EFFECT OF SMOKING AMONG NURSING STUDENTS

IN UNIVERSITY OF LUZON

A Thesis

Presented to the

Faculty of College of Nursing and Midwifery

University of Luzon

Dagupan City

In Partial Fulfillment

Of the Requirements for the Subject

Nursing Research

The Researchers

Ahmed Abdulrahman Ba Elaian

Lucy Marie Ison

Ira Shane Manzano

Neil Christian Tata

December 2020
 THESIS ABSTRACT

1. Title: EFFECT OF SMOKING AMONG NURSING

STUDENTS IN UNIVERSITY OF LUZON

2. Researchers: Ahmed Abdulrahman Ba Elaian

Lucy Marie Ison

Ira Shane Manzano

Neil Christian Tatad

3. Degree: BACHELOR OF SCIENCE IN NURSING

4. Institution: UNIVERSITY OF LUZON, DAGUPAN CITY

5. Adviser: MARIBETH J. DULNUAN, RN, PhD, DBA

6. Special Location where copies can be found:

UNIVERSITY OF LUZON, DAGUPAN CITY

7. Background of the study:

Smoking leads to disease and disability and harms nearly

every organ of the body. More than 16 million Americans are living with a

disease caused by smoking. For every person who dies because of

smoking, at least 30 people live with a serious smoking-related illness.

Smoking causes cancer, heart disease, stroke, lung diseases, diabetes,

and chronic obstructive pulmonary disease (COPD), which include

emphysema and chronic bronchitis. Smoking also increases risk for

tuberculosis, certain eye diseases, and problems of the immune system,

including rheumatoid arthritis (U.S. Department of Health and Human

Services, 2014).

Secondhand smoke exposure contributes to approximately 41,000

deaths among nonsmoking adults and 400 deaths in infants each year.

Secondhand smoke causes stroke, lung cancer, and coronary heart

disease in adults. Children who are exposed to secondhand smoke are at

increased risk for sudden infant death syndrome, acute respiratory

infections, middle ear disease, more severe asthma, respiratory

symptoms, and slowed lung growth (U.S. Department of Health and

Human Services, 2014).

In 2019, nearly 14 of every 100 U.S. adults aged 18 years or older

(14.0%) currently* smoked cigarettes. This means an estimated 34.1

million adults in the United States currently smoke cigarettes (Cornelius,

Wang, Jamal, Loretan, Neff, 2020).

If smoking continues at the current rate among U.S. youth, 5.6

million of Today’s Americans younger than 18 years of age are expected

to die prematurely from a smoking-related illness. This represents about

one in every 13 Americans aged 17 years or younger who are alive today

(U.S. Department of Health and Human Services, 2014).

 Tobacco use is a global epidemic among young people. As with

adults, it poses a serious health threat to youth and young adults in the

United States and has significant implications for this nation’s public

and economic health in the future. The impact of cigarette smoking and

other tobacco use on chronic disease, which accounts for 75% of

American spending on health care, is well documented and undeniable

(Centers for Disease Control and Prevention (US); Reports of the Surgeon

General, 2012).

Tobacco use is the single most preventable cause of death in the

world today leading to over 6 million fatalities each year. More than 5

million of those deaths are the result of direct tobacco use and the

number of deaths will increase to 10 million per year by the year 2030 if

appropriate and improved preventive measures are not implemented.

Moreover, 70% of these projected fatalities are expected to occur in low-

and middle-income countries (Chung, Craig, Gravely, Sansone, Fong,

2019).

Tobacco use is a major risk factor for cardiovascular disease

(CVD), cancer, and a wide range of chronic diseases especially chronic

respiratory diseases (Chung-Hall, Craig, Gravely, Sansone, Fong, 2019).

Manufactured cigarettes are the most common type of tobacco consumed

worldwide but other forms of tobacco, such as chewing tobacco including

snuff use in South Asia and shisha smoking (water pipe) in the Middle
East, are also quite common in these particular regions (Suliankatchi,

Sinha, Rath, Aryal, Zaman, Gupta, Karki, Venugopal, 2019).

The overall mortality and morbidity attributed to tobacco smoking

have declined steadily during the past few decades in many Western

countries; however, in Asia, a tobacco epidemic has developed rapidly

(Eriksen, Mackay, Schluger, 2015). Currently, about half the world’s

male smokers live in 3 Asian countries: China, India, and Indonesia.

Japan and Bangladesh also rank among the top 10 countries with the

largest smoking populations (Katanoda, Jiang, Park, 2014). Not only is

Asia the world’s largest tobacco consumer, it is also the largest tobacco

producer (Eriksen, Mackay, Schluger,2015).

Asian countries are in the early stages of the tobacco-smoking

epidemic during the last century, many Asian countries experienced

dynamic socioeconomic changes, such as rapid economic development,

westernization, and war. The timing of these events may have induced

different patterns of tobacco use across birth cohorts (the group of people

born in given calendar years). Studies conducted in Japan and China

have found a distinct birth cohort–specific smoking pattern that has

resulted in a different risk of death associated with tobacco smoking

(Clow, Pederson, Haworth-Brockman, Bernier, 2010). Understanding

patterns of tobacco use across birth cohorts and countries will provide

valuable data to determine the future burden of smoking-attributable

mortality in Asia. Currently, birth cohorts know little about the evolution

of the tobacco smoking epidemic and its consequences on mortality

across Asian populations. (Yang and Zheng, 2018)

8. Statement of the Problem:

The study aimed to determine the level of knowledge on the

effects of smoking among the student nurses. The results of the study

served as a basis in proposing an awareness program that will help the

student nurses better understand the effects of smoking.

Specifically, this study sought to answer the following questions:

1. What is the level of knowledge on smoking effect among student

nurses along the following areas?

A. Physical

B. Social

C. Mental

D. Psychological

2. What risk factors are associated with smoking?

3. What health awareness program can be proposed to enhance

the knowledge of student nurses on the effects of smoking?

 9. Methodology

This study utilized the descriptive research which involves

collecting data in order to test hypotheses or to answer questions

concerning the current status of the subject of the study. A descriptive

study determines and reports the way things are. According to Gay

(1992: 217) Descriptive research is scientific research that describes

about event, phenomena or fact systematically dealing with certain area

or population.

The researchers used a survey questionnaire as research

instrument to gather the needed data from the respondents, the

questionnaire is prepared according to the order of problem stated in the

study. The survey question includes the profile variable of respondents

regardless of age and sex. The question’s purpose also was to determine

the percentage of all the student nurses of University of Luzon to

determine the smoking effects on student nurses. The research was

checked by the critic reader, noted by the statistician and approved by

the research adviser. Content Validity was used in this study which

refers to the degree to which the items in an instrument adequately

represent the universe of content for the concept being measured (Polit

and Beck, 2012).

 The idea of the questionnaire was based on the researcher’s

knowledge that relevant to the study. In preparation for the instrument,

the requirements in structuring the data collection instrument were

considered. The statement describing the issues about the study was

lessened to accommodate the prepared knowledge of the respondents.

10. Findings

1. The following are the salient findings of the study:

Smoking is the first cause of respiratory system disease: Based

on the table above, the factor shows that it ranked 1st by frequency of 77

have respondents yes and one responded no and 98.72 percentage. The

nurses agreed that the first cause and factor for respiratory system

disease is smoking and how risk the smoke in our lungs and health.

Risk of smoking: Based on the table above, the factor shows that

it ranked 2st. by frequency of 76 have respondents yes and two has

respondents no and 97.43 percentage. The nurses agreed that smoking

is one of the risks on our health and life.

Second-hand smoke has increased risk in developing disease:

Based on the table above, the factor shows that it ranked 3 st. by

frequency of 68 have respondents yes and 10 have respondents no and

87.18 percentage. The nurses agreed that smoking is more dangerous on

non-smokers.
2. Risk factors associated with smoking:

Cigarette smoke is dangerous to non-smoker: Based on the

table above, the factor shows that it ranked 1st. with 71 have

respondents yes and 1 have respondents maybe and 6 have respondents

no and 2.83 percentage.

Smoking will damage your health in the future: Based on the

table above, the factor shows that it ranked 2st. with 58 have

respondents yes and 6 have respondents maybe and 14 have

respondents no and 2.56 percentage.

Smoking is addictive: Based on the table above, the factor shows

that it ranked 2st. with 39 have respondents yes and 28 have

respondents maybe and 11 respondents no and 2.35 percentage.

3. Risk factors associated with smokers:

Who influenced the smoker to smoke: Based on the table above,

the factor shows that the friends are the top factor which influenced the

smokers nurse as ranked 2st. by frequency of 12 have respondents yes

and 66 have respondents no and 15.38 percentage, and school was in

the ranked 3st. by frequency of 5 have respondents yes and 73 have

respondents no and 6.41 percentage.

Reasons why smokers smoke: Based on the table above, the

factor shows that the Relaxation / Enjoyment was in the top reason that

the smokers nurse smoked as ranked 1st. by frequency of 13 have

respondents yes and 65 have respondents no and 16.66 percentage, And

Friends / Social was in the ranked 2st. by frequency of 10 have

respondents yes and 68 have respondents no and 12.82 percentage.

Andin the third was Stress / Depression as ranked 3st. by frequency of 9

have respondents yes and 69 have respondents no and 11.45 percentage.

Smokers feeling when they smoke: Based on the table above, the

factor shows that the decreased stress was in the top feeling that the

smokers nurse felt as ranked 1st. by frequency of 13 have respondents

yes and 65 have respondents no and 16.66 percentage, and increase

focus or concentration was in the ranked 2st. by frequency of 6 have

respondents yes and 72 have respondents no and 7.69 percentage. And

third was decrease appetite as ranked 3st. by frequency of 3 have

respondents yes and 75 have respondents no and 3.85 percentage.

4. Proposed Action Plan on smoking effects

The proposed Action Plan on smoking effects for nurses was

formulated by the researcher. The plan was a key in achieving optimal

knowledge and deal with the factors that affects their self-awareness

thus affecting their health at their life. The potential barriers in action

plan of smoking effects shall be addressed for nurses to develop,

implement and evaluate self- awareness to the factors that affects their

health.

This plan aimed to help student nurses develop their

understanding on the effects of smoking as well as their nursing health.

The nurses must take action toward cessation improvement their health
and the environment while also creating knowledge on the impact of

smoking to our health and life and to who noon smokers. The plan was

involved nurses’ smoker and non-smokers student in the college of

nursing

11. Conclusion

Based from the founds of the study, it can be concluded that

smoking habit indicators were practiced by 7 student and was

smoking by 16 and 18 student who were just try from total

respondent of student 78 nurses assigned the 4 levels of college of

nursing. The fully practiced equivalent maybe attributed to the

knowledge of the nurses in the effects of smoking on the health.

However, Data has to be given more attention as it got the highest

yes and percentage rating among the questionnaires although it

still garnered the fully practiced equivalent.

Based from the found of the study. Nurses should be more

knowledgeable on smoking effects and the consequences to the

non-smokers and the environment.

Overall, the highest rating of the nurses implies that they

were good nursing who don’t smoke. However, there was still a

need to enhance their knowledge and information and update

themselves with the trends or information on smoking impacts or

effects as a nursing student for safe and quality nursing care and

improve health of well-being.

12. Recommendations

Based from the findings of the study, the following are hereby

recommended:

1. The proposed action plan herein is to be piloted. This can be used

by the nurses to address issues and concerns on smoking effects

and thus, cessation and quality nursing health.

2. Promote cessation programs among smokers by increase

awareness and the intention to quit among smokers increase

awareness among health professionals on smoking cessation

programmers, provide treatment for tobacco dependence.

3. Another research study is highly recommended to further increase

the knowledge of nurses on smoking effects in a wider coverage.

 TABLE OF CONTENTS

PAGE

Thesis Abstract iii

List of Tables xiv

List of Figures xv

Acknowledgement xvi

Dedication xix

CHAPTER

I THE PROBLEM AND ITS BACKGROUND

Rationale 1

Conceptual Framework 6

Statement of the Problem 9

Assumptions of the Study 9

Scope and Delimitation 10

Significance of the Study 11

Definition of Terms 12

II REVIEW OF RELATED LITERATURE AND STUDIES

Conceptual Literature 13

Research Literature 19

III RESEARCH DESIGN

 Research Methods to be used 24

Locale of the Study 25

Respondents of the Study 27

Instrumentation 28

Validity and Reliability 29

Ethical Considerations 30

Data Gathering Procedure 31

Statistical Treatment of Data 32

IV PRESENTATION, ANALYSIS AND

INTERPRETATION OF DATA

Risk factors that associated with smokers 35

Risk factors that associated with smoking 40

Proposed awareness program on the

effect of smoking 57

V SUMMARY, CONCLUSION, AND

RECOMMENDATIONS

Summary findings 65

Conclusion 68

Recommendation 69

BIBLIOGRAPHY 70

APPENDICES

A. Letter of Request to Conduct the Study 79

 B. Letter of Request to Gather Data 80

C. Letter for Respondents 81

D. Questionnaire 82

CURRICULUM VITAE 86

LIST OF FIGURES

No. Table Title

1 Research Paradigm of the Study 8

2 Sit maps of the local 26

LIST OF TABLES

No. Table Title

1 Risk factors associated with smokers 35

2 Risk factors associated with smoking 40

3 Risk factors associated with smokers 45

4 Summary Risk factors associated with smokers 51

5 Summary Risk factors associated with smoking 52

6 Summary Risk factors associated with smokers 53

7 Action plan 62

8 Questionnaires 82
 ACKNOWLEDGEMENT

The completion of this research wok could not have been

possible without the participation and assistance of so many

people whose names may not all be enumerated but their

contributions are sincerely appreciated and acknowledged. The

researcher wanted to express sincerest gratitude and appreciation

to the following individuals who help in accomplishing this

research proposal.

Prof. Ellen P. Gabriel, Dean of college of nursing and

midwifery, for her bright ideas and contributions to the attainment

of this goal. Her dedication and commitment to college of nursing

is a big source of hope and encouragement in the course of the

study.

Dr. Maribeth J. Dulnuan, our research adviser who gave us

the opportunity to learn and do about research and providing us

guidance throughout the study. Her vision, sincerity, and

motivation have deeply encouraged and motivated us to do better.

She has taught us different methods to carry out a research and

how to present it as clear as possible. The researchers are

privileged and deeply honored to study under her direction. The

researchers would also like to express our gratitude for her great

sense of humor and for the empathy. unconditionally provided her

knowledge, expertise, constructive criticism and selfless

understanding for the improvement of the research paper,

professional guidance, and collaborative suggestions in achieving

this proposal.

The other member of the research panel, Prof. Divina

Gracia Corrigan, for her professionalism and enthusiasms in

giving constructive criticisms which served as a guide and

enlightenment for the improvement of the study.

To the University of Luzon College of Nursing and Midwifery,

for guiding us up to this point. Thank you for showing interest to

complete this study successfully.

To our fellow student nurses, for the support to complete

this research study.

To our ever-loving parents who expressed their support not

only for the financial assistance as well as moral support, advises

and understanding, love, prayers, and sacrifices for providing us

education to prepare us for the future.

 With humbleness and respect, we would like to recognize the

authors of research book that served as our reference for the

completion of this requirement that help us.

The researchers give you the highest praise, honor and glory

to our Almighty Father who constantly blessing us with the

strength, courage and knowledge for us to accomplish this study.

The Researchers

Ahmed Abdulrahman Ba Elaian

Lucy Marie Ison

Ira Shane Manzano

Neil Christian Tata

 DEDICATION

The researchers would like to express heartfelt gratitude and

profound appreciation to the following people who helped them

accomplish this study.

The Almighty Father, who armed us with knowledge and

wisdom, strength, and patience in accomplishing this endeavor

and thus, bestow this humble work with His everlasting glory, love

and compassion,

The researchers would like to dedicate our research study to

our family. A one-of-a-kind feeling of gratitude to our loving

parents, whose words of encouragement always push us to be the

best student we can be. To our brothers and sisters who are

always on our side and are very special in our lives.

We also dedicate this study to our friends who showed and

gave us their support throughout the process of the study. We will

always appreciate the help they have done to us.,

 Also, our research adviser Prof. Maribeth J. Dulnuan, who

shared her knowledge, expertise, and assisting the researcher

comprehend the needed requirements of this study. Lastly, to the

respondents who helped the researcher obtain and analyze their

data, for their support, love, patience, and understanding as well

as their contribution for the success of this research.

The Researchers

Ahmed Abdulrahman Ba Elaian

Lucy Marie Ison

Ira Shane Manzano

Neil Christian Tata

University of Luzon
April, 2021
 Chapter I

THE PROBLEM AND ITS BACKGROUND

Rationale

Smoking leads to disease and disability and harms nearly every

organ of the body. More than 16 million Americans are living with a

disease caused by smoking. For every person who dies because of

smoking, at least 30 people live with a serious smoking-related illness.

Smoking causes cancer, heart disease, stroke, lung diseases, diabetes,

and chronic obstructive pulmonary disease (COPD), which include

emphysema and chronic bronchitis. Smoking also increases risk for

tuberculosis, certain eye diseases, and problems of the immune system,

including rheumatoid arthritis (U.S. Department of Health and Human

Services, 2014).

Secondhand smoke exposure contributes to approximately 41,000

deaths among nonsmoking adults and 400 deaths in infants each year.

Secondhand smoke causes stroke, lung cancer, and coronary heart

disease in adults. Children who are exposed to secondhand smoke are at

increased risk for sudden infant death syndrome, acute respiratory

infections, middle ear disease, more severe asthma, respiratory

symptoms, and slowed lung growth (U.S. Department of Health and

Human Services, 2014).

In 2019, nearly 14 of every 100 U.S. adults aged 18 years or older

(14.0%) currently* smoked cigarettes. This means an estimated 34.1

1
million adults in the United States currently smoke cigarettes (Cornelius,

Wang, Jamal, Loretan, Neff, 2020).

If smoking continues at the current rate among U.S. youth, 5.6

million of Today’s Americans younger than 18 years of age are expected

to die prematurely from a smoking-related illness. This represents about

one in every 13 Americans aged 17 years or younger who are alive today

(U.S. Department of Health and Human Services, 2014).

Tobacco use is a global epidemic among young people. As with

adults, it poses a serious health threat to youth and young adults in the

United States and has significant implications for this nation’s public

and economic health in the future. The impact of cigarette smoking and

other tobacco use on chronic disease, which accounts for 75% of

American spending on health care, is well documented and undeniable

(Centers for Disease Control and Prevention (US); Reports of the Surgeon

General, 2012).

Tobacco use is the single most preventable cause of death in the

world today leading to over 6 million fatalities each year. More than 5

million of those deaths are the result of direct tobacco use and the

number of deaths will increase to 10 million per year by the year 2030 if

appropriate and improved preventive measures are not implemented.

Moreover, 70% of these projected fatalities are expected to occur in low-

and middle-income countries (Chung, Craig, Gravely, Sansone, Fong,

2019).

2
 Tobacco use is a major risk factor for cardiovascular disease

(CVD), cancer, and a wide range of chronic diseases especially chronic

respiratory diseases (Chung-Hall, Craig, Gravely, Sansone, Fong, 2019).

Manufactured cigarettes are the most common type of tobacco consumed

worldwide but other forms of tobacco, such as chewing tobacco including

snuff use in South Asia and shisha smoking (water pipe) in the Middle

East, are also quite common in these particular regions (Suliankatchi,

Sinha, Rath, Aryal, Zaman, Gupta, Karki, Venugopal, 2019).

The overall mortality and morbidity attributed to tobacco smoking

have declined steadily during the past few decades in many Western

countries; however, in Asia, a tobacco epidemic has developed rapidly

(Eriksen, Mackay, Schluger, 2015). Currently, about half the world’s

male smokers live in 3 Asian countries: China, India, and Indonesia.

Japan and Bangladesh also rank among the top 10 countries with the

largest smoking populations (Katanoda, Jiang, Park, 2014). Not only is

Asia the world’s largest tobacco consumer, it is also the largest tobacco

producer (Eriksen, Mackay, Schluger,2015).

Asian countries are in the early stages of the tobacco-smoking

epidemic during the last century, many Asian countries experienced

dynamic socioeconomic changes, such as rapid economic development,

westernization, and war. The timing of these events may have induced

different patterns of tobacco use across birth cohorts (the group of people

born in given calendar years). Studies conducted in Japan and China

3
have found a distinct birth cohort–specific smoking pattern that has

resulted in a different risk of death associated with tobacco smoking

(Clow, Pederson, Haworth-Brockman, Bernier, 2010). Understanding

patterns of tobacco use across birth cohorts and countries will provide

valuable data to determine the future burden of smoking-attributable

mortality in Asia. Currently, birth cohorts know little about the evolution

of the tobacco smoking epidemic and its consequences on mortality

across Asian populations. (Yang and Zheng2018)

Nursing students have an influential role in smoking prevention

(Fernández-García, Liebana Presa, Vazquez Casares, 2007). Health professions

students are aware of their responsibility as role models for patients

regarding tobacco cessation (Sreeramareddy, Ramakrishnareddy, Rahman,

2018) Their status of smoker or non-smokers affects their activity as

health promoters, as smoker students are least likely to advice in

smoking cessation (Keshavarz, Jafari, Khami, Virtanen, 2013). Beliefs and

attitudes of students toward tobacco control are negatively influenced by

smoking (Cauchi, Mamo, 2012). In most WHO regions, health professional

students who had received formal training on smoking cessation

approaches are the minority (30%) and 80% of all students recognize that

they should receive formal cessation training (Sreeramareddy,

Ramakrishnareddy, Rahman, 2018). Nursing students have identified the

reasons people smoke, smoking cessation techniques, nicotine

4
replacement therapies, and use of anti-depressants in smoking

cessation, as the major areas of inadequate training. Educational

interventions focused on smoking cessation among students have

demonstrated to be successful in changing their attitude toward tobacco

consumption (El-Awaisi, Awaisu, 2017).

Each day there are more than 3,200 people, under the age of 18,

who smoke their first cigarette? The Centers for Disease Control and

Prevention (CDC) found that in 2012, 7% of middle school and 23% of

high school students reported current use a tobacco product. And

according to the Department of Health and Human Services it is

estimated that each day approximately 2,100 youth and young adults

who are occasional smokers become daily smokers (Larry Samuels, PhD,

2015)

Most adult smokers today state that they started smoking by age

18. In 2010, close to 70% of adult smokers reported that they would like

to quit. Research has shown that people who start smoking during

adolescence may have the hardest time quitting. It is not surprising to

hear that many people attempt to quit smoking several times before they

are successful. Remember that addiction to nicotine is a chronic,

relapsing medical condition and should be treated as such (Larry

Samuels, PhD, 2015)

5
 In this study, we were hope to apply knowledge to the students

that will minimized the used of cigarettes and expressed the harmful

effects of smoking among the student nurses in the University of Luzon.

Conceptual Framework

The Health Belief Model was a theoretical model that can be used

to guided health promotion and disease prevention programs. It is used

to explain and predict individual changes in health behaviors. It is one of

the most widely used models for understanding health behaviors. Key

elements of the Health Belief Model focus on individual beliefs about

health conditions, which predict individual health-related behaviors. The

model defines the key factors that influence health behaviors as an

individual's perceived threat to sickness or disease (perceived

susceptibility), belief of consequence (perceived severity), potential

positive benefits of action (perceived benefits), perceived barriers to

action, exposure to factors that prompt action (cues to action), and

confidence in ability to succeed (self-efficacy).

The Health Belief Model emphasized that tobacco use is

determined by an individual's perceptions regarding: Personal

vulnerability to illness caused by tobacco use, Seriousness of tobacco as

a problem, Treatment cost and effectiveness (i.e., the benefits of taking

action), Barriers to quitting, Cues to change tobacco use behavior.

Smoking is one of the risk factors in our life and to other people.

The air should be clean and when someone smokes, the person affects

6
the air that surrounds him and also affects the people around you by

inhaling the smoke you produce. Also, smoke may lead to various

problems to the health of the people and the environment.

Social and environmental factors can also be powerful drivers in

preventing uptake and encouraging quitting. Legislation that demoralizes

smoking by making it less visible and less socially acceptable (such as

advertising and promotion bans, smoke free environments, and restricted

sales to youth) has been crucial in reducing smoking rates over time.

Smoking has a huge effect on air pollution, which affects everyone

those who breathes the same air as the tobacco smoker. Not only is the

smoker putting his or her health at risk, but also the people inhaling all

the toxic smoke are prone to second-hand smoking health risks. Tobacco

is a worldwide problem affecting a large number of the world’s pollution,

which has had a huge impact on television ads to bring awareness of this

hazardous weapon threatening everyone’s life.

The researchers were proposed the idea of conducting a health

awareness program and different strategies to raise awareness and to

educate the student nurses of University of Luzon about the effects of

smoking. According to some findings, it is suggested that smoking

awareness programs should continue to target the population who are at

risk. To conduct the awareness program, the researches will gather data

through survey questionnaires according to the profile of the students in

terms of age, gender, and environment. Through an awareness program,

7
the students may gain an enhanced knowledge and a better

understanding regarding the effects of smoking among the student

nurses at University of Luzon.

Input Process Output

Data gathering Awareness Enhanced

through Survey health program awareness and
Questionnaires regarding the Gain knowledge
according to the effects of through
profile of the smoking among proposed
respondents the student programs and
involved in the nurses at strategies
study in terms University of regarding the
of: Luzon including effects of
the presentation smoking among
- Physical
of data gathered the student
- Mental nurses.

- Social
- Psychological

FEEDBACK

Figure 1. Research
Paradigm of the Study

8
Statement of the Problem

The study aimed to determine the level of knowledge on the effects

of smoking among the student nurses. The results of the study served,

as basis in proposed an awareness program that will help the student

nurses better understand the effects of smoking.

Specifically, it sought to answer the following questions:

1. What is the level of knowledge on smoking effect among student’s

nurse along the following areas?

a. Physical

b. Social

c. Mental

d. Psychological

2. What risk factors are associated with smoking?

3. What health awareness program can be proposed to enhance the

knowledge of student nurses on the effects of smoking?

Assumptions of the Study

In conducting a study ‘The Effects of Smoking Among Nursing

Students’ in a Private Institution in Dagupan City, the following

assumptions were considered in the study:

1. The questionnaire was valid and reliable.

2. Respondents provided honest answers regarding the questionnaire

9
 3. The health awareness program of the study will benefit the

respondents, University of Luzon, and future researchers on the

awareness of the effect of smoking.

Scope and delimitation

The purpose of this study was to provide knowledge and awareness

to all student nurses at University of Luzon in Dagupan City about the

risk factors of smoking and how it affects our health. Also, the

researchers sought to propose strategies or programs that can boost the

self-awareness of the student nurses.

The researchers chose all level of student nurses in university of

Luzon because of the experience that they have in the College of Nursing

that includes their development knowledge and information. The

questionnaires will be distributed to all student nurses in University of

Luzon to conduct a survey about the effects of smoking.

Since different respondents were express opinions, the

questionnaires gave to respondents with difference on age and gender.

The respondents gave only to all the student nurses of university of

Luzon. Student nurses from other university are not included in the

study.

The study is progressed to all level of student in college of nursing

in university of Luzon and others colleges are excluded.

10
Significance of the Study

The significance of this study was to raise awareness among all the

student nurses in University of Luzon. And to increase their knowledge

about the risks of smoking to the health.

The findings of this study were be beneficial to the following:

Student Nurses: The study will be use as a guide to raise their

awareness on the impact of smoking.

Institutional: This study can be of great help to the education of

student nurses. By studying and understanding the risk of smoking and

the high effect of smoking. It will serve as a tool of expectation and

prevention. This may enlighten the students on what to expect, what to

feel, how to react, and what to avoid.

Community: To enhance their awareness to promote good health

and to help decrease the growing population of people with respiratory

diseases caused by smoking and others disease.

Future Researchers: This study can be used in the future

information to increase the leave of knowledge of nursing student and

society and community to improve good health.

11
Definition of Terms:

The Definition of Terms includes the operational and conceptual

definition of significant terms used in the research study.

Smoking: A visible suspension of carbon or other particles in air,

typically one emitted from a burning substance.

Physical: Relating to the body as opposed to the mind, involving bodily

contact or activity.

Mental: Relating to the mind.

Social: Relating to society or its organization, also related to rank and

status in society.

Psychological: Affecting, or arising in the mind; related to the mental

and emotional state of a person.

Risk factors: A variable associated with an increased risk of disease or

infection, it’s used as synonym, due to lack of harmonization across

disciplines.

Proposed health awareness program: Healthcare seminars and

Lectures on subject for awareness around specific conditions and disease

that people struggle with daily to ensure appropriate information and to

enhance the knowledge of the people.

12
 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter was presenting the Review of Related Literature and

studies that are relevant to the present study.

Conceptual Literature

This part of the chapter was presenting the concepts related to the

studies of the effects of smoking on student nurses on in university of

Luzon.

Studies have found that adolescent and adult smokers

do not fully appreciate the health consequences of
smoking cigarettes (Slovic, 2001; Weinstein, 1999,
2001). Previous studies have highlighted varying
degrees of risk awareness among adolescents or
older adults (Slovic, 2001). The present study focused
specifically on risk perceptions of smoking among
college-aged students (18–24 years) after the Master
Settlement Agreement. During 1993–2000, reductions
in current smoking prevalence were reported for all
age groups, except those aged 18–24 years (Centers for
Disease Control and Prevention, 2002). Young adults
continue to be an important target of tobacco industry
marketing efforts (Cummings, Morley, & Hyland,
2002; Ling & Glantz, 2002; Sepe & Glantz, 2002;
Sepe, Ling, & Glantz, 2002). Anti-tobacco efforts
directed at young adults would be more successful if
public health educators had a better understanding of
how this age group perceives the risks of smoking.
This paper describes how college students perceive the
risks of cigarette smoking and addiction.
Previous research has found that college students
consider smoking less hazardous than the use of illegal
drugs and regret starting to smoke (Jamieson &
Romer, 2001; Luce & Merrell, 1995; Slovic, 2000b).
Slovic (2000b) found that students from the University

13
of Oregon who had smoked the longest were the most
dissatisfied with their decision to smoke and reported
the greatest difficulty in quitting smoking, and that,
overall, 65% of daily smokers in this sample would not
start smoking given the opportunity to go back in time.
In another study conducted at a mid-sized private
university in the southwest (Luce & Merrell, 1995),
students were asked to estimate and prioritize the
lethality and abuse potential of cocaine, heroin, mar-
ijuana, alcohol, and tobacco. Students overestimated
deaths from cocaine, heroin, and marijuana and under-
estimated deaths from tobacco and alcohol. In addition,
Jamieson and Romer (2001) found through the Annen-
berg study that 14–22 year olds vary in their sensitivity to
risks associated with smoking mortality vs. other risk
behaviors. For example, many students overestimated
lung cancer risk but underestimated years of life lost and
inaccurately perceived more deaths caused by gunshots,
car accidents, alcohol, and other drug use than by
smoking cigarettes
Studies have found that adolescent and adult smokers
do not fully appreciate the health consequences of
smoking cigarettes (Slovic, 2001; Weinstein, 1999,
2001). Previous studies have highlighted varying
degrees of risk awareness among adolescents or
older adults (Slovic, 2001). The present study focused
specifically on risk perceptions of smoking among
college-aged students (18–24 years) after the Master
Settlement Agreement. During 1993–2000, reductions
in current smoking prevalence were reported for all
age groups, except those aged 18–24 years (Centers for
Disease Control and Prevention, 2002). Young adults
continue to be an important target of tobacco industry
marketing efforts (Cummings, Morley, & Hyland,
2002; Ling & Glantz, 2002; Sepe & Glantz, 2002;
Sepe, Ling, & Glantz, 2002). Anti-tobacco efforts
directed at young adults would be more successful if
public health educators had a better understanding of
how this age group perceives the risks of smoking.
This paper describes how college students perceive the
risks of cigarette smoking and addiction.
Previous research has found that college students
consider smoking less hazardous than the use of illegal
drugs and regret starting to smoke (Jamieson &
Romer, 2001; Luce & Merrell, 1995; Slovic, 2000b).
Slovic (2000b) found that students from the University

14
of Oregon who had smoked the longest were the most
dissatisfied with their decision to smoke and reported
the greatest difficulty in quitting smoking, and that,
overall, 65% of daily smokers in this sample would not
start smoking given the opportunity to go back in time.
In another study conducted at a mid-sized private
university in the southwest (Luce & Merrell, 1995),
students were asked to estimate and prioritize the
lethality and abuse potential of cocaine, heroin, mar-
ijuana, alcohol, and tobacco. Students overestimated
deaths from cocaine, heroin, and marijuana and under-
estimated deaths from tobacco and alcohol. In addition,
Jamieson and Romer (2001) found through the Annen-
berg study that 14–22 year olds vary in their sensitivity to
risks associated with smoking mortality vs. other risk
behaviors. For example, many students overestimated
lung cancer risk but underestimated years of life lost and
inaccurately perceived more deaths caused by gunshots,
car accidents, alcohol, and other drug use than by
smoking cigarettes
Studies have found that adolescent and adult smokers
do not fully appreciate the health consequences of
smoking cigarettes (Slovic, 2001; Weinstein, 1999,
2001). Previous studies have highlighted varying
degrees of risk awareness among adolescents or
older adults (Slovic, 2001). The present study focused
specifically on risk perceptions of smoking among
college-aged students (18–24 years) after the Master
Settlement Agreement. During 1993–2000, reductions
in current smoking prevalence were reported for all
age groups, except those aged 18–24 years (Centers for
Disease Control and Prevention, 2002). Young adults
continue to be an important target of tobacco industry
marketing efforts (Cummings, Morley, & Hyland,
2002; Ling & Glantz, 2002; Sepe & Glantz, 2002;
Sepe, Ling, & Glantz, 2002). Anti-tobacco efforts
directed at young adults would be more successful if
public health educators had a better understanding of
how this age group perceives the risks of smoking.
This paper describes how college students perceive the
risks of cigarette smoking and addiction.
Previous research has found that college students
consider smoking less hazardous than the use of illegal
drugs and regret starting to smoke (Jamieson &
Romer, 2001; Luce & Merrell, 1995; Slovic, 2000b).
Slovic (2000b) found that students from the University

15
of Oregon who had smoked the longest were the most
dissatisfied with their decision to smoke and reported
the greatest difficulty in quitting smoking, and that,
overall, 65% of daily smokers in this sample would not
start smoking given the opportunity to go back in time.
In another study conducted at a mid-sized private
university in the southwest (Luce & Merrell, 1995),
students were asked to estimate and prioritize the
lethality and abuse potential of cocaine, heroin, mar-
ijuana, alcohol, and tobacco. Students overestimated
deaths from cocaine, heroin, and marijuana and under-
estimated deaths from tobacco and alcohol. In addition,
Jamieson and Romer (2001) found through the Annen-
berg study that 14–22 year olds vary in their sensitivity to
risks associated with smoking mortality vs. other risk
behaviors. For example, many students overestimated
lung cancer risk but underestimated years of life lost and
inaccurately perceived more deaths caused by gunshots,
car accidents, alcohol, and other drug use than by
smoking cigarettes
Studies have found that adolescent and adult smokers
do not fully appreciate the health consequences of
smoking cigarettes (Slovic, 2001; Weinstein, 1999,
2001). Previous studies have highlighted varying
degrees of risk awareness among adolescents or
older adults (Slovic, 2001). The present study focused
specifically on risk perceptions of smoking among
college-aged students (18–24 years) after the Master
Settlement Agreement. During 1993–2000, reductions
in current smoking prevalence were reported for all
age groups, except those aged 18–24 years (Centers for
Disease Control and Prevention, 2002). Young adults
continue to be an important target of tobacco industry
marketing efforts (Cummings, Morley, & Hyland,
2002; Ling & Glantz, 2002; Sepe & Glantz, 2002;
Sepe, Ling, & Glantz, 2002). Anti-tobacco efforts
directed at young adults would be more successful if
public health educators had a better understanding of
how this age group perceives the risks of smoking.
This paper describes how college students perceive the
risks of cigarette smoking and addiction.
Previous research has found that college students
consider smoking less hazardous than the use of illegal
drugs and regret starting to smoke (Jamieson &
Romer, 2001; Luce & Merrell, 1995; Slovic, 2000b).
Slovic (2000b) found that students from the University

16
of Oregon who had smoked the longest were the most
dissatisfied with their decision to smoke and reported
the greatest difficulty in quitting smoking, and that,
overall, 65% of daily smokers in this sample would not
start smoking given the opportunity to go back in time.
In another study conducted at a mid-sized private
university in the southwest (Luce & Merrell, 1995),
students were asked to estimate and prioritize the
lethality and abuse potential of cocaine, heroin, mar-
ijuana, alcohol, and tobacco. Students overestimated
deaths from cocaine, heroin, and marijuana and under-
estimated deaths from tobacco and alcohol. In addition,
Jamieson and Romer (2001) found through the Annen-
berg study that 14–22 year olds vary in their sensitivity to
risks associated with smoking mortality vs. other risk
behaviors. For example, many students overestimated
lung cancer risk but underestimated years of life lost and
inaccurately perceived more deaths caused by gunshots,
car accidents, alcohol, and other drug use than by
smoking cigarettes
Impacts of cigarette smoking:

Smoking is one of most important issues of health problems in the

world. Smoking overuse results in serious consequences for the

community health and society in Bangladesh. The major impacts on

health are physically, psychologically, socially and economically due to

smoking.

Physical effects related to tobacco use harms directly health of

smokers and second-hand smokers even to third hand smokers. Each

stick of cigarette contains over 7,000 chemicals of which 70 are known

as carcinogens. Tobacco causes over 20 different diseases (WHO, 2010).

Tobacco calls a “gate way” drug because it often precedes and anticipates

the use of alcohol, cocaine and other dangerous (Soldz & Cue, 2001 cited

in Homsin et al., 2006). The most important chemicals containing in

17
cigarettes is nicotine (Baker, Pereira Da Silva, & Smith, 2004; Fowles,

Bates, & Noiton, 2000). Nicotine intake is a principal reason why most

smokers smoke which stated by U.S. Department of health and Human

[U.S. DHHS, 1988]. Nicotine affects the brain, cardiovascular, and

pulmonary systems. The affect depends on the number of years that a

person smokes and on how much the person smokes. Starting smoking

earlier in life increases the risk of these diseases.

Moreover, there are other health effects from smoking in adolescent.

Those include developed coughing, respiratory infection, increasing of

heart rate, blood pressure, acid of stomach decreases blood supply with

oxygen, sensation of appetite taste, smell. There are also cosmetic effects

and premature ageing of skin, sallow, 19 yellow-grey complexion, stains

fingers and nails (Schane et al., 2010). Smoking may lead to coughs and

worsen respiratory diseases among young people. Adolescent smokers

experience shortness of breath at higher rates compared to nonsmoking

adolescents and produce phlegm more often than those who do not

smoke. (Page & Page; cited by Appau, 2011).

Another study revealed that the smoking is damage to different

parts of the body such as mouth, teeth, skin, fingernails and hair. It also

contains the danger elements and compounds of health such as arsenic,

carbon monoxide, nicotine and formaldehyde which may cause wrinkles,

discoloration of skin complexion and yellowing of fingernails when they

enter the bloodstream. Secondhand smoke may also result in cosmetic

18
damage when it gets in contact with the body. Smoking makes people

seem older than they actually age (McCay et al., 2009).

Furthermore, there are important chronic diseases that result of

smoking such as cancer, cardiovascular diseases, and chronic

obstructive pulmonary disease (COPD). Smoking also increases risk of

the reproductive health problems early menopause, and links to reduced

fertility, vaginal bleeding, premature delivery, abruption placenta,

placenta previa, spontaneous abortion, prenatal mortality, and having a

lower birth weight baby, Metabolic Syndrome and Diabetes, osteoporosis,

thyroid disease, deep vein thrombosis, sleep problems and aneurysms

are greater risk (Meurs, 1999). Smoking has many negative effects on the

mouth, including staining of teeth and dental restoration of the ability to

smell and taste, and the development of oral diseases such as smoker’s

palate, smoker’s melanosis, coated tongue, and possibly, oral

candidacies and dental caries, periodontal disease, implant failure, oral

pre cancer and cancer (Reibel, 2003).

On psychological effects Most smokers have stressful feeling more

than non- smokers, and adolescent smokers believe that increasing

levels of stress as they develop regular patterns of smoking (Parrott,

1999). Anxiety, hostility, and depressive symptoms were significantly

associated with a higher risk of lifetime smoking for both boys and girls

(Hayes, & Plowfield, 2007; Weiss et al., 2008). The regular and heavy

smoker reported significantly higher stress (nervousness, anxiety, worry)

19
than did similarly aged non-smokers (Mitic, McGuitre, & Neumann, 1985

cited in Parrott, 1999). 20 Adolescents smoke cigarette are more likely to

get into other risk behavior such as fighting, carrying weapons, suicidal

attempt (Busen et al., 2001; Parillo, et al., 1997). Smoking also increases

the risk of learning and behavioral problems such as Attention-Deficit

Hyperactivity Disorder (ADHD), which can disrupt schooling and life

generally (CDC, 1994).

Social effects smoker does not only harm him or herself but also

puts the life of others at risk. Research showed that an environment

devoid of smoke is effective way to protect the population from the

detrimental effects of secondhand smoke exposure (WHO, 2007).

Smoking can create a tremendous financial burden for smokers and their

families. Smoking is also related to social harms. It’s not surprising that

research shows smoking increases financial stress and reduces material

wellbeing. Spending on cigarettes means less money for essentials like

food, clothing, and housing. Giving up smoking reduces financial stress

and improves standards of living (Alters, & Schiff, 2009).

The Economic / financial costs Smoking not only ends lives

prematurely, but it also puts a tremendous strain on both federal and

state budgets (ALA, 2012). Several Studies found that people in the lower

socioeconomic classes smoke more than people in the upper

socioeconomic classes. (McCay et al., 2009). Tobacco use compromises

the health of both the smoker and nonsmokers exposed to tobacco

20
smoke. Treating of tobaccorelated diseases requires a number of medical

services, such as hospital stays, physician services, other health

practitioners’ services, prescription drugs, home care, and nursing home

care. Healthcare in many advanced countries is catered for by private

insurance and socialized health care systems whereas patients in many

developing countries pay for medical care costs themselves. As a result,

the many countries are loss of huge amount of foreign exchange for the

purposes of treatment (RITC, 2003).

Risk Factors of smoking

Smoking leads to disease and disability and harms nearly every

organ of the body. More than 16 million Americans are living with a

disease caused by smoking. For every person who dies because of

smoking, at least 30 people live with a serious smoking-related illness.

Smoking causes cancer, heart disease, stroke, lung diseases, diabetes,

and chronic obstructive pulmonary disease (COPD), which include

emphysema and chronic bronchitis. Smoking also increases risk for

tuberculosis, certain eye diseases, and problems of the immune system,

including rheumatoid arthritis). Secondhand smoke exposure

contributes to approximately 41,000 deaths among nonsmoking adults

and 400 deaths in infants each year. Secondhand smoke causes stroke,

lung cancer, and coronary heart disease in adults. Children who are

exposed to secondhand smoke are at increased risk for sudden infant

21
death syndrome, acute respiratory infections, middle ear disease, more

severe asthma, respiratory symptoms, and slowed lung growth (U.S.

Department of Health and Human Services. The Health Consequences of

Smoking—50 Years of Progress: A Report of the Surgeon General, 2014).

22
 RESEARCH LITERATURE

This part of the chapter was presenting the research studies that

support the foundation of the study relevant to the effects of smoking

and its problem encountered in various type of emergencies.

Smoking effects to student:

Tobacco smoking is the leading cause of preventable death in

developed countries and is the most important risk factor for cancer

worldwide, responsible for approximately 22% of all cancer deaths per

year [world health organization, 2013]. about 11 million adults in Italy

are still current smokers, 20.7% of the entire adult population

[Osservatorio Fumo and Alcol e Droga, 2013]. Smoking is the largest

avoidable health risk in Europe, causing more problems than alcohol,

drugs, high blood pressure, excess weight, or high cholesterol

([Link] December 26,

2020). Consequently, every year, 695,000 Europeans die prematurely of

tobacco-related diseases and it is estimated that, within the EU, smoking

causes annual costs of at least €100 billion

([Link]

tobacco_2012_en.pdf, December 26, 2020). Conversely, smoking cessation

reduces health risks and improves quality of life. In particular, the

cumulative risk of dying of cancer, cardiovascular and lung diseases can

be drastically reduced if smokers quit, even at an advanced age [P. JHA,

23
K. Pirie, 2013]. There is no doubt that medical advice helps smokers quit

[M. C. Fiore, 2008], yet often this opportunity is missed Stead, Zwar,

2009]. The frequent observation of general practitioners (GPs) not

adhering to guidelines for brief counseling might at least partially be due

to inadequate training in undergraduate education. Indeed, substantial

deficiencies in medical education on smoking-related issues have been

described [Fiore,2008, Raupach, 2014]. This is not surprising since little

attention is being paid to nicotine dependence in medical school

curricula; a worldwide survey recently revealed that only one in four

medical schools taught a specific module on nicotine dependence

[Raupach, Zwar, 2006].

Recent studies on medical education in various European

countries have consistently shown that undergraduate training in this

area is insufficient. This is surprising when considering that well-

conceived educational interventions to improve knowledge, skills, and

attitudes of medical students regarding the treatment of smokers are

available [F. T. Leone, R. Richmond,2009]. Arguably, one factor limiting

the implementation of such programs is their high cost in terms of

resources and teacher time. Therefore, there is a need for straightforward

and relatively simple but yet effective tobacco curricula. For instance,

even one single lecture on the topic might be enough to stir the interest

of students eliciting self-directed learning activities with regard to

24
tobacco toxicology and treatment options. More high-quality research in

this area is clearly needed [T. Raupach, H. Krampe, 2014].

We recently reported that Italian students attending the fourth

year of undergraduate medical education have limited knowledge about

tobacco dependence, smoking-related pathologies, and the role of

physicians in promoting smoking cessation [M. C. Grassi,2013]. While

these findings in themselves are a cause for concern, their interpretation

might be further enhanced by comparing them to survey results obtained

from nonmedical students. Since medical education needs to prepare

future physicians for their role as health advocates, one would expect

medical students to know substantially more about smoking and

cessation than students of nonmedical professions. However, to the best

of our knowledge, nonmedical students have rarely been surveyed with

regard to their knowledge about tobacco.

Based on these considerations, the aims of this study were to

verify the consistency of our previous findings [M. C. Grassi, 2012],

assess whether nonmedical students of the same age have different

perceptions and knowledge about smoking compared to medical

students, and monitor knowledge retention of tobacco dependence and

medical students smoking status, one and two years following a short

educational intervention.

25
Risk Factor of smoking

Smoking can cause lung disease by damaging your airways and the

small air sacs (alveoli) found in your lungs. Lung diseases caused by

smoking include COPD, which includes emphysema and chronic

bronchitis. Cigarette smoking causes most cases of lung cancer. If you

have asthma, tobacco smoke can trigger an attack or make an attack

worse. Smokers are 12 to 13 times more likely to die from COPD than

nonsmokers. Smoking can cause cancer almost anywhere in your body:

like Bladder, Blood (acute myeloid leukemia), Cervix, Colon and rectum

(colorectal), Esophagus, Kidney and ureter, Larynx, Liver, Oropharynx

(includes parts of the throat, tongue, soft palate, and the tonsils),

Pancreas, Stomach, Trachea, bronchus, and lung. Smoking also

increases the risk of dying from cancer and other diseases in cancer

patients and survivors. If nobody smoked, one of every three cancer

deaths in the United States would not happen. Smoking harms nearly

every organ of the body and affects a person’s overall health. Smoking

can make it harder for a woman to become pregnant. It can also affect

her baby’s health before and after birth. Smoking increases risks for:

Preterm (early) delivery, Stillbirth (death of the baby before birth), Low

birth weight, Sudden infant death syndrome (known as SIDS or crib

death), Ectopic pregnancy, Orofacial clefts in infants. Smoking can also

affect men’s sperm, which can reduce fertility and also increase risks for

birth defects and miscarriage. Smoking can affect bone health. Women

26
past childbearing years who smoke have weaker bones than women who

never smoked. They are also at greater risk for broken bones. Smoking

affects the health of your teeth and gums and can cause tooth loss.

Smoking can increase your risk for cataracts (clouding of the eye’s lens

that makes it hard for you to see). It can also cause age-related macular

degeneration (AMD). AMD is damage to a small spot near the center of

the retina, the part of the eye needed for central vision. Smoking is a

cause of type 2 diabetes mellitus and can make it harder to control. The

risk of developing diabetes is 30–40% higher for active smokers than

nonsmokers. Smoking causes general adverse effects on the body,

including inflammation and decreased immune function. Smoking is a

cause of rheumatoid arthritis (U.S. Department of Health and Human

Services. The Health Consequences of Smoking—50 Years of Progress: A

Report of the Surgeon General,2014).

27
 CHAPTER III

RESEARCH DESIGN

This chapter entails the method, which would be utilized in

conducting this research. This chapter was included research design,

locale of the study, respondents, instrumentation of validity and

reliability, ethical consideration, data gathering procedure and statistical

treatment of data.

Research methods to be used

Descriptive research involved collecting data in order to test

hypotheses or to answer questions concerning the current status of the

subject of the study. A descriptive study determined and reports the way

things were. According to Gay (1992: 217) Descriptive research was

scientific research that described about event, phenomena or fact

systematically dealing with certain area or population.

A descriptive research identified the prevalence of smoking and

examined the factors related to smoking behaviors among nursing

students in University of Luzon, Dagupan City. The independent variable

included attitudes towards smoking, cigarette accessibility, peer smoking

and school attachment; meanwhile the independent variable is smoking.

The study was conducted in the year 2020 of November and consisted of

a population based cross-sectional study of consenting adult residents in

Dagupan, one of the cities of Pangasinan.

28
 A descriptive study of smoking tobacco used a waterpipe among

college students. Nurse Practitioner’s working with college students need

to be awarded of the multiple forms of tobacco that students may

engaged in. They also should be awarded of the common beliefs about

waterpipe smoking. This information was useful when targeting and

counseling patients about alternative tobacco products like waterpipe

smoking. Waterpipe smoking is an unconventional form of tobacco use

that has been growing in popularity among young adults and college

students. The term “waterpipe” generally refers to tobacco use methods

in which smoke passes through water before it is inhaled.

Locale of the Study

The study was conducted at University of Luzon in Dagupan City.

Due to COVID-19 pandemic, the respondents were be answering

questionnaires in their houses or any comfortable places that the

respondents prefer. The researchers choose University of Luzon in

Dagupan City because the respondents are also students in University of

Luzon. It was giving the researchers the needed information about the

effects of smoking among nursing student.

The researchers chose University of Luzon because with a 66-year

tradition of educating leaders in every endeavor, the University of Luzon

maintains its core as one of the nation’s most achieved institutions.

29
Figure 2. Site map of the Locale

30
This fact was positioning the school among the top educational

communities, which actively develop more opportunities around the

globe.

In this study, descriptive study was done in the College of Nursing

in University of Luzon through an online Survey. The focus of this study

was to determine the awareness of effect of smoking of nursing student

in a private institution. The researcher tried to get the deep data and

information related to the study by giving detailed data and information.

The College of Nursing is a training ground for future health care

providers. Its primary goal is to prepare the next generation of nursing

leaders through holistic approach, which includes the application of

highest ethical standards as well as the use of modern technology.

Respondents of the Study

The researchers identified their specific study design, which was

relevant for the study purpose and research questions. The researchers

presented the inclusion and exclusion sampling criteria used to identify

the target population in this study. An inclusion criterion included all

student nurses in university of Luzon. Exclusion criteria included others

college student in university of Luzon and others nurse student in others

university. All nursing student in university of Luzon were screened for

eligibility during the study period. The researchers choose the student

31
nurse to be the subject in the study because they have more difficult

subjects that may make them have stress or depression which lead them

to smoke also, they are future health frontline and they responsible to

educates the communities. The researchers distributed questionnaires to

the respondents and surveyed about the mentioned problems. These

questionnaires, sought to answer the questions that will provide better

knowledge about smoking effects on nurse student. And it will give the

researchers the needed information about the smoking effects. Majority

of the respondents were females representing 75% while males consisted

of 25% of the responses. The highest percentage in terms of age between

the age ranges of 20-23.

Instrumentation

The researchers were used a survey questionnaire as research

instrument to gather the needed data from the respondents, the

questionnaire is prepared according to the order of problem stated in the

study. The survey question included the profile variable of respondents

regardless of age and sex. The question purposed also was to determine

the percentage of all the student nurses of University of Luzon to

determine the smoking effects on student nurses. The research was

checked by the critic reader, noted by the statistician and approved by

the research adviser. Content Validity was used in this study, it referred

to the degree to which the items in an instrument adequately represent

32
the universe of content for the concept being measured (Polit and Beck,

2012).

The idea of the questionnaire was based on the researcher’s

previous studies relevant to the study. In preparation for the instrument,

the requirements in structuring the data collection instrument were

considered. The statement describing the issues about the study was

lessened to accommodate the prepared knowledge of the respondents.

Three (3) experts who were validated the tool. One of the

experts was a professor from the college of nursing administration with a

master degree major in nursing administration and had an experience as

a clinical instructor in a Mental Health Center. The second expert was a

professor from the college of nursing with a master degree major in

nursing and currently teaching psychiatric and mental health nursing,

and lastly the third expert was a Guidance Facilitator in a private school

in Dagupan City.

Validity and Reliability

Content Validity was used in this study, it referred to the degree to

which the items in an instrument adequately represent the universe of

content for the concept being measured (Polit and Beck, 2012).

Three (3) experts who were validated the tool. One of the experts

was a professor from the college of nursing administration with a master

33
degree major in nursing administration and had an experience as a

clinical instructor in a Mental Health Center. The second expert was a

professor from the college of nursing with a master degree major in

nursing and currently teaching psychiatric and mental health nursing,

and lastly the third expert was a Guidance Facilitator in a private school

in Dagupan City.

Ethical Consideration

This research was considered the following ethical rights to protect

the respondents:

Right to Informed Consent: The student researcher provided a document

stating the purpose of this research. Each Respondents was given time to

express any concern or obtain information pertaining to the research.

Each Respondents is given a choice of location for interview to his/her

comfort.

Right to Confidentiality: Respondent’s identity and any given information

are kept confidential and a top priority. Information was kept confidential

unless otherwise permitted by the Respondents. Confidential information

was used for research purposes and nothing else.

Protection of Human Rights: This research was required the use of both

written and verbal communication by the student researchers during

34
interviews. A letter of permission was given to each respondent prior to

interview. Human rights of the respondents were be a priority.

Right to be protected from Discomfort and Harm: Respondents were

given the right to rescind or decline the Questionnaire. At any given time,

the Respondents can stop the Questionnaire if their beliefs are

violated/offended.

Data Gathering Procedure

An approval letter from the Dean of the College of Nursing was be

obtained to allow the student researcher to conducted a testing surveys

on all the student nurses to gathered our data collection procedure.

For the data gathering stage, questionnaires were be completed in

one occasion for all the level of student nurses.

The researchers have allotted vigorous time, effort and cooperation

in developing their questionnaire so as to served its intended

respondents. A survey was created using suitable questions modified

from related research and individual questions formed by the

researchers. Likers Scale was used to determine the extent of the nursing

student’s alcohol consumption. After the professor approved the

questionnaire, copies were distributed from the 1 st year nursing students

to 4th year nursing students in the College of Nursing in University of

Luzon. Participants were given time to responded and then the

researchers were collected the survey questionnaires

35
 In administering the questionnaire, the researcher was using the

time, allotted for vacant time to avoid distractions of classes. The student

responses were given an ample time to answer the questions. After

gathering the data, the researchers were collected it for the tallying of

scores and to apply the statistical treatment that were used with the

study.

The Data Gathered from this research instrument will be tallied

and computed for interpretation according to the frequency of items

checked by the participants. Along with the primary data, the

researchers were also using secondary sources in the form of published

articles and literatures to support the survey results.

Statistical treatment of Data

The following tools that were utilized the study to analyze the data

gathered for this research are Frequency and Percentage Method.

Frequency distribution is tabular representation of survey data set

used to organize and summarize the data. Specifically, it is a list of either

qualitative or quantitative values the variable takes in a data set and the

associated number of times each value occurs (Lavrakas, 2013).

Percentage analysis is a method to represent raw streams of data as

percentage for better understanding of collected data. Percentage

Analysis is applied to create a contingency table from the frequency

distribution and represent the collected data for better understanding

36
(Lima, 2018). Frequency distribution occurred by summing up the total

number of Respondents that answered yes and no. Percentage analysis

occurred by computing the specific number of responses against the total

number of Respondents then multiplying it by 100.

Frequency method formula is as follows:

F = f/p Where: F = Frequency

distribution

f = Frequency of response

P = Number of participants

Percentage method formula was as follows:

P= f/n x 100 Where: P= Percentage

f= Frequency of response

n= Number of respondents

37
 CHAPTER IV

PRESENTATION, ANALYSIS AND ENTERPRETATION OF DATA

This chapter present the analysis and interpretation of data and

presented in tabular form This sequence and order of presentation based

on the variables presented in Chapter 1

Effects of smoking among student nurses with the following areas,

(physical, mental, Social, Psychological.

(introduction)

Table 1 presented the risk factors that associated with smokers

among student nurses which prescribed consists of 10 items that is

answering in form of yes or no by the nurses were analyzed, interpreted

and discussed as follows:

38
 Table 1

Risk factors that associated with smokers

n=78

Questions No Yes Total f % R

Have you ever tried 60 18 78 18 23.08 6

smoking?

Do you still smoke now? 71 7 78 7 8.97 8

Do you smoke before? 62 16 78 16 20.51 7

Does stress trigger you 62 16 78 16 20.51 7

to smoke?

Do you think if the 33 45 78 45 57.69 4

cigarette prices
increase, will it decrease
the number of smokers?

Do you have any 2 76 78 76 97.43 2

information about the
risk of smoking?

Do you know that 1 77 78 77 98.72 1

smoking is the first
cause of respiratory
system disease?

Do you have a member 53 25 78 25 32.05 5

in your house who
smoke?

Do you smoke even if 77 1 78 1 1.28 9

you are sick?

Do you know that the 10 68 78 68 87.18 3

second-hand smoke has
increased risk in
developing disease?

Smoking is the first cause of respiratory system disease:

Based from the table above, the factor shows that it ranked 1 st by

39
frequency of 77 have respondents yes and one has respondents no and

98.72 percentage. The nurses agreed that the first caused and factor for

respiratory system disease is smoking and how risk the smoke in our

lungs and health.

Respiratory diseases are conditions which affect the airways and

other structures of the lungs. They include lung cancer, asthma,

tuberculosis (TB), chronic obstructive pulmonary disease (COPD) and

pneumonia, which are some of the leading causes of mortality and

morbidity globally. 1 2 Respiratory disease is the third-leading cause of

death in England, affecting one-in-five people over the course of their

lives, and placing a substantial burden on the health care system.3 4

Smoking or exposure to secondhand smoke is a leading cause of most

respiratory diseases, with current smokers 11 times more likely to

develop lung cancer compared to non-smokers.2 3 4 It is estimated that

smoking causes more than 77,000 premature deaths annually in

England,5 and is responsible for 15.1% of attributable cancer cases in

the United Kingdom (UK).6 In 2017, 37% of all deaths from respiratory

diseases in England were estimated to be attributable to smoking.5

Around quarter of excess mortality among smokers is accounted for by

lung cancer and COPD.( World Health Organization WHO, Ferkol T,

Schraufnagel D, Public Health England, Royal College of Physicians

(RCP).) September 2020

40
([Link]
[Link]?fbclid=IwAR3u1Q85ZkVJ9M9Yn_SRKYx1BJijOl-
6ozidsQ_wvQDtJgH0Kloi0D84xW4, Retrieved: 14 April 2021)

Risk of smoking; Based from the table above, the factor shows

that it ranked 2st. by frequency of 76 have respondents yes and two has

respondents no and 97.43 percentage. The nurses agreed that smoking

is one of the risks on our health and life and the knowledge on the risk of

it. And researcher can give them more information about the risk of

smoking.

According to U.S. Department of Health and Human Services. The

Health Consequences of Smoking—50 Years of Progress: A Report of the

Surgeon General, 2014. Atlanta, GA: U.S. Department of Health and

Human Services, Centers for Disease Control and Prevention, National

Center for Chronic Disease Prevention and Health Promotion, Office on

Smoking and Health, 2014. Smoking is the leading cause of premature,

preventable death in this country. Cigarette smoking and exposure to

tobacco smoke cause about 480,000 premature deaths each year in the

United States. Of those premature deaths, about 36% are from cancer,

39% are from heart disease and stroke, and 24% are from lung disease,

Smoking harms nearly every bodily organ and organ system in the body

and diminishes a person’s overall health. Smoking causes cancers of the

lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas,

stomach, cervix, colon, and rectum, as well as acute myeloid leukemia,

41
Smoking also causes heart disease, stroke, aortic aneurysm (a balloon-

like bulge in an artery in the chest), chronic obstructive pulmonary

disease (COPD) (chronic bronchitis and emphysema), diabetes,

osteoporosis, rheumatoid arthritis, age-related macular degeneration,

and cataracts, and worsens asthma symptoms in adults. Smokers are at

higher risk of developing pneumonia, tuberculosis, and other airway

infections. In addition, smoking causes inflammation and impairs

immune function. Since the 1960s, a smoker’s risk of developing lung

cancer or COPD has actually increased compared with nonsmokers, even

though the number of cigarettes consumed per smoker has decreased.

Smoking makes it harder for a woman to get pregnant. A pregnant

smoker is at higher risk of miscarriage, having an ectopic pregnancy,

having her baby born too early and with an abnormally low birth weight,

and having her baby born with a cleft lip and/or cleft palate.

([Link]

prevention/risk/tobacco/cessation-fact-sheet, Retrieved: 14April,2021)

Second-hand smoke has increased risk in developing disease:

Based from the table above, the factor shows that it ranked 3 st. by

frequency of 68 have respondents yes and 10 have respondents no and

87.18 percentage. The nurses agreed that smoking is more dangerous on

non-smokers who called second- hand and has more risk to develops a

disease.

42
 According to Zahid Naeem of International Journal of Health

Sciences (April 2015), Second-hand smoke causes lung cancer in adults

who have never smoked. Non-smokers who are exposed to second-hand

smoke at home or at work increase their risk of developing lung cancer

by 20–30%. Second-hand smoke causes more than 7,300 lung cancer

deaths among U.S. nonsmokers each year. As with active smoking, the

longer the duration and the higher the level of exposure to secondhand

smoke, the greater the risk of developing lung cancer. Second-hand

smoke causes numerous health problems in infants and children,

including more frequent and severe asthma attacks, respiratory

infections, ear infections, and sudden infant death syndrome. Some of

the health conditions caused by second-hand smoke in adults include

coronary heart disease, stroke, and lung cancer. Children are

particularly at risk for the effects of second-hand smoke because their

bodies are still growing and they breathe at a faster rate than adults. A

study revealed that second-hand smoke/passive smoking among

children leads to acute respiratory illness in children as pneumonia,

bronchitis, middle ear problem, cough & wheeze. Similarly passive

smoking among adults leads to eye irritation (69% cases), headaches

(33% cases), nasal symptoms (33% cases), cough and allergic attacks

(33% cases). Exposure to second-hand smoke has immediate adverse

effects on the cardiovascular system and can cause coronary heart

disease and stroke

43
([Link]
fbclid=IwAR3jM3mi9UC1y8SjB3BOG6RasZw84qLoHBIo2KknJZWVZXzD
OeD0486ctt8, , Retrieved: 14April,2021)

Table 2 presented the risk factors that associated with smoking among

student nurses which prescribing consists of 10 items that is answering in form

of yes or no by the nurses were analyzed, interpreted and discussed as follows:

Table 2

Risk factors that associated with smoking

n=78

Yes Maybe no Total % R

Is smoking 39 28 11 184 2.35 3

addictive?
(39 3=117) (28 2=56) 11 1=11)

Do you worry that 58 6 14 200 2.56 2

smoking will
damage your health (58 3=174) (6 2=12) 14 1=14)
in the future?

Do you think 71 1 6 221 2.83 1

cigarette smoke is
dangerous to non- (71 3=213) (1 2=2) (6 1=6)
smoker?

Legend:
Scale value statistical limits description
3 3.26-4.00 high agree
2 2.51-3.25 moderate agree
1 1.76- 2.50 slightly agree
0 1-1.75 disagree
Cigarette smoke is dangerous to non-smoker: Based from the

table above, the factor shows that it ranked 1 st. with 71 have

44
respondents yes and 1 has respondents maybe and 6 have respondents

no and 2.83 percentage which denoted highly agree. The result implied

that the nurses high agree in that cigarette smoke is dangerous to non-

smoke.

Approximately 7,300 lung cancer deaths occur each year among

adult nonsmokers in the United States as a result of exposure to

secondhand smoke. The U.S. Surgeon General estimates that living with

a smoker increases a nonsmoker’s chances of developing lung cancer by

20 to 30%. Secondhand smoke causes disease and premature death in

nonsmoking adults and children. Exposure to secondhand smoke

irritates the airways and has immediate harmful effects on a person’s

heart and blood vessels. It increases the risk of heart disease by an

estimated 25 to 30%. In the United States, exposure to secondhand

smoke is estimated to cause about 34,000 deaths from heart disease

each year. Exposure to secondhand smoke also increases the risk of

stroke by 20 to 30%. Pregnant women exposed to secondhand smoke are

at increased risk of having a baby with a small reduction in birth weight.

Children exposed to secondhand smoke are at an increased risk of SIDS,

ear infections, colds, pneumonia, and bronchitis. Secondhand smoke

exposure can also increase the frequency and severity of asthma

symptoms among children who have asthma. Being exposed to

secondhand smoke slows the growth of children’s lungs and can cause

them to cough, wheeze, and feel breathless. (U.S. Department of Health

45
and Human Services 2014, [Link]

cancer/causes-prevention/risk/tobacco/cessation-fact-sheet,

Retrieved:14 April 2021)

Smoking will damage your health in the future: Based from the

table above, the factor shows that it ranked 2st. with 58 have

respondents yes and 6 have respondents maybe and 14 have

respondents no and 2.56 percentage which denotes highly agreed. The

result implied that the nurses high agree on the damage of smoking in

our health in future

The chemicals in tobacco smoke can damage your body in many ways.

For example: Nicotine narrows your veins and arteries. This can damage

your heart by forcing it to work faster and harder slow your blood and

reduce oxygen to your feet and hands. Carbon monoxide deprives your

heart of the oxygen it needs to pump blood around your body. Over time,

your airways swell up and let less air into your lungs. Tar is a sticky

substance that coats your lungs like soot in a chimney. Phenols paralyse

and kill the hair-like cells in your airways. These cells sweep clean the

lining of your airways and protect them against infections. Tiny particles

in tobacco smoke irritate your throat and lungs and cause ‘smoker’s

cough’. This makes you produce more mucus and damages lung tissue,

Ammonia and formaldehyde irritate your eyes, nose and throat., Cancer-

causing chemicals make your cells grow too fast or abnormally. This can

46
result in cancer cells. Smoking tobacco can: cause yellow-brown stains

on your fingers, tongue and teeth, increase your risk of tooth loss and

bad breath, make your skin saggy and give you early wrinkles, make

your hair lose its natural shine

([Link]
smoking-and-tobacco/what-are-the-effects-of-smoking-and-tobacco,
Retrieved:14 April 2021

Smoking is addictive: Based from the table above, the factor

shows that it ranked 2st. with 39 have respondents yes and 28 have

respondents maybe and 11 have respondents no and 2.35 percentage

which denoted moderate agree. The result implied that the nurses

moderate agree on that smoking is addictive.

Smoking is highly addictive. Nicotine is the drug primarily

responsible for a person’s addiction to tobacco products, including

cigarettes. The addiction to cigarettes and other tobacco products that

nicotine causes is similar to the addiction produced by using drugs such

as heroin and cocaine (13). Nicotine is present naturally in the tobacco

plant. But tobacco companies intentionally design cigarettes to have

enough nicotine to create and sustain addiction. The amount of nicotine

that gets into the body is determined by the way a person smokes a

tobacco product and by the nicotine content and design of the product.

Nicotine is absorbed into the bloodstream through the lining of the

mouth and the lungs and travels to the brain in a matter of seconds.

47
Taking more frequent and deeper puffs of tobacco smoke increases the

amount of nicotine absorbed by the body (Hatsukami, Stead, Gupta,

2008 June, [Link] , Retrieved:

14April,2021)

Table 3 presented the risk factors that associated with smokers among

student nurses which prescribing consists of 10 items that is answering in form

of yes or no by the nurses were analyzed, interpreted and discussed as follows :

Table 3

48
 Risk factors that associated with smokers

n=78

Who influenced you to smoke? No Yes T F % R

 Family 77 1 78 1 1.28 5
 Relatives 77 1 78 1 1.28 5
 Friends
 School 66 12  78 12 15.38 2
 Others
 None 73 5 78 5 6.41 3

74 4 78 4 5.13 4

9 69 78 69 88.46 1

Why do you smoke?  No Yes Total F % R

 Craving 74 4 78 4 5.13 5
 Stimulation 77 1 78 1 1.28 6
 Relaxation / Enjoyment
 Stress / Depression 65 13 78 13 16.66 1
 Habit / Activity
 Friends / Social 69 9 78 9 11.54 3
 Lack of willpower
73 5 78 5 6.41 4

68 10 78 10 12.82 2

78 0 78 0 0 7

When you smoke, what do you No Yes Total F % R

experience or feel?
75 3 78 3 3.85 3
 Decreased appetite 65 13 78 13 16.66 1
 Decreased stress
 Increased focus or 72 6 78 6 7.69 2
concentration
 Bitter taste in mouth 76 2 78 2 2.56 4
 Good taste in mouth
78 0 78 0 0 5

Who influenced the smoker to smoke: Based from the table

above, the factor shows that the friends were the top factor which

influenced the smokers nurse as ranked 2st. by frequency of 12 have

respondents yes and 66 no and 15.38 percentage, and school was in the

49
ranked 3st. by frequency of 5 have respondents yes and 73 have

respondents no and 6.41 percentage.

Most people who smoke started smoking when they were

teenagers. Those who have friends and/or parents who smoke are more

likely to start smoking than those who don’t. Some teenagers say that

they “just wanted to try it,” or they thought it was “cool” to smoke. The

tobacco industry’s ads, price breaks, and other promotions for its

products are a big influence in our society. The tobacco industry spends

billions of dollars each year to create and market ads that show smoking

as exciting, glamorous, and safe. Tobacco use is also shown in video

games, online, and on TV. And movies showing people smoking are

another big influence. Studies show that young people who see smoking

in movies are more likely to start smoking.

([Link]
[Link], Retrieved:14 April 2021).

Reasons why smokers they smoke: Based from the table above,

the factor shows that the Relaxation / Enjoyment were the top reason

that the smokers nurse smoke as ranked 1st. by frequency of 13 have

respondents yes and 65 have respondents no and 16.66 percentage, And

Friends / Social was in the ranked 2st. by frequency of 10 have

respondents yes and 68 have respondents no and 12.82 percentage. And

50
Stress / Depression in ranked 3st. by frequency of 9 have respondents

yes and 69 have respondents no and 11.45 percentage.

Reason for smokers to smoke #1: “Don’t be a wimp” — Peer

pressure: If your teen friends are interested in smoking, drinking and

drugs, they may pressure him to experiment with those substances. The

need for acceptance and fear of being outcast can make it extremely hard

to say “no”, causing your teen to go along with what his friends suggest.

#2: “I’m bored” or “I’m stressed” — In for a thrill: Some teens turn to

substances to cope with stress and boredom, and their influence among

each other can be strong. If you keep hearing your teen saying he’s bored

or stressed, take heed. It may be a sign he is ready for anything that

excites, including harmful substances. The emotional high that comes

from doing something thrilling and forbidden, especially in a group, can

be just as addictive as the physiological high that these substances

produce. #3: “Must try once in my life” — Ignorance and curiosity: The

National Council Against Drug Abuse’s Perception Survey reveals that

Singapore youths display more liberal attitudes towards drugs, and

many do not fully understand the danger of drugs such as cannabis.

Therefore, do not assume your teen knows the dangers and health

hazards that these substances pose. Out of curiosity, they may feel that

trying it once or twice just to have fun is no big deal, until they become

addicted. #4: Trying to be an “adult” and look cool: Some teenagers want

51
to look and feel grown up and may see drinking and smoking as marks of

adulthood. Perhaps your teen is modelling his behavior after his favorite

movie stars and think they can be as cool. Or they may simply be

copying what dad or mum does, if they frequently see you drink or

smoke. #5: A rebellious phase: Sometimes kids know how to push your

buttons, whether it’s to get back at you or to get your attention. Picking

up vices such as smoking, drinking and doing drugs is a surefire way to

upset parents and force you to take notice.

([Link]
drugs---why-teens-get-hooked-on-this-triple-threat, , Retrieved:
14April,2021)

Smokers feeling when they smoke: Based from the table above,

the factor shows that the decreased stress was the top feeling that the

smokers nurse felt as ranked 1st. by frequency of 13 have respondents

yes and 65 have respondents no and 16.66 percentage, and increase

focus or concentration was in the ranked 2st. by frequency of 6 have

respondents yes and 72 have respondents no and 7.69 percentage. And

decrease appetite was ranked 3st. by frequency of 3 have respondents yes

and 75 have respondents no and 3.85 percentage.

When a person smokes, nicotine reaches the brain within about

ten seconds. At first, nicotine improves mood and concentration,

decreases anger and stress, relaxes muscles and reduces appetite.

52
Regular doses of nicotine lead to changes in the brain, which then lead to

nicotine withdrawal symptoms when the supply of nicotine decreases.

Smoking temporarily reduces these withdrawal symptoms and can

therefore reinforce the habit. This cycle is how most smokers become

nicotine dependent. Some people smoke as ‘self-medication’ to ease

feelings of stress. However, research has shown that smoking actually

increases anxiety and tension. Nicotine creates an immediate sense of

relaxation, so people smoke in the belief it reduces stress and anxiety.

This feeling is temporary and soon gives way to withdrawal symptoms

and increased cravings. Smoking reduces the withdrawal symptoms, but

doesn’t reduce anxiety or deal with the reasons someone may feel that

way. Adults with depression are twice as likely to smoke as adults

without depression. Most people start to smoke before showing signs of

depression, so it’s unclear whether smoking leads to depression or

depression encourages people to start smoking. It’s most likely that there

is a complex relationship between the two. Nicotine stimulates the

release of the chemical dopamine in the brain. Dopamine is involved in

triggering positive feelings. It is often found to be low in people with

depression, who may then use cigarettes as a way of temporarily

increasing their dopamine supply. However, smoking encourages the

brain to switch off its own mechanism for making dopamine so in the

long term the supply decreases, which in turn prompts people to smoke

more. People with depression can have particular difficulty when they try

53
to stop smoking and have more severe withdrawal symptoms. Remember

there’s lots of support available if you decide to quit, however – you don’t

have to go through it alone

([Link]
Retrived:14 April 2021)

Summary on the effects of smoking among student nurses in

University of Luzon

Table 1

Risk factors that associated with smokers

54
 N = 78

Questions No Yes Total f % R

Have you ever tried 60 18 78 18 23.08 6

smoking?

Do you still smoke now? 71 7 78 7 8.97 8

Do you smoke before? 62 16 78 16 20.51 7

Does stress trigger you 62 16 78 16 20.51 7

to smoke?

Do you think if the 33 45 78 45 57.69 4

cigarette prices
increase, will it decrease
the number of smokers?

Do you have any 2 76 78 76 97.43 2

information about the
risk of smoking?

Do you know that 1 77 78 77 98.72 1

smoking is the first
cause of respiratory
system disease?

Do you have a member 53 25 78 25 32.05 5

in your house who
smoke?

Do you smoke even if 77 1 78 1 1.28 9

you are sick?

Do you know that the 10 68 78 68 87.18 3

second-hand smoke has
increased risk in
developing disease?

Table 2

Risk factors that associated with smoking

N = 78

Yes Maybe no Total % R

55
Is smoking 39 28 11 184 2.35 3
addictive?
(39 3=11 (28 2=5 11 1=1
7) 6) 1)

Do you worry 58 6 14 200 2.56 2

that smoking
will damage (58 3=17 (6 2=12) 14 1=1
your health in 4) 4)
the future?

Do you think 71 1 6 221 2.83 1

cigarette smoke
is dangerous to (71 3=21 (1 2=2) (6 1=6)
non-smoker? 3)

Table 3

Risk factors that associated with smokers

n=78

Who influenced you to No Yes T F % R

smoke?

56
  Family 77 1 78 1 1.28 5
 Relatives 77 1 78 1 1.28 5
 Friends
 School 66 12  78 12 15.38 2
 Others
73 5 78 5 6.41 3
 None
74 4 78 4 5.13 4

9 69 78 69 88.46 1

Why do you smoke?  No Yes Total F % R

 Craving 74 4 78 4 5.13 5
 Stimulation
 Relaxation / 77 1 78 1 1.28 6
Enjoyment 65 13 78 13 16.66 1
 Stress / Depression
 Habit / Activity 69 9 78 9 11.54 3
 Friends / Social
73 5 78 5 6.41 4
 Lack of willpower
68 10 78 10 12.82 2

78 0 78 0 0 7

When you smoke, what do No Yes Total F % R

you experience or feel?
75 3 78 3 3.85 3
 Decreased appetite
 Decreased stress 65 13 78 13 16.66 1
 Increased focus or 72 6 78 6 7.69 2
concentration
 Bitter taste in mouth 76 2 78 2 2.56 4
 Good taste in mouth
78 0 78 0 0 5

Action plan on self-health awareness on smoking effect

Introduction

Nurses constituted the largest occupational group among health

professionals and were employed in variety of settings such as schools,

57
colleges, community and mental health settings, and others. When

nurses engaged in behaviors that are contradictory to health, they put

the profession in a negative light. Nursing leadership has been awarded

of the negative image of the nurse as smoker for decades. They were a

potentially powerful resource for influencing the society smoking

patterns and could play a key role in smoking cessation One of the main

motivational reasons to become a health care worker is to assist people

in achieving their full health potential, on the contrary, smoking is the

most hazardous and avoidable health risk in our society. Tobacco

smoking is a serious public health problem worldwide that the leading

preventable causes of morbidity and mortality, leading to the death of

more than 7 million people each year. More than 6 million of those

deaths are the result of direct tobacco use while around 890,000 are the

result of non-smokers being exposed to second-hand smoke. Tobacco

smoking, inclusive of secondhand smoke, is a leading risk factor

attributable to 6% of global disability-adjusted life years. As healthcare

costs continue to rise, much more attention is being focused on

unhealthy behaviors that contribute to the increasing expenses. An

estimated that more of 960 million smokers are living in 187 countries of

world and this number is expected to increase with the growing

population and worsening tobacco epidemic in developing countries.

Around 80% of the world’s 1.1 billion smokers live in low- and middle-

income countries.

58
 Smoking leads to disease and disability and harms nearly every

organ of the body. More than 16 million Americans are living with a

disease caused by smoking. For every person who dies because of

smoking, at least 30 people live with a serious smoking-related illness.

Smoking causes cancer, heart disease, stroke, lung diseases, diabetes,

and chronic obstructive pulmonary disease (COPD), which include

emphysema and chronic bronchitis. Smoking also increases risk for

tuberculosis, certain eye diseases, and problems of the immune system,

including rheumatoid arthritis (U.S. Department of Health and Human

Services, 201).

Health professionals should be trained and supported to provide a

consistent and effective intervention in tobacco users. But smoking by

health professionals constituted a barrier to the development of

intervention to promote healthy habits and the cessation of smoking with

patients who does. Tobacco use among nurses has been identified as a

prevalent habit over time and more than other health professionals

Nursing students have an influential role in smoking prevention. Health

professions students were aware of their responsibility as role models for

patients regarding tobacco cessation. Their status of smoker or non-

smokers affects their activity as health promoters, as smoker students

were least likely to advice in smoking cessation. Beliefs and attitudes of

students toward tobacco control were negatively influenced by smoking

OBJECTIVES

59
 1. Promote a health program to the student to increase their self-

awareness on the impact of smoking on our health and life.

2. Prevent the use of tobacco among young people and adults. By

increase public awareness on the consequences of tobacco use,

also increase anti-tobacco policies and programmers in schools,

reduce access to tobacco products to minors, and to reduce the

influence of the tobacco industry on young people and adults.

3. Protect from exposure to environmental tobacco smoke (ETS), by

increase awareness on the harmful effects of ETS. Also control the

contents and emissions of tobacco products. And reduce exposure

to environmental tobacco smoke in indoor and outdoor public

places.

4. Promote cessation programs among smokers by increase

awareness and the intention to quit among smokers increase

awareness among health professionals on smoking cessation

programmers, provide treatment for tobacco dependence.

Proposed strategies to enhance the self- health awareness of the

student nurses on the effects of smoking

The propose strategies to enhance the self- health awareness of the

student nurses aimed to guided and offered tips and knowledge on how

to boost their self-awareness on the effect of smoking in order to acquire

60
a positive impact on their health either physical, mental, social,

Psychological. It further helps them to achieved optimal knowledge and

deals with the factors that affects their self-awareness thus affecting

their health at their life with the use of the strategies proposed by the

researchers.

STRATEGIES TO ENHANCE THE SELF- HEALTH AWARENESS OF

THE STUDENT NURSES

Self- health awareness plays a big role in every student’s life and

human being when it comes to their health either physical, mental,

social, Psychological. Self- health awareness has an impact on the

development of every student in a way that they can carry when they

finish schooling and proceed to their career professions and their life.

That’s why it was important for self- health awareness of students to be

assessed to determine how can it be improved so these students can

achieve an optimal learning thus improving their health level.

One of the major applicable strategies to drive down smoking rates

and environmental tobacco smoke (ETS) exposure includes

dissemination of the facts concerning harmful effects of tobacco—

awareness of them is frequently associated with an intention to quit and

intentions predict future quitting attempts in a consistent manner

[Driezen, Abdullah, Nargis, 2016]. Awareness of harmful effects of

tobacco smoke also contributes to preventing the non-smokers from

61
taking up the habit [Bryant, Bonevski, Paul. 2011]. In addition, it is

important because understanding the threats that active and passive

smoking pose helps to introduce smoking bans at homes [Cavelaars,

Kunst, 2000]. Finally, if smokers are aware of the influence of their

smoking on others, they might be encouraged to quit.

Most of us knows the importance of self- health awareness in a

way that it affects our personality health, performance, and behavior at

school and our life. That’s why the researchers included to their

subproblems the possible strategies which can help the student nurses

enhance and practice to improved their self- health awareness in order to

acquire a positive impact on their health either physical, mental, social,

Psychological. And helps them to achieved optimal knowledge and deal

with the factors that affects their self- health awareness thus affecting

their health

Below includes the proposed strategies in terms of the following

health area: physical, mental, social, Psychological. The proposed

strategies are different in both variables as the activities are different. It

also included guidelines, tips, and objectives.

Health area

Health area is a term used from the study which is defined as one

of the variables where it is one of the areas that self- health awareness

affects. The student’s self- health awareness towards their health

activities that includes physical, mental, social, Psychological. It’s all

62
included on the health area. The researchers studied what is the impact

of self- health awareness on the performance of the student nurses in

this area. health area usually physical, mental and social well-being, and

also a person's ability to handle stress, to acquire skills, to maintain

relationships as used in this study. Specifically, it revolved around the

school, teachers, and students of the nursing departments from

University of Luzon Dagupan city. In this area, the researchers tried to

determine what’s the impact of self-health awareness and what are the

factors met by the student nurses that affect their health in the school

and their life. Below includes the proposed strategies specifically made

for the health area which will help these student nurses where they can

use these tips and guides to enhanced their self-health awareness to

achieved better and optimal performance.

Strategy Guidelines

 The student nurses should learn from their mistakes. They should

understand that failure is not a definition of defeat. Failure is a

process to improve oneself in order to become successful.

 Be a positive thinker. The student nurses can be more efficient in

this area if they can practice to be a positive thinker or having a

positive attitude. It will help them to be more calm and able to

adapt in a situation like an upcoming exam, strict teacher, and

fears. You might have tried to quit smoking before and not

managed it, but don't let that put you off.

63
  Look back at the things your experience has taught you and think

about how you're really going to do it this time.

 Make a plan to quit smoking: Make a promise, set a date and stick

to it. Sticking to the "not a drag" rule can really help. Whenever

you find yourself in difficulty, say to yourself, "I won't even have a

single drag", and stick with this until the cravings pass. Think

ahead to times where it might be difficult (a party, for instance),

and plan your actions and escape routes in advance.

 The student nurses utilize the skills and abilities they’re good at

and use it to improve their health. In this way, it will help the

student nurses be more comfortable which boost their self-

awareness and improve their health

 Always think that you are unique. This mindset alone will give you

a boost on your self- awareness because you know in yourself that

you are built different.

 Believe in yourself. As a student, be aware that failure will reach

everyone. But that does not mean you cannot do it. If you’re not

experiencing failure that means you’re still halfway to success. So,

no matter what happens believe in yourself. Believe that you can

do anything if you work harder than before.

 Get some stop smoking support: If friends or family members want

to give up, too, suggest to them that you give up together.

Enhancing self-awareness tips

64
 Always remember, nobody is perfect.

 Keep an open mind.

 Be mindful of your strengths and weaknesses.

 Stay focused.

 Set boundaries.

 Know your emotional triggers.

 Develop intuitive decision-making skills

 Practice self-discipline.

 Use personality tests to understand your personal traits

 Focus on what you can change

 Do what make you happy without hurting other people

 Improve yourself physically, emotionally, and mentally

 Take a break if things get rough, but don’t give up

 Avoid comparing self to others

 Spend your time to those people who appreciates you

 Be healthy.

Action Plan

AREA OF OBJECTIVE STRATEGIES/ EXPECTED

CONCERN
ACTIVITIES OUTCOME

Level of Promoted a Awareness lectures Increase the

knowledge health program and seminars level of

65
on the to the student to awareness

impact of increase their about smoking

smoking self-awareness among the

on the impact of student.

smoking on our

health and life

Number of prevent the use  public increase the

Lectures and
smokers of tobacco seminars level of self-
awareness on
among young the awareness
consequences
people and of tobacco use about the

adults  Educating tobacco use.

parents on the
dangers of
Decrease the
smoking and
monitoring
number of
their children
 increase anti-
smoking
tobacco
policies and
among young
programmers
in schools
people and
 reduce access
to tobacco adult.
products to
minors, and
the influence
of the tobacco
industry on
young people
and adults
Impact of protect from increase awareness estimate the

smokers to exposure to on the harmful magnitude of

non-smokers environmental effects of ETS. the problem of

and the tobacco smoke control the contents exposure to

environment (ETS), and emissions of ETS and

66
. tobacco products. assess the in

And reduce exposure the public

to environmental awareness of

tobacco smoke in postpartum

indoor and outdoor women to ETS.

public places Increase the

level of

knowledge on

the impact of

smoking to

non- smokers.

Decrease the

number of

smoking in

public places.

Promote promote  increase To decrease

good health cessation awareness the number of

and decrease programs among and the smokers and

number of smokers intention to improve health

smokers quit among and encourage

smokers the smokers to

 increase stop smoking.

awareness

67
 among health

professionals

on smoking

cessation

programmers,

 provide

treatment for

tobacco

dependence

Chapter V

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This chapter presented the summary of findings, the conclusion

drawn and the recommendations.

The following are the salient findings of the study:

68
 Smoking is the first cause of respiratory system disease: Based

from the table above, the factor shows that it ranked 1st by frequency of

77 have respondents yes and one has respondents no and 98.72

percentage. The nurses agreed the first cause and factor for respiratory

system disease is smoking and how risk the smoke in our lungs and

health.

Risk of smoking; Based from the table above, the factor shows

that it ranked 2st. by frequency of 76 have respondents yes and two has

respondents no and 97.43 percentage. The nurses agreed that smoking

is one of the risks on our health and life.

Second-hand smoke has increased risk in developing disease:

Based from the table above, the factor shows that it ranked 3st. by

frequency of 68 have respondents yes and 10 have respondents no and

87.18 percentage. The nurses agreed that smoking is more dangerous on

non-smokers.

Summary on risk factors that associated with smoking

Cigarette smoke is dangerous to non-smoker: Based from the

table above, the factor shows that it ranked 1st. with 71 have

respondents yes and 1 have respondents maybe and 6 have respondents

no and 2.83 percentage.

69
 Smoking will damage your health in the future: Based from the

table above, the factor shows that it ranked 2st. with 58 have

respondents yes and 6 have respondents maybe and 14 have

respondents no and 2.56 percentage.

Smoking is addictive: Based from the table above, the factor

shows that it ranked 2st. with 39 have respondents yes and 28 have

respondents maybe and 11 have respondents no and 2.35 percentage.

Summary on risk factors that associated with smokers

Who influenced the smoker to smoke: Based from the table

above, the factor shows that the friends was the top factor which

influenced the smokers nurse as ranked 2st. by frequency of 12 have

respondents yes and 66 have respondents no and 15.38 percentage, and

school was in the ranked 3st. by frequency of 5 have respondents yes and

73 have respondents no and 6.41 percentage.

Reasons why smokers they smoke: Based from the table above,

the factor shows that the Relaxation / Enjoyment was the top reason

that the smokers nurse smoke as ranked 1st. by frequency of 13 have

respondents yes and 65 have respondents no and 16.66 percentage, And

Friends / Social was in the ranked 2st. by frequency of 10 have

respondents yes and 68 have respondents no and 12.82 percentage. And

70
Stress / Depression was ranked 3st. by frequency of 9 have respondents

yes and 69 have respondents no and 11.45 percentage.

Smokers feeling when they smoke: Based from the table above,

the factor shows that the decreased stress was the top feeling that the

smokers nurse felt as ranked 1st. by frequency of 13 have respondents

yes and 65 have respondents no and 16.66 percentage, and increase

focus or concentration was in the ranked 2st. by frequency of 6 have

respondents yes and 72 have respondents no and 7.69 percentage. And

decrease appetite was ranked 3st. by frequency of 3 have respondents yes

and 75 have respondents no and 3.85 percentage.

11. Conclusion

Based from the founds of the study, it can be concluded that

smoking habit indicators were practiced by 7 student and was

smoking by 16 and 18 student who were just try from total

respondent of student 78 nurses assigned the 4 levels of college of

nursing. The fully practiced equivalent maybe attributed to the

71
 knowledge of the nurses in the effects of smoking on the health.

However, Data has to be given more attention as it got the highest

yes and percentage rating among the questionnaires although it

still garnered the fully practiced equivalent.

Based from the found of the study. Nurses should be more

knowledgeable on smoking effects and the consequences to the

non-smokers and the environment.

Overall, the highest rating of the nurses implies that they

were good nursing who don’t smoke. However, there was still a

need to enhance their knowledge and information and update

themselves with the trends or information on smoking impacts or

effects as a nursing student for safe and quality nursing care and

improve health of well-being.

12. Recommendations

Based from the founds of the study, the following are hereby

recommended:

1. The proposed action plan herein is to be piloted. This can be used

by the nurses to address issues and concerns on smoking effects

and thus, cessation and quality nursing health.

72
 2. Promote cessation programs among smokers by increase

awareness and the intention to quit among smokers increase

awareness among health professionals on smoking cessation

programmers, provide treatment for tobacco dependence.

3. Another research study is highly recommended to further increase

the knowledge of nurses on smoking effects in a wider coverage.

Bibliography

U.S. Department of Health and Human Services. The Health

Consequences of Smoking—50 Years of Progress: A Report of the
Surgeon General. Atlanta: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking
and Health, 2014 [accessed 2016 Dec

73
20].[Link]
[Link] Relieved: Relieved: On 26 December 2020

Cornelius ME, Wang TW, Jamal A, Loretan C, Neff L. Tobacco Product

Use Among Adults – United States, 2019. Morbidity and Mortality Weekly
Report, 2020. Volume 69(issue 46); pages 1736–1742. [accessed 2020
November 19]. On Relieved: 26 December, 2020

U.S. Department of Health and Human Services. The Health

Consequences of Smoking—50 Years of Progress: A Report of the
Surgeon General. Atlanta: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking
and Health, 2014 [accessed 2018 Feb 22].
[Link]
m Relieved: On 26 December 2020

World Health Organization. WHO Report on the Global Tobacco Epidemic,

2017: Monitoring Tobacco Use and Prevention Policies. Geneva,
Switzerland: World Health Organization; 2017.
[Link]
79 Relieved: on December15, 2018

Mathers  CD, Loncar  D.  Projections of global mortality and burden of

disease from 2002 to 2030.  PLoS Med. 2006;3(11):e442.
[Link]
79 Relieved: on December15, 2018
doi:10.1371/[Link].0030442PubMedGoogle ScholarCrossref

Eriksen  M, Mackay  J, Schluger  NW.  The Tobacco Atlas. 5th ed.
Atlanta, GA: American Cancer Society; 2015.
[Link]
79 Relieved: on December15, 2018

Zheng  W, McLerran  DF, Rolland  BA,  et al.  Burden of total and cause-
specific mortality related to tobacco smoking among adults aged ≥45
years in Asia: a pooled analysis of 21 cohorts.  PLoS Med.
2014;11(4):e1001631. doi:10.1371/[Link].1001631PubMedGoogle
ScholarCrossref
[Link]
79 Relieved: on December15, 2018

74
Katanoda  K, Jiang  Y, Park  S, Lim  MK, Qiao  Y-L, Inoue  M.  Tobacco
control challenges in East Asia: proposals for change in the world’s
largest epidemic region.  Tob Control. 2014;23(4):359-368.
doi:10.1136/tobaccocontrol-2012-050852PubMedGoogle ScholarCrossref
[Link]
79 Relieved: on December15, 2018

Clow B, Pederson A, Haworth-Brockman M, Bernier J. Rising to the

Challenge: Sex- and Gender-Based Analysis for Health Planning, Policy
and Research in Canada. Halifax, NS: Atlantic Centre of Excellence for
Women’s Health; 2009.
[Link]
79 Relieved: on December15, 2018

GBD 2015 Tobacco Collaborators.  Smoking prevalence and attributable

disease burden in 195 countries and territories, 1990-2015: a systematic
analysis from the Global Burden of Disease Study 2015.  Lancet.
2017;389(10082):1885-1906. doi:10.1016/S0140-6736(17)30819-
XPubMedGoogle ScholarCrossref
[Link]
79 Relieved: on December15, 2018

Jha  P.  Avoidable global cancer deaths and total deaths from
smoking.  Nat Rev Cancer. 2009;9(9):655-664.
doi:10.1038/nrc2703PubMedGoogle ScholarCrossref
[Link]
79 Relieved: on December15, 2018

Lopez  AD, Collishaw  NE, Piha  T.  A descriptive model of the cigarette
epidemic in developed countries.  Tob Control. 1994;3(3):242-247.
doi:10.1136/tc.3.3.242Google ScholarCrossref
[Link]
79 Relieved: on December15, 2018

Clow  B, Pederson  A, Haworth-Brockman  M, Bernier  J. Rising to the

Challenge: Sex- and Gender-Based Analysis for Health Planning, Policy
and Research in Canada. Halifax, NS: Atlantic Centre of Excellence for
Women’s Health; 2009.
[Link]
79 Relieved: on December15, 2018

75
Chen  Z, Peto  R, Zhou  M,  et al; China Kadoorie Biobank (CKB)
Collaborative Group.  Contrasting male and female trends in tobacco-
attributed mortality in China: evidence from successive nationwide
prospective cohort studies.  Lancet. 2015;386(10002):1447-1456.
doi:10.1016/S0140-6736(15)00340-2PubMedGoogle ScholarCrossref
[Link]
79 Relieved: on December15, 2018

Fernández-García D, Liebana Presa C, Vazquez Casares A, et al. Tobacco

use amongst nursing and physiotherapy students: a cross sectional
questionnaire study survey. Int J Nurs Stud 2007;44:780–5.
[Link]
journal/fulltext/2020/04030/smoking_in_nursing_students__a_prevalen
[Link] Relieved: on December 15,2020

[Sreeramareddy CT, Ramakrishnareddy N, Rahman M, et al. Prevalence

of tobacco use and perceptions of student health professionals about
cessation training: results from Global Health Professions Students
Survey. BMJ Open 2018;8:e017477. [Link]
journal/fulltext/2020/04030/smoking_in_nursing_students__a_prevalen
[Link] Relieved: on December 15,2020

Keshavarz H, Jafari A, Khami MR, Virtanen JI. Health professionals’ role

in helping patients quit tobacco use: attitudes among Iranian dental
students. ISRN Public Health 2013. [Link]
journal/fulltext/2020/04030/smoking_in_nursing_students__a_prevalen
[Link] Relieved: on December 15,2020

Aslam SK, Mehboob B, Zaheer S, et al. Awareness and support for anti-
tobacco policies among health professional students in Pakistan: findings
from the Global Health Professional Students Survey, 2011. Subst Abuse
Treat Prev Policy 2015;10:7. [Link]
journal/fulltext/2020/04030/smoking_in_nursing_students__a_prevalen
[Link] on Relieved: December 15,2020

[Link]
and-smoking Relieved: December 15,2020

Cauchi D, Mamo J. Smoking health professional student: an attitudinal

challenge for health promotion? Int J Environ Res Public Health
2012;9:2550–61. [Link]

76
journal/fulltext/2020/04030/smoking_in_nursing_students__a_prevalen
[Link] on Relieved: December 15,2020

El-Awaisi A, Awaisu A, El Hajj MS, et al. Delivering tobacco cessation

content in the middle east through interprofessional learning. Am J
Pharm Educ 2017;81:91. [Link]
journal/fulltext/2020/04030/smoking_in_nursing_students__a_prevalen
[Link] Relieved: on December 15,2020

Haenle M, Brockmann O S, Kron M, Bertling U, Mason A

R,Steinbach G & et al. Overweight, physical activity, tobacco and alcohol
consumption in a cross-sectional random sample of German adults.
BMC Public Health 2006; 6: 233
[Link]
Effect_of_Education_Based_on_the_Health_Belief_Model_on_Male_Smoki
ng_Students_in_Reducing_Cigarette_Smoking_in_Ahvaz Relieved: on
December 15, 2020

Rebecca Murphy-Hoefer, Stephen Alder, Cheryl Higbee, [Received 9

September 2003; accepted 16 August 2004].
[Link] Relieved:
December 26, 2020

U.S. Department of Health and Human [Link] Health

Consequences of Smoking—50 Years of Progress: A Report of the
Surgeon General. Atlanta: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking
and Health, 2014 [accessed 2017 Apr 20]. Relieved: December 26, 2020

Chung-Hall J, Craig L, Gravely S, Sansone N, Fong GT. Impact of the

WHO FCTC over the first decade: a global evidence review prepared for
the impact assessment expert group. Tob Control. 2019;28(Suppl
2):S119–28.

77
[Link]
020-08942-9 Relieved: on 26 December, 2020

The impacts of smoking

[Link]
Relieved: on 26 December, 2020

Suliankatchi RA, Sinha DN, Rath R, Aryal KK, Zaman MM, Gupta PC,
Karki KB, Venugopal D. Smokeless Tobacco Use is "Replacing" the
Smoking Epidemic in the South-East Asia Region. Nicotine Tob Res.
2019;21(1):95–100.
[Link]
020-08942-9 Relieved: on 26 December, 2020
[Link]
/effects_cig_smoking/[Link] Relieved:December 26, 2020
U.S. Department of Health and Human Services. The Health
Consequences of Smoking—50 Years of Progress: A Report of the
Surgeon General. Atlanta: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking
and Health, 2014 [accessed 2016 Dec 20]. [Link]
sa=t&source=web&rct=j&url=[Link]
mation/health_effects/[Link]%23:~:text%3DSmoking%2520causes
%2520cancer%252C%2520heart%2520disease,immune%2520system
%252C%2520including%2520rheumatoid
%2520arthritis.&ved=2ahUKEwiVhI3G4bPuAhWIv5QKHbzEDDEQFjACe
gQIAhAE&usg=AOvVaw3_rNlvu2hixF-
GI0D1C74q&cshid=1611463810631 Relieved: on 26 December, 2020

World Health Organization (WHO), “The MPOWER: a policy package to

reverse the tobacco epidemic,” Tech. Rep., Health Organization press,

78
Geneva, Switzerland,
2008, [Link]
at: Google Scholar,
[Link] on December
26, 2020

World Health Organization (WHO), “Cancer Fact sheet no. 297,”

2013, [Link]
[Link] at: Google Scholar,
[Link] on December
26, 2020

Osservatorio Fumo and Alcol e Droga (OssFAD), “Relazione annuale sul

tabagismo. Indagine DOXA,” Annual Report on Tobacco Use, Istituto
Superiore di Sanità, Roma, The DOXA study,
2013, [Link]
id=195&lang=1&tipo=[Link] at: Google Scholar,
[Link] on December
26, 2020

P. Jha, C. Ramasundarahettige, V. Landsman et al., “21st-century

hazards of smoking and benefits of cessation in the United States,” The
New England Journal of Medicine, vol. 368, no. 4, pp. 341–350,
[Link] at: Publisher Site | Google Scholar,
[Link] on December
26, 2020

M. J. Thun, B. D. Carter, D. Feskanich et al., “50-year trends in

smoking-related mortality in the United States,” The New England
Journal of Medicine, vol. 368, no. 4, pp. 351–364, [Link]
at: Publisher Site | Google Scholar,
[Link] on December
26, 2020

K. Pirie, R. Peto, G. K. Reeves, J. Green, V. Beral, and Million Women

Study Collaborators, “The 21st century hazards of smoking and benefits
of stopping: a prospective study of one million women in the UK,” The
Lancet, vol. 381, no. 9861, pp. 133–141, [Link] at: Publisher

79
Site | Google Scholar,
[Link] on December
26, 2020

M. C. Fiore, C. R. Jaén, T. B. Baker et al., “Treating tobacco use and

dependence: 2008 update. Clinical practice guideline,” Tech. Rep., U.S.
Department of Health and Human Services. Public Health Service,
Rockville, MD,
2008, [Link]
[Link] at: Google Scholar

L. F. Stead, G. Bergson, and T. Lancaster, “Physician advice for smoking

cessation,” Cochrane Database of Systematic Reviews, no. 2, Article ID
CD000165, [Link] at: Publisher Site | Google Scholar,
[Link] on December
26, 2020

N. A. Zwar, R. L. Richmond, D. Davidson, and I. Hasan, “Postgraduate

education for doctors in smoking cessation,” Drug and Alcohol Review,
vol. 28, no. 5, pp. 466–473, [Link] at: Publisher Site | Google
Scholar, [Link] on
December 26, 2020

M. C. Fiore, R. P. Epps, and M. W. Manley, “A missed opportunity.

Teaching medical students to help their patients successfully quit
smoking,” Journal of the American Medical Association, vol. 271, no. 8,
pp. 624–626, [Link] at: Publisher Site | Google Scholar,
[Link] on December
26, 2020

R. Richmond and R. Taylor, “Global dissemination of a tobacco

curriculum in medical schools,” International Journal of Tuberculosis and
Lung Disease, vol. 10, no. 7, pp. 750–755, [Link] at: Google Scholar
[Link] on December
26, 2020

T. Raupach, H. Krampe, and J. Brown, “Does research into medical

education on tobacco and alcohol get the respect it deserves?” Addiction,
vol. 109, no. 2, pp. 173–174, [Link] at: Publisher Site | Google

80
Scholar [Link] on
December 26, 2020

2014 Surgeon General's Report: The Health Consequences of Smoking—

50 Years of Progress,
[Link]
anniversary/[Link], Relieved:0n 26 December, 2020

[Link]
[Link]?fbclid=IwAR3u1Q85ZkVJ9M9Yn_SRKYx1BJijOl-
6ozidsQ_wvQDtJgH0Kloi0D84xW4 Relieved: 14 April 2021

the risk of smoking Relieved:14 April 2021

[Link]
prevention/risk/tobacco/cessation-fact-sheet
the second-hand smoke has increased risk in developing disease
[Link]
fbclid=IwAR3jM3mi9UC1y8SjB3BOG6RasZw84qLoHBIo2KknJZWVZXzD
OeD0486ctt8 14 April 2021

cigarette smoke is dangerous to non-smoker

[Link]
prevention/risk/tobacco/cessation-fact-sheet Relieved:14 April 2021

smoking will damage your health in the future

[Link]
smoking-and-tobacco/what-are-the-effects-of-smoking-and-tobacco
Relieved:14 April 2021

smoking is addictive: [Link]

Relieved:14 April 2021

Who influenced the smoker to smoke:

[Link]
[Link] Relieved:14 April 2021

The reason smokers they smoke: [Link]

healthy/1736/smoking-alcohol-and-drugs---why-teens-get-hooked-on-
this-triple-threat Relieved:14 April 20, 2021
81
Smokers feeling when they smoke: [Link]
to-z/s/smoking-and-mental-health Relieved:14 April 2021

Appendix A.

University of Luzon

College of Nursing & Midwifery

82
 Dagupan City

December 10,2020

Letter of Request to Dean

Ellen P. Gabriel

Acting Dean

University of Luzon

Dear Ma’am,

Greetings!

The third year Nursing student of University of Luzon, we presently conducting a

research study Entitled “(EFFECT OF SMOKING AMONG THE NURSING STUDENTS)”

In this connection, we seeking your technical expertise in the validation of the

questionnaire. Your corrections, comments and suggestions for the improvement of the

questionnaire are highly appreciated. Thank you very much and God bless

The Researchers

Ahmed Abdulrahman Ba Elaian

Lucy Marie Ison

Ira Shane Manzano

Neil Christian Tata

Appendix B

Letter to Respondents

December 10, 2020

83
Dear Respondent:

Greetings!

We, the third-year student nurses are conducting a research study entitled “EFFECT OF SMOKING

AMONG THE NURSING STUDENTS”. This study aims to determine the effects of smoke among the student

nurses, and the health, and also to propose a program that can boost the self awareness of student nurses. In

this regard, we have considered you as one of our respondents however, your participation in this study is

voluntary and does not have an obligation to participate should you refuse to be part of the study.

The study will observe data privacy to protect the names of the respondents. Your identity will not be

revealed while the study is being conducted or when the study is reported or published. All study data will be

collected by the researchers will be kept confidential and will not be shared with any person without your

permission.

Thank you and we are anticipating for your full cooperation.

The researchers,

Ahmed Abdulrahman Ba Elaian

Lucy Marie Ison

Ira Shane Manzano

Neil Christian Tata

I have read this letter and understood the purpose of the study and thus, I voluntarily consent to

participate in the study.

________________________ __________________

Respondents’ Signature Date

Appendix C

Informed consent

84
Dear Respondents,

The undersigned are currently conducting research entitled “effects

of smoking in University of Luzon” in partial fulfillments for 3rd year

Student Nurses. In this regard, may we ask for your precious time to

answer the attached questionnaire for this study?

Rest assured that your anonymity and the confidentiality of your

answers will be maintained.

Thank you in anticipation of your favorable response on this matter.

God Bless and more power!

The Researchers

Ahmed Abdulrahman Ba Elaian

Lucy Marie Ison

Ira Shane Manzano

Neil Christian Tata

Questionnaire

Name: (OPTIONAL) Sex: Age:

85
Course & Year Level: Date:

Questionnaire

Description and Measurement:

A more than 10-item self-report questionnaire, the tobacco dependence

screener, has also been developed for screening for tobacco/nicotine
dependence. However, tobacco/nicotine dependence is defined as a
cluster of cognitive, behavioural, and physiological symptoms for which
the individual attributes use of tobacco despite significant tobacco-
related problems. All items are answered using a 4-point Likert scale
format ranging from strongly agree to strongly disagree.

Part 1: Directions: Put a check mark in the space provided.

1. How old are you when you started smoking?

18 – 24 ( )
25 – 39 ( )
40 – 54 ( )
>55 ( )
None ( )

2. How many sticks of cigarettes do you smoke per day?

1–5 ( )
6 – 10 ( )
11 – 15 ( )
16 – 20 ( )
None ( )

3. Monthly Income
Low ( )
Middle ( )
High ( )
Noon ( )

Part 2: Put a check mark below if your answer is Yes or No

Questions No Yes Total f % R

Have you ever tried 6

86
smoking?
Do you still smoke
now?
Do you smoke before?
Does stress trigger
you to smoke?
Do you think if the
cigarette prices
increase, will it
decrease the number
of smokers?
Do you have any
information about the
risk of smoking?
Do you know that
smoking is the first
cause of respiratory
system disease?
Do you have a
member in your
house who smoke?
Do you smoke even if
you are sick?
Do you know that the
second-hand smoke
has increased risk in
developing disease?

Part 3: Put 1, 2, or 3 based on your experienced

1- Yes
2- Maybe
3- No

87
Is smoking addictive?

Do you worry that smoking will damage your health in the

future?

Do you think cigarette smoke is dangerous to non-smoker?

Part 4: Put checks if you feel or experienced the following

Who influenced you for smoking use? Yes No

 Family
 Relatives

88
  Friends
 School
 Others
 None

Why do you smoke?

 Craving
 Stimulation
 Relaxation / Enjoyment
 Stress / Depression
 Habit / Activity
 Friends / Social
 Lack of willpower

When you smoke, what do you experience or

feel?

 Decreases in appetite
 Decreases in stress
 Increases focus on concentration
 Bad taste in mouth
 Good taste in mouth

CURRICULUM VITAE

A. Personal data

Name: Ba Elaian, Ahmed Abdulrahman

89
Age: 24

Gender: Male

Birthday: January 22, 1996

Birthplace: Hadramout city, Yemen

Address: Malued, Dagupan City

Husband: N/A

Children: N/A

Parents: Abdulrahman Saleh Baolayyan

Jamila Salem Baolayyan

Educational Background

Primary: Anas Bin Tareq school & Al-Farabi School, Riyadh city, Saudi Arabia

Secondary: Al-Ezz bin Abdul Salam School, Riyadh city, Saudi Arabia

Tertiary: Bachelor of Science in Nursing

University of Pangasinan Arellano, Dagupan City, Philippines

Seminars/ Trainings/ Conventions attended

MCNAP 37th Annual Convention & 38th Founding Anniversary

“EMC2: Excellence in Maternal and Child Nursing Practice towards Attainment of

SDGs”

CURRICULUM VITAE

Personal Data

Name: Lucy Marie A. Ison

90
Age: 21

Gender: Female

Birthday: July 5, 1999

Birthplace: Dagupan city

Address: Brgy. Dinalaoan Sitio Alegria Calasiao Pangasinan

Husband: N/A

Children: N/A

Parents: Anthony D.G Ison, Sr.

Myrna A. Ison

Educational Background

Primary: Mother Lourdes Learning School

Secondary: Junior High School - Mother Lourdes Learning School

Senior High School – University of Pangasinan

Tertiary: Bachelor of Science in Nursing

University of Luzon

Perez Blvd. Dagupan City, Pagasinan, (2018- present)

Seminars/ Trainings/ Conventions attended

MCNAP 37th Annual Convention & 38th Founding Anniversary

“EMC2: Excellence in Maternal and Child Nursing Practice towards Attainment of SDGs”

Buntis Congress 2019 with the theme: "Busog-lusog si baby sa Gatas at Aruga ni Mommy

Withering Away: Facts and Myths on Depression

Understanding Latex Allergy in Healthcare Setting

Cardiology Rounds: EKG Basics & Interpretation

CURRICULUM VITAE

Personal Data

Name: Ira Shane R. Manzno Age: 21

Gender: Female

91
Birthday: August 5, 1999

Birthplace: Sta. Barbara, Pangasinan

Address: Ventinilla Sta. Barbara, Pangasinan

Husband: N/A

Children: N/A

Parents: Mr. & Mrs. Manuel C. Manzano Jr.

Educational Background

Primary: Sta. Babara Central School

Poblacion Norte Sta. Barbara, Pangasinan (2011-2012)

Secondary: Daniel Maramba National High School

Poblacion Norte Sta. Barbara, Pangasinan,

SHS (2017-2018)

JHS (2015-2016)

Tertiary: Bachelor of Science in Nursing

University of Luzon

Perez Blvd. Dagupan City, Pagasinan, (2018- present)

Seminars/ Trainings/ Conventions attended

Buntis Congress 2019 with the theme: "Busog - lusog si baby sa Gatas at Aruga ni Mommy:

"Withering Away: Facts and Myths on Depression”

"Trends in Evidence - Based Practice: Setting Nursing Practice a Step Higher

Chapter Convention 2019 with the theme: "Innovations and Advancements toward Excellence in Material and

Child Nursing Practice and Attainment of the Sustainable Development Goals"

Cardiology Rounds: EKG Basics & Interpretation

CURRICULUM VITAE

Personal Data

Name: Neil Christian Tatad

92
 Age: 21

Gender: Male

Birthday: December 23, 1998

Birthplace: POZORRUBIO, PANGASINAN

Address: #26 Reyes Subd Cabong Pozorrubio, Pangasinan

Husband:

Children:

Parents: Jacquelin tatad

Educational Background

Primary: St. Philomena’s Academy

Secondary: Mary Help of Christian learning Center, Philippines

Tertiary: Bachelor of Science in Nursing

University of Pangasinan

Arellano, Dagupan City, Philippines

Seminars/ Trainings/ Conventions attended

MCNAP 37th Annual Convention & 38th Founding Anniversary

“EMC2: Excellence in Maternal and Child Nursing Practice towards Attainment of SDGs

93