Divergent temporal patterns in adolescent behavioural risk factors across sex, age, and region in Indonesia: a national repeated cross-sectional study, 2007-2023.

Tobacco use among Indonesian adolescents increased up to 2018 and then returned to baseline levels by 2023.

• Analysis used nationally representative surveys from 2007, 2013, 2018, and 2023.
• The combined sample comprised 653,700 adolescents aged 10-18 years.
• Poisson regression with robust standard errors estimated temporal differences adjusted for sex, age, and region.

Alcohol use prevalence was broadly comparable in 2007 and 2018 but substantially lower in 2023.

• Estimates were survey-weighted population prevalences.
• Temporal differences were adjusted for sex, age, and region.
• The authors describe alcohol use as declining over the 16-year period.

Insufficient physical activity was markedly lower in 2013 than in other years, with 2018 and 2023 estimates closer to 2007.

• The authors conclude there was no sustained improvement in physical activity over 16 years.
• Data came from four national surveys (2007, 2013, 2018, 2023).

Insufficient fruit and vegetable intake declined to 2018, then rose above the 2007 baseline by 2023.

• The authors summarise this as worsening insufficient fruit and vegetable intake over the study period.
• Estimates were adjusted for sex, age, and region.

Tobacco and alcohol use were higher among males and older adolescents.

• Differences were assessed in adjusted Poisson regression models including sex, age, and region.
• The patterns persisted across the survey period according to the abstract's description of persistent demographic differences.

Insufficient physical activity was higher among females and younger adolescents, while insufficient fruit and vegetable intake was higher among females and older adolescents.

• Age range of the sample was 10-18 years.
• Sex and age differences were estimated with adjustment for region and the other covariates.

Papua had the highest combined tobacco prevalence from 2013 onward, largely reflecting higher chewing tobacco use, and Kepulauan Nusa Tenggara had the highest alcohol prevalence.

• Regional differences were estimated from nationally representative survey data.
• The Papua pattern was largely attributed to chewing tobacco.

Temporal changes varied by age and geographic region across all four outcomes.

• The four outcomes were tobacco use, alcohol use, insufficient physical activity, and insufficient fruit and vegetable intake.
• The authors note improvement in one behavioural domain did not necessarily coincide with improvement in others.

The authors conclude that Indonesia achieved limited overall improvement in adolescent behavioural health from 2007 to 2023 and recommend a two-track policy approach.

• Track one: targeted tobacco and alcohol prevention for males, older adolescents, and higher-prevalence regions.
• Track two: school-, family-, and community-based strategies to improve physical activity and diet.