Relationship between father involvement, adolescent stress, and smoking behavior in Indonesia: A cross-sectional study

Zata Ismah (Faculty of Psychology, Universitas Islam Negeri Raden Fatah Palembang, Palembang, Indonesia)
Fatma Indriani (Faculty of Public Health, Universitas Islam Negeri Sumatera Utara, Medan, Indonesia)
Rizky Indah Syahfitri (Faculty of Public Health, Universitas Andalas, Padang, Indonesia)
Citra Cahyati Nst (Faculty of Medicine, Denistry & Health Sciences, The University of Melbourne, Melbourne, Australia)
Rahmatusyifa Rahmatusyifa (Faculty of Medicine, Public Health, and Nursing, Univeristas Gadja Mada, Yogyakarta, Indonesia)
Ikrimah Nafilata (Varians Statistik Kesehatan, Tanggerang, Indonesia Blood Bank Technology Study Program, STIKES Guna Bangsa Yogyakarta, Yogyakarta, Indonesia)
Zaharuddin Zaharuddin (Faculty of Psychology, Universitas Islam Negeri Raden Fatah Palembang, Palembang, Indonesia)
Cholila Shinta Jatisari (Faculty of Psychology, Universitas Islam Negeri Raden Fatah Palembang, Palembang, Indonesia)

Jurnal NERS
Vol. 21 No. 2 (2026): VOLUME 21 ISSUE 2 (MAY 2026)

Introduction: Adolescents experiencing fatherlessness often reported feelings of emotional deprivation and a lack of affection and quality time with their fathers compared to their peers. Some adolescents resorted to smoking as a coping mechanism. Therefore, this study aimed to examine the relationships between father involvement, adolescent stress, and smoking behavior, and the path model linking these variables. Methods: This cross-sectional study was conducted among high school adolescents in Medan City, Indonesia. A total of 1,221 adolescents were selected using cluster random sampling. Data on father involvement, stress, and smoking behavior were collected using questionnaires. The data were analyzed using chi-square tests and path analysis. Results: Adolescents in the fatherless group showed higher levels of severe stress compared to those with positive father involvement, particularly among females and early adolescents. Severe stress was also associated with higher smoking behavior both males and females, particularly among late adolescents. Lower father involvement was significantly associated with increased stress (β=-0.12, p<0.0001).) and smoking behavior (β=-0.11, p<0.0001). Stress was associated with smoking behavior and potentially mediated the association between father involvement and smoking behavior (R² = 0.02). Conclusions: Father involvement was associated with adolescent psychological well-being, while stress was potentially associated with smoking behavior. These associations differed according to age and sex, with females and early adolescents experiencing low father involvement showing a higher risk of severe stress, whereas late adolescents with severe stress were more likely to engage in heavy smoking.