A model of student smoking cessation behavior based on pictorial health warnings as an intervening variable

https://doi.org/10.35912/ahrmr.v5i4.3205
Published: Dec 1, 2025

Abstract:

Purpose: This research examines smoking cessation among students at seven universities following pictorial health warnings under Government Regulation No. 28 of 2024 on Tobacco Control. Using the Theory of Planned Behavior, it analyzes how attitudes toward smoking’s health impacts and perceived behavioral control influence smoking cessation through pictorial warnings as an intervening variable, aiming to foster a healthier Indonesian society.

Research Methodology: This quantitative study used purposive sampling with 200 student respondents who quit smoking at seven universities in Soloraya. Data were collected through surveys and interviews, analyzed using item validity, reliability, goodness-of-fit, and Structural Equation Modeling (SEM) to test variable influences, with moderating analysis conducted via AMOS 21.

Results: The results of quantitative research showed that two independent variables directly influenced students' smoking cessation behavior, with attitude having a dominant influence. Pictorial health warnings acted as an intervening variable.

Conclusions: The research concludes that attitude values and perceived behavioral control significantly influence students’ smoking cessation behavior. It highlights the need for government regulation, increased tobacco excise, and family support, with recommendations for further research on broader smoking cessation models.

Limitations: The study’s subjects were limited to students who quit smoking at seven universities in Soloraya. Future research should include students across Central Java or nationwide and enhance the model by adding moderating variable tests for broader applicability and deeper analysis.

Contribution: This study reinforces the Theory of Planned Behavior by introducing pictorial health warnings as an intervening variable and urges the Indonesian Ministry of Health to expand warning displays to enhance fear and awareness of smoking’s negative health impacts.

Keywords:
1. Behavior
2. Horrific Health Images
3. Intervening
4. Students Quit Smoking
Authors:
1 . Arif Julianto Sri Nugroho
Universitas Widya Dharma Klaten, Jawa Tengah, Indonesia
2 . Anis Marjukah
Universitas Widya Dharma Klaten, Jawa Tengah, Indonesia
3 . Dandang Setyawanti
Universitas Widya Dharma Klaten, Jawa Tengah, Indonesia
4 . Abdul Haris
Universitas Widya Dharma Klaten, Jawa Tengah, Indonesia
5 . Ummu Hany Almasitoh
Universitas Widya Dharma Klaten, Jawa Tengah, Indonesia
6 . Tasari Tasari
Universitas Widya Dharma Klaten, Jawa Tengah, Indonesia
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How to Cite
Nugroho, A. J. S., Marjukah, A., Setyawanti, D., Haris, A., Almasitoh, U. H., & Tasari, T. (2025). A model of student smoking cessation behavior based on pictorial health warnings as an intervening variable. Annals of Human Resource Management Research, 5(4), 1–14. https://doi.org/10.35912/ahrmr.v5i4.3205
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Vol. 5 No. 4 (2025): December
Articles
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References

    Ajzen, I. (2020). The Theory of Planned Behavior: Frequently Asked Questions. Human Behavior and Emerging Technologies, 2(4), 314-324. doi:https://doi.org/10.1002/hbe2.195

    Andriani, P., Fahdi, F. K., Ligita, T., Fujiana, F., & Fauzan, S. (2023). Pengaruh Gambar Peringatan Kesehatan pada Kemasan Rokok Terhadap Rasa Takut dan Intensitas Berhenti Merokok. MAHESA: Malahayati Health Student Journal, 3(4), 872-889. doi:https://doi.org/10.33024/mahesa.v3i4.10035

    Ardelia, V., & Dewi, T. K. (2016). Intensi Berhenti Merokok pada Wanita Emerging Adult Ditinjau dari Prediktor Theory of Planned Behavior. INSAN: Jurnal Psikologi dan Kesehatan Mental, 2(2), 111-119. doi:https://doi.org/10.20473/jpkm.V2I22017.111-119

    Baca, B. (2021). Halal Life Style sebagai Dakwah Determinasi Diri dan Sosial Masyarakat Indonesia. Jurnal Al-Hikmah, 19(1), 1-12. doi:https://doi.org/10.35719/alhikmah.v19i01.41

    Baharuddin, N. H., Puspitasari, A., & Islamiah, N. (2024). Implikasi Sistem Peringatan Kesehatan Bergambar pada Kemasan Rokok: Studi Wilayah Sosial Ekonomi Rendah. Journal of Language and Health, 5(1), 279-286. doi:https://doi.org/10.37287/jlh.v5i1.3465

    BPS. (2022). Survei Sosial Ekonomi Nasional (Susenas) Maret 2022. Retrieved from https://rotendaokab.bps.go.id/id/news/2022/03/17/23/survey-sosial-ekonomi-nasional-susenas-maret-2022.html

    Brown, Q. L., Linton, S. L., Harrell, P. T., Mancha, B. E., Alexandre, P. K., Chen, K.-F., & Eaton, W. W. (2014). The Influence of Religious Attendance on Smoking. Substance use & misuse, 49(11), 1392-1399. doi:https://doi.org/10.3109/10826084.2014.912224

    Cheng, O. Y., Yam, C. L. Y., Cheung, N. S., Lee, P. L. P., Ngai, M. C., & Lin, C.-Y. (2019). Extended Theory of Planned Behavior on Eating and Physical Activity. American journal of health behavior, 43(3), 569-581. doi:https://doi.org/10.5993/AJHB.43.3.11

    Crabtree, S. (2010). Religiosity Highest in World's Poorest Nations. Retrieved from https://news.gallup.com/poll/142727/religiosity-highest-world-poorest-nations.aspx

    Fahrizal, I., Budiono, A., Khalid, J., & Santoso, B. (2025). From Inclusion to Engagement: the Psychological Safety Role in Mediating Inclusive Leadership and Diversity Initiatives in the Indonesian Workplace. Annals of Human Resource Management Research, 5(2), 243-260. doi:https://doi.org/10.35912/ahrmr.v5i2.2795

    Fardin, M. A. (2020). COVID-19 Epidemic and Spirituality: A Review of the Benefits of Religion in Times of Crisis. Jundishapur Journal of Chronic Disease Care, 9(2), 1-4. doi:https://doi.org/10.5812/jjcdc.104260

    Hair, J., Babin, B., Anderson, R., & Black, W. (2019). Multivariate Data Analysis. England: Pearson Prentice.

    Hamdan, S. R. (2015). Pengaruh Peringatan Bahaya Rokok Bergambar pada Intensi Berhenti Merokok. MIMBAR: Jurnal Sosial dan Pembangunan, 31(1), 241-250. doi:https://doi.org/10.29313/mimbar.v31i1.1323

    Handayani, E., Prabamurti, P. N., & Handayani, N. (2023). Perilaku Merokok Elektrik Pada Komunitas Trustsquad Semarang. Media Kesehatan Masyarakat Indonesia, 22(1), 46-53.

    Indrawani, S. N., Mailani, L., & Nilawati, N. (2014). Intensi Berhenti Merokok: Peran Sikap Terhadap Peringatan pada Bungkus Rokok dan Perceived Behavioral Control. Psikologia: Jurnal Pemikiran dan Penelitian Psikologi, 9(2), 65-73. doi:https://doi.org/10.32734/psikologia.v9i2.8761

    Kemenkes. (2022). Temuan Survei GATS: Perokok Dewasa di Indonesia Naik 10 Tahun Terakhir. Retrieved from https://kemkes.go.id/id/temuan-survei-gats-perokok-dewasa-di-indonesia-naik-10-tahun-terakhir

    Komakech, E., Obici, G., & Mwesigwa, D. (2021). Efficacy of Inspirational Motivation on the Performance of Public Health Workers in Mid-North of Uganda. Annals of Human Resource Management Research, 1(2), 85-97. doi:https://doi.org/10.35912/ahrmr.v1i2.509

    Kuijpers, D., Wintels, S., & Yamakawa, N. (2020). Survey: Food Retail in Indonesia during the COVID-19 Pandemic. Retrieved from https://www.mckinsey.com/industries/retail/our-insights/survey-food-retail-in-indonesia-during-the-covid-19-pandemic

    Liu, D., Lee, S., & Hwang, J.-Y. (2021). Factors Related to the Intention of Healthy Eating Behaviors Based on the Theory of Planned Behavior: Focused on Adults Residing in Beijing, China. Journal of Nutrition and Health, 54(1), 67-75. doi:https://doi.org/10.4163/jnh.2021.54.1.67

    Lü, W., Wu, Q., Liu, Y., Wang, Y., Wei, Z., Li, Y., . . . Zhang, X. (2022). No Smoking Signs with Strong Smoking Symbols Induce Weak Cravings: An fMRI and EEG Study. Neuroimage, 252, 1-11. doi:https://doi.org/10.1016/j.neuroimage.2022.119019

    Mayasari, Sudarjat, H., & Sholih, M. G. (2018). Pengaruh Peringatan Visual Iklan Kemasan Rokok: Pengukuran Tingkatan Perasaan Takut yang Dibedakan Berdasarkan Jenis Kelamin dan Usia. Jurnal Politikom Indonesiana, 3(2), 189-201. doi:https://doi.org/10.35706/jpi.v3i2.1667

    Melinda, G. (2024). Tantangan Berat Menurunkan Angka Perokok Anak. Retrieved from https://www.kompas.id/artikel/tantangan-berat-menurunkan-angka-perokok-anak

    Michaelidou, N., & Hassan, L. M. (2008). The Role of Health Consciousness, Food Safety Concern and Ethical Identity on Attitudes and Intentions Towards Organic Food. International Journal of Consumer Studies, 32(2), 163-170. doi:https://doi.org/10.1111/j.1470-6431.2007.00619.x

    Pujiati, H., Feani, D. P., & Cahaya, Y. F. (2025). Self-Efficacy, Engagement, and Spiritual Intelligence on Performance Via OCB Among Jakarta Educators. Annals of Human Resource Management Research, 5(1), 43-59. doi:https://doi.org/10.35912/ahrmr.v5i1.2861

    Reskiaddin, L. O., & Supriyati, S. (2021). Proses Perubahan Perilaku Berhenti Merokok: Studi Kualitatif Mengenai Motif, Dukungan Sosial dan Mekanisme Coping. Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior, 3(1), 58-70. doi:https://doi.org/10.47034/ppk.v3i1.4142

    Riswanda, A. Z., & Millanyani, H. (2025). The Influence of Electronic Service Quality and Perceived Value on Customer Loyalty with Electronic Trust and Customer Satisfaction as Mediating Variables on the Agoda Application. Annals of Human Resource Management Research, 5(2), 463-478. doi:https://doi.org/10.35912/ahrmr.v5i2.3161

    Salehudin, I., & Mukhlish, B. M. (2012). Pemasaran Halal: Konsep, Implikasi dan Temuan di Lapangan (Halal Marketing: Concept, Implication and Field Finding). SSRN Electronic Journal, 293-305. doi:https://doi.org/10.2139/ssrn.1752567

    Sekaran, U., & Bougie, R. (2016). Research Methods for Business: A Skill Building Approach Seventh Edition. New York: John Wiley & Sons.

    Shrestha, S., Pokhrel, S., Subedi, S., Paudel, H., Viswakarma, R. C., Poudel, D., . . . Ward, K. (2022). Perception of Cigarette Graphic Health Warnings and Its Impact on Smoking Behavior: A Cross-Sectional Study among Current Smokers of Western Part of Nepal. Journal of Smoking Cessation, 1-9. doi:https://doi.org/10.1155/2022/5787856

    Sjarifudin, D., Widyastuti, T., Renwarin, J. M., & Suroso, S. (2025). The Influence of Self-efficacy, Work Discipline, and Compensation on Employee Performance Through Work Motivation in Textile and Garment Companies in West Java. Annals of Human Resource Management Research, 5(2), 277-294. doi:https://doi.org/10.35912/ahrmr.v5i2.2953

    Syaputra, Z. M., & Coralia, F. (2022). Pengaruh Ketiga Prediktor dalam Theory of Planned Behavior terhadap Intensi Berhenti Merokok pada Perokok Dewasa. Bandung Conference Series: Psychology Science, 2(1), 341-348. doi:https://doi.org/10.29313/bcsps.v2i1.1092

    Tapera, R., Mbongwe, B., Mhaka-Mutepfa, M., Lord, A., Phaladze, N. A., & Zetola, N. M. (2020). The Theory of Planned Behavior as a Behavior Change Model for Tobacco Control Strategies among Adolescents in Botswana. Plos One, 15(6), 1-13. doi:https://doi.org/10.1371/journal.pone.0233462

    Taufick, A. L. K., Nugroho, A. D., Wulandari, A. A., Budiman, D. T., Wibisono, A. B., & Leda, F. J. (2023). Dinamika Adiksi Perokok dalam Usahanya Untuk Berhenti Merokok. Jurnal Psikologi Unsyiah, 6(1), 1-28. doi:https://doi.org/10.24815/s-jpu.v6i1.26269

    Taylor, S., & Todd, P. A. (1995). Understanding information technology usage: A test of competing models. Information systems research, 6(2), 144-176. doi:https://doi.org/10.1287/isre.6.2.144

    Wang, S. D., Loftus, P., Pang, R. D., & Kirkpatrick, M. G. (2021). Impact of Self-Efficacy on Daily Intention to Not Smoke. Addictive Behaviors, 118(4). doi:https://doi.org/10.1016/j.addbeh.2021.106877

  1. Ajzen, I. (2020). The Theory of Planned Behavior: Frequently Asked Questions. Human Behavior and Emerging Technologies, 2(4), 314-324. doi:https://doi.org/10.1002/hbe2.195
  2. Andriani, P., Fahdi, F. K., Ligita, T., Fujiana, F., & Fauzan, S. (2023). Pengaruh Gambar Peringatan Kesehatan pada Kemasan Rokok Terhadap Rasa Takut dan Intensitas Berhenti Merokok. MAHESA: Malahayati Health Student Journal, 3(4), 872-889. doi:https://doi.org/10.33024/mahesa.v3i4.10035
  3. Ardelia, V., & Dewi, T. K. (2016). Intensi Berhenti Merokok pada Wanita Emerging Adult Ditinjau dari Prediktor Theory of Planned Behavior. INSAN: Jurnal Psikologi dan Kesehatan Mental, 2(2), 111-119. doi:https://doi.org/10.20473/jpkm.V2I22017.111-119
  4. Baca, B. (2021). Halal Life Style sebagai Dakwah Determinasi Diri dan Sosial Masyarakat Indonesia. Jurnal Al-Hikmah, 19(1), 1-12. doi:https://doi.org/10.35719/alhikmah.v19i01.41
  5. Baharuddin, N. H., Puspitasari, A., & Islamiah, N. (2024). Implikasi Sistem Peringatan Kesehatan Bergambar pada Kemasan Rokok: Studi Wilayah Sosial Ekonomi Rendah. Journal of Language and Health, 5(1), 279-286. doi:https://doi.org/10.37287/jlh.v5i1.3465
  6. BPS. (2022). Survei Sosial Ekonomi Nasional (Susenas) Maret 2022. Retrieved from https://rotendaokab.bps.go.id/id/news/2022/03/17/23/survey-sosial-ekonomi-nasional-susenas-maret-2022.html
  7. Brown, Q. L., Linton, S. L., Harrell, P. T., Mancha, B. E., Alexandre, P. K., Chen, K.-F., & Eaton, W. W. (2014). The Influence of Religious Attendance on Smoking. Substance use & misuse, 49(11), 1392-1399. doi:https://doi.org/10.3109/10826084.2014.912224
  8. Cheng, O. Y., Yam, C. L. Y., Cheung, N. S., Lee, P. L. P., Ngai, M. C., & Lin, C.-Y. (2019). Extended Theory of Planned Behavior on Eating and Physical Activity. American journal of health behavior, 43(3), 569-581. doi:https://doi.org/10.5993/AJHB.43.3.11
  9. Crabtree, S. (2010). Religiosity Highest in World's Poorest Nations. Retrieved from https://news.gallup.com/poll/142727/religiosity-highest-world-poorest-nations.aspx
  10. Fahrizal, I., Budiono, A., Khalid, J., & Santoso, B. (2025). From Inclusion to Engagement: the Psychological Safety Role in Mediating Inclusive Leadership and Diversity Initiatives in the Indonesian Workplace. Annals of Human Resource Management Research, 5(2), 243-260. doi:https://doi.org/10.35912/ahrmr.v5i2.2795
  11. Fardin, M. A. (2020). COVID-19 Epidemic and Spirituality: A Review of the Benefits of Religion in Times of Crisis. Jundishapur Journal of Chronic Disease Care, 9(2), 1-4. doi:https://doi.org/10.5812/jjcdc.104260
  12. Hair, J., Babin, B., Anderson, R., & Black, W. (2019). Multivariate Data Analysis. England: Pearson Prentice.
  13. Hamdan, S. R. (2015). Pengaruh Peringatan Bahaya Rokok Bergambar pada Intensi Berhenti Merokok. MIMBAR: Jurnal Sosial dan Pembangunan, 31(1), 241-250. doi:https://doi.org/10.29313/mimbar.v31i1.1323
  14. Handayani, E., Prabamurti, P. N., & Handayani, N. (2023). Perilaku Merokok Elektrik Pada Komunitas Trustsquad Semarang. Media Kesehatan Masyarakat Indonesia, 22(1), 46-53.
  15. Indrawani, S. N., Mailani, L., & Nilawati, N. (2014). Intensi Berhenti Merokok: Peran Sikap Terhadap Peringatan pada Bungkus Rokok dan Perceived Behavioral Control. Psikologia: Jurnal Pemikiran dan Penelitian Psikologi, 9(2), 65-73. doi:https://doi.org/10.32734/psikologia.v9i2.8761
  16. Kemenkes. (2022). Temuan Survei GATS: Perokok Dewasa di Indonesia Naik 10 Tahun Terakhir. Retrieved from https://kemkes.go.id/id/temuan-survei-gats-perokok-dewasa-di-indonesia-naik-10-tahun-terakhir
  17. Komakech, E., Obici, G., & Mwesigwa, D. (2021). Efficacy of Inspirational Motivation on the Performance of Public Health Workers in Mid-North of Uganda. Annals of Human Resource Management Research, 1(2), 85-97. doi:https://doi.org/10.35912/ahrmr.v1i2.509
  18. Kuijpers, D., Wintels, S., & Yamakawa, N. (2020). Survey: Food Retail in Indonesia during the COVID-19 Pandemic. Retrieved from https://www.mckinsey.com/industries/retail/our-insights/survey-food-retail-in-indonesia-during-the-covid-19-pandemic
  19. Liu, D., Lee, S., & Hwang, J.-Y. (2021). Factors Related to the Intention of Healthy Eating Behaviors Based on the Theory of Planned Behavior: Focused on Adults Residing in Beijing, China. Journal of Nutrition and Health, 54(1), 67-75. doi:https://doi.org/10.4163/jnh.2021.54.1.67
  20. Lü, W., Wu, Q., Liu, Y., Wang, Y., Wei, Z., Li, Y., . . . Zhang, X. (2022). No Smoking Signs with Strong Smoking Symbols Induce Weak Cravings: An fMRI and EEG Study. Neuroimage, 252, 1-11. doi:https://doi.org/10.1016/j.neuroimage.2022.119019
  21. Mayasari, Sudarjat, H., & Sholih, M. G. (2018). Pengaruh Peringatan Visual Iklan Kemasan Rokok: Pengukuran Tingkatan Perasaan Takut yang Dibedakan Berdasarkan Jenis Kelamin dan Usia. Jurnal Politikom Indonesiana, 3(2), 189-201. doi:https://doi.org/10.35706/jpi.v3i2.1667
  22. Melinda, G. (2024). Tantangan Berat Menurunkan Angka Perokok Anak. Retrieved from https://www.kompas.id/artikel/tantangan-berat-menurunkan-angka-perokok-anak
  23. Michaelidou, N., & Hassan, L. M. (2008). The Role of Health Consciousness, Food Safety Concern and Ethical Identity on Attitudes and Intentions Towards Organic Food. International Journal of Consumer Studies, 32(2), 163-170. doi:https://doi.org/10.1111/j.1470-6431.2007.00619.x
  24. Pujiati, H., Feani, D. P., & Cahaya, Y. F. (2025). Self-Efficacy, Engagement, and Spiritual Intelligence on Performance Via OCB Among Jakarta Educators. Annals of Human Resource Management Research, 5(1), 43-59. doi:https://doi.org/10.35912/ahrmr.v5i1.2861
  25. Reskiaddin, L. O., & Supriyati, S. (2021). Proses Perubahan Perilaku Berhenti Merokok: Studi Kualitatif Mengenai Motif, Dukungan Sosial dan Mekanisme Coping. Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior, 3(1), 58-70. doi:https://doi.org/10.47034/ppk.v3i1.4142
  26. Riswanda, A. Z., & Millanyani, H. (2025). The Influence of Electronic Service Quality and Perceived Value on Customer Loyalty with Electronic Trust and Customer Satisfaction as Mediating Variables on the Agoda Application. Annals of Human Resource Management Research, 5(2), 463-478. doi:https://doi.org/10.35912/ahrmr.v5i2.3161
  27. Salehudin, I., & Mukhlish, B. M. (2012). Pemasaran Halal: Konsep, Implikasi dan Temuan di Lapangan (Halal Marketing: Concept, Implication and Field Finding). SSRN Electronic Journal, 293-305. doi:https://doi.org/10.2139/ssrn.1752567
  28. Sekaran, U., & Bougie, R. (2016). Research Methods for Business: A Skill Building Approach Seventh Edition. New York: John Wiley & Sons.
  29. Shrestha, S., Pokhrel, S., Subedi, S., Paudel, H., Viswakarma, R. C., Poudel, D., . . . Ward, K. (2022). Perception of Cigarette Graphic Health Warnings and Its Impact on Smoking Behavior: A Cross-Sectional Study among Current Smokers of Western Part of Nepal. Journal of Smoking Cessation, 1-9. doi:https://doi.org/10.1155/2022/5787856
  30. Sjarifudin, D., Widyastuti, T., Renwarin, J. M., & Suroso, S. (2025). The Influence of Self-efficacy, Work Discipline, and Compensation on Employee Performance Through Work Motivation in Textile and Garment Companies in West Java. Annals of Human Resource Management Research, 5(2), 277-294. doi:https://doi.org/10.35912/ahrmr.v5i2.2953
  31. Syaputra, Z. M., & Coralia, F. (2022). Pengaruh Ketiga Prediktor dalam Theory of Planned Behavior terhadap Intensi Berhenti Merokok pada Perokok Dewasa. Bandung Conference Series: Psychology Science, 2(1), 341-348. doi:https://doi.org/10.29313/bcsps.v2i1.1092
  32. Tapera, R., Mbongwe, B., Mhaka-Mutepfa, M., Lord, A., Phaladze, N. A., & Zetola, N. M. (2020). The Theory of Planned Behavior as a Behavior Change Model for Tobacco Control Strategies among Adolescents in Botswana. Plos One, 15(6), 1-13. doi:https://doi.org/10.1371/journal.pone.0233462
  33. Taufick, A. L. K., Nugroho, A. D., Wulandari, A. A., Budiman, D. T., Wibisono, A. B., & Leda, F. J. (2023). Dinamika Adiksi Perokok dalam Usahanya Untuk Berhenti Merokok. Jurnal Psikologi Unsyiah, 6(1), 1-28. doi:https://doi.org/10.24815/s-jpu.v6i1.26269
  34. Taylor, S., & Todd, P. A. (1995). Understanding information technology usage: A test of competing models. Information systems research, 6(2), 144-176. doi:https://doi.org/10.1287/isre.6.2.144
  35. Wang, S. D., Loftus, P., Pang, R. D., & Kirkpatrick, M. G. (2021). Impact of Self-Efficacy on Daily Intention to Not Smoke. Addictive Behaviors, 118(4). doi:https://doi.org/10.1016/j.addbeh.2021.106877