Empowering Women in Tobacco Control: A Participatory Study on Household Smoking Behavior in Aceh, Indonesia.

Tobacco smoking remains a critical public health concern in Indonesia, particularly in Aceh Province, where male smoking prevalence reaches 56.12%. Cultural permissiveness and weak enforcement of tobacco control regulations have contributed to this high prevalence. Women, especially wives, are central figures in family health and may play an essential role in influencing household smoking behavior. However, their roles and strategies remain underexplored, especially in conservative cultural settings. This qualitative study employed a Participatory Action Research (PAR) approach to examine the roles of women in controlling the smoking behavior of family members in Aceh. A total of 75 research subjects were selected from three districts (Aceh Singkil, Gayo Lues, and Pidie Jaya) using a combination of purposive sampling and snowball sampling methods. Data were collected through semi-structured in-depth interviews and were analyzed thematically using NVivo 15 software. The analysis framework was based on Lawrence Green's PRECEDE model, which includes predisposing, enabling, and reinforcing factors. This study found that women demonstrated progressive attitudes toward smoking, evolving from passive acceptance to active responsibility. They employed both persuasive strategies (health education, emotional appeals, and motivation) and coercive actions (household smoking bans, threats, and withdrawal of privileges). Women also positioned themselves as health monitors and guardians within the household. Despite cultural limitations and gender hierarchy, many participants reported partial or complete success in encouraging their husbands to quit smoking, particularly when supported by religious norms and health awareness. Women play a pivotal role in shaping smoking-related behavior in the family. Empowering women through participatory frameworks and culturally tailored interventions can enhance their effectiveness as health advocates. This study underscores the need to integrate gender-sensitive strategies into national tobacco control policies, especially in culturally conservative regions.