table 3, it was illustrated that high appraisal support was given to 45 out of 63 respondents (71%). Counterproductively, low tangible support was meant to55 out of 63 respondents (87%). Nonetheless, as many as 61 out of 63 respondents (97%) were equipped with high self-esteem support. At last, there were 58 out of 63 respondents (92%) named to receive high belonging support. Regarding Table 4 it was portrayed that 45 respondents (71%) had shown high quittance motivation, 13 respondents (21%) moderate, and only five respondents (8%) low. The result of this current research had indicated that most of the respondents showed moderate smoking behavior. Smoking behavior, in essence, is attributed to some indicators, namely smoking habit, preferability on smoking area, and the number of cigarettes consumed. Regarding theoretical review in this research, smoking behavior is affected by three significant factors, including predisposition (lack of information), eliciting (affordability and calmness gained), and contributing (smoker-dominated environment) factors. According to Sulastri, Herman, & Darwin (2018), male students had shown a higher tendency of smoking than females. The researchers had found that only male respondents were smoking at the canteen and cafes around the campus area. However, they could not resist their desire to smoke when they were in other faculties' areas, canteen, parking slot, and boarding house as they were frequently in touch with and offered the cigarettes by their smoker companions. In nature, the environment is considered to play a significant role in behavioral change. This condition had been shown by the faculty that had regulated a prohibitional rule for smoking activity. As a consequence, those who were in such a regulated area had to strive not to smoke. On the other hand, some other faculties that had yet to stipulate a similar rule would be the best option for the smokers to keep consuming their cigarettes and share seductive influence to those who had actively been willing to quit smoking.
Moreover, this current result showed that the respondents were dominated by those who had been spending a 3-years length of study. This finding implied that the respondents had been aware enough of some possible health problems the cigarettes might cause, but never did they suffer from the health problems. It was supported by research from Sinaga (2016), claiming that the respondents' high acquaintance about the negative sides of the cigarettes shown through the research had contributed to less significant influence upon the smoking behavior despite the perceived relationship between a personal acquaintance and smoking risks. Besides, probably, it was because smoking threats occur in the very long term, and passive smokers still have a high tolerance rate upon the smoke.
Furthermore, the research also showed that the majority of the respondents were equipped with high social support (indicating 84%). In line with the theory said in the theoretical review, three main factors influence social support, namely social interaction, self-esteem in receiving others' help, and skill under the broader scope of society.
As shown by the data, five respondents were named as heavy smokers but received high social support. Besides, only three respondents had low social support but categorized as moderate smokers. This condition might be due to familial and collegial supports -when the family gave the total support for the smokers to quit, their close friends seduced them to keep smoking. This postulation was supported by research brought up by Suri (2018), commenting that ex-smoker respondents revealed the most-faced obstacle to committing the quittance from smoking was from their companions. In general, companions or friends are supposed to give the best support for their relatives to do positive things. Consuming cigarettes every day is one of the usual ways for smokers to strengthen social ties (Paul et al., 2010), given that students do not feel that there are many possible social interactions (Andersen et al., 2016). However, it does not rule out the possibility that friends can also provide high motivation in stopping smoking. The results of research by (Heffner et al., 2016) showed that both smokers with moderate to severe smoking could be helped the same as ordinary smokers because of the level of consistency in the study and motivation to stop smoking, besides that it is essential considering the benefits of helping these smokers quit before they switch to a pattern of use that is more rooted.
Another factor that influences smoking behavior is social media. Research explains that expressing and receiving pro-smoking messages had significant associations with smoking attitudes and intentions. However, the expression and reception of antismoking messages exhibited no significant relationships with the same outcomes.
These results are in concert with previous research suggesting that pro-smoking messages are more influential than antismoking messages in predicting college students' smoking behaviors. Antismoking messages have only a limited effect on changing intentions and behaviors in smoking prevention and cessation (Yoo et al., 2016). Moreover, the age of the respondents involved in this research ranged between 19-22 years old (late-adolescent phase). The age factor did not significantly influence the quittance motivation from smoking, as supported by research from Suri (2018), which stated that the ages of the respondents in the quittance motivation varied from 19 to 65 years old.
The majority of the respondents in this current study received high appraisal support, which was indicated by advice or suggestion given to quit smoking. In other words, this sort of support could be defined as advisory assistance for quittance motivation from smoking. This research, further, was similar to that of Sulastri et al. (2018), showing that 150 (90.36%) out of 166 students of vocational high school were found as smokers said that they had received or were receiving advisory assistance from particular programs or professionals to quit smoking, which had got them motivated to quit smoking.
Moreover, in terms of tangible support, most of the respondents (87%) had received low exposure to this sort of help. Actional and material rescues indicated support. In other words, tangible support was seen as actional and material assistance to quit smoking. The current research showed that the respondents were lack of support for quittance from smoking, especially to move to any objects to consume other than the cigarettes. Conversely, eight respondents (13%) had been shown to gain tremendous tangible support by having alternative objects of consumption other than the cigarettes. The revealing finding was similar to that of Suri's (2018), in which the ex-smokers had uttered that those who would strongly like to quit smoking needed other alternative objects to consume, such as sweets or other sorts of snacks.
As a consequence, the quitters' mind was controlled to focus more on chewing something than sucking the cigarettes. Suri (2018) also inspired this current study in terms of coping mechanism use. Adaptive and maladaptive coping mechanisms were used to support this study. The former was reflected through performing particular activities and self-withdrawal from the smokers, while the latter was shown through purchasing cigarettes, chewing sweets, consuming snacks, and re-smoking.
Further, it was also shown that the majority of the respondents (97%) gained high selfesteem support. This sort of support was indicated by self-respect support and behavioral control over quittance from smoking, which means that this support came from other people concerning self-esteem and quittance from smoking. This result was in line with Suri's research (2018), in which the quitters argued that smoking used to be the best option to take in the event of problems or chaotic situations as they believed that solution would come along with their smoking. In other words, only if they got help from others for their problems, certainly would they quit smoking. Besides, people could give never-ending support to find the best way to solve the smokers' problems to encourage them not to smoke any longer for the search for a solution. Research brought up by Anbarlouei et al. (2018) had shown that self-esteem had a significant correlation upon the smoking phase, which means that every improvement on the self-esteem value would degrade the probability value of higher growth on smoking behavior (5%). Another result of previous research also reinforced the correlation between self-esteem and smoking, especially in adolescent scope. For that reason, it is suggested that preventive programs on smoking behavior be consistently developed by attaching comprehensive health education or promoting health programs of self-esteem enhancement training. Moreover, this research showed that most of the respondents were equipped with high quittance motivation from smoking, in addition to having a strong desire and interest at smoking following the research indicators, including desire, interest, and attempt. Referring to the theoretical review, quittance motivation from smoking constitutes internal and external encouragement to solidify the quittance motivation from smoking. Further, motivation is undoubtedly influenced by two significant factors, internal and external. The internal comes from a personal view to show act without any external prevention, while the latter is derived from the exogenous aspects one cannot control over. The external factors that can be influenced by a lower socioeconomic status. Factors often hamper cessation of smoking in these groups in the social environment; for example, unfavorable norms for smoking cessation and more smoking in their environment. Also, they are often not quite sure of the benefits of quitting and often experience low self-efficacy (Gallo andMatthews, 2003, Chandola et al., 2004) in (Stanczyk et al., 2016). Both of the factors, also, are shown through passion and interest, encouragement and need, hope and expectation, appreciation and respect, friendly environment, and excitement.
This finding was in line with the research of Suri's (2018), commenting that motivation is divided into two, internal and external. In the smoking case, the former was influenced by their self-awareness of quitting smoking due to health problems that occurred upon the smoker respondents. As a consequence, the respondents showed a strong desire to quit smoking. Besides, the latter evoked occurred due to familial, health, and economic influences. Other research explains that there is a significant relationship between ambition and motivation, this means that with high expectations to achieve something, the motivation to achieve it will also be high (Anugrahwati & Hartati, 2017). Studies by (Sumiatin et al., 2017) have shown that there is an effect of perception on teen intention/intention in behavior.
Perception will form adolescent opinions about something that is believed and then with the support of intentions or intentions will be realized in real action. The family members had to be worried about the health damages caused by smoking behavior upon the smokers and the people around them, especially children. In addition to smoke exposure or pollution, the behavior might be a poor example the children could imitate in the future. For that reason, all the family members and close friends who are cons upon the smoke could be the triggering factor that strengthens the quittance motivation from smoking. The social support that is in it is also a family social assistance that is very important for behavior change (Indrianingsih et al., 2018). The respondents also uttered that quitting smoking could help them save money and keep their economic stability secure. Alawiyah (2017), in research, had described the perception upon the prices of electrical cigarettes in which most of the respondents had shown negative perception with 54.8%, meaning that the respondents considered that e-cigarettes were pricier than conventional ones. In line with the research, conventional cigarettes were named more consumed than e-cigarettes.