The results of the analysis inform that female workers in urban areas in both countries have a higher probability of becoming smokers than those living in rural areas. The urban area is defined by 19 as an area that can be seen from several aspects, including population, infrastructure, and public facilities. Thus, with various kinds of facilities in the urban area and easy access to these existing facilities, female workers have the potential to become smokers. This is in line with research conducted in Indonesia by 20 which states that the female respondents of the study in Surabaya (one of the major cities in Indonesia) smoked 13 cigarettes a day in a day.
Other studies show similar findings from this study, such as research conducted by 21 in Shanghai, stated that there are a small proportion of migrant workers in Shanghai who are female smokers. Another study in Indonesia, also shows that women living in Yogyakarta (another big city in Indonesia) compensate for their stress feelings by smoking 22. Studies in China regarding female students who smoke with urban and rural backgrounds state that the prevalence of smoking students in urban settings is higher than that of smoking students in rural settings 23.
The results of the study found that the age group is one of the determinants of smoking behavior among female workers in the Philippines and Indonesia. The age group of 45-49, have a smaller risk of smoking than other age groups. Human age can be divided into several periods, according to 24, there are at least 8 age periods, and the 45-49 age group is an age group known as middle adulthood. At the age of 45-49, people feel in good condition, so that the relative problem does not become a psychological burden, so that the risk of smoking becomes small. This is different from the age group below which psychologically still sees a problem as a burden, so that it has the potential to engage in smoking as a coping mechanism.
Research conducted by 25 supports the above statement, that there are some young women in China's Shandong Province who smoke, either with the classification of "ever smoked" or "frequently smoked" in 30 last day. Study conducted in the America by 26 is in line with what was found from this study, namely that the number of female smokers is dominated by the 26-44 year age group. However, a different situation exists in Australia, 27 stated that the age group categorized as middle age has a smoking prevalence rate that is quite high compared to the age groups below it.
The binary logistic regression results found that marital status is one of the determinants for female workers in the Philippines and Indonesia to become a smoker. Female workers with marital status never in union and married / living with a partner have a lower probability of becoming a smoker than those who have marital status in the widowed/divorced category. The problems faced by widowed women are increasingly complex and varied, including violence, nutritional status, and reproductive health 28. The complexity of these problems can be categorized as stressful life events 29 of a window which can then trigger smoking as a coping strategy 30.
Research conducted in the Netherlands, widows' groups also smoke, not only conventional cigarettes, but also using electronic cigarettes 31. Another study by 32 which aims to shed light on one side of the contentious debate just outlined by investigating whether e-cig advertising on television and in magazines encourages adult smokers to quit. From this study, one of the findings that are in line with the research findings is that the widow group also does smoking activities. Other findings from existing research are from 33, stated that the group of widows who smoke in Korea makes up nearly 10% of the researchrespondents.
The analysis also reveals that the level of education is found to be one of the determinants of smoking behavior among female workers in the Philippines and Indonesia. A phenomenon that illustrates that a person's education level can influence his decision to smoke or not. Research conducted by 34 stated that there are several aspects in the context of the level of education that affect a person's smoking behavior. Research conducted in Italy 35 found that the prevalence of smoking in the group with a high level of education (university graduation) was lower than in other groups.
The phenomenon of the prevalence of female smokers with a low level of education was also found in studies in China. The study found that education level was significantly related to smoking behavior 36. Another study conducted in Japan found a similar pattern, namely that in the group of female smokers, the level of education was significantly associated with current smoking behavior 37. Also, research conducted by (Justus, SantAnna, Davanzo, & Moreira, 2020) in Brazil found a similar pattern to the above research, namely that higher education levels are associated with lower smoking probability and lower daily consumption intensity.
Moreover, parity is informed as a determinant for female workers to become smokers in the two countries. This study found that female workers who were grand multiparous had a lower risk of smoking compared to other age groups. The reason the multiparous group has a low risk of smoking, among others, is because they have a strong desire and commitment not to become pregnant while pregnant, this is related in several studies, including 39, 40 and 41.
Research in other countries shows more or less the same pattern, including research conducted in Ireland which found that smoking rates in the grand multiparous group were quite low compared to other groups 42. The same research results were also found by 43, that multiparous women are less likely to quit on their own. Meanwhile, research conducted in Greece by 44, found different things, namely that the multiparous group was less likely to quit smoking when pregnant.
The analysis result found that currently pregnant is a protective factor for female workers in the Philippine and Indonesia to become a smoker. This reinforces the concept that pregnant women who smoke have a health risk, both for the mother and for the fetus/womb. 45 states that smoking during pregnancy increases the risk of health problems for developing babies, including preterm birth, low birth weight, and birth defects of the mouth and lip. Smoking during and after pregnancy also increases the risk of sudden infant death syndrome (SIDS) 46 stated that the harm from cigarette smoking is primarily from carbon monoxide and tar, which contribute to the complications seen during pregnancy. Nicotine alters fetal brain development and contributes to behavioral disorders in the offspring of smokers.
Research on pregnancy and smoking behavior shows some interesting things to explore. Research conducted by 47 identifies the prevalence of smoking during pregnancy, and the general result is that globally the figure is relatively small, namely 1.7%. Meanwhile, the highest prevalence of smoking during pregnancy was in the European Region (8.1%, 4.0–12.2), and the lowest prevalence of smoking during pregnancy was in the African Region (0.8%, 0.0 –2.2). Meanwhile, in China, research conducted by 48 stated that based on their research results there are about 82.9% of smoking women quit smoking after they were pregnant, and the prevalence of smoking among pregnant women was 3.8%.
The multivariate test results found that wealth status was also a determinant of smoking behavior for female workers in both countries. The poor cannot be separated from their dependence on cigarettes for several reasons, including stress relievers, cheap free time, compensation for loneliness, separation, or termination of employment 49. The Truth Initiative, one of the NGOs engaged in tobacco control, states that the causes of the poor are still caused by the programs developed by the cigarette industry, including the proliferation of cigarette sales places, massive cigarette advertisements, and cheap cigarette prices 50.
Research conducted by 51 stated that living in a poorer environment presents a unique risk for smoking among adults aged 30 to 39 years and over. Other studies in China also produced the same findings, 52 stating that the lower the socio-economic conditions of the respondents, the higher the prevalence of smoking. Research by comparing several countries conducted by 53 also shows a pattern, namely that the lower the socioeconomic level of a group, the higher the smoking behavior level of that group.