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Journal of Epidemiology and Public Health
ISSN : 25490273     EISSN : 25490273     DOI : -
Core Subject : Health,
Journal of Epidemiology and Public Health (JEPH) is an electronic, open-access, double blind and peer-reviewed international journal, focusing on epidemiology and public health. The journal began its publication on June 2, 2015, and is published three times yearly. It seeks to improve scientific and professional knowledge of epidemiology and to advance public health research, policy, practice, and education worldwide.
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Articles 103 Documents
The Effect of Obesity, Oral Contraceptive and Passive Smoking on the Risk of Cervical Cancer Arfailasufandi, Roiela; Mudigdo, Ambar; Sudiyanto, Aris
Journal of Epidemiology and Public Health Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Studies have investigated the effects of obesity on cancer development. However, the relationship between obesity and cervical cancer risk is unclear. This study aimed to determine the effect of obesity, oral contraceptive and passive smoking on the risk of cervical cancer.Subjects and Method: A case-control study was conducted at Dr. Moewardi Hospital, from October to December 2018. A sample of 200 patients was selected by fixed disease sampling, consisting of 100 cervical cancer patients and 100 noncervical cancer patients. The dependent variable was cervical cancer. The independent variables were obesity, oral contraceptive use, smoking exposure, parity, age at first sexual intercourse, and family history. The data were obtained from the medical record. The data were analyzed by multiple logistic regression.Results:The risk of cervical cancer increased with obesity (OR= 6.83; 95%CI= 2.44 to 19.17; p<0.001), cigarette smoke exposure (OR= 12.57; 95% CI= 4.59 to 34.41; p<0.001),oral contra­ceptive use (OR= 3.43; 95%CI= 1.27 to 9.25; p= 0.015), parity (OR= 3.94; 95%CI= 1.47 to 10.59; p= 0.006), and family history (OR= 5.63; 95%CI= 1.94 to 16.34; p= 0.001).The risk of cervical cancer decreased with delayed menarche (OR= 0.24; 95%CI= 0.09 to 0.68; p= 0.007) and delayed age at first sexual intercourse (OR= 0.21; 95%CI= 0.86 to 0.53; p= 0.001).Conclusion: The risk of cervical cancer increases with obesity, oral contraceptive use, smoking exposure, parity, and family history. The risk of cervical cancer decreases with delayed menarche and delayed age at first sexual intercourse.Keywords: obesity, oral contraception, smoking exposure, cervical cancerCorrespondence: Roiela Arfailasufandi. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta 57126, Central Java, Indonesia. Email: andi_suf@ymail.com. Journal of Epidemiology and Public Health (2019), 4(3): 189-197https://doi.org/10.26911/jepublichealth.2019.04.03.06
Effectiveness of Larva Monitoring Training on Knowledge of Dengue Hemorragic Fever Control among Primary School Students in Sibolga, North Sumatera Damanik, Wandi; Nurmaini, Nurmaini; Rochadi, Kintoko
Journal of Epidemiology and Public Health Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Dengue hemorrhagic fever (DHF) is one of the most important public health problems in tropical developing countries. It also has major economic and societal consequences. This study aimed to assess the effectiveness of larva monitoring training on knowledge of dengue hemorrhagic fever control among primary school students in Sibolga, North Sumatera.Subjects and Method: This was a quasi-experiment before and after with no controlled design. The study was conducted in elementary school in Sibolga, North Sumatera, in 2018. A sample of 30 students was selected for this study and received training on DHF for four days. The training employed leaflet and video. The dependent variable was know­ledge. The independent variable was training on DHF. The data were collected by questionnaire and tested by t-test.Results: Knowledge of DHF among students increased by mean= 26.67 (SD= 14.51) after training, and it was statistically significant (p= 0.037).Conclusion: Knowledge of DHF among students increases after training, and it is statistically significant.Keywords: training, knowledge, dengue hemorrhagic fever.Correspondence: Wandi Damanik. Masters Program in Public Health, Universitas Sumatera Utara, Jl. Universitas No. 21. Kampus USU, Medan 20115, Indonesia. Email: wandidamanik4981@gmail.com. Epidemiology and Public Health (2019), 4(3): 183-188https://doi.org/10.26911/jepublichealth.2019.04.03.05
Determinants of Recurrence and Death in HIV-Malaria Co-Infection Patients in Jayapura, Papua, Indonesia Winiarti, Dian; Mudigdo, Ambar; Murti, Bhisma
Journal of Epidemiology and Public Health Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Human Immunodeficiency Virus (HIV) is one of the important public health problems in the world which causes death of more than 35 million people annually. HIV infection is often associated with several comorbidities caused by the presence of endemic infectious diseases in certain regions, one of them is malaria. Analyzing the survival of HIV / AIDS patients malaria coinfection is based on risk factors for recurrence and death due to malaria. This study aimed to examine the determinants of recurrence and death in HIV-malaria co-infection patients in Jayapura, Papua, Indonesia.Subjects and Method: This was a retrospective cohort study conducted in the VCT room at Dok II Regional General Hospital, Jayapura, Papua Province, Indonesia, from May to June 2018. A sample of 183 people living with HIV/AIDS (PLWH) was selected by fixed disease sampling. The dependent variable was recurrence. The independent variables were drug taking adherence, nutritional status, economic status, use of mosquito nets, spraying residues in the house, healthy hygiene behavior, co-infection with malaria. The data were obtained from medical record. The other data were collected by questionnaire. The data were analyzed using path analysis.Results: The risk of recurrence in PLWH co-infected with malaria decreased with ARV treatment adherence (b= -2.17; 95% CI= -3.24 to -1.09; p<0.001) and compliance with Cotrimoxazole treatment (> 95 %) (b= -1.88; 95% CI= -2.58 to -1.19; p<0.001). The risk of recurrence in PLWHA co-infected with malaria increased with low income <Rp 2,000,000 (b= 3.06; 95% CI= 2.04 to 4.07; p <0.001), poor health behavior (mean <5) (b= 1.66;  95% CI= 0.92 to 2.40; p<0.001), poor nutritional status (b= 2.10; 95% CI= 1.44 to 2.76; p<0.001), and did not use bed nets (b= 0.73; 95% CI= 0.16 to 1.29; p= 0.011). The risk of death in PLWHA coinfected with malaria decreased with ARV treatment adherence (> 95%) (b= -2.08; 95% CI= -3.02 to -1.14; p<0.001) and healthy behavior (mean> 5) (b= -1.43; 95% CI= -2.15 to -0.70; p<0.001). The risk of death in PLWHA co-infected with malaria increased with low income (<Rp 2,000,000) (b = 3.06; 95% CI= 2.04 to 4.07; p <0.001), poor health behavior (mean <5) (b= 1.66; 95% CI= 0.92 to 2.40; p <0.001), and poor nutritional status (b = 2.10; 95% CI= 1.44 to 2.76; p <0.001).Conclusions: The risk of recurrence in PLWHA co-infected with malaria increases with low income, poor health behavior, and poor nutritional status, but decreases with adherence to ARV treatment and Cotrimoxazole treatment. The risk of death of PLWHA coinfected with malaria increases with low income, poor health behavior, and poor nutritional status, but decreases with adherence to ARV treatment.Keywords: recurrence, co-infection, HIV/AIDS, malaria, death, path analysis, people with HIV/AIDSCorrespondence: Dian Winiarti. Masters Program in Public Health. Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java 57126, Indonesia. Email: Dianwiniarti@gmail.com. Mobile: +6281344266960.Journal of Epidemiology and Public Health, 2019, 4(3): 138-155https://doi.org/10.26911/jepublichealth.2019.04.03.01
Biological and Social Economic Determinants of Adherence and Cure of Tuberculosis Treatment: Path Analysis Evidence from Yogyakarta Fitriani, Tri Godha; Rahardjo, Setyo Sri; Prasetya, Hanung
Journal of Epidemiology and Public Health Vol 4, No 4 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Tuberculosis (TB) was an infectious disease which was still a health problem world­wide, including in Indonesia, which only had a population of around 261 million. The purpose of this study was to analyze biological and social economic determinants of adherence and cure of TB treatment.Subjects and Method: This was an analytic observational study with a case control design. The study was conducted in Bantul, Yogyakarta, from April to May 2019. A sample of 225 TB patients was selected by random sampling. The dependent variable was adherence and cure of TB treat­ment. The independent variables were age, gender, education, family income, nutritional status, healthy behavior, complication, family support, drug taking supervisor, drug taking adherence, environment, and smoking. The data were collected by questionnaire and analyzed by path analysis.Results: Adherence and cure of TB treat­ment was directly increased with good nutritional status (b= 076; 95% CI= 0.03 to 1.49; p= 0.042), drug taking adherence (b= 3.67; 95% CI= 1.47 to 5.92; p= 0.001), drug taking supervisor (b= 3.64; 95% CI= 1.26 to 6.02; p= 0.003), strong family support (b= 2.03; 95% CI= -3.85 to -0.21; p= 0.029), and healthy physical environment (b= 4.05; 95% CI= - 0.09 to 8.20; p= 0.056). Adherence and cure of TB treat­ment was directly decreased with age ≥65 years old (b= -0.54; 95% CI= - 1.85 to 0.75; p= 0.411), female gender (b= -0.05; 95% CI= - 0.86 to 0.76; p= 0.900), unhealthy behavior (b= -3.20; 95% CI= - 5.02 to -1.36; p= 0.001), smoking (b= -1.50; 95% CI= - 2.56 to -0.43; p= 0.006), complication (b= -1.41; 95% CI= - 2.60 to -0.23; p= 0.019). It was indirectly affected by nutritional status, education, family income, and healthy environment.Conclusion: Adherence and cure of TB treat­ment is directly increased with good nutritional status, drug taking adherence, drug taking supervisor, strong family support, and healthy physical environment. Adherence and cure of TB treat­ment is directly decreased with age ≥65 years old, female gender, unhealthy behavior, smoking, complication. It is indirectly affected by nutritional status, education, family income, and healthy environment.Keywords: tuberculosis treat­ment, drug taking adherence, path analysisCorrespondence: Tri Godha Fitriani. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: trigodha@gmail.com. Mobile: +6287738200610.Journal of Epidemiology and Public Health (2019), 4(4): 270-282 https://doi.org/10.26911/jepublichealth.2019.04.04.02
The Correlation of Age with Uric Acid in Kadipiro, Surakarta Nurhayati, Yeti; Umarianti, Tresia
Journal of Epidemiology and Public Health Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Uric acid is the final product of purine metabolism. Purines (adenine and guanine) are nucleic acid contituents. Purine rotation occurs continuously in the body along with the synthesis and decomposition of DNA and RNA, although there is no intake of purine, a substantial amount of uric acid will still be formed. Uric acid is synthesized mainly in the liver by the xanthine oxidase enzyme. This study aimed to examine the correlation of age with uric acid.Subjects and method: This was a cross-sectional study conducted in Gambirsari Health Center, Kadipiro Village, Mojosongo, Surakarta, Central Java. A sample of 50 gout patients was selected by purposive sampling. The dependent variable was uric acid. The independent variable was age. The data were analyzed by Pearson correlation.Results: There was a correlation between age and uric acid (r= 0.37; p= 0.009).Conclusion: There is a correlation between age and uric acid.Keywords: gout, age, uric acidCorrespondence: Yeti Nurhayati. Nursery Study Program, School of Health Sciences Kusuma Husada, Surakarta, Central Java. Email: yeti_nurhayati234@yahoo.com.Journal of Epidemiology and Public Health (2019), 4(3): 180-182https://doi.org/10.26911/jepublichealth.2019.04.03.04
Logistic Regression on Factors Affecting Depression among the Elderly Wahyuningsih, Christiana Sri; Subijanto, Achmad Arman; Murti, Bhisma
Journal of Epidemiology and Public Health Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Mental health problems, especially depression, have a major impact on the elderly. Depression is a major contributor to the burden of disease globally which can cause suicide. This study aimed to determine the factors that influence depression in the elderly.Subjects and Method: This was an analytic observational study with a cross-sectional design. It was conducted from October to December 2018. A total of 200 elderly was selected by simple random sampling. The dependent variable was depression. The independent variables were income, history of chronic illness, family function, social interaction, social support, social isolation, and loneliness. Data on depression was measured by Geriatric Depression Scale 15 (GDS-15). The other data were collected by questionnaire and analyzed by multiple logistic regression.Results: The risk of depression in elderly increased with history of chronic illness (OR= 8.03; 95% CI= 1.48 to 43.42; p= 0.016), social isolation (OR= 6.05; 95% CI= 1.41 to 25.98; p= 0.015), and loneliness (OR= 7.14; 95% CI= 1.62 to 31.41; p= 0.009). It decreased with high income (OR= 0.14; 95% CI= 0.03 to 0.60; p= 0.008), strong family function (OR= 0.13; 95% CI= 0.02 to 0.67; p= 0.014), strong social interaction (OR= 0.11; 95% CI= 0.02 to 0.48; p= 0.003), and strong social support (OR= 0.16; 95% CI= 0.04 to 0.65; p= 0.011).Conclusion: The risk of depression in the elderly increases with a history of chronic illness, social isolation, and loneliness. It decreases with high income, strong family function, strong social interaction, and strong social support.Keywords: depression, elderly, income, chronic illness, family function, social factors, lonelinessCorrespondence: Christiana Sri Wahyuningsih. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami No. 36 A, Surakarta, Indonesia. Email:anachristi19@gmail.com.Mobile: +6281287783924.Journal of Epidemiology and Public Health, 2019, 4(3): 171-179https://doi.org/10.26911/jepublichealth.2019.04.03.03
The Contextual Effect of Village on Health Preventive Behavior for Dengue Hemorrhagic Fever in Pati, Central Java Fatimah, Nurul; Rahardjo, Setyo Sri; Murti, Bhisma
Journal of Epidemiology and Public Health Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Dengue is a mosquito-borne infection that has emerged to become a major public health issue and can result in death. Various efforts have been made as an attempt to empower the community in dengue preventive behavior, but has not yet reached the optimal result. This study aimed to examine the effect of the village on the health preventive behavior for dengue hemorrhagic fever in Pati, Central Java.Subjects and Method: This was a case-control study conducted in Pati, Central Java, in November 2018. A sample of 225 household heads was selected by simple random sampling. The dependent variable was DHF preventive behavior. The independent variables were education, access to information, knowledge, attitude, self-efficacy, community health behavior, social capital, and villages. Data on DHF status was measured by medical record. The other data were collected by questionnaire. The data were analyzed by multilevel multiple logistic regression.Results: DHF preventive behavior improved with high education (b= 0.86; 95% CI= 0.04 to 1.70; p= 0.040), good knowledge (b= 0.86; 95% CI= 0.06 to 1.67; p= 0.036), strong self efficacy (b= 0.87; 95 % CI= 0.06 to 1.68; p= 0.036), good access to information (b= 1.98; 95% CI= 1.06 to 2.87; p <0.001), positive attitude (b= 1.40; 95% CI= 0.55 to 2.25; p= 0.001), good community behavior in DHF prevention (b= 0.86; 95% CI= 0.02 to 1.70; p= 0.045), and strong social capital (b= 1.07; 95% CI= 0.26 to 1.89; p= 0.010). Village had strong contextual effect on DHF prevention behavior with ICC= 20.30%.Conclusion: DHF preventive behavior improves with high education, good knowledge, strong self-efficacy, good access to information, positive attitude, good community behavior in DHF prevention, and strong social capital. The village has a strong contextual effect on DHF prevention behavior.Keywords: dengue hemorrhagic fever, preventive behavior, village, multilevel analysisCorrespondence: Nurul Fatimah. Masters Program in Public Health.Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: nurul.fatimah00049@gmail.com. Mobile: +6281329501844.Journal of Epidemiology and Public Health (2019), 4(3): 198-204https://doi.org/10.26911/jepublichealth.2019.04.03.07
Multilevel Analysis on the Contextual Effect of Village on the Incidence of Hemorrhagic Dengue Fever in Grobogan, Central Java Sari, Ambar; Rahardjo, Setyo Sri; Sulaeman, Endang Sutisna
Journal of Epidemiology and Public Health Vol 4, No 3 (2019)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Dengue hemorrhagic fever (DHF) is a disease caused by the dengue virus through the bite of the Aedes aegypti mosquito. DHF is an endemic disease in more than 100 countries. There were 728 cases of DHF and 8 cases of death in Grobogan, Central Java, in 2017. The purpose of this study was to examine the contextual effect of the village on the incidence of DHF.Subjects and Method: This was a case-control study conducted in Grobogan, Central Java, from November to December 2018. A sample of 200 study subjects was selected by fixed disease sampling. The dependent variable was DHF. The independent variables were the presence of water shelter, ponds, farmland, mosquito larvae, hanging clothes, house density, eradication of mosquito nest, education, and employment. The data were collected by questionnaire and observation. The data were analyzed by a multilevel logistic regression.Results: Existence of water shelter (b= 4.53; 95% CI= 1.29 to 7.76; p= 0.006), ponds (b= 2.71; 95% CI= 0.26 to 5.17; p= 0.030), farm land (b = 3.40; 95% CI = 0.52 to 6.28; p= 0.021), mosquito larvae (b= 3.45; 95% CI= 0.61 to 6.29; p= 0.017), hanging clothes (b= 2.39; 95% CI= 0.23 to 4.56; p= 0.030), and house density (b= 5.55; 95% CI= 1.59 to 9.51; p= 0.006), increased the risk of DHF.  Education ≥senior high school (b= -4.79; 95% CI= -8.44 to -1.13; p= 0.010), employed (b= - 5.36; 95% CI= -9.22 to -1.49; p= 0.006), and exposed to DHF mosquito nest eradication program (b= -4.31; 95% CI= -7.64 to -0.97; p= 0.011) decreased the risk of DHF. Village environment had strong contextual effect on DHF with ICC= 51.33%.Conclusion: Existence of water shelter, ponds, farmland, mosquito larvae, hanging clothes, and house density, increase the risk of DHF.  Education ≥senior high school, employed and exposed to DHF mosquito nest eradication program decrease the risk of DHF. Village environment has a strong contextual effect on DHF.Keywords: dengue hemorrhagic fever, environmental factors, eradication of mosquito nests, village strata, multilevel analysisCorrespondence: Ambar Sari. Masters Program in Public Health. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: ambarsari69.as@gmail.com. Mobile: +625647847180; 08562623045Journal of Epidemiology and Public Health (2019), 4(3): 156-170https://doi.org/10.26911/jepublichealth.2019.04.03.02
Risk of Hypertension in Adolescents with Over Nutritional Status in Pangkalpinang, Indonesia Yusrizal, Mirza; Indarto, Dono; Akhyar, Muhammad
Journal of Epidemiology and Public Health Vol 1, No 1 (2016)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Adolescents are the changes of children to be adults. Gender, family history of disease, age, sodium intake and physical activity affect the pravelence of hypertensionAdolescences are the time change from children into adults. Gender, family history of disease, body mass index or BMI according to age, sodium intake and physical activity affect the prevalence of hypertension in adulthood.  Hypertension disorders in teenagers most will settle on adulthood. This study aimed to analyze risk factors of hypertension in adolescent aged 15-17 years with over nutritional status.Subject and Methods: This was an observational analytic study with cross sectional design. This was conducted in Pangkalpinang, Bangka Belitung Indonesia. A total of 120 students in grade X-XI in four high schools were selected by fixed-exposure sampling. BMI measurement used antropometri. Physical activity questionnaire used International Physical Activity Questionnaire. Sodium intake was measured with a food frequency questionnaire. Blood pressure was measured by using a sphygmomanometer. Data analysis was using a multiple linear regression.Results:  Gender and nutritional status more positively associated with hypertension, (B = 5.77; p = 0.017) and (B = 4.85; p = 0.001), while sodium intake,  family disease history and physical activity have a negative relationship, (B = 0.01; p = < 0.076),  (B =-1.73; p = 0.481) and (B = >-0.01; p = 0.592). Multiple linear analysis obtained adjusted R2 = 0356 (35.6%).Conclusions: Young men have a higher average blood pressure than women of 5.77 mmHg. Any increase of 1 kg/m2 equivalent BMI will raise the blood pressure of 4.85 mmHg. Adolescents with more nutritional status can increase knowledge about hypertension, as well as regulate eating habits according to needs of physical growth and development.Keywords: hypertension, adolescent, gender, family history of disease, BMI, sodium intake, physical activity.Correspondence: Mirza Yusrizal. Health Department of Pangkalpinang, Bangka Belitung, Indonesia. Email: mirzayusrizal@yahoo.co.idJournal of Epidemiology and Public Health (2016), 1(1): 27-36https://doi.org/10.26911/jepublichealth.2016.01.01.04 
Individual and Environmental Risk Factors of Tuberculosis: A New Evidence from Ponorogo, East Java Sayidah, Diana; Rahardjo, Setyo Sri; Murti, Bhisma
Journal of Epidemiology and Public Health Vol 3, No 3 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Background: For centuries, TB has been linked anecdotally with environmental risk factors that go hand-in-hand with poverty: indoor air pollution, tobacco smoke, malnutrition, over­crowded living conditions, and excessive alcohol use. But to date, there is no empirical evidence from East Java, Indonesia, to support these anecdotal evidences. The purpose of this study was to provide new evidence on the individual and environmental risk factors of tuberculosis in Po­no­ro­go, East Java.Subjects and Method: A case control study was conducted in Ponorogo, East Java, from April to May 2018. A sample of 200 study subjects was selected for this study by fixed disease sampling. The dependent variable was tuberculosis. The independent variables were age, gen­der, education, nutritional status, dwelling density, smoking, and alcohol drinking. Data on tuberculosis infection status were obtained from the medical record at District Health Office Po­no­­rogo. The data were collected by questionnaire and analyzed by a multiple logistic re­gres­sion on Stata 13.Results: Age ≥ 44 years (b= 3.18; 95% CI= 1.66 to 4.69; p<0.001), nutritional status (b= 1.42; 95% CI= 0.02 to 2.82; p=0.046), dwelling density ≥ 5 (b= 1.87; 95% CI= 0.37 to 3.36; p=0.014), smoking (b= 2.23; 95% CI= 0.61 to 3.85; p=0.007), and alcohol drinking (b= 2.83; 95% CI= 1.38 to 4.27; p<0.001) were associated with increased risk of tuberculosis. Higher education (b= -2.56; 95% CI= -4.16 to -0.96; p=0.002) and female (b= -1.36; 95% CI= -2.92 to -0.20; p=0.087) were associated with decreased risk of tuberculosis.Conclusion: Age, nutritional status, dwelling density, smoking, alcohol drinking, education, and female, are shown in this study to be the risk factors of tuberculosis.Keywords: tuberculosis, individual factor, environmental factorCorrespondence: Diana Sayidah. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami No. 36 A, Surakarta 57126, Central Java. Email: dianasayidah13@gmail.com. Mobile: +6282234721294.Journal of Epidemiology and Public Health (2018), 3(3): 353-360https://doi.org/10.26911/jepublichealth.2018.03.03.06

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