The impact of smoking and tobacco use on health cannot be over emphasized. Cigarette smoking remains a gigantic public health problem and is still regarded as one of the leading preventable causes of morbidity and mortality worldwide. Over the past four decades, tobacco use has caused an estimated 12 million deaths in the world, including 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases and 94,000 infant deaths related to mothers smoking during pregnancy and on average cigarette smokers lose about 15 years of their life. It has been found that, knowledge about the health hazards of smoking has not always helped to prevent people from smoking. The objective of this study is to assess the pattern of smoking among out-of-school youth and their health risk perception.
This research was a cross-sectional survey which was carried out among 137 out-of-school youth in selected motor parks in Oshodi Local Government Area of Lagos State, Nigeria. A semi-structured instrument (questionnaire) was used for data collection. Data collected were analyzed using Statistical Package for Social Science (SPSS) version 21 with levels of significance set at 0.05.
The findings of this study revealed that mean age of respondents was 25.80 ± 8.585 ranging between the ages of 23-38years. Findings showed that there were more male respondents (88.3%) than there were female respondents (2.2%), indicating that majority of out-of-school youth at the motor parks are male. Prevalence of smoking among respondents was average at 56.2%. It was revealed that the rate of smoking was highest among respondents who initiated smoking at age 25 years old (13.94 ± 4.28) at 69.7%. It was also found that respondents’ perceived susceptibility to effect of smoking on health was very low at 15 point rating scale (4.57 ± 2.38). Also findings shows that respondents’ perceived severity/seriousness of the effect of smoking on health was very low at 15 point rating scale (5.18 ± 2.50) and that respondents’ perceived benefit of quitting smoking was below average at 15 point rating scale (6.11 ± 3.06). Findings revealed that there was significant difference in the level of smoking prevalence across the age of respondents (df = 16; F = 6.448; P < 0.05). Result showed that there is a significant association between prevalence of smoking and health risk perception of respondents (df = 3; r = 0.432; P < 0.05) and that there is no significant association between prevalence of smoking and health risk knowledge of respondents (df = 1; r = 0.089; P = 0.301).
This study concluded that out-of-school youths’ low health risk perception increased their smoking rate. The findings of this study suggest implementation of educational intervention towards improving out-of-school youths’ health risk perception of smoking.
Keywords: Smoking, Out-of-School Youth, Prevalence, Perception of smokers, Knowledge of smokers
Word Count: 455
TABLE OF CONTENTS
Title page i
Table of Contents vi
List of Tables x
List of Figures xi
CHAPTER ONE: INTRODUCTION
- Background to the Study 1
1.2 Statement of the Problem 2
1.3 Objective of the study 4
1.4 Research Questions 4
1.5 Justification for the Study 4
1.6 Hypotheses 5
1.7 Operational Definition of Terms 5
CHAPTER TWO: REVIEW OF LITERATURE
2.1 Introduction 7
2.2 Prevalence and Pattern of Tobacco Use 8
2.3 Knowledge about smoking 14
2.4 Attitude towards smoking 16
2.5 Perception of smoking 16
2.6 Theoretical Model 21
2.7 Construct of the Health Belief Model used for this Study 24
2.7.1 The modifying factors 24
2.7.2 Individuals perceptions 24
2.7.3 Likelihood of action 25
2.7.4 Conceptual Model 26
CHAPTER THREE: METHODOLOGY
3.1 Research Design 27
3.2 Population 27
3.3 Sample size and Sampling Technique 28
3.4 Study Variable and Test of Hypotheses 28
3.4.1 Study Variable 28
3.4.2 Test of Hypotheses 29
3.5 Instrument for data collection 29
3.6 Validity and Reliability of Instrument 30
3.6.1 Validity 30
3.6.2 Reliability 30
3.7 Method of Data collection for the study 30
3.8 Ethical Consideration 31
3.8.1 Informed consent 32
3.8.2 Confidentiality 32
3.8.3 Anonymity 32
3.8.4 Right to withdraw 32
3.8.5 Compensation 32
3.8.6 Post Research Benefits 33
3.9 Method of Data Analysis 33
CHAPTER FOUR: DATA ANALYSIS, RESULTSAND
DISCUSSION OF FINDINGS
4.1 Demographic Characteristics 34
4.2 Research Questions 37
4.2.1 At what level is the prevalence of smoking among respondents? 37
4.2.2 What is the pattern of smoking among respondents? 40
4.2.3 Do respondents have a good health risk perception of smoking? 43
4.3 Hypotheses Testing 51
4.3.1 There will be no significant difference in level of smoking prevalence across
The demographic characteristics of respondents. 51
4.3.2 There will be no significant association between prevalence of smoking and
health risk perception of respondents. 64
4.3.3 There will be no significant association between prevalence of smoking and
Health risk knowledge of respondents. 66
CHAPTER FIVE: SUMMARY, CONCLUSION AND
5.1 Summary 68
5.2 Conclusion 69
5.3 Recommendations 70
5.4 Implication to Health Promotion and Education 70
5.5 Limitations of the Study 70
LIST OF TABLES
4.1 Showing demographic characteristics of respondents 35
4.2 Showing frequency distribution of prevalence of smoking among respondents 38
4.3 Showing prevalence of smoking in respondents. 39
4.4 Showing respondents smoking rate across the different ages of 41
initiation of smoking
4.5 Showing respondents’ years of smoking 42
4.6 Showing respondents’ perceived susceptibility of the effect of smoking on health
4.7 Showing perceived susceptibility descriptive Statistics
4.8 Showing respondents’ perceived severity/seriousness of the effect of smoking on
4.9 Showing descriptive statistics of respondents’ perceived
4.10 Showing respondents’ perceived benefit of quitting smoking
|4.11 Showing respondents’ descriptive statistics of perceived benefit of
4.12 Showing level of smoking prevalence across the age of respondents
4.13 Showing the level of smoking prevalence between and within groups
4.14 Showing level of smoking across the gender of respondents
4.15 Showing the level of smoking between and within groups across
gender of respondents
4.16 Showing level of smoking across the marital status of respondents
4.17 Showing the level of smoking between and within groups across the marital
status of respondents
4.18 Showing level of smoking across the religion of respondents
4.19 Showing the level of smoking between and within groups across the religion of
4.20 Showing level of smoking across the educational status of respondents
4.21 Showing the level of smoking between and within groups across the educational
status of respondents
4.22 Showing level of smoking across the ethnicity of respondents
4.23 Showing level of smoking between and within groups across the ethnicity of
4.24 Showing regression analysis and association between level of smoking prevalence
and health risk perception of respondents
4.25 Showing regression analysis and association between level of smoking prevalence
and respondents knowledge of the effects of smoking on health
LIST OF FIGURES
2.1 Health Belief Model 23
2.2 Application of the Health Belief Model. 26
4.1 Showing respondents’ age frequency distribution 36
ANOVA: Analysis of Variance
BUHREC: Babcock University Health Research Ethics Committee
CDC: Center for Disease Control and Prevention
HBM: Health Belief Model
NCD: Non-Communicable Disease
WHO: World Health Organization
- Background to the Study
The impact of smoking and tobacco use on health cannot be over emphasized. Cigarette smoking remains a gigantic public health problem and is still regarded as one of the leading preventable causes of morbidity and mortality worldwide (Can, Topbas, Ozuna, Ozgun, Can & Yavuzyilmaz, 2009; Mpabulungi & Muula, 2004; Salawu, Danburam, Desalu, Olokoba, Agbo & Midala, 2009;World health Organisation, 2015). It is well-known that many smokers start before the age of 18 years, however, it is of great interest to know that the increasing trend in smoking prevalence amongst youths and the likelihood that many of these young people who begin to smoke at an early age, will continue to do so throughout adulthood (Adebiyi, Faseru, Sangowawa & Owoaje, 2010).
Although tobacco use has declined in many high income countries such as the United States and United Kingdom, it is increasing in many low and middle income countries (Boutayeb & Boutayeb, 2005; Warren, Jones, Eriksen & Asma, 2006) and in current situation, tobacco smoking is by far the most popular form of smoking and is practiced by over one billion people in the majority of all human societies (Akinpelu, 2015). Tobacco is the most common hazardous substance and this is aided by its legally availability, heavy promotion and wide consumption and has been revealed to be problematic including other forms of use other than cigarettes, which is on the rise among adolescents in many countries, and is likely to jeopardize progress in reducing chronic diseases and tobacco-related mortality (CDC, 2010; Warren et al., 2006).
The constant increase in the consumption of tobacco among adolescents is emerging as a complex and multidimensional problem (Soni & Raut, 2012). Melgosa (2006) rightly considers tobacco as a drug with the lowest risk, in the short term but one which takes away health and life from the greatest number of people in the long term.
Cigarette smoking is said to be responsible for over 25 diseases in humans some of which include: ischemic heart disease, chronic bronchitis and cancers of the lung, oral cavity, urinary bladder, pancreas, and larynx (Desalu, Olokoba, Danburam, Salawu & Issa, 2008). Over the past four decades, tobacco use has caused an estimated 12 million deaths in the world, including 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases and 94,000 infant deaths related to mothers smoking during pregnancy (WHO, 2009; Centers for Disease Control and Prevention, 2002; Ekrakene & Igeleke, 2010) and on average cigarette smokers lose about 15 years of their life (The global tobacco survey collaborative group, 2002; Raji, Abubakar, Oche & Kaoje, 2013).
It is estimated that number of deaths due to tobacco will increase from 3 million per year worldwide to 70 million per year by 2025 (Reddy & Arora, 2005; US Department of Health and Human Services, 2012). It has been said that adolescents are especially vulnerable to these effects and may be more likely than adults to develop an addiction to tobacco (Chakraborty, 2009). In addition, it has been predicted that if the pattern currently seen among youth continues, a lifetime of tobacco use would result in the deaths of 250 million children and young people alive today, most of them in developing countries (WHO, 2012).
Like other developing countries, the most susceptible age for initiating tobacco has been found between the ages of 15-24 years as evident in the study by Gboyega, Adesegun and Chikezie (2013) identifying youths as a major group involved in smoking over the last two decades,an age group where most are expected to be in school. Educational attainment is widely regarded as an important health risk factor because of how strongly it has been associated with health outcomes, health-related behaviors, and other risk factors (National Center for Health Statistics, 1999). For the past 30 years, smoking prevention programmes have been focused almost exclusively upon youth, mainly within the school setting (Backinger, 2003;Ekanem, 2008; Salawu, Danburam & Isa, 2010; Fawibe & Shittu, 2011; Hammond, 2005; Nwafor, Ibe & Aguwa, 2012; Odukoya, Odeyemi & Oyeyemi, 2013; Okagua, Opara & Alex-Hart, 2015) despite School dropouts being more likely to smoke heavily than students (Aloise-Young, Cruickshank & Chavez, 2002). In Nigeria, the prevalence of tobacco use among youth tends to be higher than among adults (Odukoya, Odeyemi, Oyeyemi & Updhyay, 2013).
- Statement of the Problem
Smoking among youths has been on an increase worldwide (Pomara, Cassano, D’Errico, Bello, Romano & Riezzo et al, 2012) with values ranging from 721 million in 1980 to 967 million in 2012 (Marie, 2013). Studies have revealed that there has been a high increase in the prevalence rate of smoking among youth in sub-Saharan Africa(Shafey, Dolwick & Guindon, 2012) and Nigeria precisely (Drope, 2011; Yahya, Hammangabdo & Omotara, 2010), with statistics showing that youths form over 40% of the Nigerian population and 18% of the youths smoke, identifying youths as a major group involved in smoking over the last two decades (Gboyega, Adesegun & Chikezie, 2013).
Smokers’ low perception of the negative effects of their smoking behavior on their health also results in many of them being unwilling to quit smoking with most of them expressing a sense of invincibility to the hazards of smoking (Fawibe & Shittu, 2011). Studies have shown that individuals who perceive fewer risks and greater benefits of smoking are more susceptible to initiation (Song, Morrell, Cornell, Ramos, Biehl, Kropp & Halpern-Felsher, 2009).Literatures have shown that perceptions about health risks influence cigarette smoking among youths (Aryal, Petzold & Krettek, 2013; Mantler, 2013).Further studies havealso shown that each day, more than 3,200 people under 18 smoke their first cigarette, and approximately 2,100 youth and young adults become daily smokers.
Furthermore, studies have indicated that as at 2012 it was noted that death as a result of non-communicable diseases (respiratory tract infection inclusive), accounted for 2.7 million deaths in sub-Saharan Africa with the inclusion of Nigeria as a result of smoking (WHO, 2000-2012). Also literature has shown that nearly 9 out of 10 lung cancers are caused by smoking and smokers today are much more likely to develop lung cancer than smokers were in 1964 (Siegel, Miller, Jemal, 2016). In Nigeria and worldwide smoking causes many types of cancer, including cancers of the throat, mouth, nasal cavity, esophagus, stomach, pancreas, kidney, bladder, and cervix, as well as acute myeloid leukemia (Jha, Ramasundarahettige & Landsman, 2013). Also studies still shows that 8 out of 10 COPD (Chronic Obstructive Pulmonary Disease) deaths are a result of smoking and currently, there is no cure for COPD (Madu, Matla, 2014).
In spite of the passage of the National Tobacco Control Bill by the National Assembly in Nigeria, a bill aimed at domesticating WHO Framework Convention on Tobacco Control (FCTC) to avert the unimaginable disaster associated with smoking many youth are still caught in the web of the act, thereby endangering their lives.It will therefore be of immense benefit to investigatepatterns of smoking and health risk perception of out-of-school youths in selected motor parks in Oshodi local government area of Lagos state, Nigeria.
1.3 Objective of the Study
The general objective for this study is to assess the pattern of smoking among out-of-school youth and their health risk perception.
The specific objectives are to:
- measure the level of smoking prevalence among respondents;
- assess the pattern of smoking among respondents and
- determine if respondents have a good health risk perception of smoking.
1.4 Research Questions
- At what level is the prevalence of smoking among respondents?
- What is the pattern of smoking among respondents?
- Do respondents have a good health risk perception of smoking?
- Justification for the Study
Smoking harms nearly every organ of the body and gradually reduces quality of life (Abdulahi, 2014). Studies revealed the Nigerian population to be more inclined to smoking with majority of smokers being youths (Ogunmola, Adegboyega, Oluwafemi, 2015) indicating that Nigerian smokers are more likely to be predisposed to its health risks. Over 4.5 million adult Nigerians are tobacco addicts and about 5.4 million deaths occur yearly due to smoking compared to 3 million and 1 million deaths caused by AIDS and malaria respectively (Global Health Sector Strategy, 2011). The unavailability of the tar contents of the recent cigarette produced in Nigeria may also be another area of concern (Egbe, Petrerson & Mayer-Weitz, 2016). According to an Independent Tobacco Control Activist, Olusegun Owotomo, available statistics show that about 93 million sticks of cigarette are produced and consumed yearly in Nigeria which has led to respiratory infections among 150,000-300,000 children under the age of 18 months as a result of passive smoking.
With the trend of tobacco use seen among youth in Nigeria and studies indicating about half of all lifelong smokers will die prematurely, losing on average about 10 years of life (Gholamreza, Mostafa, Mahmoud, Hadi, Masoud & Atena, 2015). It is anticipated that a huge epidemic of tobacco-related diseases might occur and with the long term consequences of smoking on health (Melgosa, 2006). It is of great importance that its reduction should be upmost interest in public health promotion and education as not only the smokers but also non-smokers are predisposed to these hazardous effects. As there is neither a safe tobacco product, nor a safe level of tobacco use, the best way to prevent tobacco-related deaths is to avoid using it.
Studies conducted in Nigeria to examine smoking among youths are few, and these studies have concentrated on describing pattern of use among in-school youths in urban areas (Osungbade & Oshiname, 2013) leaving out-of-school youths unattended to.This study intends to describe the pattern of smoking and health risk perception amongst a set of youths who are more likely to be overlooked by program planners. The findings will give an insight to the current situation of out of school youth smoking habit with the result aimed at giving recommendations towards health program interventions that will reduce to the simplest minimum the smoking habits among out-of-school youths in Lagos, Nigeria. Also the results emanating from it would provide adequate guidance and a benchmark for program planners to include these set of youths in smoking prevention intervention programs in Nigeria. This will go a long way to improve the health of youths in Nigeria and by extension people in Sub-Sahara Africa.
H1: There is a significant difference in level of smoking prevalence across the demographic characteristics of respondents.
H2: There is a significant association between prevalence of smoking and health risk perception of respondents.
H3: There is a significant association between prevalence of smoking and health risk knowledge of respondents.
1.7 Operational Definition of Terms
Smoking: This is one of the most common forms of recreational drug use.
Out-of-school youths: They are described as several groups of young people, those who have dropped out of school, those who never attended school, or those who participate in non-formal school programs (August, Claudia, William, Erin, Rosemary & Jane). These youths are a diverse group who may have completed elementary school (but lack basic skills to progress to high school or vocational training), dropped out or never started school. Those who drop out of school may fail to acquire fundamentals of basic education and life skills (Fatoye, 2013).
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