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"Pendahuluan: Wasting, underweight, dan stunting meningkatkan angka mortalitas dan morbiditas serta merupakan permasalahan yang masih ditemukan di Indonesia. Paparan asap rokok terhadap anak meningkatkan resiko wasting, underweight, dan stunting pada anak. Penelitian ini bertujuan untuk mengetahui asosiasi antara paparan asap rokok terhadap status gizi anak 0-59 bulan yang berdomisili di DKI Jakarta.Metode: Studi dengan pendekatan potong lintang dilakukan terhadap 121 orangtua dengan anak yang berusia 0-59 bulan pada Jakarta Pusat. Data mengenai paparan asap rokok diambil melalui kuesioner yang dibagikan kepada responded. Analisis data dilakukan dengan program SPSS. Status gizi anak dianlisa berdasarkan WHO Weight-for-Height, Weight-for-Age, and Height-for-Age Z-score.Hasil: Dalam riset ini, prevalensi wasting, underweight, and stunting masing-masing adalah 6.6%, 9.1% and 31.4%. Analisis statistik bivariat dilakukan menggunakan chi-square dan fisher’s exact test yang menunjukan tidak adanya asosiasi antara paparan asap rokok dari ayah dan ibu yang merokok dengan wasting, underweight, dan stunting pada anak. Ditemukan adanya asosiasi anatara paparan asap rokok terhadap ibu saat kehamilan terhadap stunting pada anak (p= 0.024; OR= 0.409; CI(95%)= 0.186-0.898). Melalui analisa logistic regression, ditemukan assosiasi anatara umur ibu (p=0.042; OR= 3.223) dan pendidikan ayah (p=0.011; OR= 4.082) terhadap terjadinya stunting pada anak. Terdapat pula asosiasi antara umur ibu dan underweight pada anak (p= 0.047; OR= 4.229).Kesimpulan: Tidak ditemukan asosiasi anatara paparan asap rokok terhadap anak dan wasting, underweight, dan stunting. Terdapat asosiasi anatara paparan asap rokok terhadap ibu saat hamil terhadap stunting pada anak.

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Introduction:Wasting, underweight, and stunting is associated with an increase morbidity and mortality in children and is still a problem in Indonesia. Environmental tobacco smoke exposure towards children has been associated with an increase risk of wasting, underweight, and stunting in children. In this research, we aim to investigate the association between tobacco smoke exposure in DKI Jakarta household and nutritional status of children <5 years old.Methods : Cross-sectional study with random sampling technique in 121 parents with children age 0-59 months in Central Jakarta. Tobacco smoke exposure is measured through questionnaire. The results are analyzed using SPPS statistic program. Nutritional status of children is analyzed through WHO Weight-for-Height, Weight-for-Age, and Height-for-Age Z-score.Results: In this research, the prevalence of wasting, underweight, and stunting are 6.6%, 9.1% and 31.4%, respectively. Bivariate statistical analysis using chi-square and Fisher’s Exact Test showed no association between tobacco smoke exposure with wasting, underweight, and stunting, while an association was found between tobacco smoke exposure during pregnancy with stunting in children aged 0-59 months (p= 0.024; OR= 0.409; CI(95%)= 0.186-0.898). Logistic regression analysis showed that Mother's age (p and paternal education (p=0.011; OR= 4.082) increases risk of stunting in children. Age of mother is associated with Underweight in children (p= 0.047; OR= 4.229).Conclusion: No association between paternal and maternal smoking with underweight, wasting, and stunting is found, while an association was found between tobacco smoke exposure during pregnancy with stunting in children."

"ABSTRAK Latar Belakang : Kotinin merupakan hasil metabolit utama nikotin dankadarnya pada urin merupakan indikator pajanan asap rokok. Penlitian ini untukmengetahui kadar kotinin urin pada anak yang terpajan dan tidak terpajan asaprokok di lingkungan rumah. Metode : Penelitian potong lintang pada anak usia sekolah dasar yang tidakmerokok. Subjek dikelompokkan menjadi kelompok terpajan dan tidak terpajanberdasarkan status pajanannya. Data yang diperoleh dari kuesioner dan sampelurin sewaktu yang diukur dengan metode ELISA. Hasil : Total subjek 128 anak usia 6-12 tahun yang terdiri dari 64 anak padakelompok terpajan dan 64 anak yang tidak terpajan. Kadar kotinin urin padakelompok terpajan lebih tinggi dibandingkan kelompok tidak terpajan (median30,1 vs 8,45 ng/ml; p<0.05). Terdapat perbedaan kadar kotinin pada anak yangterpajan asap rokok dengan jumlah batang rokok yang dihisap oleh perokok dirumah (p<0.05). Status pajanan asap rokok berhubungan dengan keluhan batuk,infeksi saluran napas atas dan rawat inap karena keluhan respirasi pada anak. Nilaititik potong optimal kadar kotinin urin pada anak untuk menilai pajanan asaprokok yaitu 17,95 ng/ml (sensitifitas 81%, spesifisitas 81%, AUC 91,2%, p<0.05).Kesimpulan: Kadar kotinin urin dapat digunakan sebagai biomarker yang tidak invasif untuk evaluasi pajanan asap rokok pada anak.ABSTRACT Introduction : The cotinine is major metabolite of nicotine and the level ofurinary cotinine is an indicator of tobacco smoke exposure. This study investigate role of urinary cotinine level in children exposed and unexposed to tobacco smokeat home.Method : A Cross sectional study that enrolled elementary school nonsmokerschildren classified into exposed group and unexposed group based on tobaccosmoke sexposure status. The questionnaire and spot urinary samples werecollected and urinary cotinine levels were measured by ELISA.Results : A total 128 nonsmokers children age 6-12 years divided into 64 childrenin exposed group and 64 children in unexposed group. The urinary cotinine levelsin exposed group significantly higher than unexposed group (median 30,1 ng/m;vs 8,45 ng/ml; p<0.05). There was significant difference of urinary cotinine levelin exposed group with number of cigarettes (p<0.05). Tobacco smoke exposurestatus associated with frequent cough symptom, upper respiratory infection andhospitalization because of respiratory symptoms in subjects. The optimal cut offpoint urinary cotinine in children to distinguish unexposed children with exposedto tobacco smoke at home was 17,95 ng/ml (sensitivity 81%, spesificity 81%,p<0.05).Conclusion : The urinary cotinine level is useful and noninvasive biomarker for evaluating tobacco smoke exposure in children. ;Introduction : The cotinine is major metabolite of nicotine and the level ofurinary cotinine is an indicator of tobacco smoke exposure. This study investigate role of urinary cotinine level in children exposed and unexposed to tobacco smokeat home.Method : A Cross sectional study that enrolled elementary school nonsmokerschildren classified into exposed group and unexposed group based on tobaccosmoke sexposure status. The questionnaire and spot urinary samples werecollected and urinary cotinine levels were measured by ELISA.Results : A total 128 nonsmokers children age 6-12 years divided into 64 childrenin exposed group and 64 children in unexposed group. The urinary cotinine levelsin exposed group significantly higher than unexposed group (median 30,1 ng/m;vs 8,45 ng/ml; p<0.05). There was significant difference of urinary cotinine levelin exposed group with number of cigarettes (p<0.05). Tobacco smoke exposurestatus associated with frequent cough symptom, upper respiratory infection andhospitalization because of respiratory symptoms in subjects. The optimal cut offpoint urinary cotinine in children to distinguish unexposed children with exposedto tobacco smoke at home was 17,95 ng/ml (sensitivity 81%, spesificity 81%,p<0.05).Conclusion : The urinary cotinine level is useful and noninvasive biomarker for evaluating tobacco smoke exposure in children. ;Introduction : The cotinine is major metabolite of nicotine and the level ofurinary cotinine is an indicator of tobacco smoke exposure. This study investigate role of urinary cotinine level in children exposed and unexposed to tobacco smokeat home.Method : A Cross sectional study that enrolled elementary school nonsmokerschildren classified into exposed group and unexposed group based on tobaccosmoke sexposure status. The questionnaire and spot urinary samples werecollected and urinary cotinine levels were measured by ELISA.Results : A total 128 nonsmokers children age 6-12 years divided into 64 childrenin exposed group and 64 children in unexposed group. The urinary cotinine levelsin exposed group significantly higher than unexposed group (median 30,1 ng/m;vs 8,45 ng/ml; p<0.05). There was significant difference of urinary cotinine levelin exposed group with number of cigarettes (p<0.05). Tobacco smoke exposurestatus associated with frequent cough symptom, upper respiratory infection andhospitalization because of respiratory symptoms in subjects. The optimal cut offpoint urinary cotinine in children to distinguish unexposed children with exposedto tobacco smoke at home was 17,95 ng/ml (sensitivity 81%, spesificity 81%,p<0.05).Conclusion : The urinary cotinine level is useful and noninvasive biomarker for evaluating tobacco smoke exposure in children. "

"ABSTRAKLatar Belakang : Benzo(a)pyrene (BaP) adalah hidrokarbon aromatik polisiklik sangat karsinogenik yang terdapat dalam asap rokok. Tidak hanya perokok yang perlu menjadi perhatian, namun bahaya yang ditimbulkan akibat asap rokok pada orang yang tidak merokok juga perlu diperhatikan.Metode : Penelitian ini berjenis potong lintang pada 26 perempuan dewasa bukan perokok yang terpajan asap rokok dan 15 perempuan tidak terpajan asap rokok di rumahnya di kelurahan Palmeriam Kecamatan Matraman, Jakarta. Kadar BPDE-protein adducts diukur menggunakan metode ELISA. Kadar CO ekspirasi, informasi kebiasaan merokok anggota keluarga di rumah pada subjek penelitian dikumpulkan melalui kuesioner.Hasil : Nilai BPDE-protein adducts <40 ng/ml sebanyak 16 orang (61,5%) dan nilai BPDE-protein adducts >40 ng/ml sebanyak 10 orang (38,5%), sedangkan pada kelompok perempuan tidak terpajan asap rokok di rumah, nilai BPDE-protein adducts <40 ng/ml sebanyak 11 orang (73,3%) dan nilai BPDE-protein adducts >40 ng/ml sebanyak 4 orang (26,7%), hasil analisis menunjukkan perbedaan yang tidak bermakna (p=0,443). Pengukuran kadar CO ekspirasi pada penelitian ini memperoleh nilai tengah kadar CO ekspirasi pada kelompok perempuan yang terpajan asap rokok sebesar 5,5 ppm. Pada kelompok perempuan yang tidak terpajan asap rokok, rerata kadar CO ekspirasi sebesar 6 ppm, hasil analisis tidak menunjukkan adanya perbedaan yang bermakna (p=0,398). Lama pajanan, jenis rokok, banyaknya jumlah rokok yang dihisap serta banyaknya jumlah perokok aktif dirumah tidak mempengaruhi kadar BPDE-protein adducts.Kesimpulan : Nilai BPDE-protein adducts >40 ng/ml pada perempuan terpajan asap rokok lebih tinggi dibandingkan dengan perempuan yang tidak terpajan asap rokok di lingkungan rumah.

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ABSTRACTBackground: Benzo(a)pyrene (BaP) is a polycyclic aromatic hydrocarbon contained in cigarette smoke. This highly carcinogenic substance is also found in Environmental Tobacco Smoke (ETS) which equally dangerous to the health of population and equally require attentions as much as cigarette smoke. This study observes level of BaP among those in risk of ETS exposure.Methods: A cross-sectional study was performed involving 26 women exposed to ETS and 15 women unexposed to ETS in Palmeriam Matraman area, Jakarta, Indonesia. The BPDE (Benzo(a)pyrene Diol Epoxide) protein levels of adducts were measured using ELISA method. In addition, exhaled carbon-monoxide (CO) level during expiration was measured and family members smoking habits at home was obtained using questionnaire.Results: The mean age of women exposed to ETS was 35.8 ± 6.5 years and women unexposed to ETS was 41.7±7.5 years. In the ETS exposed women, the BPDE level of <40 ng/mL was found in 16 people (61.5%) and the BPDE level of >40 ng/mL was found in 10 people (38.5%). In the ETS unexposed women, the BPDE level of <40 ng/mL was found in 11 people (73.3%) and the BPDE level of >40 ng/mL was found in 4 people (26.7%). None of these results were significantly different (p=0.443). The median exhaled CO level of ETS exposed women was 5.5 ppm and of ETS unexposed women was 6.0 ppm. None of these results were significantly different (p=0.398). No correlation was found between length of ETS exposure, types of cigarettes, number of cigarettes smoked and number of active smokers at home and BPDE-protein adducts level.Conclusion: The BPDE level of ETS exposed women was higher than of ETS unexposed women (>40 ng/mL and <40 ng/mL, respectively). The median exhaled CO level of ETS exposed women was lower than of ETS unexposed women (5.5 ppm and 6.0 ppm). However, none of these results were statistically significant."

"Latar belakang - Asap rokok lingkungan merupakan faktor risiko bagi timbulnya masalah kesehatan masyarakat. Dampak kesehatan yang ditimbulkan bukan hanya mengenai perokok, tetapi juga mengenai orang lain. Dari semua kelompuk umur dalam masyamkat, bayi dan anak-anak merupakan kelompok yang rentan terkena dampak kesehatan akibat pajanan asap rokok lingkangan. Pajanan asap rokok lingkungan pada anak-anak dapat menyebabkan peningkatan risiko terkena infeksi saluran pemapasan akut dan kronis, asma, radang telinga tengah (otitis media), dan alergi. Bagi anak-anak, rumah merupakan lokasi terpenting yang berkontribusi dalam pajanan asap rokok lingkungan. Tujuan - Mengetahui hubungan kejadian otitis media dengan pajanan asap rokok lingkungan di rumah dan faktor kovariat lain (jenis kelamin, status gizi, tingkat pendidlkan bapak, tingkat pendidikan ibu, pengeluaran keluarga, kepadatan penghuni rumah, dan ventilasi rumah) pada anak kelas satu Sekolah Dasar (SD) Kelurahan Grogol, Jakarta Barat, tahun 2008. Metode - Penelitian observasional analitik, melalui pendekatan desain studi kasus kontrol. Populasi adalah seluruh anak kelas satu Sekolah Dasar (SD) di wilayah Kelutahan Grogol, Jakarta Barat, tahun 2008. Kasus adalah semua anak kelas satu SD Kelurahan Grogol tahun 2008 yang pada pemeriksaan telinga dengan otoskop ditemukan satu atau lebih tanda klinis berupa sekret di liang telinga, retraksi membran timpani, udem membran timpani, warna membran hiperemis atau kuning pucat, perforasi membran timpani, bayangan cairan di belakang membran timpani pada salah satu satu atau kedua telinganya. Kontrol adalah semua anak kelas satu SD Kelurahan Grogol tahun 2008 yang pada pemeriksaan telinga dengan otoskop tidak didapati tanda klinis seperti pada kelompok kasus. Hasil - Kejadian otitis media berhubungan bermakna dengan pajanan asap rokok lingkungan di rumah pada anak kelas satu SD Kelurahan Grogol Jakarta Barat tahuo 2008. Hasil uji regresi logistik ganda mendapatkan peningkatan resiko tiga kali lebih besar untuk menderita otitis media pada anak yang tinggal di rumah dengan pajanan asap rokok lingkungan tingg! setelah dikontrol dengan tingkat pendidikan bapak. Saran - Temuan pada penelitian ini diharapkan dapat menjadi masukan bagi anak sekolah, orangtua, guru, masyarakat, dan pemerintah dalam upaya promotif dan preventif bahaya asap rokok lingkungan hagi anak-anak serta upay. kuratif dan rehabililatif atas dampak kesehatan yang ditimbulkan.

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BackgrOund - Environmental tobacco smoke (ETS) is known as one of risk factors for public health. The health problems caused by ETS affect more people than just smokers. Children are especially vulnerable to ETS exposure than others. Children's exposure to ETS is responsible for increasing risk of acute and chronic respiratory infections, asthma, otitis media, and allergy. The most important location for children's exposure to ETS is their home.

Objectives - To analyze asssociation between otitis media and ETS exposure at home and other covariats (sex, nutritional status, paternal education level, maternal education level, family expenditure, house crowding, and ventilation) on 1st year of basic school children in Grogol, West Jakarta, 2008.

Method - Analytic observational study with case-control design. Population of this study are all 1st year of basic school children in Grogol, West Jakarta, 2008. Cases are all I" year of basic school children in Grogol, West Jakarta, 2008, with sign/s of otitis media on otoscopy. Controls are all 1st year of basic school children in Gragoi, West Jakarta, 2008, without sign of otitis media on otoscopy.

Result - Otitis media significantly associated with Children's exposure to ETS at home in this study area. Multiple logistic regression analysis showed that odds ratio for otitis media was 3 after adjustment for paternal education level.

Suggestion - The findings of this study are expecred to be an important information for all student, parents, teachers, public, and government on promotive-preventive programmes of ETS exposure, and on curative-rehabilitative programmes of ETS's health effects."

"Latar Belakang: Menurut Global Youth Tobacco Survey GYTS Indonesia 2014, 57,3 siswa terpajan asap rokok. Pajanan asap rokok menyebabkan inflamasi saluran nafas dan paru, serta penurunan fungsi paru. Kotinin sebagai metabolisme nikotin dapat digunakan sebagai biomarker pajanan asap rokok.Tujuan: Mengetahui efek pajanan asap rokok lingkungan terhadap kadar kotinin urin dan uji fungsi paru pada anak.Metode: Penelitian teknik potong lintang dengan subyek siswa berusia 11-16 tahun di Jakarta. Data didapat dari kuesioner, spirometri, dan penghitungan kadar kotinin urin dengan metode ELISA.Hasil: Terdapat 92 subyek, terdiri dari 46 kelompok kasus dan 46 kelompok kontrol. Kadar kotinin urin >10 ng/ml ditemukan pada 37,0 kelompok kasus dan 4,3 kelompok kontrol; p=0,000; OR=8,50 95 IK 2,08-34,71 . Terdapat perbedaan bermakna kadar kotinin urin terhadap jumlah perokok p=0,027 dan jumlah batang rokok per hari p=0,037 . Tidak ditemukan hubungan pajanan asap rokok dengan uji fungsi paru. Terdapat perbedaan bermakna absensi anak pada kelompok kasus dibandingkan kelompok kontrol; p=0,004; OR=6,00 95 IK 1,42-25,33 .Kesimpulan: Anak yang terpajan asap rokok memiliki kadar kotinin urin lebih tinggi dibandingkan yang tidak terpajan, yang dapat dipengaruhi oleh jumlah perokok dan jumlah batang rokok per hari.

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Background Global Youth Tobacco Survey GYTS 2014 in Indonesia showed that 57,3 of students are exposed to enviromental tobacco smoke, which causes inflammation of respiratory tracts and decrease of lung function. Urinary cotinine can be used as biomarker for cigarette smoke exposure.Objectives To examine effects of enviromental tobacco smoke exposure on urinary cotinine level and lung function test in children.Methods Subjects were students aged 11 16 years old in Jakarta. Data were obtained from questionnaire, spirometry, and urinary cotinine test using ELISA method.Results There were 92 subjects, consisted of 46 case group and 46 control group. Urinary cotinine level 10 ng ml was found in 37,0 of case group and 4,3 of control group p 0,000 OR 8,50 CI 95 2,08 34,71 . There were significant differences between urinary cotinine level with number of smokers p 0,027 and number of cigarettes per day p 0,037 . No association was found between cigarette smoke exposure and lung function test. There was a significant difference in school abscence between case group and control group p 0,004 OR 6,00 CI 95 1,42 25,33 .Conclusions Children exposed to enviromental tobacco smoke have higher urinary cotinine level than non exposed children. Factor such as number of smokers and number of cigarettes per day may affect urinary cotinine level. "

"Pneumonia balita merupakan salah satu masalah kesehatan anak global yang menyumbang angka morbiditas dan mortalitas tertinggi khususnya di negara berkembang. Di Indonesia Timur, pneumonia balita sebagian besar dipicu oleh faktor lingkungan yakni terpaparnya anak pada asap rumah tangga maupun asap rokok. Hal ini disebabkan oleh kurangnya informasi dan kesadaran orang tua akan bahaya asap rokok pada balita pneumonia. Penelitian ini bertujuan untuk menggali persepsi orang tua tentang bahaya asap rokok terhadap balita pneumonia. Penelitian ini merupakan penelitian kualitatif dengan pendekatan fenomenologi. Partisipan dalam penelitian ini adalah orang tua yang memiliki balita pneumonia berjumlah 11 orang. Pengumpulan data dilakukan dengan wawancara mendalam kemudian dianalisis menggunakan metode Colaizzi. Tema yang dihasilkan di dalam penelitian ini meliputi (1) pandangan orang tua mengenai bahaya asap rokok, (2) bahaya asap rokok bagi balita, dan (3) dampak asap rokok bagi keluarga. Tema tersebut mengidentifikasi persepsi orang tua dengan balita pneumonia di Kabupaten Manggarai bahwa balita pneumonia di Manggarai rentan terpapar asap rokok pada berbagai kesempatan. Asap rokok berbahaya bukan hanya bagi kesehatan balita tetapi juga memberi beban pada kesejahteraan sosial dan ekonomi keluarga. Peningkatan kesadaran orang tua akan bahaya asap rokok perlu terus difasilitasi oleh perawat dengan komunikasi edukasi yang efektif dan menyesuaikan dengan kebutuhan serta kondisi keluarga.

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Pneumonia on under-five children is define as one of the major pediatric health crisis, contribute to highest morbidity and mortality globally particularly in developing nations. In Eastern Indonesia, pneumonia on under-five children is mostly predicted by environmental factor such as children are exposed to household smoke and tobacco smoke. This is caused by the lack of information received and lack of awareness on the effect of secondhand smoke on under-five children with pneumonia. This study was aimed to explore the parents perception on the effect of tobacco smoke exposure on under-five children with pneumonia. This study was a qualitative study using fenomenology approach. The participants in this study were 11 parents of under-five children with pneumonia. The data collection conducted through in-depth interview then analyzed using Coalizzi method. The themes identified in this study were (1) parents views on the effect of tobacco smoke; (2) the effect of tobacco smoke on under-five children; and (3) the impact of tobacco smoke on family. These themes identified the perception of parents with under-five children with pneumonia in Manggarai that the under-five children in Manggarai were on high risk of tobacco smoke exposure on several occasions. Tobacco smoke would not only endangering childs health but also burdening familys social and economy well-being. The improvement of parental awareness on the effect of tobacco smoke needed to comprehensivelyfacilitated by nurses through effective educating communication that suited with familys needs and conditions."

"Sepertiga penduduk dunia telah terinfeksi tuberkulosis dan terdapat lebih dari 8 juta orang yang menderita TB setiap tahunnya. Sementara itu, 3 juta orang meninggal akibat kebiasaan merokok setiap tahunnya di dunia ini. Indonesia sendiri sebenarnya adalah penyumbang kasus TB ke-3 terbesar di dunia. Indonesia juga menduduki peringkat keempat dalam jumlah perokok di dunia. Hubungan antara kebiasaan merokok dan tuberkulosis telah diketahui sejak lama, walaupun bukti epidemiologis belum amat menunjang, demikian juga dengan penjelasan patofisiologis serta perubahan biomolekuler yang terjadi. Dewasa ini makin banyak kita temukan data epidemiologis yang menyokong hubungan antara tuberkulosis dan kebiasaan merokok. Penelitian lebih lanjut amat diperlukan guna menggali lebih dalam aspek-aspek hubungan ini dan menghilangkan faktor pengganggu yang mungkin berpengaruh. Harus dilakukan kerja sama yang harmonis untuk dapat melaksanakan program penanggulangan tuberkulosis dan penanggulangan merokok secara sinergistik. Tuberkulosis –di mana Indonesia menduduki peringkat ke-3 di dunia– dan masalah merokok –di mana Indonesia menduduki peringkat ke-4 di dunia- adalah dua masalah kesehatan masyarakat yang penting bagi bangsa kita. Bila memang ada hubungan asosiatif antara keduanya maka masalah kesehatan itu bahkan akan makin besar. Kita perlu menguasai pengetahuan tentang tuberkulosis dan juga tentang kebiasaan merokok pada populasi Indonesia untuk meningkatkan status kesehatan masyarakat. Program penanggulangan tuberkulosis dan program penanggulangan masalah merokok merupakan modal yang amat penting untuk derajat kesehatan bangsa Indonesia. (Med J Indones 2003; 12: 48-52)

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One third of the world population is infected with tuberculosis, and over 8 millions people were developing each year. On the other hand tobacco is responsible for 3 millions death in the world. For Indonesia, our country has the third biggest TB cases in the world. Whereas Indonesia is ranked as having the fourth largest number of smokers in the world. A relationship between smoking and TB has been suspected for a long time, even though the epidemiological evidence has not been convincing so far, as well as the pathophysiology and the biomolecullar changes. At present time there are more and more epidemiological data to suggest relationship between TB and tobacco. Further research should be done to get more indepth relationship as well as avoiding the confounder factor. To be able to perform TB control as well as tobacco control successfully there should be emphasize on synergistic public health approaches. Tuberculosis –which Indonesia got 3rd rank in the world- as well as smoking problem –which Indonesia got 4th rank in the world- are two important public health problem for the country. If there are relationship between tobacco and tuberculosis, health problem faced by Indonesian even become bigger. Knowledge about tuberculosis as well as tobacco among Indonesian population is very essential to improve the public health situation. Tuberculosis control programme as well as smoking control programme are essential tools for the well being of Indonesian people. (Med J Indones 2003; 12: 48-52)"

"Skripsi ini membahas tentang peranan dan hubungan Akuntansi Manajemen Lingkungan / Environmental Management Accounting (EMA) dalam sistem manajemen manufaktur, dengan menelaah penerapan, pemahaman dan manfaatnya pada industri rokok di PT Djarum, Kudus, Indonesia. Dasar penerapan EMA adalah integrasi peningkatan produktivitas, kualitas dan kepedulian lingkungan yang didukung kelengkapan informasi data fisik dan moneter dalam penetapan alokasi biaya sesuai kaidah akuntansi terhadap kegiatan ekonomi lingkungan. Fakta di lapangan dan diskusi dengan staf perusahaan disinkronisasikan dengan teori EMA untuk digunakan sebagai dasar dalam mengarahkan analisis EMA yang mudah dipahami secara umum, dan diterapkan di perusahaan sesuai dengan arah dan kebutuhan masing-masing organisasi. Analisis EMA yang disusun dalam skripsi ini diharapkan dapat memberi arahan untuk mempermudah pemahaman dan penerapannya di industri manufaktur di Indonesia sehingga mampu bersaing di pasar global demi keberlangsungan bisnis lestari (business continuity and sustainability in global market).

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This thesis aims to explain about the role of Environmental Management Accounting (EMA) and its relationship with manufacturing management system by analyzing the implementation, comprehension, and the benefits of EMA in the tobacco industry, specifically at PT Djarum, Kudus, Indonesia. Basic implementation of EMA is the integration of productivity, quality, and environmental concern supported by the completeness of physical and monetary data information for determination of cost driver allocation based on accounting principle toward environmental-economic activities. The facts and discussions with company?s staffs are synchronized with EMA theory to develop a basis for analysis of EMA that can be understood generally, to be implemented in all types of manufacturing industry regardless their needs. The analysis of EMA in this thesis may give a better understanding about its implementation in manufacturing industries in Indonesia so that they will be able to compete globally, especially in terms of business continuity and sustainability in global market."