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SUMMARY Since the ‘Health Behavior in School-Aged Children’ (HBSC) study was implemented by three European countries in 1982, it has been adopted by over 25 countries, including Canada and Australia. It is generally expected that African and Asian countries will follow. This paper reviews some methodological constraints in adapting the HBSC study in Indonesia. Although the international HBSC team has reported methodological problems in the cross-national study, no attempt to extend the original European study to South-east Asia has been described before. Cultural, religious, economical and social differences create specific obstacles as well as challenges. Next to problems related to adaptation of the questionnaire, we experienced more structural problems both in its preparation and implementation. Lack of technical infrastructure and communication facilities can serve as an example. This might be a problem insofar it affects the results. It is argued that for some behaviors such as smoking, cross-national comparability is probably not a problem. For others, e.g. use of alcohol, comparability of the data should be treated with caution. Smoking is one of the most compromising healthrisk behaviors among male youngsters in Indonesia, with about 25% regular smokers (at least once a week) among 15-year-old boys. Alcohol use is less common, but data are probably less reliable because of the social and religious taboos on alcohol use and confusion about alcoholic drinks. More efforts should be made in order to examine validity of the HBSC study in non-Western countries. Furthermore, insofar developing countries will participate in this study in the near future, it is recommended that specific strategies are elaborated. These include detailed rules for translation and adaptation of the standard questionnaire, and the development of specific culturerelevant additional packages.

The Health Behavior in School-Aged Children study in Semarang, Indonesia: methodological problems in cross-cultural research