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 Epidemiology and Society Health Review| ESHR 
Vol. 5, No. 1, 2023, pp. 11-20 ISSN 2656-6052 (online) | 2656-1107 (print) 
      http://journal2.uad.ac.id/index.php/eshr/index                                                   eshr@ikm.uad.ac.id 

 
 

 

  10.26555/eshr. v5i1.7237  

 
11 

 
 

  

Research Article 
 
Study of adolescent health behavior towards non-
communicable disease risk factors in Special Region of 
Yogyakarta 
 
Luthfi Nur Rochman Sudarko1, Sitti Nur Djannah1*, Lina Handayani1, M. 
Syamsu Hidayat1, Intan Wahyuni Tukiyo1 
1 Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia 
 
* Correspondence: sitti.nurdjannah@ikm.uad.ac.id. Phone: +6285868180863 
correspondence: sitti.nurdjannah@ikm.uad.ac.idcom. Phone: +62858-6818-0863 
Received 04 January 2023; Accepted 02 February 2023; Published 08 February 2023 
 

ABSTRACT 

Backgrounds: Non-Communicable Diseases (NCDs) are still one of the causes of high 
incidence and death rates in people of various age groups, especially adolescents with poor 
lifestyles and health behaviors due to a lack of awareness to prevent NCDs from an early 
age. This study aimed to analyze adolescents health behavior of adolescents aged 15-24 
years toward risk factors for non-communicable diseases based on the RISKESDAS results 
of the Special Region of Yogyakarta. 
Methods: This research is a quantitative descriptive study using secondary data to analyze 
the health behavior of adolescents aged 15-24 towards risk factors for non-communicable 
disease behavior based on data collected from RISKESDAS data for the Special Region of 
Yogyakarta in 2007, 2013, and 2018. Data analysis was carried out descriptively for each 
risk factor and presented as a percentage chart. 
Results: The research shows that the risk factors for smoking every day and occasionally 
have decreased from 2007 to 2018. There has been an increase in the awareness of 
consuming fruits and vegetables. Meanwhile, there was an increase in alcohol consumption 
in 2018 and a decrease in doing sufficient physical activity for one week in adolescents aged 
15-24 years in the Special Region of Yogyakarta. 
Conclusion: It can be concluded that risk factors for health behavior related to non-
communicable diseases in adolescents are still caused by a lack of physical activity and the 
large number of adolescents who consume alcohol. 

Keywords: Adolescent, Health Behavior, Non-Communicable Disease, RISKESDAS, Risk 
Factors 

 



 
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INTRODUCTION  

Non-communicable diseases (NCDs) kill 41 million people yearly, equivalent to 74% of all 
deaths globally. Each year, 17 million people die from NCD before age 70; 86% of these 
premature deaths occur in low- and middle-income countries. Of all NCD deaths, 77% are in 
low- and middle-income countries. Cardiovascular disease is the most common cause of NCD 
death, or 17.9 million people each year, followed by cancer (9.3 million), chronic respiratory 
disease (4.1 million), and diabetes (2.0 million including deaths from chronic kidney disease). 
Tobacco use, physical activity, harmful alcohol use, and unhealthy eating patterns all increase 
the risk of death from NCDs. Over 80% of NCD deaths occur from these four disease groups. 
Detection, screening, and treatment of NCDs and palliative care are critical components of 
the prevention and treatment of NCDs.1 People with degenerative diseases (diseases caused 
by decreased organ function) are increasing due to modern lifestyles, including eating 
patterns, smoking, drinking, and using drugs.2 An unhealthy diet, lack of physical activity, 
exposure to tobacco smoke, or harmful alcohol use are all risk factors that contribute to NCDs 
in children, adults, and the elderly.1 

Basic Health Research (Riskesdas) 2013 shows the trend of non-communicable diseases as 
a cause of death is increasing, from 49.9% (2001) to 59.5% (2007). These non-communicable 
diseases include hypertension (25.8%), obesity (15.4%), stroke (12.1‰), diabetes mellitus 
(6.9%), coronary heart disease (1.5%), and chronic kidney failure (0.2%).3 The disease is 
driven by unplanned rapid urbanization, globalization of unhealthy lifestyles, and population 
aging. Unhealthy eating patterns and lack of physical activity can appear in people as 
increased blood pressure, increased blood glucose, increased blood lipids, and obesity. 
Regarding premature mortality, cardiovascular disease is the most common NCD caused by 
metabolic risk factors.1 

The prevalence of hypertension in the Special Region of Yogyakarta, according to the 2018 
Riskesdas, is 11.01% or higher compared to the national figure (8.8%). The Yogyakarta 
Special Region is in 4th place as a province with high cases of hypertension. Hypertension 
has been included in the top 10 diseases and the top 10 causes of death in the Special Region 
of Yogyakarta for the last few years based on the Integrated Disease Surveillance Health 
Center and Integrated Disease Surveillance Hospital. In 2020, based on the Integrated 
Hospital Disease Surveillance Report in DI Yogyakarta, 6,171 new cases of hypertension and 
33,507 were recorded. The total estimated number of hypertension sufferers aged ≥ 15 years 
is 210,112 cases. In 2020, the estimated number of hypertension sufferers aged ≥ 15 years 
have received health services is 69.6%. Several Diabetes mellitus cases in the Special Region 
of Yogyakarta.4 

Non-communicable diseases are diseases that are not caused by bacterial or viral infections. 
Non-communicable diseases often encountered include hypertension, diabetes mellitus, 
asthma, cardiovascular disease, mental disorders, and accidents. Modernization, improved 
economic status, and lifestyle changes have increased the prevalence of non-communicable 
diseases. In the Special Region of Yogyakarta in 2021, it is estimated that there will be 
251,100 cases of hypertension sufferers aged ≥ 15 years. Those who have received health 
services are 129,420 cases or 51.5%. Cases of diabetes mellitus in 2021 are 83,568 cases, 
and those who receive standard health services are 50,530 cases (60.5%).2,5 



 
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Looking at increasingly modern lifestyles and the impact of diseases caused both 
internationally and nationally, it can also be described in the behavior of adolescents that leads 
to risk factors for non-communicable conditions in the current era. Changes in lifestyle which 
are risk factors for NCDs, can also be described in the behavior of adolescents at this time. 
The prevalence of risk factors is the characteristics, signs, and symptoms of individuals 
statistically associated with an increased incidence of disease in the future. An unhealthy 
lifestyle is often associated with teenagers because of their numerous activities and bad eating 
habits.6–8 In another study, risky alcohol use, drug use, smoking, poor sleep, 
overweight/underweight, sedentary behavior, high media use, and truancy were linked to a 
range of poor mental health outcomes, including depression, anxiety and suicide among them. 
Adolescents (mean age 14.9 years). Risky alcohol use, drug use, smoking, unprotected sex, 
and sleep were all highly clustered lifestyle risk factors, while BMI was not. A risk index of risky 
alcohol use, drug use, unprotected sex, and sleep duration predicted the disease burden 
outcomes with the most incredible precision. More than thirty percent (31.9%) of the sample 
reported one or more of these behaviors. The risk index does not include energy balance risk 
behaviors, but BMI is used as a proxy for these behaviors. Physical inactivity, eating patterns, 
and sedentary behavior was found to coexist in adolescents.9–11 

Previous studies have shown that risk factors for NCD that are at risk in adolescents are less 
consumption of vegetables and fruit and consumption of fast food.12 In addition, adolescents 
are also prone to risky behavior that has not been routinely carried out, namely blood pressure 
checks, physical activity, exercise, lack of consumption of fruits and vegetables, fast food, and 
smoking habits. Early smoking is a risk factor for NCDs, such as hypertension, heart disease, 
stroke, and cancer.6 

Non-communicable diseases occur due to various factors, such as smoking habits, unhealthy 
diets or eating patterns, minimal physical activity, and alcoholic beverages. In addition, family 
health history can also be a trigger for non-communicable diseases. Many productive age 
groups are now experiencing disorders usually experienced by this elderly group. This 
condition is a threat that cannot be ignored. How could it not be? The productive age group is 
expected to become the next generation that will bring Indonesia to face global 
competition.13,14 

According to previous studies, the signs and symptoms generally do not appear during 
childhood and adolescence, making it difficult to detect during this period. Nonetheless, the 
prevalence shows that most hypertension is lower in children or adolescents.15 Based on this 
description, the purpose of this study was to analyze the health behavior of adolescents aged 
15-24 years towards the risk factors for non-communicable disease behavior based on the 
RISKESDAS results from the Special Region of Yogyakarta. 

METHODS 

This research is a quantitative descriptive study using secondary data to analyze the health 
behavior of adolescents aged 15-24 years toward risk factors for non-communicable disease 
behavior. Data was generated from Riskesdas data for the Special Region of Yogyakarta in 
2007, 2013, and 2018. The sample criteria for this study were adolescents aged 15-24 years 
old and having behaviors/habits: smoking habits (passive and active) both daily and 
occasionally, consuming less than five servings of fruit and vegetables, and having a history 



 
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of drinking alcohol in the last month, history of physical activity for less than one week. Data 
analysis was carried out descriptively for each risk factor and presented as a percentage chart. 

RESULTS 

Figure 1 shows the health behavior risk factors in adolescents aged 15-24 years related to 
smoking habits, alcohol consumption habits, daily fruit and vegetable consumption, and a 
history of physical activity for at least 30 minutes daily. The history of smoking habits in 
adolescents aged 15-24 years was dominated by non-smoking adolescents in 2007, 2013, 
and 2018 but experienced a significant decrease every year. The daily history of smoking in 
adolescents decreased in 2007 from 19.2% to 17.26% in 2018. Likewise, smokers sometimes 
also reduced to 7.47% in 2018 compared to 2007 (8.8%) and 2013 (8.35%). This is also 
supported by an increase in ex-smokers in 2018 of 12.78%, a far increase compared to 2007 
of only 2.3%.  

 

Figure 1. Percentage of smoking history behavior in adolescents aged 15-24 years in the 
Special Region of Yogyakarta 

The history of consuming alcohol in adolescents aged 15-24 years in the last month 
increased by 7.5% in 2018 compared to 2007, only 3.7% in 2013 (Figure 2). 

 

Figure 2. Percentage of alcohol consumption in the last month at the age of 15-24 years in 
the Special Region of Yogyakarta 

Figure e shows that the lack of fruit and vegetable consumption in adolescents aged 15-
24 years, as much as five portions in 7 days, has decreased significantly from 2007 at 86.3% 
to 2018 at 31.23%. This shows that awareness of consuming fruits and vegetables among 
adolescents in the Special Region of Yogyakarta has increased regarding one of the risk 
factors that trigger the emergence of non-communicable diseases in adolescents.  

 

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HISTORY OF SMOKING BEHAVIOR

2007 2013 2018

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ALCOHOL CONSUMPTION



 
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Figure 3. Percentage of lack of fruits and vegetable consumption (<5 servings/week) in 15-

24 years old  

Figure 4 shows the behavioral risk factors in adolescents on physical activity. It shows that 
the physical activity carried out by adolescents is still inconsistent; adolescents who did the 
less physical activity for at least 30 minutes per day decreased in 2013 by 31.05%, while 
adolescents who did enough physical activity decreased from 2013 by 63, 95% to 54.26% in 
2018. 

 

Figure 4. Percentage of physical activity (30 minutes/day) in people aged 15-24 years in the 
Special Region of Yogyakarta 

DISCUSSION  

Healthy living behaviors are actions related to a person's efforts or activities to maintain and 
improve their health or a healthy lifestyle. These behaviors include, among others: 1) eating a 
balanced menu (containing nutrients the body needs), and the amount is sufficient to meet 
the body's needs; 2) having regular exercise also includes quality (movement) and quantity in 
terms of the frequency and time used for sports or physical activities other than sports; 3) no 
smoking; 4) avoid drink alcohol or drugs.16 

This study indicated that adolescents aged 15-24 still lack the awareness to consume fruits 
and vegetables and exercise for at least 30 minutes daily. On the other hand, the declining 
number of non-smokers is one of the focus factors for non-communicable diseases. Smoking 
is one of the risk factors for non-communicable diseases that are common in society. Still, 
according to Riskesdas results, smoking is decreasing among people aged 15-24 years. 
Health impacts that can arise from smoking behavior in adolescents include high blood 
pressure and heart problems caused by the influence of chemicals in cigarettes, such as 
nicotine and tar. In addition, it causes a decrease in the sensitivity of the sense of smell and 
taste for smokers.17  

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RC
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GE

LACK OF FRUIT AND VEGETABLES CONSUMPTION
0

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54
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RC

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GE

HISTORY OF PHYSICAL ACTIVITY

Moderately Active Less Active



 
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The research results in developing countries show that smoking habits and diet quality, such 
as low fruit and vegetable consumption, are significantly higher in groups with low 
socioeconomic status, which directly relate to low education. Residents with low education are 
associated with low awareness of healthy living behaviors and inadequate access to 
healthcare facilities, thereby increasing the risk of unhealthy lifestyles.18,19 Based on previous 
studies, it was found that smoking behavior has a significant relationship with hypertension in 
adolescents and severe stress in adolescents.20–22 Smoking by adolescents is a risk factor for 
dietary mistakes, poor oral health, and more dynamic damage to teeth, which may result in 
pain and tooth loss.23 

Our study indicates an increase in alcohol consumption in 2018 compared to 2007, but a 
history of alcohol consumption in 2013 was not recorded. The most significant factor for people 
consuming alcohol is environmental factors and friendships that influence a person's behavior. 
Therefore self-awareness and self-principles are highly prioritized to make oneself avoid a 
particular risk factor.24 Alcohol consumption, smoking habits, and excessive stress levels will 
impact health in the long term, one of which is an increase in blood pressure because alcohol 
has the same effect as carbon monoxide, which causes blood acidity to increase and blood 
pressure to rise.25 

Previous research on high school adolescents showed consistent results, namely that there 
were risk factors for high school students to experience infectious diseases due to smoking, 
consuming alcohol regularly, eating fewer vegetables and fruit, less physical activity, and 
blood pressure above normal and BMI above the normal standard.26 Similar to research 
conducted at the Anak Dalam Tribe in Nyogan Village, dietary patterns include fruit and 
vegetable consumption and risky foods such as sweets and foods containing seasonings. 
Physical activity is a risk factor for hypertension and type II diabetes mellitus (DM). The Anak 
Dalam society, which has a poor diet, has a risk of suffering 11.23 times from DM compared 
to Suku Anak Dalam (SAD), who have a good diet; it was seen from the lack of diversity and 
energy intake in one week.22 

In contrast to alcohol consumption, adolescent awareness of consuming fruit and vegetables 
has increased; this is indicated by the decrease in the number of adolescents who consume 
fewer fruits and vegetables, at least five servings per week. This is in line with the previous 
research, which said that residents with poor diets and lack of fruit and vegetable consumption 
increase the incidence of non-communicable diseases and even death. The habit of 
consuming foods that are high in calories can cause obesity.2,27 The lack of fruit and 
vegetables is caused by the fact that fruits and vegetables are still considered complementary 
food, not a priority to consume. Mothers' and parents' lack of understanding and skills in 
getting children to consume fruits and vegetables from an early age and a lack of variety in 
serving fruit is considered the primary cause of this behavior. Besides, people have the 
perception that fruit is expensive.28,29 Awareness of consuming fruits and vegetables can be 
increased with regular and continuous education to prevent non-communicable diseases.30 

In line with the consumption of fruits and vegetables as a risk factor for non-communicable 
diseases, the risk factors for non-communicable diseases also experience a decrease in 
physical activity for 30 minutes per day. Adolescents' awareness of physical activities to 
prevent non-communicable diseases still needs to improve. Lack of physical activity, namely 
all body movements that burn calories, can be a risk factor for non-communicable diseases, 
including cardiovascular disease, obesity, and even diabetes mellitus.2,13,14,26 According to the 



 
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Ministry of the Health Republic of Indonesia, tNCD is caused by an unhealthy lifestyle, one of 
which is a lack of physical activity. Intense activities and high mobility make people allocate 
less time to exercise. In addition, advanced technology makes it easier for people to meet 
their needs, so activities that require body movement are decreasing. Lack of physical activity 
has also caused the trend of NCD to change; which initially only affected the elderly age group, 
but now it has been found in the young age group (0-15 years) and the productive age group 
(15-65 years ).31 

Previous research conducted at the School of HPER at Indiana University found that out of 
four risky behavior patterns, it was found that as many as 22% of women and 34% of men 
were included in a high-risk class characterized by poor eating patterns, lack of physical 
activity, and levels of substance use. Female students in the "low substance use but other 
poor health behaviors" class were associated with racial/ethnic minority status and lower 
parental education levels.32 Research by Richardo et al. showed that the accumulation of non-
communicable disease risk factors was higher in girls, older adolescents, those who did not 
live with both parents, children of less-educated mothers, students attending public schools, 
and residents of cities in more developed urban areas of the country.33 It has been supported 
by other studies which state that being a boy, increasing age, and the presence of parental 
support reduce the likelihood of having risk factors for non-communicable disease 
behaviour.34 

Based on research conducted by Yuningrum (2021) explains that the lifestyle of today's youth 
is at risk of non-communicable diseases as indicated by the consumption of vegetables and 
fruit, most of which are in the wrong category.12 Research conducted by other studies also 
showed an unhealthy lifestyle, such as consumption of soft drinks, smoking, alcohol, and lack 
of physical activity, which causes a high risk of non-communicable diseases.35,36 The number 
of teenagers who rarely do physical activity and have a low level of physical activity to maintain 
body fitness is quite a lot. As a result, teenagers' health will be at risk because their body's 
metabolism is not adequately stimulated as they age. This condition is very worrying because 
the lack of physical activity will put you at risk for various degenerative diseases and even 
accelerate the onset of these diseases.7 

Non-communicable diseases that result from poor health behavior are also based on 
supporting factors, namely socio-economic status, income, and gender, to body mass index, 
which has an impact on adolescent obesity, especially in rural areas.37 Supported by other 
studies which also state that heart disease globally contributes to 7.2-7.6% of deaths due to 
lack of physical activity, especially in developing countries depending on the population in the 
country.38 

The vulnerability of non-communicable diseases in adolescents needs to be controlled and 
prevented related to healthy behavior and a healthier lifestyle. One of them is by conducting 
non-communicable disease screening through the Integrated Development Post or Posbindu 
NCD for adolescents, which is very useful for early detection of symptoms of non-
communicable diseases, monitoring and providing health education to increase youth 
understanding and knowledge regarding risk factors for non-communicable diseases among 
adolescents who are assisted by cadres or health center staff, also several strategies with 
policy-level implications which could be used to reduce smoking, improve nutrition, and 
increase physical activity.29,30,39,40 



 
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The Germas program must continue to be encouraged to increase public awareness of 
adopting a healthy lifestyle. Prevention efforts are far better than treatment when you have 
contracted the disease. With the increasing incidence of NCD, it is necessary to provide 
education and assistance to the community to carry out early detection or screening of NCD, 
especially in at-risk groups. Besides that program, the beneficial effects of physical activity 
and cardiorespiratory fitness for the prevention of chronic non-communicable diseases. 
Society should always be invited to recognize the disease. It is important to carry out 
community services regarding screening and assistance to prevent Non-Communicable 
Diseases in the community.2,41 

CONCLUSION 

Based on the results and discussion above, it can be concluded that there was a fluctuation 
of health behavior risk factors of Riskesdas in 2007, 2013, and 2018 related to non-
communicable diseases. It can be caused by a poor lifestyle and unhealthy behavior such as 
smoking, alcohol consumption, lack of fruit and vegetables, and less physical activity. A 
related stakeholder is necessary to prevent and control non-communicable disease risk 
factors. One is conducting routine screening with health center cadres/officers through the 
Integrated Development Post (POSBINDU) NCD for adolescents. 

Acknowledgments 

We want to thank the Riskesdas Special Region of Yogyakarta team for the data and survey 
in Yogyakarta and the Ministry of Health Research and Development Center of the Health 
Republic of Indonesia. 

Declarations 

Author's contribution 

LNR, SND, & IWT contained the presented idea of this study. SND and IWT developed the 
theory and designed the method. LNR collected the data, and SND & IWT verified the 
analytical methods. LH and MSH reviewed and revised, and edited the manuscripts and 
publications. All authors have agreed on the manuscript's final draft before submitting it for 
publication. 

Funding Statement 

This research has not received external funding 

Conflict of interests 

There is no conflict of interest in this research. 

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