Journal of Youth Studies

Vol. 7, No. 1, March 2004, pp. 7387

The Teen Tobacco Epidemic in Asia:

Indonesia, Nepal, Philippines, Taiwan,
and Thailand
Minja Kim Choe, Shyam Thapa, Chai Podhisita,
Corazon Raymundo, Hui-Sheng Lin & Sulistina
Achmad

This paper examines the prevalence of smoking, the age pattern of initiation of smoking,
and factors associated with current smoking status among 1519 year olds in five Asian
societies, using data from large-scale youth surveys. The life-table method is used to
examine the age pattern of initiation of smoking and logistic regression is used to
examine factors associated with current smoking status.
Smoking prevalence is high among boys but very low among girls. Among boys, 82
percent in Indonesia, 73 percent in Thailand, 70 percent in the Philippines, and 35
percent in Nepal begin smoking by age 20. In all countries, smoking is much more
prevalent among teens who have experienced some transitions to adulthood. In Indonesia and Nepal, teen smoking is more prevalent in less developed regions. Among Filipino
girls, residence in metro Manila is associated with high probability of smoking. In most
countries, teens who have close relationships with parents are less likely to smoke.

Introduction
Smoking is a major public health problem worldwide (World Health Organization
1997, 1999; Satcher 2001; Gori 2002). A recent estimate suggested that 29 percent of
the adult population were smokers globally in 1995 (Peto & Lopez 2000). Deaths due
to tobacco use are expected to increase from four million in 1999 to 10 million in
Minja Kim Choe, Research Program, East-West Center, Honolulu, HI, USA. Shyam Thapa, Family Health
International, Arlington, VA, USA. Chai Podhisita, Institute for Population and Social Research, Mahidol
University, Thailand. Corazon Raymundo, University of the Philippines Population Institute, Philippines.
Hui-Sheng Lin, Bureau of Health Promotions, Department of Health, Taiwan. Sulistina Achmad, Demographic Institute, University of Indonesia, Indonesia. Correspondence to: Minja Kim Choe, Ph.D., Senior
Fellow, Research Program, EastWest Center, 1601 EastWest Road, Honolulu, HI 96848-1601, USA. Tel: 1
808 944 7475; Fax: 1 808 944 7490; Email: mchoe@hawaii.edu
ISSN 1367-6261 print/1469-9680 online/04/010073-15 2004 Taylor & Francis Ltd
DOI: 10.1080/1367626042000209967

74

M. K. Choe et al.

2030 (Murray & Lopez 1996). By then, tobacco use is expected to cause more
premature deaths and disabilities than any other single cause. These expected
increases in death are not distributed evenly across the regions. Developing regions
are expected to experience much larger share of the increases than the developed
regions. For example, the Asian region is expected to experience a fourfold increase
while the developed regions will experience a 50 percent increase (Jha et al. 2002).
Smoking among teens is associated with additional health and social problems.
Smoking affects the physical growth and activities of teenagers. The younger people
start smoking, the more likely they are to become strongly addicted to nicotine.
Furthermore, teens who smoke are much more likely to use alcohol, use drugs,
engage in fighting, and engage in unprotected sex (Center for Disease Control 1994;
Willard & Shoenborn 1995).
Most smokers begin smoking during their teen years. Yet, studies on smoking
behavior among teens are rare for most Asian countries. This paper examines the
prevalence of smoking, the age pattern of initiation of smoking, and factors
associated with current smoking status among 1519 year olds in Indonesia, Nepal,
the Philippines, Taiwan, and Thailand using data from national youth surveys
collected in recent years.
Data and Methods
The youth surveys we used were designed and carried out independently from each
other, but have many common characteristics. All of them are either nationally
representative (Philippines, Taiwan, and Thailand) or representative of a large
proportion of their populations (Indonesia and Nepal). The samples consist of all
youth in their late teens and early 20s who were residents of representative samples
of households. All surveys include information on transition to adulthood such as
completion of education, leaving the parental home, and beginning of employment;
dating, marriage, and sexual behavior; substance use such as smoking, drinking, and
drug use; as well as selected community, family, and individual background characteristics. All surveys used a face-to-face interview method except that in the Taiwan
survey; the parts related to sexual behavior were filled out by the respondents and
then were collected in sealed envelopes.
For Indonesia, we used data from the Baseline Survey of Young Adult Reproductive Welfare conducted in 1998. The survey collected information from 3978
female and 4106 male youths aged 1524 in Java and Sumatra. Metropolitan areas
were excluded from the survey. For Nepal, we used the Nepal Adolescent and Young
Adults Survey conducted in 2000. The sample consists of 4175 female and 3802 male
youths aged 1422. The mountain ecological region that is sparsely populated was
excluded from the survey (Thapa 2001). The urban youth was over-sampled to allow
reliable separate estimates for them. For the Philippines, we used data from the
second Young Adult Fertility and Sexuality Study conducted in 1994. The survey
interviewed a national probability sample of 5266 male and 5612 female youths aged
1524 (Raymundo et al. 1999). For Taiwan, the 1994 Taiwan Young People Survey

Journal of Youth Studies

75

was used. It consists of 884 male and 2766 female youths aged 1529, which is a
probability sample of residents in the Taiwan area. For Thailand, we used the Family
and Youth Survey of 1994, consisting of a national probability sample of 1087 male
and 1092 female youths aged 1524 (Podhisita & Pattaravanich 1995).
The year of survey ranges from 1994 to 2000. Three surveys (Philippines, Taiwan,
and Thailand) were conducted in 1994. The time lag between these three surveys and
that of Indonesia is relatively short, at four years. The time lag between these three
surveys and Nepal, where the survey was conducted in 2000, is relatively long. This
factor needs to be kept in mind while interpreting the results. That is, some of the
observed differences between Nepal and the three countries where the survey took
place early might be due to time lag.
Current smoking status was obtained from responses to the simple question Are
you currently smoking? In four surveys current smoking status was asked after the
questions on any experience of smoking. The exception is the Taiwan survey, which
asked the current smoking status first followed by the question on smoking
experiences in the past. In Nepal the question was on smoking cigarettes or bidis
(bidis are tobaccos folded in dry leaves, smaller in size than cigarettes, produced and
consumed primarily in South and Southeast Asia) [1].
We first examine the prevalence of smoking. This is followed by the examination
of the age pattern of initiation of smoking using the life-table method. Finally, we
estimate the effects of community, family, and individual characteristics on the
current smoking status using logistic regression models. We limit the analysis to
1519 year olds, separately for boys and girls. For countries that utilized stratified
sampling with varying sampling probabilities for different strata, we used sample
weights in the analysis.
Studies in the United States and other countries have identified a number of
factors that are associated with teen smoking behavior. Teens residing in communities with easy access to tobacco products and permissive norm on teen smoking are
more likely to smoke; teens who grew up with both parents and who have close
relationships with parents are less likely to smoke; teens who are strongly connected
to schools and who are strongly religious are less likely to smoke; and teens who have
low self-esteem are more likely to smoke (Jessor et al. 1991; Blum & Rinehart 1997;
Jessor & Jessor 1997; Resnick et al. 1997, Jessor et al. 1998; Domingo & Marquez
1999). We expect these factors to affect smoking behavior among teens in Asia in
similar ways. In addition, in the context of high prevalence of smoking among adult
men, we expect that a large proportion of boys begin smoking during their transition
period to adulthood. In countries with traditionally low prevalence of smoking
among women, we expect girls to be much less likely to smoke than boys. At the
same time, given the context of rapid social changes in these countries, we expect
teen girls in more modernized environment to behave less traditionally and thus
more likely to smoke than girls in less modernized communities.
In this paper, we examine four sets of variables as potential factors associated with
the likelihood of smoking. The first set of variables consists of indicators of
community characteristics. In general, we expect the gender difference to be lower

76

M. K. Choe et al.

in urban areas than in rural areas. For Philippines and Thailand, in addition to the
usual urbanrural designation of the residence, we also include dummy variables
designating the capital cities as separate categories. In less developed countries where
ethnic and cultural background varies greatly, access to tobacco products and
tolerance towards teen smoking may vary by region, resulting in differentials in
smoking prevalence. In order to examine such hypothesis, we include dummy
variables indicating different regions for Indonesia and Nepal.
The second set of variables consists of parents characteristics and indicators of
respondents relationships to their parents. We include the levels of parents education, as indicators of familys economic and social status. In societies where the
sociocultural norm tolerates smoking among youth and the youth are not well
informed of the health risks of smoking, teens with a high level of fathers education
are likely to have easier access to cigarettes and more likely to smoke than teens with
a low level of fathers education. This is likely to be the case for teen boys in Asia.
If, however, the sociocultural norm does not tolerate smoking among youth, parents
with a high level of education are more likely to be able to protect their children
from risk-taking, including smoking. This is likely to be the case for teen girls in
Asia.
Our data have information on whether the teens were brought up by two parents,
and the level of contact and communication with parents for some countries and we
include them in the analysis. Even in societies where the sociocultural norm tolerates
smoking among youth and the youth are not well informed of the health risks of
smoking, smoking at very young ages are not likely to be tolerated by parents. We
expect that teens who grew up with both parents and who have close relationships
with parents are less likely to smoke.
The Philippines data have information on religiosity. We expect strong religiosity
to be associated with low probability of smoking. Data from the Philippines, Taiwan,
and Thailand have information on educational aspiration. We include in the analysis
whether the respondent intends to go to college, or already has some college
education. A high level of educational aspiration, as a measure of self-esteem, is
likely to be associated with low probability of smoking.
The final set of variables consists of those indicating stages of transition to
adulthood. Most teens are likely to adopt behaviors that are very common among
adults sometime during their transition to full adulthood. Smoking is one of them,
especially for boys in most Asian countries where male smoking prevalence is high.
We expect the probability of smoking to be higher among teens who are older, who
have completed their education, who have experiences of living away from parents,
and who are married.
In order to identify factors that are associated with higher probability of smoking,
we use logistic regression models using current smoking status as the dependent
variable. The actual set of independent variables used for analysis varies slightly from
country to country, reflecting social, economic, and cultural situations, as well as the
availability of data. For Indonesian and Thai surveys, the combination of small
sample size and low level of smoking prevalence resulted in very few girls age 1519

Journal of Youth Studies

77

Table 1 Year of youth survey, number of boys and girls aged 1519 in the survey, the
percentage who ever smoked, and the percentage currently smoking in Indonesia, Nepal,
the Philippines, Taiwan, and Thailand

Boys
Indonesia
Nepal
The Philippines
Taiwan
Thailand
Girls
Indonesia
Nepal
The Philippines
Taiwan
Thailand

Year of
survey

Number of youths
aged 1519

Ever smoked
(%)

Currently
smoking
(%)

1998
2000
1994
1994
1994

2,669
2,667
3,071
297
644

76
22
48
41
49

38
12
28
30
33

1998
2000
1994
1994
1994

2,300
2,433
3,250
989
756

7
5
12
10
9

1
4
3
5
2

who were current smokers, and the logistic regression models could not be estimated.

Results
Prevalence of Smoking
Table 1 presents the percentages of boys and girls age 1519 who ever smoked and
who were currently smoking at the time of the survey, together with the year of
survey and the sample size. Among boys, more than three-quarters in Indonesia,
nearly one-half in the Philippines, Taiwan, and Thailand, and nearly one-quarter in
Nepal have experienced smoking. Among girls about one in 10 or fewer have
experienced smoking.
Current smoking prevalence among boys is very high in Indonesia (38 percent),
high in the Philippines, Taiwan, and Thailand (28 percent, 30 percent, and 33
percent, respectively), and moderate in Nepal (12 percent). The estimated levels for
boys in the Philippines, Taiwan, and Thailand are comparable with the prevalence
among US high school students (Corraro et al. 2000). Smoking prevalence is very
low among girls in every country under study. Thus, the gender differences in teen
smoking are very large in these Asian countries compared with the patterns observed
in Europe and the Americas (Corraro et al. 2000; Grunbaum et al. 2002). The
pattern of gender differences in teen smoking is similar to the gender differences in
smoking among adults. Our data from Indonesia and the Philippines have information on parents attitude on smoking of their children as reported by the children.
Not surprisingly, the large majority of boys report that their parents have permissive
views on their smoking but the majority of girls report that their parents are against

78

M. K. Choe et al.

Figure 1 Cumulative percentages of boys and girls who have initiated smoking by ages
1020 in Indonesia, Nepal, the Philippines, and Thailand. Note: The percentages are
estimated by the life-table method using information on the age when the respondent
first smoked from youths aged 1524 in Indonesia, the Philippines, and Thailand, and
from youths aged 1422 in Nepal.

their smoking (Choe et al. 2001). This pattern suggests that the gender difference in
smoking among teenagers in these countries reflects the cultural norms to a large
extent.
Age Pattern of Initiation of Smoking
Data from Indonesia, Nepal, Philippines, and Thailand have information on when
the youth first began to smoke [2]. Using this information from all youths included
in the survey (ages 1524 in Indonesia, the Philippines, and Thailand, and ages
1422 in Nepal), the cumulative proportions who have initiated smoking by each age
between ages 10 and 20 are estimated using the life-table method. The results are
shown in Figure 1.
In all four countries, substantial proportions of boys initiate smoking by age 15:
19 percent in Indonesia, 16 percent in Thailand, 12 percent in the Philippines, and
11 percent in Nepal. In contrast, less than three percent of girls have initiated
smoking before age 15 in all four countries. By age 20, a large majority of boys have
initiated smoking: 82 percent in Indonesia, 73 percent in Thailand, and 70 percent
in the Philippines. In Nepal, just 35 percent begin smoking before age 20. Thus 63
percent of boys in Indonesia, 57 percent in Thailand, 58 percent in the Philippines,
and 24 percent in Nepal begin smoking between ages 15 and 20. Substantial
proportions of girls have some smoking experience by age 20 in the Philippines,

Journal of Youth Studies

79

Thailand, and Nepal (19 percent, 14 percent, and seven percent, respectively) but
only two percent of Indonesian girls do. Compared with the teens in the United
States, teens in many Asian countries begin smoking at later ages. According to a
recent survey, more than one-half of ninth graders in US high schools (age 14 or 15)
have used tobacco products (Corraro et al. 2000). By age 20, however, Asian boys
catch up with the US boys.
Descriptive Statistics of the Factors Examined
Table 2 presents the list of variables included in the logistic regression models and
their mean values for each country. The large majority of teens in Nepal and
Indonesia were living in rural areas, whereas in the Philippines, Taiwan, and
Thailand more than one-half of teens were living in the urban areas. Because the
average level of education differs greatly between Indonesia and Nepal on one hand,
and the Philippines, Taiwan, and Thailand on the other, we classified fathers and
mothers education as high or low using different cut-off points for two sets of
countries [3]. For Indonesia and Nepal education beyond primary school was
classified as high, and for the Philippines, Taiwan, and Thailand education beyond
high school was classified as high. Much smaller proportions of mothers than fathers
had a high level of education in Indonesia and Nepal. In the Philippines and
Thailand, similar proportions of mothers and fathers had a high level of education.
In Taiwan, mothers and fathers levels of education were highly correlated and we
could include only one of them for analysis. We included fathers level of education.
The Philippines survey had information on religiosity and it was included in the
estimation model. A slightly higher proportion of girls than boys were strongly
religious (participating in religious activities once a week or more often). Surveys
from the Philippines, Taiwan, and Thailand had information on whether respondents were planning to go to college. We used this variable as a proxy for self-esteem.
About one-half of boys and girls in these three countries were planning to go to
college (or already had some college education).
Mean ages of the respondents were similar across countries, both for boys and
girls. The proportion of teens not in school varied somewhat across countries, being
very low in Taiwan and higher in other countries. In Nepal, girls were much more
likely to be out of school than boys. Marital status was included in the models for
Indonesia, Nepal, and the Philippines. Marital status was not included in the models
for Taiwan and Thailand because there were just a few married teens there. In Nepal,
substantial proportions of boys and girls age 1519 were married.
Whether the boy or girl had ever lived away from parents was included in the
model for Philippines and Thailand, where substantial proportions of teens were
living away from parents either to attend school or for employment purposes. For
Nepal and Indonesia, a slightly different variable was used: whether the teen was
single and not living with family. Only a small proportion of teens fell in this
category. The Taiwan survey did not have information on residential history and the
variable was not included in the model.

n.a.
0.14
n.a.
n.a.
n.a.
0.51
0.16
0.25
0.06
0.88
n.a.
n.a.
n.a.
n.a.
n.a.
n.a.
16.8
0.39
n.a.
0.14
0.03

n.a.
0.27
0.25
0.25
0.24
n.a.
n.a.
0.09
0.05
0.87
0.75
0.88
n.a.
n.a.
n.a.
n.a.
16.8
0.56
n.a.
0.01
0.08

Boys

Nepal

0.27
0.05
0.86
n.a.
n.a.
n.a.
n.a.
n.a.
n.a.
16.7
0.60
n.a.
0.38
0.02

n.a.
n.a.
n.a.
0.48
0.15

n.a.
0.12

Girls

0.15
0.15
0.86
n.a.
n.a.
n.a.
n.a.
0.22
0.52
16.9
0.40
0.29
0.02
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

0.09
0.44

Boys

0.14
0.14
0.83
n.a.
n.a.
n.a.
n.a.
0.27
0.59
16.8
0.35
0.41
0.08
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

0.11
0.46

Girls

The
Philippines

0.12
n.a.
n.a.
0.73
0.85
0.26
0.44
n.a.
0.47
16.8
0.23
n.a.
n.a.
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

n.a.
0.5

Boys

Girls

0.10
n.a.
n.a.
0.70
0.86
0.21
0.52
n.a.
0.44
17.0
0.21
n.a.
n.a.
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

n.a.
0.51

Taiwan

0.08
0.06
n.a.
0.76
0.86
n.a.
n.a.
n.a.
0.47
16.8
0.45
0.37
n.a.
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

0.20
0.39

Boys

Thailand

Note: n.a., variable is not included in the model.

Other urban areas include the capital city for Nepal and Taiwan.
b
More than primary school education in Indonesia and Nepal; more than high school education in the Philippines, Taiwan, and Thailand.
c
Had frequent conversation up to age 15 in Indonesia; Have a lot of time together in Taiwan; Get along well in Thailand.

Residence (reference rural)

Capital city
Other urban areasa
Region in Indonesia (reference Central Java)
Lampung
West Java
East Java
Terai region in Nepal (reference Hill)
Mid/Far-west region in Nepal
(reference Central, East, West)
Fathers education: highb
Mothers education: highb
Raised by two parents
Close relationship with fatherc
Close relationship with motherc
Talk to father when in trouble
Talk to mother when in trouble
Strongly religious
Planning to go to college
Age
Not in school
Lived away from parents
Married
Single, not living with family

Boys

Indonesia

Table 2 List of variables included in the logistic regression model of current smoking status and their mean values for boys and girls aged
1519 in Indonesia, Nepal, the Philippines, Taiwan, and Thailand

80

M. K. Choe et al.

Journal of Youth Studies

81

Factors Associated with Current Smoking

The estimated odds ratios of current smoking status associated with each variable in
the model are presented in Table 3. The odds ratios that are different from 1.0 at the
5 percent level of statistical significance are indicated by asterisks. We first discuss the
results for each country separately, and then summarize them in the Summary and
Discussion section.
Indonesia
Urban residence does not have statistically significant effect on smoking for boys, but
the province of residence does. Boys in Lampung and East Java are more likely to
smoke than boys in Central Java. Central Java is more developed than other areas of
Indonesia. This pattern suggests that teen smoking is considered an acceptable
behavior in relatively less developed areas in Indonesia. Teens in these areas may also
have easy access to traditional tobacco products with little monetary cost.
Parents education has little effect on the smoking behavior among boys, but one
of the three measures of relationship with parents does. Boys who had frequent
conversations with their father during childhood (up to age 15) are less likely to
smoke than the boys who did not.
Three of the four indicators of transition to adulthood have statistically significant
effects on smoking. Older age, being out of school, and being married increases the
probability of smoking among boys. Living away from parents as a single youth,
however, does not have a statistically significant impact on current smoking status.
Nepal
Three variables describe the community in Nepal: urban/rural residence, ecological
region, and development region. Nepal consists of three ecological regions: Terai,
Hill, and Mountains. The Mountain region, which is sparsely populated, with less
than 5 percent of the total population, is not included in the NAYA survey. The
Terai region is the subtropical agricultural belt in the south, bordering Northern
India. The Hill region, which includes the capital city of Kathmandu, is ethnically
diverse and economically more modernized than other areas in the country. Midwestern and Far-western districts are much less developed than other districts
(Western, Central, and Eastern) in terms of economy, education, and social development (Thapa 1995).
Teen smoking is more prevalent among Hill residents than among Terai residents,
especially for girls, perhaps due to ethnic diversity. Teen smoking is more prevalent
in under-developed regions (Mid-western and Far-western districts) than in developed regions (Eastern, Central, and Western districts). Similar to the situation in
Indonesia, teen smoking may be considered as acceptable behavior and teens may
have easy access to traditional tobacco products in these areas.
A high level of fathers education has a positive relationship with smoking among
boys and a negative relationship with smoking among girls. The different effects of

Note: See footnotes to Table 2. *p 0.05.

Residence (reference rural)

Capital city
Other urban areasa
Region in Indonesia (reference Central Java)
Lampung
West Java
East Java
Terai region in Nepal (reference Hill)
Mid/Far-west region in Nepal
(reference Central, East, West)
Fathers education: highb
Mothers education: highb
Raised by two parents
Close relationship with fatherc
Close relationship with motherc
Talk to dad when in trouble
Talk to mom when in trouble
Strongly religious
Planning to go to college
Age
Not in school
Lived away from parents
Married
Single, not living with family
n.a.
1.43
n.a.
n.a.
n.a.
0.58*
1.96*
1.79*
0.98
0.88
n.a.
n.a.
n.a.
n.a.
n.a.
n.a.
1.34*
4.49*
n.a.
2.02*
0.58

2.03*
1.15
1.43*
n.a.
n.a.
0.94
1.27
0.95
0.73*
1.00
n.a.
n.a.
n.a.
n.a.
1.43*
3.22*
n.a.
3.77*
0.93

Boys

n.a.
1.09

Boys

Indonesia

0.38*
0.94
0.76
n.a.
n.a.
n.a.
n.a.
n.a.
n.a.
1.24*
8.59*
n.a.
3.97*
3.12

n.a.
n.a.
n.a.
0.18*
1.76*

n.a.
0.47

Girls

Nepal

1.22
0.95
0.93
n.a.
n.a.
n.a.
n.a.
0.82
0.67*
1.37*
2.11*
1.48*
1.45
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

0.81
1.12

Boys

1.3
1.29
0.61*
n.a.
n.a.
n.a.
n.a.
1.07
0.76
1.30*
1.04
1.06
1.64
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

2.98*
1.47

Girls

The
Philippines

0.34
n.a.
n.a.
0.42*
1.36
1.18
0.25*
n.a.
0.38*
1.13
4.38*
n.a.
n.a.
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

n.a.
0.95

Boys

1.74
n.a.
n.a.
0.87
0.71
0.51
0.50*
n.a.
0.29*
0.80
3.93*
n.a.
n.a.
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

n.a.
0.75

Girls

Taiwan

1.23
0.79
n.a.
1.23
0.79
n.a.
n.a.
n.a.
0.54
1.46*
2.14*
1.75*
n.a.
n.a.

n.a.
n.a.
n.a.
n.a.
n.a.

1.10
1.06

Boys

Thailand

Table 3 Estimated odds ratios of current smoking status, boys and girls aged 1519 in Indonesia, Nepal, the Philippines, Taiwan, and
Thailand

82

M. K. Choe et al.

Journal of Youth Studies

83

fathers education on the smoking behavior of boys and girls may be explained by
the gender differences in the norms. It is likely that, in general, smoking is viewed
as an acceptable behavior for boys but not for girls, especially among the unmarried.
Boys whose fathers have high level of education are likely to be economically better
off and can pay for tobacco products more easily than those whose fathers have less
education. On the other hand, for girls, having fathers with more education may
mean a higher level of parental supervision of their behavior and less smoking.
Three of the four variables indicating transition to adulthood have large impacts
on smoking behavior. Smoking prevalence increases with age for both boys and girls.
Boys and girls who are out of school are much more likely to smoke than those who
are still in school. Married teens are more likely to smoke than single teens, for both
sexes.
Philippines
Residence has no effect on the smoking behavior of boys, but has a statistically
significant effect among girls: girls in Manila are more likely to smoke than girls
elsewhere.
Neither fathers education nor mothers education has a statistically significant
effects on the smoking behavior of boys and girls age 1519. The relationship with
parents has some effect on the smoking behavior of girls: the girls who are raised by
both parents are less likely to smoke than those who are not raised by two parents.
Three of the four variables indicating transition to adulthood have statistically
significant effects on smoking among boys: older age, being out of school, and
having lived away from parents all increase the probability of smoking among boys
age 1519. On the other hand, only age has statistically significant effect on smoking
among girls.
Planning to have college education is associated with a low prevalence of smoking
among boys, but not among girls. Being strongly religious does not affect smoking
behavior of either sex. It is interesting to note, however, that the study of other
risk-taking behavior found that strong religiosity is associated with lower probability
of drinking and drug use (Choe & Raymundo 2001).
Taiwan
Among Taiwanese teens, urban residence and fathers education do not have
statistically significant effects on smoking behavior. Of the four variables describing
relationship with parents, two have statistically significant effects on smoking
behavior among boys. Among boys, having a lot of time with father, and talking to
mother at times of trouble lowers smoking prevalence. Among girls, only one of the
four factors describing the relationship with parents is statistically significant: girls
who talk to mothers at times of trouble are less likely to smoke.
One of the two variables describing transition to adulthood, age, is not statistically
significant for either boys or girls. Not going to school, on the other hand, has large
and statistically significant effects on smoking among both boys and girls age 1519.

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M. K. Choe et al.

Thailand
Urbanrural residence and parents education do not have statistically significant
effects on the boys smoking behavior in Thailand. Whether boys get along well with
father and mother, or whether they plan to go to college or not do not affect
smoking behavior of teen boys either.
On the other hand, all three variables indicating stages of transition to adulthood
have statistically significant effects on smoking behavior among boys: being older,
being out of school, and having lived away from parents increase the probability of
smoking.

Summary and Discussion

In the five diverse Asian societies we examined, smoking is quite prevalent among
boys age 1519 but rare among girls. The gender difference is largest among
Indonesian teens and smallest among Nepalese teens. Thus, the gender difference in
smoking behavior among adolescents reflects the gender differences among adults,
indicating the impact of norms. More than one-half of boys in Indonesia, Thailand,
and the Philippines begin smoking between ages 15 and 20. In Nepal, 24 percent of
boys do. This finding indicates that education on health implications on smoking
should begin with adolescents under age 15 and should include programs to help
youth who have already begun to smoke to quit smoking.
In the following, we summarize the results of the analysis, estimating the effects
of covariates on the currents status of smoking. As we discuss the similarities and
differences in the covariates of smoking, it should be noted that the discussions are
based on a set of statistical models estimated separately for each country and gender.
No formal statistical tests have been made regarding the similarities and differences.
Rather, the discussions are based on informal comparisons.
The effect of residence on current smoking behavior shows an interesting pattern.
In the Philippines, girls living in Manila are much more likely to smoke than girls
living elsewhere. It is interesting to note that, of the five countries under study,
lifetime experience of smoking among girls is highest in the Philippines. Similar
findings about the effect of living in metropolitan areas on smoking behavior have
been observed among South Korean teen girls, where the prevalence of smoking
among teens increased substantially in recent years (Han et al. 2001). When the
prevalence of smoking among teen girls increases in Asian countries, it seems to
increase first in metropolitan areas. This finding is consistent with our hypothesis
that modernization narrows the gender differences in smoking. It indicates that
continuing modernization is likely to result in high prevalence of smoking among
teen girls in Asian countries.
At the same time, variations in the prevalence of smoking by region in Indonesia
and Nepal, two of the least developed countries in our study, indicate that smoking
is more prevalent in agricultural rural areas where teens are likely to have easy access
and teen smoking may be viewed as acceptable. In summary, smoking continues to

Journal of Youth Studies

85

be a traditional health risk for some youth in developing countries and is also
emerging as a new health risk for some other youth.
Parents, especially fathers, have potentially important roles in reducing tobacco
epidemic among teens. Teen boys who have close relationships with their fathers are
less likely to smoke than the boys who do not. This finding is consistent with our
hypotheses on the parental role in adolescent behavior.
Consistent with our hypotheses, smoking is much more prevalent among teens
who have experienced some transitions to adulthood such as leaving school, living
away from parents, and being married. Among them, being out of school has the
most consistent and strong effect on smoking behavior in all five countries. Being
married has a strong effect on smoking in Indonesia and Nepal. These findings
suggest that large proportions of teens in these Asian countries, especially boys, pick
up smoking as a part of normal behavior associated with their transition to
adulthood. A high prevalence of smoking among young married women under age
20 such as those found in Nepal calls for special needs in reproductive health
programs. Young married women need to be informed about risks associated with
smoking during pregnancy, such as low birth weights and the high probability of
perinatal complications, and be encouraged not to smoke.
Most countries in Asia have weak policies and programs for tobacco control, with
the exception of Thailand. The tobacco control programs in Thailand are reported
to be comparable with the best in the world. Taxes on cigarettes are high, no
advertisement of cigarettes in any media is permitted, and there are strong and
varied warning labels on cigarette packets (Corraro et al. 2000). Studies show that
these strong policies and programs for tobacco control in Thailand are beginning to
take effect (Subhawongse et al. 1997). Similarly strong programs, when adopted, can
probably lower the smoking prevalence in other Asian countries.
Acknowledgements
The survey in Indonesia was carried out by the National Family Planning Coordinating Board and Demographic Institute, University of Indonesia, with financial
support from USAID, through Pathfinder Internationals FOCUS on Young Adults
program, and the World Bank. The Nepal survey was carried out by Valley Research
Group with technical support from Family Health International (FHI) and financial
support from USAID through FHI. In the Philippines, the Population Institute of
the University of Philippines carried out the survey with financial support from
UNFPA. In Taiwan, the survey was carried out by the Taiwan National Institute for
Family Planning with financial support from the Department of Health, Taiwan. In
Thailand the survey was carried out by the Institute for Population and Social
Research, Mahidol University, with financial support from UNFPA. The analysis of
data for this paper was supported by funds from USAID through its MEASURE
Evaluation project. Shi-Jen He and Jin-Young Byon at the EastWest Center helped
with data analysis. Comments from anonymous reviewers contributed significantly
in improving the manuscript.

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M. K. Choe et al.

Notes
[1]

[2]

[3]

The information on ever smoked was collected by the simple question Have you ever
smoked? in Nepal, Taiwan, and Thailand. The Indonesian survey included the phrase Did
you smoke just to try?, and those who responded positively are included as ever having
smoked. The Philippines survey asked Have you ever tried smoking? The information on
current smoking status was collected by Do you still smoke at present? in Indonesia. The
question was asked only if the respondent ever smoked, excluding those who just tried. In
Nepal, the survey asked Do you smoke now? In the Philippines survey, the question was
Currently, are you regularly smoking cigarettes?, with response categories regularly,
occasionally, and no. Respondents who responded either regularly or occasionally are
classified as current smokers. In the Taiwan survey, the question was Do you smoke?, and
the respondents who answered yes were classified as current smokers. The Thai survey
asked How often did you smoke last month?, and those who answered everyday, 45
times a week, 23 times a week, or once a week or less are classified as current smokers.
Age at first initiation of smoking was obtained from the question At what age did you
smoke for the first time? The question was asked for all respondents who ever smoked
excluding those who just tried in Indonesia, and for all respondents who ever smoked in
Nepal, Taiwan, and Thailand. In the Philippines survey, the question was At what age did
you first try to smoke cigarettes?
To see whether the results are sensitive to the definitions for a high level of education, we
tried a few different definitions, but all of them gave similar results.

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