RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
ANNEXURE-I
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT DISSERTATION
1 / NAME OF THECANDIDATE AND ADDRESS / N.RAJKANNAN,
RAJEEV COLLEGE OF NURSING,HASSAN.
2 / NAME OF THE INSTITUTION / Rajeev College of Nursing
Shankarmutt Road,
Hassan Karnataka
3 / COURSE OF STUDY AND SUBJECT / Master in Nursing
Mental health Nursing
4 / DATE OF ADDMISSION TO THE COURSE / 15 MAY 2007
5 / TITLE OF THE TOPIC / Evaluate the effectiveness of structured teaching programme about tobacco abuse on the knowledge and attitude of II year Basic B.sc Nursing students at Rajeev college of nursing .
6. / STATEMENT OF THE PROBLEM / A Quasi experimental study to evaluate the effectiveness of structured teaching programme about tobacco abuse on the knowledge and attitude of II year Basic B.sc Nursing students at Rajeev college of nursing in Hassan city.
6.1. INTRODUCTION
Tobacco is the biggest enemy of the public health today and the distributors are one of the richest business groups. Tobacco smoking and chewing is the main cause of lung cancer and oral cancer. Tobacco use usually begins in adolescents; the time of their observation, understanding, struggling, facing challenges and psychological development. Prevalence of tobacco use in India is continuously increasing but there are considerable changes in the methods of its use. According to WHO estimates, about 194 million men and 45 million women use tobacco in smoked or smokeless form in India. Information on prevalence of tobacco use is available from several studies, which shows a great deal of variation by region, social customs, gender and form of tobacco consumption. Tobacco is the second major cause of death in the world. WHO sources emphasizes the rate of tobacco consumption especially in developing countries as an epidemic. Tobacco death toll is expected to double by 2025 from the present 5 million deaths (approx). At every 6.5 seconds, one dies because of tobacco related disease globally. This is occurring mostly in developing countries like India, adding significantly to their burden of disease, poverty and economy1.
Tobacco smoking practices in India
In India tobacco is used in smoke and smokeless form tobacco is used for smoking by variety of methods as follows;
Beedi: Beedi is the most popular smoking form of tobacco in India It is prepared by rolling a dried rectangular piece of Tendu leaf with 0.15-0.25gram of sun dried flaked tobacco 34% of tobacco produced in India is used for making beedies.
Cigarette: cigarette smoking is the 2nd most popular smoking form of tobacco used in India.
Cheroot: cheroot is a roll made form tobacco leaves.
Chatta: chatta is coarsely prepared cheroot nearly 9% tobacco produced in India is used for making chattas .In India chatta smoking is wide spread in the coastal areas of Andhra pradesh,Tamil nadu and orissa.
Dhumati: Dhumati is a kind of conical cigar made by rolling tobacco leaf in the leaf of another plant.
Hookili: Hookili is the clay pipe commonly used for tobacco smoking.
Hookah: The hookah is an Indian water pipe in which the tobacco smoke passes through water before inhalation.
Tobacco, which was originally cultivated in America thousands of years ago, spread throughout the world after the arrival of the first European settlers. Each culture developed its own form of tobacco consumption ,and tobacco is now consumed in a multitude of forms in south Asia tobacco is smoked in clay pipes called ‘suipa’where as in north Africa it is smoked in water pipes called ‘shisha’or ‘Hubbly bubbly’Beedis are predominant form of tobacco use in India and leaf wrapped clove flavored products called ‘kretecks’are smoked in Indonesia cigarettes are smoked throughout the world; and are dominant form of tobacco use worldwide .china alone is responsible for almost 60% of the worlds cigarette consumption with the average Chinese man smoking 16 cigarettes per day. There are 5.5 trillion cigarettes produced yearly, enough to provide 1000 cigarettes to every man, woman and child on the planet .
Fifteen billion cigarettes are smoked worldwide everyday by nearly one billion male smokers and a quarter of a billion female smokers currently in developed countries 35% of men and 22% of women smoke whereas in developing countries 58% of men and only 9% of women smoke 2
The adverse effects of smoking are extensive smoking is closely associated with respiratory cancer and chronic obstructive pulmonary diseases and conditions related to heart. The health risks associated with smoking are greater among young smokers The are also a great risk of many other non-fetal diseases, including osteoporosis, and cataract smoking in pregnancy is associated with increased risk for reduced birth weight for gestational age .3
Psychiatric aspect of smoking
The united state’s surgeon general report 1988 reported that cigarette as well as other forms of tobacco are addicting .Nicotine is the chemical in tobacco that causes addiction
The pharmacological and behavioral process that determine tobacco addiction is similar to those processes determine addiction to drugs like heroine and cocaine .4
Nicotine dependence is the most common substance use disorder in the united states where about 25% of population is addicted to tobacco Nicotine dependence was first included as substance use disorder in the third version of diagnostic and statistical manual of mental disorders in 1980 then it was included in the tenth version of international classification of disorders (ICD-10) and the fourth version of diagnostic and statistical manual .5
Back ground of the problem
Tobacco use is major preventable cause for death in many parts of the world today (WHO,2004) most of the regular smokers initiate smoking habit in their adolescent period of life
The national household survey of drugs and alcohol abuse in India (2002) reported that 55.8% of tobacco users belonged to the age group of 12-18 .It was observed that the prevalence of tobacco user was increased as the age advanced and more than 50% of smokers begin to smoke during their adolescent period .This finding is supported by global growth tobacco survey fact sheet had shown that 25% of students of 13-14yrs experienced one or other form of tobacco.
Studies have shown that students had inadequate knowledge and favorable attitude towards tobacco use .This reflects the need for education to students of 12-18years of age for helping them to stay away from initiating smoking.
As adolescents are the beginners for smoking behaviour,there is a need to empower them to take decision not to smoke this should be a primary concern for health professionals health education will be helpful for the beginners to decide not to initiate smoking or to stop smoking.
6.2: NEED FOR THE STUDY
Many studies have shown that many regular smokers start smoking before or during their adolescent period The individuals who start with the few cigarettes during adolescence are at double the risk to be regular smoker during early adulthood monthly smoking during adolescence raises the risk of young adult smoker, more them 16 times to become regular smoker. Additionally adolescents have higher rates of dependence at the same level of nicotine use as adults at the same quantity smoked daily.
Education about dangers of smoking and benefits of stopping smoking is first line intervention of tobacco cessation education helps to increase the knowledge regarding consequences of smoking and to develop unfavorable attitudes and beliefs regarding stopping and providing a social milieu that supports smoking cessation can be the effective way for prevention and cessation of smoking among adolescents .
Smoking is one of the leading preventable cause of death in all over the world tobacco related diseases kill approximately 6 million people globally every year Nurses have an role to play in school mental health programme where in she can educate the adolescents regarding harmful effects of tobacco abuse and control the morbidity and mortality related to tobacco abuse .A healthy and safe college environment, free of tobacco abuse especially tobacco smoking is national public health priority health education and intervention to stop tobacco abuse should therefore becomes the central goal of Nursing practice.
Investigator entered into the field of nursing profession about 9 years back. He found many of his classmates smoking regularly although knowing that smoking leads to ill health on discussion with them investigator felt that they do not have sufficient knowledge about tobacco damaging vital organs in the body. similarly when he had become teacher of nursing students he found many of his students smoking they were expressing the difficulty to give up the habit of smoking .since nursing personnel whether they are nursing students or nursing teachers they are looked upon as role models by many of the patients and their family members. It is essential that nursing personnel practice healthy activities and give up smoking. If they have to educate public about the importance of non smoking they them selves should be non smokers .To give health education to public nursing personnel must possess adequate knowledge about ill effects of smoking and also should possess unfavorable attitude towards smoking .Therefore investigator who aims to continue his teaching career felt the need for evaluating the effectiveness of structured teaching programme on knowledge and attitude of tobacco abuse among nursing students.
.
6.3.STATEMENT OF THE PROBLEM.
A Quasi experimental study to estimate the effectiveness of structured teaching programme about tobacco abuse on the knowledge and attitude of II year Basic B.sc Nursing student in Rajeev college of nursing in Hassan city.
6.4. OBJECTIES OF THE STUDY:
· To assess the socio demographic characteristic of II year Basic B.sc nursing students
· To study the level of knowledge about tobacco abuse among the II year Basic B.sc nursing students
· To find the attitude of II year Basic B.sc nursing students towards tobacco abuse.
· To evaluate the effectiveness of structured teaching program on knowledge and attitude of study subjects towards tobacco abuse.
6.5. HYPOTHESIS
· There will be a statistically significant difference in the scores obtained by study subjects on the level of knowledge about tobacco abuse prior to and after the structure teaching programme.
· There will be statistically significant difference in the scores obtained by study subjects on the attitude towards tobacco abuse.
6.6.Assumption
· Most of the II year Basic B.sc nursing students expressed their desire to have the experience of tobacco use (smoking)
· Although adolescents starts smoking for experimentation but in long run they become tobacco addicted.
· Adolescents need scientific information systematically learned to control smoking desire ,use ,abuse ,and addiction.
7.OPERATIONAL DEFINITIONS
Knowledge
In this study knowledge refers to the correct responses of students to the item on the knowledge questionnaire on tobacco abuse.
Attitude
In this study attitude refers to the expressed feelings of college students regarding tobacco abuse which is measured by attitude questionnaire.
Tobacco abuse
For the purpose of present study it refers to the use of tobacco in smoking form of cigarette and beedi
7.1CRITERIA FOR SAMPLE SELECTION
A) INCLUSION CRITERIA
II year Basic B.sc Nursing students age between 17-19 yrs male and female students in Rajeev college of nursing Hassan
B) EXCLUSION CRITERIA
· Consist of those who are in not Nurisng programme.
· Those students who are not from II year Basic B.sc Nursing .
· Those Nursing students of other colleges of Hassan.
· Those who are not willing to attend all the teaching sessions.
7.2. DELIMITETIONS OF THE STUDY
· The sample size is limited to 50 students.
· Prescribed data collection is only 4-6 weeks
7.3.SIGNIFICANCE OF THE STUDY
The study signifies that structured teaching programme has effectiveness in tobacco abuse on the knowledge and attitude of adolescents .
7.4.CONCEPTUAL FRAME WORK
Based on pender health promotion model
7.5. REVIEW OF LITERATURE
General population:
The study conducted in year(2002) examined the co-occurrence of tobacco and alcohol in general population of Delhi two surveys were done at two points with a gap of one year Total 10,312 individuals (5,414 male and 4,898 female) of age more than 10 years were selected from five clusters of colonies from different city zones .The clusters were selected randomly and each house hold was selected by systematic random sampling. The individuals were interviewed by using structured format based in DSM-IIIR criteria for use of tobacco ,alcohol cannabis and opioids result were focusing that tobacco use was most prevalent (18.1%) followed by concurrent use of tobacco and alcohol (96%) at first survey. It was observed that the rate of concurrent use of tobacco and alcohol were increased At the second survey the onset of alcohol drinking was found to be significantly higher (25.1%) among tobacco users compared to non users (1.7%) Among the tobacco user 61.2% were dependent smoker. The incidence of tobacco use below age of 20yrs was 0.8/100 person for male and 0.1/100 person for female.6
The study was conducted in the year 2003 on smoking behavior among arts students of a college in mangalore,Dakshina kannada.176 arts students out of 450 students doing under-graduation in an age range of 17 to 24 years returned a questionnaire designed to test their level of knowledge about smoking, attitude towards smoking and practice of smoking.96.6% of the respondents were aware of the injurious nature of smoking. potential to induce lung cancer was known by 93.2% of them, but only 34.1% knew it was a factor for GI malignancy. A higher proportion of males had good knowledge whereas females had moderate knowledge (p=0.04). the incidence of smoking was 33.1% .A higher proportion of smokers chewed pan and consumed supari.68.2% of smokers wished to quit smoking. Easy availability (47.7%) and influence fo friends (34.1%) were the predominant reasons to smoke .Interestingly,48% of males felt that smoking women had appeal. Anti smoking campaigns in addition to provision of information has to focus towards a change in attitude to smoking.7
In this study compared the tobacco smoking beliefs and risk awareness among university students from twenty three centuries. The study design was anonymous questionnaire survey. A questionnaire was prepared by the investigation and it was translated into seventeen languages to use in participating countries .The collaborators were asked to collect 400 samples for male and female university students aged 17-30years each country. All subjects were selected from non medical educational field Total of 19,298 subjects (8,482 men,10,816 women) participated .The statistical analysis revealed over all 34% of men and 27% of women were current smokers .There was large variation, in prevalence across countries ranging from 14%(Thailand) to 47% (Portugal) in men and 2% (Thailand) to 46% (Spain) in women, more than half of smokers in all countries wanted to stop smoking with proportion ranging from 54% (Netherlands) to 82% (Venezuela) in men and 58% (Germany) to 89% (Japan)among women. The beliefs in not smoking were strong on average, with relatively little variation across the country. The correlation between the beliefs and the smoking prevalence were computed for men and women using fisher’s z procedure. The results indicated that countries with the stronger belief had a lower prevalence of smoking more aware about the association of smoking and lung cancer on average 57% men and 52% women knew about the influence of smoking on heart.8