The Correlation Between Smoking Behavior and Hypertension in the

Productive Age Population at Banjar Ubung Kaja, North Denpasar

I Gde Yudara Sandra Putra

, I Gusti Agung Tresna Wicaksana

and Ni Wayan Sri Rahayuni

Bachelor of Nursing Program, Faculty of Health, Institute of Technology and Health Bali, Bali, Indonesia

Bachelor of Midwifery Program, Faculty of Health, Institute of Technology and Health Bali, Bali, Indonesia

Keywords: Smoking Behavior, Hypertension, Productive Age.

Abstract: Hypertension is an asymptomatic condition in which abnormally high pressure in the arteries causes an

increased risk of stroke, aneurysm, heart failure, and heart attack among other conditions. One of the causes

of hypertension is smoking, which is an activity many people engage in, including teenagers or people in

the productive age. This study aimed to determine the correlation between smoking behavior and

hypertension of people in the productive age at Banjar Ubung Kaja, North Denpasar. This study employed

a correlational analytic design with a cross-sectional approach. There were 183 respondents recruited as the

sample through probability sampling with the random sampling technique. The data were collected using

observation sheets, sphygmomanometer tools, and a questionnaire. Furthermore, the data were processed

through the bivariate data analysis with Spearman’s Rho test. This study found that based on the statistical

analysis test, the p-value (sig) was 0.000 (<0.05), which meant that there was a correlation between smoking

behavior and hypertension in productive age people at Banjar Ubung Kaja, North Denpasar. There was a

correlation between smoking behavior and the incidence of hypertension with a significant correlation value

of -.397. This indicates that the higher the smoking behavior, the higher the incidence of hypertension.

1 INTRODUCTION

Hypertension is a blood circulation system disorder

that results in an increase in blood pressure above the

normal value or blood pressure of 140/90 mmHg

(KEMENKES, 2019). Hypertension is an

asymptomatic condition, where abnormally high

pressure in the arteries causes an increased risk of

stroke, aneurysm, heart failure, heart attack, and

damage (Umam et al., 2020). Hypertension is a silent

killer where symptoms can vary in each individual

and are almost the same as the symptoms of other

diseases. Hypertension symptoms include headache/a

heavy feeling in the neck, nausea (vertigo), heart

palpitations, being easily fatigued, blurred vision,

ringing in the ears (tinnitus), and nosebleeds

(KEMENKES, 2019).

According to data from the World Health

Organization (WHO) in 2015, hypertension is defined

as having a systolic blood pressure of 140 mmHg

https://orcid.org/0000-0003-1616-5873

https://orcid.org/0000-0002-1578-9898

https://orcid.org/0000-0003-3042-8799

and/or diastolic blood pressure of 90 mmHg. The

WHO has predicted that by 2025, 1.5 billion people

in the world will suffer from hypertension every year

(Umam et al., 2020). The high hypertension incidence

in the world is influenced by two types of factors,

namely modifiable and non-modifiable. Non-

modifiable factors are those that cannot be changed

such as age, gender, and race. Modifiable factors

include obesity, alcohol consumption, lack of

exercise, excessive salt consumption, and smoking

habits.

Smoking is a problem that continues to grow, and

a solution has not been found in Indonesia until now.

According to WHO data from 2011, in 2007,

Indonesia was in the 5th position with the highest

number of smokers in the world (Suhadi & Pratiwi,

2020). Smoking can cause hypertension due to

chemicals contained in tobacco that can damage the

inner lining of the artery walls, making the arteries

more susceptible to plaque buildup (atherosclerosis).

Putra, I., Wicaksana, I. and Rahayuni, N.

The Correlation Between Smoking Behavior and Hypertension in the Productive Age Population at Banjar Ubung Kaja, North Denpasar.

DOI: 10.5220/0011937900003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 15-19

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

This is mainly due to nicotine which can stimulate the

sympathetic nerves, which triggers the heart to work

harder and causes blood vessel constriction. This also

triggers the carbon monoxide function, which can

replace oxygen in the blood and force the heart to

meet the body's oxygen needs. Today, smoking is not

taboo for most people. Smoking behavior has been

entrenched in the global community, especially

among teenagers.

The chemicals contained in cigarettes are

addictive, which means they can cause dependence,

and if they are dependent, people will continue to

smoke cigarettes. Smoking behavior, especially in

adolescents, if carried out continuously, will cause

various diseases, one of which is hypertension. This

study was carried out in Banjar Ubung Kaja, North

Denpasar on adults and adolescents. The stages of

development can be characterized by an increased

smoking frequency and intensity. This often results in

them becoming addicted to nicotine. Nicotine can

cause addiction, both in active smokers and passive

smokers.

Nicotine is a stimulant alkaloid (Dwi, 2013).

Smoking behavior refers to sucking tobacco smoke

from a lit cigar or cigarette. Smoking can cause

hypertension due to the chemicals contained in

tobacco, especially nicotine, which can stimulate the

sympathetic nerves to trigger the heart to work faster.

This results in quicker blood circulation and blood

vessel constriction. This also impacts carbon

monoxide’s role in replacing oxygen in the blood and

forcing the heart to meet the body's oxygen needs

(Rachmat et al., 2013).

2 METHODS

This study used a correlative analytic research design

with a cross sectional approach. It was conducted

from February to March 2022. The population in this

study was the productive age community in Banjar

Ubung Kaja, North Denpasar with a total of 350

people. The sampling technique used was probability

sampling. Data collection was carried out using

Google Forms and tension measuring devices. The

inclusion criteria in this study were people who were

willing to participate, agreed to sign the study’s

informed consent form, had a mobile phone with the

WhatsApp (WA) application and were able to use it,

and people of productive age (15-64 years) who

smoked.

The research instrument consisted of four parts,

the first part being informed consent, the second part

demographic data, the third part a smoking behavior

questionnaire, and the fourth part a hypertension

observation sheet. The smoking behavior

questionnaire was a standardized questionnaire, and

there were changes made according to a validity test.

The hyperthesis observation sheet was a non-standard

observation sheet on which the validity test had been

carried out. The normality test in this study had the

value of sig < 0.05. Data were analyzed using

Spearman’s Rho test.

3 RESULTS

Table 1: Respondents’ Characteristics.

Characteristic Frequency

(

)

Percentage

(

)

Productive Age (17-60) 183 (100%)

Gender

Male 177 (98%)

Female 6 (2%)

Occupation

Student 38 923%)

Government employee 19 (5%)

Farmer 48 (30%)

Private employee 11 (9%)

Laborer 26 (14%)

Businessman 38 (25)

Unemployed 3 (2%)

Marital Status

Married 111 (85%)

Single 72 (15%)

Table 1 shows respondents’ characteristics in this

study, namely age, gender, occupation, and marital

status (n = 183). Based on the results of data

collection, it is evident that the majority of

respondents were 56. Based on occupation, the largest

proportion of respondents were farmers with as many

as 48 with that occupation (26.2%). Based on marital

status, the majority were married, with as many as

111 respondents (60.7%). Based on the results of data

collection, it was found that the majority of

respondents engaged in light smoking behavior at as

many as 150 respondents (82%), and heavy smoking

behavior was identified in as many as 33 respondents

(18%).

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

Table 2: Hypertension History.

Hypertension

History

Characteristics

Frequency

(n)

Percentage

(%)

History of HT

Yes 160 87.4%

No 23 12.6%

Diagnosed with

Yes 160 87.4%

No 23 12.6%

History of genetic

Yes 163 89.1%

No 20 10.9%

On the distribution of hypertension frequency and

percentage (n = 183) (31.7%), stage 1 hypertension

category was found in as many as 28 respondents

(15.3%), and stage 2 hypertension in as many as six

respondents (3.3%). Table 2 consists of the

correlation coefficient (r), p-value, and the number of

respondents. Spearman’s Rho was used to analyze the

relationship between smoking behavior and

hypertension in the productive age population in

Banjar Ubung Kaja, North Denpasar (n = 183). Other

variables and data were not normally distributed with

a p-value of 0.000 (p <0.05), which means Ha was

accepted and H0 was rejected. This study found that

there was a relationship between the smoking

behavior and hypertension variables. The correlation

coefficient was calculated to be -.397, which means

indicates a negative direction and sufficient

relationship strength where the higher the smoking

behavior, the higher the hypertension incidence.

4 DISCUSSION

According to (Astuti, 2012) smoking behavior refers

to burning tobacco which is then smoked, either using

cigarettes or pipes. In this study, smoking behavior

was divided into two categories, namely light

smokers with less than 10 cigarettes per day,

moderate smokers with 10-20 cigarettes per day, and

heavy smokers with more than 20 cigarettes per day.

The results obtained from the 183 respondents were

that as many as 150 respondents (82.0%) were in the

mild category and as many as 33 respondents (18.0%)

were in the severe category. In regards to the

statement "I still smoke even though I have family or

friends around me who do not smoke", 35% of

respondents answered “never”.

Based on these results, smoking behavior is

thought to be closely related to the surrounding

environment’s influence and conditions. The

questionnaire results showed that out of 183

respondents, 21.9% answered “always” to the

question about smoking 1-9 cigarettes a day, 12.6%

answered “always” to the question about smoking 10-

20 cigarettes in a day, and 11.5% answered “always”

to the question about smoking 20-30 cigarettes per

day. It is assumed that the smoking behavior in the

Ubung Kaja village among those within the

productive age mostly falls into the mild category.

This is because even though the respondents smoke,

it is still within reasonable limits, which is an average

of 1-9 cigarettes per day. Light smoking behavior is

caused by people knowing that smoking behavior is

influenced by peers, parents, the work environment,

as well as the environment at home. In this study,

smoking behavior was mostly found to be light due to

the respondents still being in the productive age,

implying they spent more time at work and did not

have time to smoke in short intervals. The productive

age is the age where the activities carried out are quite

dense, such as work.

Workplace rules that prohibit employees from

smoking contribute to reducing smoking behavior,

resulting in lighter smoking behavior in Banjar

Ubung Kaja. Although most respondents had light

smoking behavior, 18% still engaged in heavy

smoking behavior. This is due to other factors such as

environmental influences, social influences, family

environment, and self-will to smoke. Smoking is one

of the risk factors for hypertension. Nicotine in

cigarettes causes an increase in blood pressure

immediately after the first puff. Like other chemicals

in cigarette smoke, nicotine is absorbed by the tiny

blood vessels in the lungs and circulated into the

bloodstream. In just a few seconds, nicotine will

reach the brain.

Behavior is the action or activity of the organism

concerned, which can be observed directly or

indirectly (Hartanto, 2012). Behavior is defined as an

action reaction of organisms to their environment.

New behavior occurs when something is needed to

cause a reaction, which is called a stimulus. This

means that the stimulus will produce a certain

reaction or behavior (Daud, 2020).

Hypertension is an increase of more than 140

mmHg in systolic blood pressure and an increase of

more than 90 mmHg in diastolic blood pressure on

two measurements with an interval of five minutes in

a state of sufficient rest/quiet (Indonesian Ministry of

Health, 2014). Table 5.5 shows that 91 respondents

had normal blood pressure (49.7%). These results are

supported by the questionnaire results, namely that

87.4% of respondents answered that they did not have

a history of hypertension, 88.9% had never been

diagnosed with hypertension, and 89.1% did not have

The Correlation Between Smoking Behavior and Hypertension in the Productive Age Population at Banjar Ubung Kaja, North Denpasar

a hereditary history of hypertension. However,

although most respondents' blood pressure was

normal, there were still respondents who got results

in the categories of pre-hypertension, stage 1

hypertension, and stage 2 hypertension. The

respondents in this study were still of productive age

and it is possible that the respondents will experience

hypertension as they get older.

Respondents who did not have normal blood

pressure may place the blame on several factors that

play a role in hypertension incidence. Risk factors for

hypertension include obesity, lack of exercise,

smoking, and consuming alcohol. Other factors that

influence hypertension prevalence include obesity,

high salt intake, and a family history of hypertension.

Emotional disturbances, excessive alcohol

consumption, excessive coffee stimulation, smoking

habits, and stimulating drugs can also play a role in

hypertension development. However, this disease is

strongly influenced by heredity. This disease also

affects more women than men (Handayani et al.,

2022).

Spearman's Rho yielded results where if the p-

value was 0.000 (p < 0.05), then Ha is accepted and

H0 is rejected. This indicates that there was a

significant relationship between the smoking

behavior and hypertension variables with a

correlation strength of -.397. This means the

relationship between the variables was negative (-)

because the results were that the lighter the smoking

behavior, the lower the hypertension incidence in the

productive age population in Banjar Ubung Kaja. The

productive age is a period where the body's organs

and physical strength are in good condition, meaning

their immunity is stronger than the elderly’s.

Unhealthy lifestyle behaviors such as smoking have

no visible impact at the productive age. However,

with time and increasing age, it is feared that smoking

can make health conditions worse, such as

experiencing hypertension in old age due to smoking

behavior in one’s younger years. Although

respondents’ current smoking behavior tended to be

mild and most did not have hypertension, it is better

to maintain a healthy lifestyle because smoking

causes hypertension, whether the impact can be seen

now or at later stage in life.

Smoking is a modifiable factor. The relationship

between cigarettes and hypertension stems from

nicotine, which causes an increase in blood pressure

when absorbed by small blood vessels and circulated

in the lungs and to the brain. The brain reacts to

nicotine by signaling the adrenal glands to release

epinephrine (adrenaline). This powerful hormone

constricts blood vessels, forcing the heart to work

harder and causing higher blood pressure. The carbon

monoxide in cigarette smoke replaces oxygen in the

blood. This results in higher blood pressure because

the heart is forced to pump to transfer sufficient

oxygen into the body’s organs and tissue (Ishwari

Adhikari & Santosh, 2021). Toxic chemicals in

cigarettes can cause high blood pressure or

hypertension. One of these toxic substances is

nicotine, which can increase adrenaline which makes

the heart beat faster and work harder; the heart rate

and contractions increase, causing increased blood

pressure (Abedini et al., 2020).

Differences in hypertension levels can be

attributed to differences in cigarette consumption,

basically meaning smoking affects hypertension

incidence. Toxic chemicals, such as nicotine and

carbon monoxide, that are inhaled through cigarettes

and enter the bloodstream can damage the arteries’

endothelial lining, resulting in atherosclerosis and

high blood pressure. An autopsy found a close

relationship between smoking habits and the presence

of atherosclerosis in all blood vessels. Smoking in

patients with high blood pressure further increases the

risk of damage to the heart. This study is similar to

the research of Irene, Josef, and Nurmansyah in 2019

entitled "The Relationship Between Smoking and

Hypertension at the Kawangkoa Health Center”. In

this study, it was found that smoking behavior was

mostly moderate, with the majority having normal

blood pressure. However, this study differs from the

research of Eric Untario (2017) with the title "The

Relationship of Smoking to the Incidence of

Hypertension". The study stated that there was no

relationship between smoking habits and

hypertension incidence because the sample size used

was insufficient to show the significance in this study.

5 CONCLUSION

From the results of research conducted in Banjar

Ubung Kaja, North Denpasar regarding the

relationship between smoking behavior and

hypertension in the productive age population with

183 respondents, the results were: 13 respondents

were 56 years old (7.1%), 177 were male (96%), 48

were farmers (26.2%), and 111 were married

(60.7%). The study found that as many as 150

respondents were light smokers (82%). The study

found that most respondents with normal

hypertension were in their productive age with as

many as 91 people (49.7%). Based on Spearman’s

Rho correlation test, there was a relationship between

smoking behavior and the hypertension incidence in

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

the productive age population in Banjar Ubung Kaja,

North Denpasar.

6 SUGGESTION

Further researchers can examine similar topics by

reviewing various factors from this study that have

not been disclosed such as age, occupation, and stress.

REFERENCES

Abedini, M. R., Bijari, B., Miri, Z., Emampour, F. S., &

Abbasi, A. (2020). The quality of life of the patients

with diabetes type 2 using EQ-5D-5 L in Birjand. 8, 1–

Astuti, K. (2012). Gambaran Perilaku Perokok Pada

Remaja Di Kabupaten Bantul. Insight, 10(1), 77–87.

http://fpsi.mercubuana-yogya.ac.id/wp-

content/uploads/2012/06/6.GAMBARAN-

PERILAKU-MEROKOK-PADA-REMAJA-DI-

KABUPATEN-BANTUL.pdf

Daud, E. R. L. (2020). Pekerja Rumah Tangga Sebagai

Korban Kekerasan Dalam Rumah Tangga. Jurist-

Diction, 3(5), 1681.

https://doi.org/10.20473/jd.v3i5.21973

Dwi, S. (2013). Perilaku merokok di kalangan pelajar (

Studi kasus tentang faktor dan dampak dari perilaku

merokok pada kalangan pelajar SMA Negeri 2

Karanganyar). SOSIALITAS; Jurnal Ilmiah Pend. Sos

Ant, 3(2), 1–14.

http://jurnal.fkip.uns.ac.id/index.php/sosant/article/vie

w/2645

Handayani, D., Dominica, D., Pertiwi, R., Putri, F. R. .,

Chalifatul, T., & Ananda, D. (2022). Evaluasi Kualitas

Hidup Pasien Diabetes Melitus Tipe 2 Dengan

Antidiabetik Oral Di Rumah Sakit Harapan dan Do’a

Kota Bengkulu. Jurnal Ilmiah Farmasi Farmasyifa,

5(1), 9–19. https://doi.org/10.29313/jiff.v5i1.7983

Hartanto, C. (2012). Universitas Indonesia Universitas

Indonesia Jakarta. Fmipa Ui, 0806455143, 1–95.

Ishwari Adhikari, B., & Santosh, B. (2021). Self-care

Management among Patients with Type 2 Diabetes

Mellitus in Tanahun, Nepal. Archives of Community

Medicine and Public Health, 7, 037–042.

https://doi.org/10.17352/2455-5479.000131

KEMENKES. (2019). Health Statistics (Health Information

System). In Short Textbook of Preventive and Social

Medicine. https://doi.org/10.5005/jp/books/11257_5

Rachmat, M., Thaha, R. M., & Syafar, M. (2013). Perilaku

Merokok Remaja Sekolah Menengah Pertama.

Kesmas: National Public Health Journal, 7(11), 502.

https://doi.org/10.21109/kesmas.v7i11.363

Suhadi, & Pratiwi, A. (2020). Pengaruh Hipnosis Lima Jari

Terhadap Tingkat Kecemasan Pasien Pre Operasi di

Ruang Perawatan Bedah RSUD Pakuhaji. Jurnal

Health Sains, 1(5), 2548–1398.

http://jurnal.healthsains.co.id/index.php/jhs/article/vie

w/54/89%0Ahttp://jurnal.healthsains.co.id/index.php/j

hs/article/view/54

Umam, M. H., Solehati, T., & Purnama, D. (2020).

Gambaran Kualitas Hidup Pasien Dengan Diabetes

Melitus. Jurnal Kesehatan Kusuma Husada, 70–80.

Jurnal.ukh.ac.id

The Correlation Between Smoking Behavior and Hypertension in the Productive Age Population at Banjar Ubung Kaja, North Denpasar