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etermined to tackle malnutrition in Indonesia, President Joko “Jokowi” Widodo’s administration aims to reduce the rate of stunted growth from 29.6 to 28 percent by 2019. A recent study suggests the government might not achieve that goal without stricter tobacco control.

The study, released on Monday by the University of Indonesia’s (UI) Social Security Research Center (PKJS-UI), reveals a grim reality for the country, which is among those with the highest prevalence of smoking: Children exposed to cigarette smoke at home are at a higher risk of stunting.

The researchers, based on a longitudinal dataset from 1993 to 2014 provided by the Indonesia Family Life Survey (IFLS), measured the height and weight of children from 2,700 families in 13 provinces in 2008 and compared that data to the children’s growth in 2014.

The PKJS-UI found that children whose parents did not smoke were 1.5 kilograms heavier and 3.4 millimeters taller than the children of heavy smokers. The latter also had a 5.5 percent higher probability of stunting, the study found.

“Children who live with heavily smoking parents tend to suffer stunted growth, both in terms of their height and weight, compared to those who live in smoke-free households,” UI’s Department of Economics chairman Teguh Dartanto said on Friday.

“Parents’ smoking habit also affected their children’s intelligence,” he said. “It is statistically indirect, but the impact [is obviously a high prevalence of] stunting.”

The proportion of household spending on tobacco products rose from 3.6 percent in 1993 to 5.6 percent in 2014, while expenditure for protein-rich food — which is important to support children’s growth — such as meat and fish, dropped from 10.1 to 7.8 percent.

Stunting was caused by various issues, including malnutrition, genetic factors and an unhealthy environment, Teguh said, explaining that chronic exposure to tobacco products created an environment that could harm children’s growth.

Indonesian Pediatrician Association (IDAI) member Bernie Endyarni Medise said a smoking habit among parents affected children in two ways: first in the decrease of spending on nutritious food and health care, and second in the direct impact of smoke from tobacco products.

“Cigarette smoke disrupts the nutrient absorption in children, which in the end will interfere with their growth,” Bernie said.

Currently, almost 8 million Indonesian children are stunted. The Health Ministry recorded in 2017 that 29.6 percent of children under five years of age were stunted, an increase from 27.5 percent in 2016.

The government has attempted to address the challenge by providing nutritious biscuits for pregnant mothers and toddlers over the last three years.

“However, if [the government] only focuses on nutrition issues without taking into account the environmental conditions, the target [for tackling stunting] is indeed too ambitious,” Teguh said.

Around 40 percent of Indonesians above the age of 15 are tobacco smokers, one of the highest rates in the world, accoding to World Health Organization data.

The PKJS-UI study also reveals that the prevalence of smokers has increased rapidly in Indonesia. In the age group of 11-20 years, the rate of smokers rose to 7.73 percent in 2014 from 1.97 percent in 1993. The rate of smokers aged 21-30 years increased to 23.6 percent from 14.5 percent over the same period.

“The government should immediately take urgent measures for tobacco control. It is important to tackle stunting, which is also caused by smoking,” said UI public health expert Hasbullah Thabrany.

The study recommended that the government strengthen policies to control the consumption of tobacco products, such as by increasing the cigarette excise or requiring larger health warnings on cigarette packs.

The Finance Ministry’s customs and excise policy head, Nasruddin Djoko Surjono, said he believed increasing the cigarette excise was a low-cost effort to effectively reduce the prevalence of smokers in the country.

“This is a good moment, since we are currently mulling an excise revision for next year,” Nasruddin said.