RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
PROFORMA FORREGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME AND ADDRESS OF THE CANDIDATE / MR. PREM CHAND RAM2 / NAME OF THE INSTITUTION / ACHARYA COLLEGE OF NURSING , CHOLANAGAR
R. T. NAGAR POST BANGLORE.
3 / COURSE OF THE STUDY AND SUBJECT / M. Sc. NURSING 1st YEAR COMMUNITY HEALTH NURSING
4 / DATE OF ADMISSION / 19 /10 /2010
5 / STATEMENT OF THE PROBLEM / A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING SMOKING HAZARDS AMONG ADOLESCENT BOYS IN SELECTED URBAN PRE UNIVERSITY COLLEGE ,BANGALORE.
6 BRIEF RESUME OF THE INTENDED WORK:
“Prevention Is Better Than Cure”
-K.Park
INTRODUCTION:
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. It is primarily practiced as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them available for absorption through the lungs. It can also be done as a part of rituals, to induce trances and spiritual enlightenment.1
The most common method of smoking today is through cigarettes, primarily industrially manufactured but also hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, vaporizers and bongs. It has been suggested that smoking-related disease kills one half of all long term smokers but these diseases may also be contracted by non-smokers. A 2007 report states that about 4.9 million people worldwide each year die as a result of smoking.1
The harmful effects of smoking tobacco are well known. Early age intervention strategies for smoking prevention were based on the ‘rational or information deficit model’ which assumed that by enhancing awareness of the health consequences of smoking, prevalence could be reduced. Programs often employed scare tactics. In 1967 Janis posited his ‘inverted-U’ theory, suggesting that very low or very high levels of fear inhibit both attitude and behavioral modification. The use of scare tactics in health education subsequently declined and the focus of school-based interventions shifted to skill building.2
The World Health Organization (WHO) states that "Much of the disease burden and premature mortality attributable to tobacco use disproportionately affect the poor". Among 1.22 billion smokers, 1 billion of them live in developing or transitional economies. Rates of smoking have leveled off or declined in the developed world. In the developing world, tobacco consumption is rising by 3.4% per year as of 2002; however, this figure could just be as high as the population growth.The WHO in 2004 projected 58.8 million deaths to occur globally, from which 5.4 million are tobacco-attributed, and 4.9 million as of 2007. As of 2002, 70% of the deaths are in developing countries. It is predicted that 1.5 to 1.9 billion people will be smokers in 2025.3
Smokingamong adolescents is a major concern because smoking long termposes many health hazards. Most all adolescents know what the longterm effects of smoking are and many do not care, because they arenot concerned with what might happen to them forty or fifty yearsdown the road. Adolescent smoking is a global issue because thereis not a single country around the world where teens are not smoking.Smoking affects all subsets of adolescents.4
6.1. NEED FOR STUDY:
Anti-Tobacco Day or World No Tobacco Day is observed on May 31every year. Governments and non-governmental organizations unite to draw attention to the dangerous health problems that tobacco use can cause. Attempts are made to inform people of health problems associated with tobacco use. Various activities are launched in many parts of the world to raise awareness against the use of tobacco. The use of tobacco can cause havoc in people’s lives. It has consumed millions of lives all across the world. The situation is quite grim in developing countries where a large majority of the population is addicted to tobacco.
In many parts of the world, governments have banned consumption of tobacco and smoking in public places. People found breaking the law will be fined or sent to prison. Volunteers also make an effort to stop addicted people from smoking. Print, electronic and online campaigns are launched against tobacco on World No Tobacco Day.5
The adverse effects of smoking are bad to the active smoker as well to the passive smoker. Yet many people adhere to smoking addiction that becomes hard for them to control and quit. Sometimes, when individuals think about the health hazards of smoking, they make an attempt to reduce the total intake of cigarettes. Many people try to restrict their smoking to a moderate level. Since smoking is unhealthy in the long run, its effects on the human heart have to be considered. Continuous smoking badly affects the cardiovascular system in humans. Prolonged cigarette smoking damages the arteries that lead to deadly diseases like heart blockage and atherosclerosis. Hence, awareness about the risk factors related to smoking addiction is very important6
A study was conducted regarding correlates of current cigarette smoking among2014 school-going adolescents in Punjab. Weighted logistic regression analysis was used for this study. The result indicated that Adolescents who received pocket money were more likely to be smokers compared to adolescents who did not receive pocket money (OR = 1.25; 95%CI 1.23, 1.26). Male respondents tended to be older than females (21.2% of males, and 13.1% of females were of age 16 years or above). Adolescents who had parents who smoked, chewed or applied tobacco were more likely to be smokers compared to adolescents who did not have parents who smoked or chewed tobacco (OR = 1.34; 95%CI 1.32, 1.37). This study concluded that associations between current smoking on one hand and peer smoking, and perception that boys who smoke are less attractive on the other, deserve further studies.7
A study was conducted regarding Smoking in a Saudi community: prevalance, influencing factors, and risk perception among 634 males over the age of 12.Questionnaire method was adopted for this study.The result indicated that 34.4% (218) were current smokers, 16.4% (104) were ex-smokers, and 49.2% (312) were nonsmokers. The most common (66%) reason for starting smoking was friends' influence. About 75% had thought of stopping smoking, and 55% had actually attempted to stop. The most common (34%) reason reportedforfailed attempts to stop smoking was lack of willpower. Awareness regarding the harmful effects of smoking was high (97.2%). More than 80% thought that a special smoking clinic would be helpful for quitting smoking.Thus to conclude Smoking prevalence is high in our community in Saudi Arabia.8
In Pakistan during 1998, the prevalence of smoking was around 36% in males and 9% in females. There is lack of recent data. In developing countries like Pakistan, India with weak anti-tobacco legislation and lack of awareness among the people regarding smoking, the tobacco related diseases are also expected to show a significant increase in coming years. Tobacco use is not only capable of damaging nearly every organ of the human body but also causes at least 15 different cancers and is single-handedly responsible for 30% of all cancer related deaths. The number of cases of lung cancers, chronic obstructive pulmonary disease and myocardial infarction are increasing since the sale of cigarettes is rising. Moreover, lung cancer is the leading malignancy among the Pakistani males.9
Health Professionals are in an excellent position that allows them to have a prominent role on tobacco control. They can intervene to prevent and demand reduction measures concerning tobacco dependence and cessation as they reach a high percentage of the population through education, communication, informational campaigns that raise awareness regarding effects of tobacco on health. They have the opportunity to help people change their behaviour and can give advice, guidance and answers to questions related to the consequences of tobacco use. However, marked deficits have been found in the amount and type of training medical professionals receive in smoking cessation counseling with little attention paid to determination of effective training methods.10
Schools have a great influence on the health status of young people and health education programs have existed in schools for many years. A lack of evidence for positive long-term impact of these programs has led to the development of a new approach to school-based health promotion—Health Promoting Schools. This is a comprehensive whole-school approach which incorporates the principles of the Ottawa Charter and has attracted a great degree of interest and commitment at international, national and state levels. However, it is not clear whether or how this approach is being adopted and implemented at the school level and what the current state of research in the field.11
6.2.REVIEW OF LITERATURE:
A review of literature enables one to get an insight into the various aspects of the problem under study. It covers promising methodological tools, throws light on ways to improve the efficiency of data collection and suggest how to increase effectiveness of data analysis and interpretation. Review of literature is therefore an essential step in the development of the research project.
The result of studies conducted in various aspects is presented below. It is mainly divided into
6.2.1. Studies related to knowledge of adolescents boys regarding smoking hazards.
6.2.2. Studies related to self instructional module regarding smoking hazards.
6.2.1.Studies related to knowledge of adolescent boys regarding smoking hazards.
A study was conducted to determine the level of awareness of tobacco smoking hazards and secondhand smoke inhalation among adolescent boys in China. Household surveys were conducted with a total of 13,354 respondents aged 15 years or over from 100 counties of 28 Chinese provinces using a stratified multi-stage geographically clustered sample design. The findings of the study revealed that 81.8% of the population was aware that smoking causes serious diseases, and 27.2% and 38.7% were aware that smoking causes stroke and heart attack, respectively. Only 64.3% of respondents were aware that secondhand smoke can cause serious diseases, and 27.5%, 51.0%, and 52.6% were aware that secondhand smoke causes heart disease in adults, lung disease in children and lung cancer in adults, respectively.12
A study was conducted on Childhood smoking: the research, clinical and theoretical imperative for nursing action among child and adolescent populations at the personal and community level, characteristics of child smokers, the processes associated with smoking cessation, intervention approaches and intervention models for use by nurses across the spectrum of clinical settings.Findings of the study revealed that the evidence exists that behaviorally based interventions by nurses for smoking prevention/cessation are effective with children in school.13
A cross sectional study was conducted on knowledge about the health hazards of tobacco predetermine the intention to quit smoking in Ukraine at a baseline level in 2005 among 2,239 collected questionnaires a sub sampleof 775 smokers was analyzed.The finding of the study revealed that the Level of knowledge was higher in more educated respondents, men, in those living in the Eastern region of Ukraine. Willingness to quit was higher in younger age groups and in occasional smokers.14
A randomized controlled trial study was conducted on Intervention to Reduce Intentions to Use Tobacco among adolescent boys. Participants included 103 adolescent boys between the ages of 10 and 18 years who were randomly assigned to either a standard care control (SCC) group or a tobacco intervention (TI) group. The effect of our intervention was assessed by self-reported knowledge, perceived vulnerability, and intentions at baseline, 6, and 12 months. The result of the study revealed that the adolescent knowledge, perceived vulnerability to health risks, and intentions to use tobacco can be modified by a risk counseling intervention. The delayed effect of our intervention indicates that these changes may evolve over time.15
A cross sectional study was conducted on prevalence and determinants of cigarette smoking among 15197 Turkish youth and transition among smoking stages. Males and high-school students have higher odds of being susceptible to smoking compared with other non-smokers and higher odds of becoming established smokers. Exposure to parent, teacher, and peer smoking, anti-tobacco curricula, cigarette promotions, and perceived ease of access to cigarettes are all significant predictors of being susceptible to smoking and established smoking. The results revealed that the importance of early prevention programmes, which should begin before high school, and targeting efforts towards male students.16
6.2.2Studies related to self instructional module regarding smoking hazards.
A cross-sectional study was conducted on smoking prevention and cessation education delivered as part of the UK National Curriculum and to evaluate the relative effectiveness of health, social influence and other/non-health components. In all, 1789 students aged 15-20 from 12 secondary schools completed online surveys assessing smoking status, factors known to be related to smoking and experience of smoking education. A total of 1421 of 1722 (83%) students remembered some school-based education. Of these, 803 (57%) said that the lessons changed their ideas about smoking. The relative effectiveness of 16 lesson themes was assessed. Significantly more students changed their ideas about smoking as a result of ‘health’ compared with ‘social influence’ (χ2 (1) 124.0, P < 0.001) or ‘other/non-health’ (χ2 (1) 63.16, P < 0.001) topics. Smoking hazards is the most effective health topic and may provide a suitable model for both smoking and risky drinking prevention17.
According to National Health Interview Survey (NHIS). the proportion of U.S. adults who were current cigarette smokers declined 3.5% (from 24.1% to 20.6%). However, the proportion did not change significantly from 2007 (19.8%) to 2008 (20.6%). In 2008, adults aged >or=25 years with low educational attainment had the highest prevalence of smoking (41.3% among persons with a General Educational Development certificate [GED] and 27.5% among persons with less than a high school diploma, compared with 5.7% among those with a graduate degree). Adults with education levels at or below the equivalent of a high school diploma, who comprise approximately half of current smokers, had the lowest quit ratios (2008 range: 39.9% to 48.8%). Evidence-based programs known to be effective at reducing smoking should be intensified among groups with lower education, and health-care providers should take education level into account when communicating about smoking hazards and cessation to these patients.18
A study was conducted on the factors associated with junior high school personnel advising students to quit smokingSchool personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. The study concluded that reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training in school.19
A cross-sectional survey was conducted on cigarette smoking in medical students and data was collected through a self administered questionnaire from students at King Edward Medical University in Lahore (Pakistan) from April1 to May 30, 2009.the result of this study was the response rate was 65.4%, of these 396 (60.55%) were male and 88(13.45%) were smokers. Smoking was more among the male students than females (p-value <0.001). The greatest percentage of smokers was in 3rd Year (n=29, 26.85%), majority were of 21-30 years age (n=59, 19.53%), started smoking between 11-20 years (n=48, 54.54%), smoked <10 cigarettes/day (n=37, 42.04%) and started smoking due to influence of friends (n=53, 60.23%). Majority (n=69, 78.4%) had no intention to quit in the next 6 months. Lack of Incentive (n=32, 36.36%) and Addiction (n=24, 27.27%) were the main reasons for not quitting.20
6.4 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of Self Instructional Module on knowledge regarding smoking hazards among adolescent boys in selected urban pre university college, Bangalore”.
6.5 OBJECTIVES OF THE STUDY :
1. To assess the pretest knowledge level regarding smoking hazards among adolescent boys in selected pre university colleges.
2. To assess the effectiveness of self instructional module by comparing pre and post test knowledge level.
3. To determine the association between post test knowledge of adolescent boys regarding smokinghazards and their selected socio demographic variables.
6. 6. OPERATIONAL DEFINITIONS:
In this study it refers to:
Evaluate :
the statistical measurement of pre and post test knowledge regarding awareness of smoking hazards which is elicited through structured questionnaire.
Effectiveness :
the significant gain in knowledge on awareness of smoking hazards after administered self instructional module as determined by significant difference in pre and post test knowledge scores.
Self instructional module :
Self instructional module is a learning material prepared in English language by the researcher to provide information regarding awareness of smoking hazards to the adolescent boys. The component includes concepts of smoking, types of smoking and health hazards of smoking.
Knowledge :
the correct response of the participant regarding understanding of smoking hazards elicited through structured knowledge questionnaire.
Smoking hazards :
the ill effects caused by inhaling substance like tobacco and cannabis.
Adolescent boys :
the boys those who are between the age group of 15-18 years.
6.7. HYPOTHESIS :
H1- Post test knowledge score will be significantly high than the pre test score regarding knowledge of smoking hazards among adolescent boys.
H2- There will be significant association between knowledge regarding awareness of smoking hazards among adolescent boys with selected socio demographic variables.
6.8 RESEARCH VARIABLE :