Sex Differences and Co-occurrence of Self-Reported Smoking and Alcohol Consumption Among Adults in a Rural Coastal Village in Indonesia: A Cross-Sectional Study
DOI:
https://doi.org/10.33755/jkk.v12i4.1072Keywords:
Alcohol consumption; cross-sectional study; rural health; sex differences; smoking; IndonesiaAbstract
Background: Smoking and alcohol use contribute substantially to preventable morbidity and mortality. In Indonesia, tobacco use is strongly patterned by sex, but community-level evidence describing the co-occurrence of smoking and alcohol consumption in rural coastal settings is limited.
Objective: To describe self-reported smoking and alcohol consumption among participating adults in Pulisan Village, compare the proportions reporting each behaviour by sex, and examine the crude association between smoking and alcohol consumption.
Methods: A cross-sectional study was conducted among 216 adults recruited by convenience sampling. Two investigator-developed yes/no questions, administered in private interviews, asked whether participants smoked and consumed alcohol; neither question specified a reference period, frequency, quantity, or product type. Frequencies and percentages were reported overall and by sex. Pearson chi-square tests and crude odds ratios (ORs) with 95% confidence intervals (CIs) were used for 2 × 2 comparisons.
Results: Among participating men, 82/115 (71.3%) reported smoking and 67/115 (58.3%) reported alcohol consumption; among women, the corresponding proportions were 5/101 (5.0%) and 7/101 (6.9%). Sex differences were statistically significant for smoking (crude OR = 47.71, 95% CI 17.80–127.84; p < 0.001) and alcohol consumption (crude OR = 18.74, 95% CI 7.99–43.97; p < 0.001). Alcohol consumption was reported by 64/87 (73.6%) smokers and 10/129 (7.8%) non-smokers (crude OR = 33.11, 95% CI 14.85–73.85; p < 0.001).
Conclusion: In this convenience sample, self-reported smoking and alcohol consumption were concentrated among men and frequently co-occurred. Because the measures lacked a defined reference period and the smoking–alcohol estimate was unadjusted for sex and age, the findings should be interpreted as descriptive and hypothesis-generating rather than as population prevalence or evidence of a causal relationship
References
1. World Health Organization. Tobacco and nicotine [Internet]. Geneva: WHO; 2026 Jun 26 [cited 2026 Nov 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco
2. World Health Organization. Alcohol [Internet]. Geneva: WHO; 2024 Jun 28 [cited 2026 Nov 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/alcohol
3. World Health Organization. Global Adult Tobacco Survey: Indonesia 2021 fact sheet [Internet]. Geneva: WHO; 2022. Available from: https://cdn.who.int/media/docs/default-source/ncds/ncd-surveillance/data-reporting/indonesia/indonesia-national-2021-factsheet.pdf
4. Kementerian Kesehatan Republik Indonesia. Survei Kesehatan Indonesia (SKI) 2023 dalam angka. Jakarta: Kementerian Kesehatan RI; 2023.
5. Wihatno E, Asri Y, Kushayati N, Murtiyani N, Ariyani AD, Fibriana LP, et al. Socio-demographic determinants of alcohol consumption among young adults in Indonesia: a cross-sectional analysis of the 2023 Indonesian Health Survey. J Ilm Keperawatan. 2025;11(1):41-47. Available from: https://doi.org/10.33023/jikep.v11i1.2501
6. Witvorapong N, Vichitkunakorn P. Investigation of tobacco and alcohol co-consumption in Thailand: a joint estimation approach. Drug Alcohol Rev. 2021;40(1):50-57. Available from: https://doi.org/10.1111/dar.13128
7. Ho RKS, Fok PWY, Chan HCH. Pattern and determinants of alcohol and tobacco co-use and its relationship with smoking cessation in Hong Kong. Tob Prev Cessat. 2021;7:21. Available from: https://doi.org/10.18332/tpc/132288
8. Molaeipour L, Ghalandari M, Kangavari HN, Alizadeh Z, Jafari E, Gholami F, et al. The association between current smoking and binge drinking among adults: a systematic review and meta-analysis of cross-sectional studies. Front Psychiatry. 2023;13:1084762. Available from: https://doi.org/10.3389/fpsyt.2022.1084762
9. Ricvan ND, Long MC, Heni H. Age and gender differences in alcohol, tobacco, and substance use, reproductive health, and awareness of sexually transmitted disease prevention among secondary school students in Bukittinggi, Indonesia. Afr J Infect Dis. 2025;19(2 Suppl):15-22. Available from: https://doi.org/10.21010/Ajidv19i2S.2
10. Kakaire G, Chumoh EC. Sex differences in alcohol and tobacco use in Ugandan adults: a log-linear analysis of interaction patterns. PLoS One. 2025;20(12):e0337755. Available from: https://doi.org/10.1371/journal.pone.0337755
11. Firdausi S, Sutarsa IN, Astuti PAS, Kelly M. Smoking patterns, quitting intentions and associations with pro- and anti-smoking messages: insights from the Indonesian GATS Survey (2011 and 2021). Public Health Chall. 2026;5(1):e70202. Available from: https://doi.org/10.1002/puh2.70202
12. Muhammad F, Ummah AS, Aisyah F, Danuaji R, Mirawati DK, Subandi, et al. Active and passive smoking as catalysts for cognitive impairment in rural Indonesia: a population-based study. Oman Med J. 2024;39(4):e655. Available from: https://doi.org/10.5001/omj.2024.94
13. Kurniasih DAA, Paramashanti BA, Nugraheni WP, Puspita T, Rachmat B, Faisal DR. Factors associated with intention to quit smoking in Indonesia: findings from a cross-sectional Global Adult Tobacco Survey. Korean J Fam Med. 2026;47(3):267-273. Available from: https://doi.org/10.4082/kjfm.25.0016
14. Septiono W. Quasi-experimental study on the impact of local smoke-free policies on smoking among Indonesian adults: evidence from repeated national health surveys. Int J Drug Policy. 2024;124:104307. Available from: https://doi.org/10.1016/j.drugpo.2023.104307
15. Rahim FK, Nurmansyah MI, Nasir NM, Safira N, Ahsan A, Ye C, Richardson S. Analysis of impact of province-level smokefree policies on smoking status and indoor second-hand smoke exposure in Indonesia between 2013 and 2018 via a difference-in-differences approach. Nicotine Tob Res. 2026;28(1):143-155. Available from: https://doi.org/10.1093/ntr/ntaf151
16. Ekawati FM, Novitasari DA, Putri DAD, Fitriyani N, Ihyauddin Z. Rural Indonesian adolescents' smoking behaviours during the COVID-19 pandemic: rapid survey and cotinine test of school-attend adolescents in Gunung Kidul, Yogyakarta. Sci Rep. 2024;14(1):2208. Available from: https://doi.org/10.1038/s41598-023-50123-2
17. Putra TMH, Siburian R, Mukmina S, Wardhani N, Alam FE, Wattanasiriporn W, Munirwan H. Tobacco smoking in a high-IQ society in Indonesia. Tob Induc Dis. 2025;23(July):102. Available from: https://doi.org/10.18332/tid/205841
18. GBD 2021 ASEAN Tobacco Collaborators. The epidemiology and burden of smoking in countries of the Association of Southeast Asian Nations (ASEAN), 1990-2021: findings from the Global Burden of Disease Study 2021. Lancet Public Health. 2025;10(6):e442-e455. Available from: https://doi.org/10.1016/S2468-2667(24)00326-8
19. Garnett C, Oldham M, Brose L, Cheeseman H, Cox S. Prevalence and characteristics of co-occurrence of smoking and increasing-and-higher-risk drinking: a population survey in England. Addict Behav. 2024;150:107928. Available from: https://doi.org/10.1016/j.addbeh.2023.107928
20. Neddermann-Carrillo S, Abidi L, Gea A, Bes-Rastrollo M, de la Fuente-Arrillaga C, Lahortiga-Ramos F, et al. Tobacco and alcohol co-use: lifestyle and sociodemographic factors, and personality aspects as potential predictors in the Seguimiento Universidad de Navarra cohort. Res Nurs Health. 2024;47(2):251-265. Available from: https://doi.org/10.1002/nur.22367
21. Kowitt SD, Cox MJ, Jarman KL, Kong AY, Sivashanmugam A, Cornacchione Ross J, et al. Communicating the risks of tobacco and alcohol co-use. Addict Behav. 2022;134:107383. Available from: https://doi.org/10.1016/j.addbeh.2022.107383
22. van Amsterdam J, van den Brink W. The effect of alcohol use on smoking cessation: a systematic review. Alcohol. 2023;109:13-22. Available from: https://doi.org/10.1016/j.alcohol.2022.12.003
23. Burton R, Fryers PT, Sharpe C, Clarke Z, Henn C, Hydes T, et al. The independent and joint risks of alcohol consumption, smoking, and excess weight on morbidity and mortality: a systematic review and meta-analysis exploring synergistic associations. Public Health. 2024;226:39-52. Available from: https://doi.org/10.1016/j.puhe.2023.10.035
24. Ranney LM, Kowitt SD, Jarman KL, Lane RM, Goldstein AO, Cornacchione Ross J, et al. Messages about tobacco and alcohol co-users. J Stud Alcohol Drugs. 2025;86(1):140-148. Available from: https://doi.org/10.15288/jsad.23-00415
25. 25. Sokolovsky AW, Micalizzi L, Murphy CM. Longitudinal trends in the past 30-day co-use of nicotine/tobacco, alcohol, and cannabis among youth and adults in the PATH study. Addict Behav. 2026;176:108633. Available from: https://doi.org/10.1016/j.addbeh.2026.108633
