Knowledge about The Dangers of Smoking and Smoking Behavior of Students in Septembro Unamet 4th High school Dili, Timor Leste

Most adults who are dependent on nicotine start smoking in their teens. Timor-Leste is the country with the highest smoking rate in the world. Every year, more than 700 people in Timor-Leste are killed by tobacco-related diseases. Tobacco-related diseases are the fourth leading cause of death. assessment to find out knowledge about the dangers of smoking and smoking behavior. This research design uses Crosssectional in high school with sample 122 student. Data collection was carried out by Quetionare. In this research the researchers conducted an assessment of knowledge about the dangers of smoking and smoking behavior. This study said out of 122 respondents, it was found that 59.8% had poor knowledge, 27.0% had normal knowledge and 13.1% and out of 122 respondents, 86.6% smoked and 48.3% of them had poor knowledge. The results of statistical tests showed that there was a relationship between knowledge about the dangers of smoking and smoking behavior in high school students. Solution to overcome the problem of knowledge about the dangers of smoking and smoking behavior is the provision of health education about the impact of smoking using methods that are attractive to high school students and carried out consistently.


INTRODUCTION
Tobacco use, especially smoking, has the highest mortality rate in America. Most adults who are dependent on nicotine start smoking in their teens (Brooke L et al., 2017). Smoking behavior has become a lifestyle for teenagers today. Smoking is a behavior that can cause harm to individual and community health, because cigarettes are one of the addictive substances that must be avoided (Kurniasih H, Widjanarko B, 2016). Cigarettes have three main components, namely nicotine which causes addiction, tar which is carcinogenic and carbon monoxide whose activity is very strong on hemoglobin so that oxygen levels in the blood are reduced and other chemicals that are harmful to the body (Nur, 2021).
Timor-Leste is the country with the highest smoking rate in the world. Every year, more than 700 people in Timor-Leste are killed by tobaccorelated diseases. Tobacco-related diseases are the fourth leading cause of death. In 2020, the prevalence of tobacco users by smoking was 60.7% adult men and 9.4% adult women and among young people aged 13-15 years around 42% boys and 21% girls (ACT-TL, 2021).
Factors that influence smoking behavior include the influence of friends, personality factors and the influence of advertising (Nur, 2021). Other factors that influence smoking behavior include age 20-24 years with an OR value of 2.8, work status (OR: 2.24), education level (OR: 1.93), getting information from magazines (OR: 0.78) and from video access (1.28). Based on the results of these studies, it can be concluded that most of the teenage boy's smoke. Cigarette advertising in radio and magazines, lower income and education increase the risk of smoking (Ferry et al., 2019). Based on the results of research, it is said that no environmental factors, work, family, friends and role models have an effect on smoking behavior, so that related parties such as schools and the health office continue to improve education for adolescents about the dangers of smoking (Titik et al., 2022). Knowledge is a predisposing factor that influences a person's behavior, those with high knowledge are expected to behave positively (Muhammad et al., 2013). Based on the results of the study, it was found that 650 women aged more than 5 years, who have good knowledge about the impact of smoking have a tendency to behave positively towards cigarettes (Ali et al., 2020).
Sociodemographic and lifestyle factors play an important role in determining smoking behavior in tobacco use in Timor-Leste (Lung & yong, 2022). Lifestyle is influenced by knowledge and seen from behavior. The Government of Timor Leste has tried to educate about the dangers of smoking but in Septembro 4 high school Unamet Dili it has not been carried out optimally, therefore it is necessary to do an assessment to find out knowledge about the dangers of smoking and smoking behavior in Unamet Dili high school Septembro 4 high school Unamet Dili students.

METHOD
This research design uses Crosssectional. Data collection was carried out by Quetionare. In this research the researchers conducted an assessment of knowledge about the dangers of smoking and smoking behavior of students. The sample of this study amounted to 122 which were taken by random sampling from 167 students in Septembro 4 high school Unamet Dili.

RESULT
Data Characteristics of Respondents. Characteristics of respondents in this study 55.7% were male and 44.3% were female. Of the 122 respondents, 31.1% had never been exposed to information about the dangers of smoking, 68.9% had received information about smoking, 11.5% from television and 57.4% from health education.  13.1 More than half of senior high school students at Unamet Dili smoked (86.9%) and 51.6% were male and 35.3% female. Of the students who smoked (86.9%) almost all (88.5%) had received information about the dangers of smoking, 48% of them from health education and 27.8% from television. Of the students who smoked, more than half (59.8%) had poor knowledge.  (0.000) The results of statistical tests showed that there was a relationship between knowledge about the dangers of smoking and smoking behavior in high school students at Septembro 4 high school Unamet Dili (P value: 0.00).

DISCUSSION
Based on Table 2 of 122 respondents, it was found that 59.8% had poor knowledge, 27.0% had normal knowledge and 13.1% had good knowledge. Knowledge is closely related to values in life.
Smoking is part of the life style of the people of Timor Leste, because Timor Leste is the highest tobacco-producing country, so most types of cigarettes consumed are tobacco. Knowledge about the impact of tobacco consumption on health can be realized in a long process. Someone who has never received information about the dangers of smoking and is supported by people who are around smokers, tends to form low knowledge about the dangers of smoking. This is because knowledge is the result of knowing what happens after someone performs the sensing process of a particular object. The process of sensing comes from sight, hearing, smell, taste and touch. A person will gain insight effectively through sight and hearing (Maretalinia et al., 2021). Of the 59.8% who have poor knowledge 2.5% have never received information about the dangers of smoking and 57.3% have received information from health education, while 2.7% who have normal knowledge 15.6% of them have never received knowledge about the dangers of smoking and 11.4% get information from television. The results of this study indicate that 59.8% of respondents who have less knowledge, more than half (36%) are female. The results of the study do not support the results of the study (Rabeya, 2021). Gender is significantly associated with the average knowledge of the health effects of smoking. Men have a significantly higher average level of knowledge than women.
Factors that influence knowledge are not only information but also experience. The government of Timor Leste has tried to educate about the dangers of smoking, but in Septembro 4 high school Unamet Dili it has not been carried out optimally. Health education about the dangers of smoking to senior high school students has not been done consistently. In addition, several factors that can affect health promotion include education level, socio-economic and cultural level (Notoatmodjo, 2014). The culture of smoking is very attached to the people of Timor Leste, this has also resulted in the unsuccessful efforts to provide health education about the dangers of smoking by the Timor Leste government. In addition, it is also necessary to examine the compatibility between the methods used in providing education and the target. Knowledge about the dangers of smoking to various health conditions varies widely. Knowledge was associated with demographic characteristics and exposure to anti-tobacco information, as well as smoking health and nicotine dependence. Public health would benefit from health education targeting segments of the population that lack knowledge about the health effects of smoking (Sarah & Christhoper, 2022).

Description of the Level of Knowledge of the Dangers of Smoking for Health in Adolescents
Aged 15-20 Years in South Tangerang. These results indicate a tendency that low knowledge will shape adolescent behavior to smoke, conversely, high knowledge is more likely to have non-smoking behavior (Ismayatun & Mustaqim, 2022). So, it is necessary to modify the implementation of health education about the dangers of smoking Septembro 4 high school Unamet Dili in order to increase knowledge. Furthermore, it is necessary to change the image of adolescents about smoking if their knowledge has increased to reduce smoking behavior in adolescents (Mochamad et al., 2019).

Smoking Behavior
The results of this study said that out of 122 respondents, 86.6% smoked and 48.3% of them had poor knowledge. Most of the respondents who smoked, the cigarette they consumed was tobacco. The results of statistical tests showed that there was a relationship between knowledge about the dangers of smoking and smoking behavior in high school students at Unamet Dilli (P value: 0.00). The results of this study are in accordance with the results of research conducted by (Maretalinia et al., 2021) that knowledge and behavior are significantly related to tobacco use. Furthermore, based on multivariable results, behavior was the largest influence (AOR= 4.25, 95% CI (1.93 -9.36)) and was followed by knowledge (AOR= 2.46, 95% CI (1.00 -6.04)). The main reasons for smoking in adolescents in Saudi Arabia are having smoking friends (78.2%), family neglect (45.5%), having smoking parents (41.8%), family problems (37.3%), pleasure, and have relatives who smoke (Ali, 2018). Perceptions that support smoking behavior include smoking makes a person more confident, looks like someone who is cooler, makes friends easily, can relieve stress and symbolizes one's virility and maturity (Mochamad et al., 2019). Other factors that are significantly related to current smoking behavior are marital status, gender, age, and area of residence (Ameraah et al., 2021). This Septembro 4 high school Unamet Dili student comes from various regions, both urban and rural areas, so it can be concluded that regional origin does not guarantee student behavior in consuming cigarettes. The results of research in Indonesia show that most teenagers and young men in rural Indonesia smoke tobacco (Ferry et al., 2019) All respondents in this study were teenagers. The crisis of psychosocial aspects in adolescents is an identity crisis that clashes with confusion. The crisis of this psychosocial aspect occurs because adolescents are in an effort to find their identity which is accompanied by a mismatch between psychological and social development. To cope with the pressure caused by the crisis, teenagers do smoke behavior as a way to cope or just try something new in order to find their identity. Internal factors that can motivate and make teenagers choose to smoke are personality factors. On the personality factor, the individual tries to smoke for reasons of curiosity. External factors of parents are people who influence the emergence of smoking behavior from the family environment. Teenagers who see their parents smoking will make them feel like trying what their parents did. In addition, the influence of friends with smoking behavior in adolescents. The stronger the influence of friends, the more male teenagers become active smoking behavior (Yunus & Eveline, 2019). In this study 86.6% smoked, it can be concluded that the influence of peers in the Septembro 4 high school Unamet Dili environment is very large on smoking behavior.
Smoking behavior in women has become a debate about its ethics in certain societies which eventually raises various assumptions. Smoking is considered not something that is normally done by women, because women who smoke are considered a characteristic that will distinguish them from other women who do not smoke. The results of another study found that 98.1% of adolescents who did not smoke more than half of adolescents were female (58.89%) (Titik et al., 2022). But not in this study of 86.6% who smoked 51.6% men and 35% women. Along with the development of an increasingly modern society, smoking is no longer a taboo in people's lives. The level of need for a modern lifestyle, makes community members, especially women, to try new things in their lives. In this case, of course, there are many factors that cause women to finally choose to consume cigarettes. Based on a phenomenological study of women smoking in the campus environment, the results showed that the student smoked because when he smoked, he could be more confident and make it easier to solve a problem. This woman interprets cigarettes as First, cigarettes as a friendship relationship because cigarettes can lighten the atmosphere when doing social activities. Second, smoking as a necessity.
Smoking can no longer be abandoned because it has become an addiction. Third, smoking as a lifestyle, because living in urban areas so smoking is no longer a taboo thing to do. A meaning to cigarettes for women cannot be separated from the "because of motive" before the "in order to motive" which is the cause of women smoking and the purpose of why they become smokers (Fauzi, 2020).

CONCLUSION
There is a significant relationship between knowledge about the dangers of smoking and smoking behavior of high school students at Septembro 4 high school Unamet Dili. The not enaugh knowledge about the dangers of smoking, the higher student's behavior in smoking.

SUGGESTION
Solution to overcome the problem of knowledge about the dangers of smoking and smoking behavior is the provision of health education about the impact of smoking using methods that are attractive to high school students and carried out consistently. In addition, the government of Timor Leste must commit to implementing the Convention for Tobacco Control (FCTC).

ACKNOWLEDGEMENT
We thank the high school of September 4 high school Unamet Dili for facilitating our research and all students who are willing to be respondents' cooperation.

FUNDING
The authors received no specific funding for this work.

CONFLICTS OF INTEREST
The authors declare that they have no conflict of interest.