Hrev_master Healthcare in Low-resource Settings 2024; volume 12(s1):13046 The analysis of adolescents’ behaviors through demographic characteristics and basic health knowledge in Taiwan Wesiana Heris Santy, Rahmadaniar Aditya Putri, Firdaus, Siti Nurjanah, Siti Nur Hasina Department of Nursing, Faculty Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Surabaya, East Java, Indonesia Abstract Adolescents’ unstable personalities are responsible for poor behavioral choices, which adversely affect their quality of life. Therefore, this study aimed to examine health-related behaviors, such as drinking and smoking, alongside demographic character- istics and basic health knowledge. A total of 100 adolescents aged 11 to 20 were randomly selected as respondents using a cross-sec- tional observational analytical method. Data collection relied on interviews, which were subjected to univariate analysis using logistic regression and Chi-Square tests. The results showed that there was a significant correlation (p-value 0.003) between smok- ing and reproductive health behaviors. However, no significant correlation (p-value 0.410) was found between reproductive health behaviors and alcohol consumption. In conclusion, the research uncovered a significant correlation between smoking and reproductive health behaviors. It was necessary to instill healthy lifestyle skills in adolescents early on to deter them from engaging in risky health behaviors. Introduction Given that adolescents constitute one-fifth of the global popu- lation, this demographic group is considered significant, with far- reaching implications for social, economic, and demographic fac- tors. Adolescents are characterized by numerous hormonal, social, and physical changes.1 necessitating significant attention due to the enrollment in both schools and the workforce, where they are particularly vulnerable to health issues, such as HIV/AIDS, psy- chotropic drug use, other addictive substances (NAPZA), and pre- marital sexual behaviors.2,3 Additionally, adolescents behaviors are prevalent, often arising from unstable personalities, leading to the adoption of unhealthy behaviors that negatively affect their quality of life.4,5 The results from the Basic Health Research (Riskesdas) showed that among adolescents aged 15 to 19, 22 out of 100 have reported smoking, with a prevalence rate of 9.1% among those under the age of 18.6 Many adolescents initiate smoking during their school years or even earlier, raising significant concerns regarding the future health and well-being of the younger genera- tion.7 Several investigations on adolescents alcohol consumption show that 3.4% of those who began drinking at the age of 10 and above did so with traditional beverages (38.8%).8 According to Riskesdas (2018), 4% of adolescents in East Java between the ages of 10 and 20 reported consuming alcohol in 2018. Adolescents are prone to engaging in unhealthy behaviors, includ- ing low awareness and practice of sexual and reproductive health. A mere 0.4% of girls and 1.9% of boys have engaged in premarital sexual intercourse. The limited awareness among adolescents regarding reproductive health issues shows the urgent need for greater attention to adolescents reproductive health.9-11 The aforementioned issues arise from various factors, includ- ing adolescents’ limited understanding of sexuality (sex, contra- ception, pregnancy, and others.), compounded by parental neglect, which inadvertently condones their behaviors without considering the consequences. In reality, incomplete and false knowledge often arises from unreliable sources, such as peers, informational media like blue films and pornographic magazines, and socially accepted myths.12-13 Given that parental knowledge serves as the primary source of initial reproductive health education, parents should also be knowledgeable about its issues.14-15 In Taiwan, a developing nation, the adolescents population will undoubtedly influence future social, economic, and demographic develop- ments. Therefore, the health of adolescents in the nation must be comprehensively evaluated from both biopsychosocial and spiri- tual perspectives.16,17 This study aims to investigate health-related behaviours, such as alcohol consumption and tobacco use, in con- junction with demographic characteristics and fundamental health knowledge. Materials and Methods This study used an observational analytic method with a cross- sectional design. The analysis was conducted at the Jagir Community Health Center, Surabaya, from April to June 2021, and in the PCINU Taiwan Working Area in August. Inclusion cri- teria included adolescents aged 11-21 years, in good health, and possessing literacy skills. Exclusion criteria pertained to individu- als unwilling to participate as respondents. The study population was all immigrant adolescents who were members of PCINU Taiwan, totaling 106 individuals, and the sample consisted of 100 randomly selected respondents. Data collection used a question- naire aimed at gathering demographic characteristics and health behaviors. The validated questionnaire included sections address- Significance for public health Adolescents represent the future, and reproductive health and behaviors require great attention because these factors will profoundly impact their lives in the future. They are influenced by various external factors, including parental influence, environmental surroundings, community culture, and lifestyle choices. The development of adolescents aims to foster growth toward adulthood, form identity, and shape personality. The variables significantly influence adolescents' behaviors, particularly in terms of health. [page 80] [Healthcare in Low-resource Settings 2024;12(s1):13046] Non -co mmerc ial us e o nly ing knowledge and attitudes regarding health behaviors, reproduc- tion, smoking, alcohol consumption, and drug use among respon- dents, their peers, and family members, as well as individuals and parental characteristics. Statistical analysis comprised the use of Chi-Square and logistic regression tests with a hypothesis signifi- cance level set at p<0.05. Results and Discussion Table 1 shows the majority of respondents were male (62%), aged between 15 and 17 (67%), and came from rural areas (52%). Their fathers had secondary education (72%) and were used in the private sector (72%). Conversely, 78% of respondents’ mothers had only a high school diploma, with 87% being used. Financially, respondents reported that their fathers earned slightly above the minimum wage, with 24% of adolescents initiating smoking, cate- gorized as light smokers (5 cigarettes per day), while 1% reported alcohol consumption. A mere 1% of respondents reported drug use, without specifying the type, and 60% of them had a history of dis- eases, with headaches being a prevalent complaint. According to Table 2, the data showed that the majority of respondents correctly answered questions related to basic knowl- edge of reproductive health, with 65% understanding the impact of unprotected sex, and 53% comprehending the dangers of smoking (53%). Almost half of them were knowledgeable about alcoholic drinks (47%). Table 3 showed a significant correlation (p-value 0.03) between smoking and reproductive health behaviors. Adolescents who smoke (12%) had a higher percentage of good reproductive health compared to non-smokers (5%). However, there was no significant correlation (p-value 0.410) between repro- ductive health behaviors and alcohol consumption, likely due to the small number of adolescents alcohol users. Adolescents smok- ing behaviors and alcohol consumption had a significant correla- tion, with a p-value of 0.001. The percentage of adolescents who smoke (10%) mirrored the percentage of those who did not con- sume alcohol. The results of a multivariate analysis of independent variables with health behaviors as the dependent variable were presented in 4. Tobacco use, alcohol consumption, and sexual and repro- ductive health were among the unhealthy behaviors assessed. The statistical analysis showed that gender, knowledge, and attitudes significantly influenced health behaviors, with p-values of 0.006, 0.012, and 0.011, and odds ratios of 0.130, 0.144, and 7.580, respectively. This showed that adolescents boys had 0.130 times greater protection against harmful behaviors. Adolescents with high knowledge levels were 0.142 less likely to engage in risky behaviors and those with positive outlooks were 7,580 times more likely to be shielded from behaviors. Knowledge was shaped by individuals’ experiences, which could be expressed and believed to fuel motivation.18 It was also influenced by environmental factors, including physical and non- physical settings, as well as socio-cultural contexts. Sight and hear- ing were identified to be the primary sources of knowledge,19 and adolescents with high knowledge levels were 0.144 less likely to engage in risky behaviors. According to the analysis results, infor- mation from various sources, media exposure, and influence from parents and peers were acknowledged to affect individuals’ knowl- edge. The multivariate analysis showed that adolescents’ conduct regarding reproductive health was influenced by attitudes toward abstaining from negative behaviors.20 When low parental income was combined with income above the Regency/City Minimum Wage (UMK), the highest level of parental education tended to be medium (equivalent to high school). There was a correlation between parents’ educational attainment and adolescents’ perspective on reproductive health. Several investigations suggested that parents with higher incomes might contribute to the children’s academic performance, thereby influencing their viewpoints. Higher-income parents might also provide their children with more opportunities to access additional sources of information.21 Several reviews have shown that most adolescents received free information on HIV/AIDS, the dangers of smoking, and alcohol consumption from counselors, schools, and healthcare professionals. This explained why the level of parental income did not affect the quantity of information sources 4th International Nursing and Health Sciences Symposium Table 1. Characteristics of respondents. Characteristics f % Age 11-14 years old 29 29 15-17 years old 67 67 18-20 years old 4 4 Gender Man 62 62 Woman 38 38 Residence Rural 52 52 Urban 48 48 Father's Education Elementary (Elementary-Middle School) 16 16 Intermediate (High School) 72 72 Higher (Diploma-Bachelor) 12 12 Father's occupation PNS 15 15 Private 72 72 Self-employed 13 13 Father's Income UMK 52 52 Below UMK 48 48 Mother's Education Elementary (Elementary-Middle School) 78 78 Intermediate (High School) 14 14 Higher (Diploma-Bachelor) 8 8 Mother's Job Work 87 87 Doesn't work 13 13 Smoke Yes 24 24 No 76 76 Alcohol consumption Yes 1 1 No 99 99 Drug consumption Yes 1 1 No 99 99 History of illness There is 60 60 No 40 40 Mental Health Risks There are complaints 27 27 No complaints 73 73 [Healthcare in Low-resource Settings 2024;12(s1):13046] [page 81] Non -co mmerc ial us e o nly 4th International Nursing and Health Sciences Symposium Table 2. Frequency distribution of respondents' knowledge about reproductive health, smoking behavior, and alcohol consumption. Basic knowledge Number of Respondents answered Correct (n=100) % Reproduction health Characteristics of puberty in teenagers 30 30 Reproductive organs 59 59 Various types of casual sexual behavior 43 43 The impact of free sex 65 65 How to prevent promiscuous sexual behavior 36 36 How to resist sexual desires/desires 47 47 The right way to socialize 53 53 Smoke Cigarette content 33 33 Danger of cigarette 53 53 Diseases caused by smoking 41 41 How to prevent smoking 34 34 The process of entering cigarette smoke and its effects on the body 29 29 Alcohol consumption Type of liquor 47 47 Ingredients for making alcohol 28 28 Ingredients for making alcohol 22 22 The impact of alcohol on health 37 37 The impact of alcohol on health 35 35 Physical and psychological dangers of alcohol 32 32 A picture of a future destroyed by alcohol 30 30 Table 3. Relationship between smoking, alcohol consumption and reproductive health in adolescents. Reproduction health p Good Bad f % f % Smoke Yes 12 12 21 21 0.003 No 5 5 63 65 Alcohol consumption Yes 10 10.4 2 2.1 0.410 No 24 25 60 62.5 Reproduction health p Good Bad f % f % Alcohol consumption Yes 10 8 6 6 0.001 No 10 8 74 74 Table 4. Results of multivariate analysis of demographic, knowledge and attitude variables with health behavior (dating behavior, smok- ing and alcohol consumption). Variable B SE Wald Sign Exp (B) 95% CI Lower Upper Age (>16 years) 1.390 .910 2.663 0.102 4.442 0.740 26.580 gender (Women) -2.022 .761 7.127 0.006 0.130 0.026 0.572 Knowledge (Good) -1.442 .970 2.418 0.012 0.144 0.030 0.642 Attitude (Positive) -2.026 .796 6.336 0.011 7.580 1.578 36.280 [page 82] [Healthcare in Low-resource Settings 2024;12(s1):13046] Non -co mmerc ial us e o nly available to adolescents in the study area. According to the analysis results, the majority of respondents (65%) correctly answered questions regarding the impact of unprotected sex on basic repro- ductive health knowledge. This included recognizing that unpro- tected sex increased the risk of contracting STDs, particularly hep- atitis B, HIV, herpes simplex, genital warts, and gonorrhea. Oral or anal sex was the primary means through which the diseases were transmitted. Additionally, smoking posed a significant public health risk (53%), given its addictive nature and widespread preva- lence. Cigarettes contain harmful chemicals, including tar, carbon monoxide, and nicotine, which could lead to various diseases, par- ticularly cancer and heart disease. Approximately half (47%) of respondents correctly identified the type of alcohol as a strong or mild intoxicant. Alcohol content in the beverage largely deter- mined its intoxicating effects. When the liquor had a low alcohol content and was consumed within safe limits, the likelihood of los- ing consciousness was low. Conversely, a high alcohol content increased the risk of becoming tipsy (showing that alcohol was beginning to take effect), feeling excited (with vision becoming hazy or drowsy), confused, and even unconscious. Cigarettes have the potential to cause several diseases, includ- ing cancer and heart disease, due to their harmful substances.22 Approximately half (47%) of respondents correctly identified the type of alcohol as a strong or mild intoxicant. Alcohol content in the beverage largely determined its intoxicating effects. When the liquor had a low alcohol content and was consumed within safe limits, the likelihood of losing consciousness was low. Conversely, a high alcohol content increased the risk of becoming tipsy (show- ing that alcohol was beginning to take effect), feeling excited (with vision becoming hazy or drowsy), confused, and even uncon- scious. Adolescents might use alcohol and smoking as symbolic behaviors to project an image of maturity, bravery, strength, and attractiveness to their peers and the opposite sex.23 There was no significant correlation between alcohol consumption and reproduc- tive health behaviors (p-value 0.410), likely due to the low preva- lence of alcohol consumption among adolescents. Conclusions In conclusion, adolescents need to be more aware of the numerous risks associated with unhealthy behaviors, particularly regarding reproductive health. It was essential to consider all rele- vant factors in addressing the issues. Adolescents could greatly benefit from the guidance provided by educators, parents, friends, media, and other sources of information. There were various strate- gies to prevent risky behaviors, such as avoiding environments that promote them, asserting firm boundaries, refusing immoral requests, practicing self-control, abstaining from drugs and alco- hol, and having education about religion. References 1. Hoare J, Fouche JP, Phillips N, et al. Alcohol use is associated with mental health problems and brain structural alterations in adolescents with perinatally acquired HIV infection on ART. Alcohol 2021;97:59–66. 2. Smith L, López Sánchez GF, Pizzol D, et al. Global Trends in the Prevalence of Alcohol Consumption Among School-Going Adolescents Aged 12–15 Years. J Adolescent Health 2024;74:441–8. 3. Raine S, Kent SA. The grooming of children for sexual abuse in religious settings: Unique characteristics and select case studies. Aggress Violent Behav 2019;48:180–9. 4. Musindo O, Jafry S, Nyamiobo J, et al. 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Tel.: +62318479070, E-mail: rahmadaniar@unusa.ac.id Key words: adolescents; alcohol; health behaviors; reproductive health; smoking Contributions: WHS, RAP, F, SN, SNH collaborated in the conceptual- ization process and manuscript writing. WHS was responsible for the methodology, while RAP and F were accountable for validating the instruments. SNH was responsible for the analysis, and SN and SNH were accountable for the investigation. In addition, RAP provided resources, and F managed data curation Conflict of interest: the authors declare no conflicts of interest. Funding: this study received financial support from Universitas Nahdlatul Ulama Surabaya. Ethics approval: the ethics approval has been granted by the Committee of the Department of Nursing, Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, located in Surabaya, East Java, Indonesia, under reference number No. 028/016/V/EC/KEP/LCBL/2023. Conference presentation: part of this article was presented at the 4th International Nursing and Health Sciences Symposium, from 27th-28th of October 2023, Universitas Brawijaya, Malang, East Java, Indonesia. Acknowledgments: the authors thank all respondents who participated in this study and also appreciate PCINU for their collaboration during data collection and the study process. Received: 3 November 2023. Accepted: 18 July 2024. Early view: 10 September 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12(s1):13046 doi:10.4081/hls.2024.13046 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. 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