Anima Indonesian Psychological Journal

2016, Vol. 31, No. 4, 170-179

Intrepretative Phenomenological Analysis: Perception of Health Risk of

Smoking and Smoking Cessation Among Pharmacy Students
Amelia Lorensia and Anggara Martha Pratama Ananta Yudiarso
Faculty of Pharmacy Faculty of Psychology
Universitas Surabaya Universitas Surabaya

Smokers can experience addiction that impedes their efforts to quit smoking. Smokers’ per-
ception and view of quitting smoking are worthy input for health practitioners to promote
smoking cessation programs. The purpose of this study was to explore the perception of health
risks of smoking and smoking cessation. The method was based on the phenomenological per-
spective using interpretative phenomenological analysis involving pharmacy students. The
study was conducted over two years using snowball-purposive sampling. Participants were
smokers who started smoking when they were 18 years old and had previously tried to quit
smoking. Results showed that participants started smoking because of curiosity and influences
from environments. All participants understood the risks of smoking, and had tried to quit
smoking because smoking affected their health and economical status. Therefore, health pro-
grams need to focus on smokers’ behavior and barriers to quitting smoking since those who
have good knowledge on the risks of smoking can experience difficulty in quitting smoking.

Keywords: perception, smoking cessation, pharmacy students

Perokok dapat mengalami adiksi sehingga menyulitkan usaha berhenti merokok. Persepsi
dan pandangan seorang perokok terhadap pengalaman berhenti merokok, menjadi masukan
bagi tenaga kesehatan dalam meningkatkan program berhenti merokok. Tujuan penelitian
adalah menggali persepsi kesadaran kesehatan dalam berhenti merokok. Metode penelitian
ini berdasarkan perspektif fenomenologis dengan interpretatif fenomenologis analisis pada
mahasiswa fakultas farmasi yang dilakukan selama dua tahun dengan menggunakan snow-
ball-purposive sampling. Partisipan adalah perokok sejak berusia 18 tahun dan pernah men-
coba berhenti merokok. Hasil penelitian menunjukkan bahwa awal mula partisipan mero-
kok dipengaruhi rasa penasaran dan pengaruh lingkungan. Semua responden mengetahui
bahaya akibat merokok, dan telah mencoba berhenti merokok karena rokok telah memenga-
ruhi faktor kesehatan dan financial mereka. Oleh karena itu, program kesehatan perlu difo-
kuskan terhadap perilaku dan hambatan seorang perokok, karena mereka yang memiliki pe-
ngetahuan yang baik terhadap bahaya rokok juga mengalami kesulitan berhenti merokok.

Kata kunci: persepsi, berhenti merokok, mahasiswa farmasi

Cigarettes are a serious threat to the health of peo- kers and other people (Fawzani & Triratnawati, 2005;
ple around the world that can lead to death. Indonesia Hutapea, 2013). The most effective or healthiest way
is the fifth largest producer of tobacco as well as the is quitting smoking. However, the habit of smoking
largest producer and exporter of cigarettes in the world. can create problems to those who are addicted to ciga-
Further, Indonesia is the third largest cigarette consu- rettes (Neal & Benowitz, 2008).
mers in the world (GATS, 2012). Cigarettes and to- Nicotine is the main substance in cigarettes that
bacco smoke contain dangerous chemical substances causes addiction. Nicotine stimulates acetylcholine re-
that are harmful to the body, causing the body sus- ceptors on neurons that contain dopamine. This sti-
ceptible to diseases that could risk the health of smo- mulation causes an increase of dopamine in the cen-
tral of brain reward system. The peak level of nico-
Correspondence concerning this article should be addressed to tine and activation of brain reward system are fol-
Amelia Lorensia, Departement of Clinical-Community Pharmacy
Faculty of Pharmacy Universitas Surabaya Jalan Raya Kalirungkut lowed by a gradual decrease level of nicotine to the
Surabaya 60293. E-mail: [email protected] point of withdrawal that can only be removed by smo-

170
 HEALTH RISK AND CESSATION OF SMOKING 171

king. Nicotine causes the feeling of pleasure that leads spective using interpretative phenomenological ana-
to addiction. When smokers attempt to reduce or quit lysis (IPA) to explore and obtain a complete picture
smoking, they show the symptoms of anxiety and rest- of life context of smokers in which the smoking
lessness. The longer nicotine stays in the body, the cessation occurred. Based on the government regu-
stronger smoking behavior, which makes smokers ex- lation number 81 in 1999 (PP No. 81 tahun 1999),
perience difficulties in quitting smoking (Neal & cigarettes are the result of processed tobacco in
Benowitz, 2008; Sadikin & Lousia, 2011; Mansvelder wrap, including cigars or other forms produced by
& McGehee, 2002; Berrendero, Robledoa, Trigoa, plants, such as Nicotina tabacum, Nicotina rustiuca,
Martín-Garcíaa, & Maldonadoa, 2010). and other species, or synthesis containing nicotine
Efforts to quit smoking can be hindered by fac- and tar with or without additives. Variables in this
tors, such as smokers’ lack of confidence and low study were knowledge, perception, and risks. Know-
self-esteem that lead to depression, which is the sig- ledge was defined as participants’ knowledge about
nificant factor that causes a failure in smoking ces- smoking cessation, including definitions, benefits,
sation (Guillon, Crocq, & Bailey, 2007). Thus, it is and understanding of smoking cessation in relation
important that health practitioners work in collabo- to health, economy, and environment. Perception was
ration with other health professionals to assist peo- referred to the opinion of participants about smoking
ple who have a desire to quit smoking and to provi- cessation, including benefits felt and difficulties en-
de counseling on the risks of smoking (BPOM, 2005; countered based on their experiences, impressions,
BPOM, 2007). and knowledge, as well as the known risks to self
The guideline of smoking cessation suggests that and surroundings in relation to smoking cessation
health practitioners should give more attention to the based on their experiences, impressions, and know-
smoking status of each patient and hold a smoking ledge.
cessation program at least once a year (Sinclair, Bond,
& Stead, 2008). Health practitioners needs to have Population and Sample
knowledge not only about the role of smoking as
the main risk factor of heart disease, but also about Population in this study was pharmacy students at
the impact of smoking on other pathophysiology, the the University of XXX. Sample (participants) was
interaction between nicotine and other medicines, active smokers aged 18 years and over, under-
and the pathophysiology of nicotine addiction, in- graduate students at the Faculty of Pharmacy at the
cluding the withdrawal symptom of nicotine so as to University of XXX. This study included pharmacy
provide an accurate and satisfying information to students as they represented individuals with good
active smokers. Health practitioners should also un- educational backgrounds who understood the risks
derstand that smoking is not only related to nicotine of smoking to health. We included those who were
addiction, but also a matter of habit (Sadikin & Lousia, 18 years and over, as people at this age range were
2011). Research by Twyman, Bonevski, Paul, and most likely to smoke (GATS, 2012; Health United
Bryant (2014) indicated the barriers experienced by States; 2010), and those who had previously tried
participants to quit smoking based on the phenome- but failed to quit smoking.
nological perspective, or from the perspectives of Sampling techniques were snowball sampling
participants in order to reconstruct the service of and purposive sampling, the prospective partici-
primary health care (Veny et al., 2011). Based on the pants were encountered in several public places on
research background above, the aim of this study campus where students commonly smoked. The
was to explore factors that initially influence parti- smokers who were participants in this study were
cipants to smoke, attempts made by participants to asked to introduce the authors to their friends/re-
quit smoking, the impact of smoking, and partici- latives who were then approached as prospective
pants’ perception on smoking cessation. participants.

Data Collection and Analysis

Methods
The process of data collection involved prepara-
Research Type and Variables tion of equipment, such as interview guidelines, sta-
tionery, and a recorder. Data were collected using
This study was based on the phenomenological per- in-depth interviews until data reach saturation.
172 LORENSIA, PRATAMA, AND YUDIARSO

Data analysis is a technique in qualitative research tried ARDATH® cigarette as well, I quitted smo-
that is conducted after data have been collected. It king some time during the third grade, but I start-
starts with open coding, axial coding and then se- ed to smoke again when I was in the junior high
lective coding. At the stage of open coding, verba- school.”
tim transcription was conducted with the purpose of Internal factors (self). Smoking among ado-
describing the interview process and reflecting the lescents could be related to a psychosocial crisis as
results of interview (self-reflection). a part of adolescent developmental stage, in parti-
cular when adolescents search for their identity. How-
ever, efforts to form identity do not always run well
Results in accordance to the society’s expectations. Several
adolescents smoked for compensation; that is, as a
Based on in-depth interviews conducted with 15 way to promote their self-confidence during identity
participants regarding their perception on smoking formation process.
cessation programs, it was found that across partici- “Yes, at first I just wanted to try, it’s truly a per-
pants, the answers were relatively the same. This stu- sonal desire, Mas.”
dy had been conducted for almost two years (from “No worries, Mas, at first I’d like to try a bit, I
March 2014 to July 2016). The focus of the study found that it tasted good and finally, I’ve got ad-
was on exploring factors that initially influenced par- dicted, Mas, all started from trial and error, Mas.”
ticipants to smoke, attempts they made to quit smo-
king, the impact of smoking, and participants’ per- Participants’ Knowledge About the Impact
ception on smoking cessation. After conducting in- of Smoking.
terviews with participants, the authors transcribed
the interviews, summarized them in a table and used The most obvious consequence of smoking as
parts of the interviews to further understand the the- mentioned by all participants was health problems,
mes of the interview related to the topic of study. particularly respiratory problems that might cause
cancer and death. Participants knew about the risks
Initial Factors Influencing Participants to Smoke of smoking; that is, disadvantages of smoking to fi-
nances and health.
External factors (environment). Other peo- “Oh, I often experience that, Mas, shortness of
ple’s influences, such as friends or family members. breath, Mas, I had difficulties to breathe for 4-5
“At first, it’s only experimenting because of fri- months, Mas.”
ends, Mas, then I’m starting to get addicted.” “I don’t have any sickness, Mas, but when I woke
“Yes, from the very start, my friend is smoking, up in the morning, Mas, I felt my chest was tight,
Mas.” Mas.”
“Just experimenting, Mas, I only follow my fri- “I know, Mas, it can cause cancer, Mas.”
ends who are used to smoking.” “Yes, Mas, I know, Mas, lung cancer and others, Mas.”
“At first, I went along with my friends, Mas, ex- “Yes, Mas, I know what are the risks of smoking,
perimenting with my friend’s cigarette, and then I Mas, shortly, it can lead to death, Mas.”
become addicted, Mas.” “I know, Mas, the dangers of smoking, Mas, it
“I think it’s a matter of relationships, Mas, be- can cause lung diseases, and at the end, it can
cause my friends are smoking, I’m following them lead to death, Mas.”
and smoke, Mas.”
“In the beginning?? Hmmm my family is all smo- Participants’ Perception on the Risks of Smoking
kers, that is why I tried to smoke, and by coinci-
dence my friends also like to smoke, so I began The participants’ perceptions on the risks due to
to smoke as well, Mas.” smoking habit were as follows:
“I started to smoke when I was in the third grade Health problems.
of elementary school, at that time my uncle took “In the past, every time I woke up in the mor-
me to a stall and tried ARDATH®, ARDATH® ning, I felt my chest was painful, really hurt, Mas,
cigarette tasted sweet, after coming back from the feeling sick, having a fever, Mas.”
stall, at home we have a store, I took a cigarette “I’ve ever felt that way, Mas, it’s hard to breathe
from the store and began to smoke, at that time I in the morning, Mas, when I just woke up, Mas.”
 HEALTH RISK AND CESSATION OF SMOKING 173

“Oh, I had that experience, Mas, it’s painful in school but started to smoke again in the first
the chest, Mas, but for shortness of breath, I have grade of junior high school, in the second grade I
this only sometimes.” tried to quit smoking, Mas.”
“Yes, Mas, I feel sick, Mas, in the morning when “I have, Mas, I have tried to quit smoking, Mas”
I’ve just waken up, Mas.” “Twice, Mas, it’s been a long time, Mas, two
“Yes, I have, Mas, my chest was tight.” years ago when I was in the junior high school,
“But when I smoke... uh...my body...I felt like Mas.”
coughing, Mas, and I had phlegm.” “In the third grade of junior high school, Mas, I’d
Losing weight when participants smoke. tried to quit, Mas.”
“I’ve got skinny when I keep smoking, Mas, I “Twice, Mas, I tried to quit smoking, Mas."
don’t feel sick, Mas.” "Long time ago, Mas, when I was in the junior
Did not experience health problems. high school and the second grade of senior high
“Wah, I’ve never experienced sickness, Mas.” school, I tried to quit smoking, Mas.”
Addiction. “Twice, Mas, in the past when I was about to go
“What can I do, Mas, I’m addicted, Mas.” to university and in the middle of college year,
“Yeah, what else can I do, Mas, I feel good when Mas, because of illness that I mentioned before,
smoking, this makes me keep smoking, Mas.” Mas.”
“I can’t stand, Mas, it becomes a habit, after eat- “Because in the junior high school, I had a
ing, I have to smoke, Mas, I think I’ve already girlfriend who didn’t like people who smoke.”
addicted, Mas.” “Yap, Mas, in the junior and senior high school, I
Feeling calm. lived alone, Mas, my parents did not monitor me,
“When I smoke, I feel calm, Mas.” Mas.”
“When I was in the senior high school, I’d tried
Participants’ Knowledge and Efforts in Re- to quit smoking, Mas, because of shortness of
lation to Smoking Cessation Programs breath, because of illness, Mas. At that time, I
changed to Marlboro cigarette, the red Marlboro.”
Numerous participants did not know about smo- However, their attempts to quit smoking often
king cessation programs, which can be seen from failed. Most participants quit smoking only for se-
the interviews below: veral months.
“I’ve ever heard that, Mas, only heard, Mas.” “Quit only for three months, Mas, if I’m not
“Wah, what is that, Mas, I don’t know.” wrong, but then I couldn’t stand, Mas.”
“Wah, I have never heard of it, Mas” “Oh, no, Mas, I instantly quitted, Mas, yes, I
“Wah, I have never heard of this at all.” quitted, but only for several months, then I began
“No, Mas, I’ve never heard of it, Mas.” to smoke again, Mas.”
“What is that, Mas, I’ve never heard of it, Mas.” “I had, Mas, but it didn’t last long, after a week, I
“I have never heard of this program, Mas.” smoked again, Mas.”
“What is that, Mas? I don’t know what that is.” “Only for a month, Mas, then I started to smoke
“Wah, I don’t know, Mas, how it looks like, Mas? again, Mas.”
It’s been a while that I want to quit smoking, but “For about a month or two, Mas, but then I
I can’t.” couldn’t stand it any longer, Mas.”
From the interview above, it can be concluded “Not that long, Mas, only for 2 weeks, I quitted
that most participants did not know about smoking smoking, Mas.”
cessation programs. Although the participants did “I had, Mas, for about 3 months, I quitted smo-
not know about the smoking cessations programs king, Mas.”
that have been officially promoted by the govern- The reasons participants quitting smoking were:
ment, they had previously tried to quit smoking. Financial reasons. Participants felt burdened
Although most participants started to smoke sin- by the cost of cigarettes bought regularly.
ce they were young, they had tried to quit smoking “Because I didn’t have pocket money, Mas, that’s
at the early stage. They had tried to quit smoking why I quitted smoking, Mas.”
for some time; that is, when they were in the junior Internal factors (self). Participants tried to
high school, or senior high school or at college. search for other activities as a way to distract their
“Yeah, Mas, I quitted when I was in the elementary attentions from a desire to smoke. To distract their
174 LORENSIA, PRATAMA, AND YUDIARSO

attentions away from smoking, they ate food, for financial perspective, I receive benefits as well, I
example, or did activities. can save money, Mas.”
“Nah, in the past, when I was in the elementary “I’d ever quit smoking for three months, Mas, I
school, I couldn’t smoke at home because my could save up to 250-300 thousand, Mas.”
parents were around, but during junior high
school, I lived in Malang, I met friends, Mas, and Factors Influencing Participants to Quit Smoking
started to smoke again.”
“I usually eat a lot, have snacks more than usual, Participants understood the risks of smoking to
keep my mouth busy, Mas.” health.
“Yeah, if I have to quit, I just quit, Mas, but I will “Yes, I know the risks of getting ill, Mas.”
eat lots of snacks, Mas.” “Yap, it’s hard to breathe, Mas, but when there’s
“Yes, Mas, it’s a matter of changing behavior, no breathing difficulties, I started to smoke, Mas.”
Mas, watching other people playing futsal, if they “Yes, I’m a bit concerned about this pain, Mas,
can play for a long time, why I can’t play futsal it’s hard to breathe, Mas.”
that long.” “Yeah, this is because of motivation that I have
“Yes, it’s a matter of self-motivation, Mas, I join mentioned, Mas, watching friends who don’t
sports with friends that don’t smoke, I feel better, smoke, Mas, they’re healthy, they can play sport
Mas, I can play sports for longer time, Mas.” for a long time, not coughing, Mas.”
However, there were participants who tried to “Yes, my body is continuously painful, I can’t
quit smoking either immediately or gradually, or play sport for long time, Mas.”
they avoided environment that supported their “Yap, because I have difficulty to breathe, Mas, I
desire to smoke. feel my body is heavy, I have shortness of breath
“Yes what can I do, Mas, I just quit, quitting when doing heavy work activities.”
smoking.” Financial problems. Participants did not have
“Yes, I immediately quitted, Mas, I changed the pat- money to purchase cigarettes.
tern of my behavior, I didn’t smoke anymore, Mas.” “Because I didn’t have pocket money, Mas, that’s
“Yes, I can’t do anything, Mas, I tried to take it, why I didn’t smoke, Mas.”
not smoking, Mas, I just held it, Mas.” “Because of this, Mas, financial problems, no
“How to quit, I think, don’t buy any cigarette and money.”
don’t ask for a cigarette, Mas.” “Yeah, what can I do, Mas, I had lots of expenses
“Yes, the only way is not going anywhere, Mas, and it’s not good for your health, Mas.”
you just quit, Mas.” “Yap, because of financial problems, Mas, and I
“Yap, I cut it step by step, Mas, for example, 6- know the consequences, Mas.”
10 cigarettes, then the next day I’d smoke only Society’s views.
five cigarettes, Mas.” “Why is that, Mas, because women should not
The impacts experienced by participants when smoke, Mas, people will say something bad to
they tried to quit smoking were as follows: women who smoke, that’s why I quit smoking.”
Discomfort in mouth. “What can I say, Mas, my parents caught me
“It doesn’t feel good, Mas, craving, Mas, I want when I was in the junior high school, that’s why I
to have a cigarette in my mouth, Mas.” wanted to quit, Mas.”
Dizziness. “Yeah, I started to smoke again, Mas, what can I
“It’s weird, Mas, if I don’t smoke, I feel dizzy, Mas.” do, Mas, smoking is a part of my life, Mas.”
Gaining weight.
“No, Mas, it’s not because of illness. But when I
quitted smoking, I gained weight, Mas.” Discussion
Improvement in the respiratory system.
“There’s a change, Mas, breathing is much Initial Factors Influencing Participants to Smoke
easier, Mas.”
Saving money. Factors that initially influence people to smoke
“In terms of money, I can save money, Mas.” can arise from social environment and from self.
“In fact, I’ve got lots of benefits for not smoking, Previous studies explained numerous factors that in-
Mas, living a long life, living healthy, from fluence participants to start smoking. The main fac-
 HEALTH RISK AND CESSATION OF SMOKING 175

tors were social and environmental factors that con- Participants’ Knowledge and Efforts In Re-
tribute to an individual’s adjustment (Lloyd-Richardson, lation to Smoking Cessation Programs
Papandonatos, Kazura, Stanton, & Niaura, 2002;
Kim, Fleming, & Catalano, 2009). Almost all participants explained that they had
Factors that influence adolescents to smoke have never heard of smoking cessation programs. There
been discussed by Khurshid and Ansari (2012) and is not many people overseas who know about smo-
this is related to a psychosocial crisis experienced king cessation although the guidelines of smoking
by adolescents during their development, particu- cessation have been developed, for example Smo-
larly when adolescents search for their identity. Par- king Cessation Guideline for Australian General
ticipants in the study had previously tried to quit Practice (2004, as cited in Department of Health
smoking for a period of time; that is, since they and Ageing, 2014). The World Health Organization
were in junior or senior high school or at college, Regional Office for Europe (2013) developed
but they did not succeed. similar guidelines in the European Tobacco Control
Status Report 2013 and the European Network for
Participants’ Knowledge About the Impact Smoking and Tobacco Prevention aisbl (ENSP;
of Smoking 2012) has developed the European Smoking Ces-
sation Guideline. Nonetheless, based on the 2002
Participants understood the risks of smoking, data in the United States, in the last five years, 23.5%
which can be seen from the interview excerpts. A adult smokers decided to continue smoking and
half of participants indicated that smoking might 33% of them were under the age of 24 years.
cause painful chest and discomfort in the body as Notably, the guidelines and journal articles pu-
well as shortness of breath. Coughing that com- blished in Europe and Australia did not report the
monly occurs in smokers is an attempt to release prevalent rates of community members who par-
thick mucus that is difficult to be removed from the ticipated in smoking cessation programs, including
airway (Hutapea, 2013). Smoking a cigarette con- those involved in certain programs and those show-
taining a high or low level of nicotine can increase a ing their own initiatives. Further, there has been no
diastolic and systolic blood pressure, increase a data on the effectiveness of smoking cessation pro-
heart rate, and leave a demand for oxygen in heart grams associated with the guideline. In Indonesia,
muscles. The increased blood pressure causes nore- in 2002 the WHO indicated that Indonesia was the
pinephrine to be released locally from axon termi- top fifth country in consuming cigarettes.
nals that are adrenergic and leaves a demand for Furthermore, smoking cessation programs have
oxygen in heart muscles causing the release of cate- already been implemented to promote health levels
cholamine from the adrenal medulla and chromaffin using a cognitive therapy, a behavioral therapy and
tissue in the heart. Nicotine works on chemorecep- medications. This has been conducted because smo-
tors in the carotid and aortic bodies that cause in- king is associated with reversible damage potential
creased pulse rate and arterial pressure, and there- and dose-related arterial dilation of endothelium-
fore, the low levels of nicotine can stimulate hyaline related. It causes the narrowing of proximal and dis-
cells of the sympathetic ganglion (Hutapea, 2013). tal epicardial coronary arteries and increased coro-
Most participants knew the health risks of nary vascular tone despite the increased needs for
smoking, in particular the risk of having lung can- oxygen in myocardial infarctions and smokers show
cer. This is possibly because of the educational back- a basal decrease which is not stimulated by nitric
grounds of participants where most of them had oxide induced by vasodilation (Pittilo, 2000).
completed studying or still studied at the faculty of Economic factors can influence smokers’ deci-
pharmacy which is a health-related field of study. sion by increasing their desire to quit smoking, as
Although the majority of participants had academic experienced by several participants. This mainly oc-
qualifications in the health area, they might not curs among smokers with low socioeconomic sta-
have an awareness of the benefits of quitting smo- tus. Hence, smokers generally prefer to stop a treat-
king. The most important factor that influences smo- ment (for diseases/problems due to smoking or o-
kers to quit smoking is their own awareness and thers) rather than to quit smoking because of eco-
social support from their family (Ardini & Hendriani, nomic reasons. In this case, the government's policy
2012). raising the price of tobacco products is basically an
176 LORENSIA, PRATAMA, AND YUDIARSO

intervention to control tobacco that seems to be the Dizziness and restlessness. Nicotine in ciga-
most potential way to reduce the health risks of rettes causes an addiction (dependence). When a per-
consuming tobacco (Hiscock, Bauld, Amos, Fidler, son quits smoking, the body’s need for nicotine is
& Munafo, 2012: Hiscock, Judge, & Bauld, 2011). not met, the receptors previously bounded with ni-
There were smokers in this study who quitted cotine are no longer connected, and this will cause
their habit of smoking independently or without the symptoms of nicotine withdrawal that generally
following a therapy. Individuals are considered to occurs 1-2 days after quitting smoking, such as diz-
be independent if they attempt to quit smoking be- ziness/headache, weaknesses, nausea, anxiety, desi-
cause they have a desire to become themselves, can res to smoke, concentration difficulties, sleepless-
make a decision based on their own consideration, ness, mood changes; that is, becoming more sensi-
and are responsible for their own decisions. Many tive and easily angry, excessive hunger, and so forth
participants quit smoking only by hanging their (ASH Fact Sheet on Smoking and Cancer, 2013).
behavior on the basis of their own desires and with- Gaining weight. Smoking influences the appe-
out taking medications (Ardini & Hendriani, 2012). tite, specifically nicotine can cause a decrease in ap-
Few examples of attempts to quit smoking that are petite. Nicotine in cigarettes has an effect on a de-
related to internal factors (self) are searching for crease in appetite, when a person smokes, nicotine
activities to distract their attention from smoking, derived from tobacco will be absorbed quickly into
such as playing sport or doing exercises and others the lung and absorbed into the veins in the lung, and
(Ardini & Hendriani, 2012). then enters the brain that will bind it to the nicotinic
Smoking dependence can be defined as a plea- receptors connected to the ion channel (Grillner &
sure that generates a psychological satisfaction. The Svensson, 2000), which open to the incoming cati-
symptom is called tobacco dependence, that is, smo- ons, such as sodium and potassium and release a va-
king behavior which is pleasurable and can shift riety of neurotransmitters. This process will lead to
into obsessive activities. According to Kassel, Stroud, the release of catecholamine, dopamine, serotonin,
and Paronis (2003), the motives of smoking are re- norepinephrine, GABA (Gamma Aminobutyric Acid)
laxation to reduce tensions, improve concentration, and other neurotransmitters (McGovern & Benowitz,
and create enjoyable experiences and relaxation. 2011), in order that the central nervous system rele-
Efforts made to quit smoking were avoiding the ases several neurotransmitters associated with a de-
environment that increased smoking desires and crease in appetite (Carr, Kim, & Vaca, 2000). The
reducing gradually the frequency of smoking. higher the levels of nicotine in blood, the stronger
their stimulation to postsynaptic cells in nicotinic
The Consequences Experienced by Partici- receptors (Zhou, Gao, & Picciotto, 2015).
pants When Trying to Quit Smoking were: Improving in respiratory health system, breath-
ing more easily. Smoking increases the risk of
Discomfort in mouth. Smoking habit poten- lung disease, thus, quitting smoking will improve the
tially decreases the sensitivity of taste. The negative function of lung. Smoking can lead to lung diseases
effect of smoking on the soft tissues of teeth and in the long term, such as emphysema and chronic bron-
mouth varies depending on age, gender, lifestyle, chitis, or commonly known as chronic obstructive
types of cigarettes, duration of smoking, and daily pulmonary disease (COPD), with the main symptoms
consumption of cigarettes (Dewi, 2005). The sensi- of shortness of breath. COPD causes chronic illness
tivity to bitter taste occurs more frequently in smo- and disability that deteriorate over time and some-
ker groups. Taste receptors on the entire surface of times, can be fatal (ASH Fact Sheet on Smoking and
tongue can recognize sweet and bitter taste, but Cancer, 2013).
taste receptors in certain locations are more sen- Improving in economic factor. The most no-
sitive than others (Simamora & Primasari, 2012). ticeable advantage after participants stopped smo-
Smokers who have recently quit smoking may ex- king for a period of time is the cost (economic fac-
perience discomfort in mouth, such as coughs, dry tor) and health factor. Addiction due to nicotine de-
throat and mouth. This may be due to nose and throat pendence causes a smoker to purchase cigarettes re-
attempts to remove mucus that is produced from the gularly because nicotine in cigarettes has gradually
previous smoking (Sadikin & Louisa, 2011). changed his or her brain cells that make the smoker
 HEALTH RISK AND CESSATION OF SMOKING 177

feel the urge to smoke. not consider participants’ place of origin. Differen-
ces in the place of origin might influence partici-
Factors Influencing Participants to Quit Smoking pants’ perception and attitudes towards smoking.
People living in rural areas had a higher frequency
Health factors. Participants knew the health of smoking in comparison to people living in urban
risks of smoking and therefore, they had a desire to areas (GATS, 2012).
quit smoking. The brain reacts to the incoming ni- Age. Age of participants in this study was at the
cotine by sending a signal to the adrenal glands in range of young adults who was still undergraduate
order to release epinephrine (adrenaline). This power- students, excluding those with older age. Thus, the
ful hormone will react by constricting blood vessels, results of this study can only be generalized to stu-
and because of the narrowing brain blood vessels, the dents of similar age to the participants in this study.
heart will work harder due to the higher pressure. If Older-aged students was excluded because the Latin
the pumping of the heart is sufficiently strong and blood American Project for Investigation of Obstructive
vessels in the brain are constricted due to the strong Lung Disease (PLATINO) reported that the preva-
reaction to epinephrine, then the blood vessels of lence of COPD was higher in smoker and ex-smo-
the brain will be broken and this causes a stroke. ker groups than never-smoke groups, as well as in
Current smokers have at least a two to fourfold people aged over 40 than below 40. The prevalence
increase in the risk of stroke compared to never of COPD was also higher in males than females
smokers or individuals who has quitted smoking for (GOLD, 2014).
more than 10 years (Shah, & Cole, 2010). In additi-
on, cigarette smoke can also trigger respiratory pro- Conclusions
blems, such as the occurrence of symptoms of breath-
ing problems, declined lung function, and asthma at- Participants’ smoking initiation was influenced
tacks (Hutapea, 2013). by their own curiosity and environment, such as fa-
Financial factors. Participants did not have mily or friends. All participants understood the risks
sufficient money to purchase cigarettes. and consequences of smoking, and had previously
Social factors. Participants may quit smoking tried to quit smoking since smoking influenced their
because of social factors, such as a judgement that life, causing financial and health problems. Notably,
women should not smoke. Female smokers compa- although they had received the benefits of quitting
red to male smokers are perceived negatively in so- smoking, such as improvements in respiratory health,
ciety. A negative stigma to female smokers influ- cost savings, and freshness due to quitting smoking,
ences the meaning of smoking to female adolescent participants failed to stop smoking. This failure might
smokers. The process to form the meaning of smo- be caused by a discomfort arising from not smoking
king to female adolescent smokers is also influen- as a result of addiction to nicotine in cigarettes. This
ced by their purpose of smoking, smoking becomes study only described the initial conditions of active
the symbol of ‘cool’ appearance, or the symbol of smokers and their problems when they tried to quit
rebellion, or a way to gain pleasure (Martini, 2014). smoking. Therefore, further study should follow this
up with a solution in terms of designing and deve-
Limitations of Study loping the most effective smoking cessation programs.
Smoking cessation programs should not only in-
Limitations of this study are related to the parti- crease smokers’ knowledge, but should also change
cipants’ backgrounds, which are explained as follows: their attitudes and perception. It is expected that
Gender. This study involved participants from smoking cessation programs will not only focus on
both gender (males and females). However, previ- increasing the knowledge about the risks of smo-
ous studies have indicated that gender is related to king, but also actively overcoming the challenges
people’s attitude to smoking, due to negative stigma faced by smokers when they try to quit smoking.
and a greater pressure from the society on female smo-
kers compared with male smokers. This has caused fe-
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