CHAPTER ONE
Introduction
1.1 Background of the Study
A teenager is the period of transition between childhood and adulthood. Children who are
entering adolescence are going through many changes (physical, intellectual, personality
and social developmental). Adolescence begins at puberty, which now occurs earlier, on
average, than in the past. Adolescence begins at puberty, which now occurs earlier, on
average, than in the past. The end of adolescence is tied to social and emotional factors
and can be somewhat ambiguous (Sharma, & Panigrahi, 2020).
World Health Organization (WHO) identifies adolescence as the period in human growth
and development that occurs after childhood and before adulthood, in the age group of 10
to 19 years. The adolescent period is a time of considerable risk to bad behaviors such as;
cigarette smoking: Tobacco use is a leading cause of preventable death worldwide and an
estimated 250 million children and adolescents in developing countries die prematurely
because of tobacco consumption (Moonajilin, et al., 2021).
Smoking as well as combined smoking and smokeless tobacco was more common among
boys.. Tobacco use by family is a major reason behind using tobacco indicating an urgent
need to carry out behavior change communication (BCC) activities among adolescents
and their family members. The urban-slum population has emerged as a new section
which is known to fare very poorly on issues related to health (Rautela, et al., 2019).
Cigarette smoking during adolescence causes significant health problems among young
people, including an increase in the number and severity of respiratory illnesses,
decreased physical fitness and potential effects on lung growth and function. Most
importantly, this is when an addiction to smoking takes hold, often lasting into and
sometimes throughout adulthood (Kelkar, et al., 2019). Nicotine is only one of more
than 4,000 chemicals in tobacco, but it is the major component that acts on the brain. The
lungs readily absorb nicotine from the smoke of cigarettes, cigars, or pipes. The tissues of
the mouth can also absorb nicotine when a person smokes cigars or pipes, or chews
tobacco (Swain, & Singh, 2020).
Nicotine reaches the brain within seconds and has a direct effect on the body for up to 30
minutes. When a person uses tobacco regularly, the levels of nicotine accumulate in the
body during the day and persist overnight, exposing the person to the effects of nicotine
for 24 hours. In the body, nicotine acts as both a central nervous system stimulant and
sedative
(Banerjee, et al., 2021). The person immediately feels the stimulant effect and
pleasurable sensation. It increases alertness, relaxes muscles, improves memory and
attention, and decreases irritability. The stimulant effect causes a sudden increase in
blood pressure, breathing rate, and heart rate. The central nervous system stimulation is
followed by depression and fatigue, causing the person to want another cigarette
(Kumar, et al., 2020).
Smoking affects a person's appearance by causing bad breath, yellow teeth and
fingernails, and wrinkles. It also affects a person's fitness and stamina level. Tobacco also
leads to serious health problems, including: Long-term (chronic) cough, shortness of
breath, and wheezing. Increased risk for heart disease, lung and other cancers, stroke, and
emphysema, increased risk among women for having babies with a low birth weight,
which may result in the death of the baby. Women who smoke are also at risk for
menstrual problems, early menopause, and osteoporosis, Increased risk among men for
erection problems, and Increased risk for upper respiratory infections like the common
cold, the flu, and sinusitis (Hadara, 2019).
1.2 Statement of the Problem
The challenge to provide effective tobacco-use prevention programs to all young persons
is an ethical imperative. Schools are ideal settings in which to provide such programs to
all children and adolescents. School-based tobacco prevention education programs that
focus on skills training approaches have proven effective in reducing the onset of
smoking, according to numerous independent studies. A summary of findings from these
studies demonstrates positive outcomes across programs that vary in format, scope, and
delivery method (Sarkar, et al., 2019).
School students take an active stance against teen smoking. Participate in local and
school-sponsored smoking prevention campaigns. Support efforts to make public places
smoke-free and increase taxes on tobacco products. Talk to your teen early and often
about the dangers of smoking and vaping (Rose, et al., 2019). Prevention can also take
place at the school or community level. Merely educating potential smokers about the
health risks has not proven effective. Successful evidence-based interventions aim to
reduce or delay initiation of smoking, alcohol use, and illicit drug use, and otherwise
improve outcomes for children and teens by reducing or mitigating modifiable risk
factors and bolstering protective factors (Trindade, et al., 2020).
Community health nurses play an important role in raising the issue of smoking cessation
with teenagers and they can offer a balanced perspective on the challenges they might
face. They can then sign-post teenagers to the most appropriate smoking cessation
options. Nurses have wide access to patients in many settings, from the community to the
hospital, and are in frequent contact with smokers. They may feel they lack the
counseling skills to persuade smokers to stop but there are many simple ways in which
they can encourage them to seek help (Singh, 2019).
Nurses have a key role to play in influencing the health of patients. Whether working in a
hospital or the community, nurses are ideally placed to encourage smokers to give up.
Even the most basic intervention by a health professional can have a profound effect on
encouraging a smoker to stop or to seek help in stopping (Banga, et al., 2019). In
primary care, smoking cessation guidelines for health professionals recommend that
nurses should be prepared to offer encouragement and support for known smokers to
stop. Where possible nurses should be given sufficient practical and theoretical training
to enable them to provide opportunistic advice, encourage cessation and offer advice on
using NRT or bupropion
(Onodugo, et al., 2019).
In secondary care settings it is highly recommended that nurses should be part of systems
that record the smoking status of outpatients and inpatients to ensure that these records
are kept up to date. This will allow for suitable advice to be offered to patients. Many
hospitals host local smoking cessation services and these should be made available to
inpatients, see smoking cessation information as professional advice and to treat the
subject nonjudgmentally. Nurses will be familiar with patients’ past experiences and are
well placed to be able to advice on smoking cessation services and treatments available
(Jayakumar, & Nair, 2019).
1.3 Objective of the study
• Assessing teenagers’ reported practices toward smoking and smoking prevention.
• Assessing health hazards of smoking on teenage students’ health.
• Assessing teenage students’ attitude toward smoking.
Research questions:
• What is the level of health awareness of teenager school students about risk of
smoking on health?
• What are the relations between factors leading to smoking and students’ attitude
towards smoking?
• What are the relations between teenage students’ awareness about health hazards of
smoking and students’ attitude towards smoking?
Significance of the study
Tobacco consumption is an emerging threat to health of adolescents in urban slums. At
the end of the twentieth century, deaths from smoking related illnesses had risen to 4
million a year worldwide and projections indicate that this could rise to 10 million a year
by 2030. This constitutes burden on community economics in the form of cost treatment
of diseases related to smoking such as cancers,
About 19.6% of Egyptian population are smokers and most of them are youth.
Number of deaths related to smoking in Egypt is 61295 persons every year. Tobacco
smoking damage 18324000 Egyptian pound every year (Tobacco Atlas organization
2018)
Fortunately, smoking is a preventable issue through increasing health awareness of
teenagers about risk of smoking on health, family, community as whole (Banks, Rawaf
and Hassounah (2017)).We can also help in preventing smoking through health
education, counseling, programmed learning sessions..etc
CHAPTER TWO
LITERATURE REVIEW
Many anti smoking campaigns have been launched all over the world and earlier studies
have examined the impact of campaign on change in smoking behavior using aggregate
level data. O’Keefe points out in the population-based statistical survey data, that the
influence of such mass media campaign is quite limited. In Ekiti, Hu et al., have tried to
identify the separate effect of anti smoking media campaign on tobacco smoking, with
the industry’s magazine advertising response and with controls for tobacco tax policy [2
– 3]. As per their findings media campaign reduced per capita cigarette consumption by
7.7 packs per 100 packs during the period of 2018-2019, they have also suggested that it
is necessary to conduct intensive survey studies about how such media campaign
influences individual behavior, including individual exposure to message perception of
media campaign and change in smoking behavior and attitude. Stavrinos studies the case
of Greece and found that health warnings conveyed by anti smoking campaigns reduced
the cigarette consumption by 7.3% in short run and by 13.5% in the long run, which
might be more effective than tobacco policy . Mattila suggested that anti smoking
advertisements with emotional appeals generated higher awareness compared to rational
and just informative advertisements . Biener et al., demonstrated that both adult smokers
and non smokers in Massachusetts were highly exposed to anti smoking media campaign,
but the effectiveness of the campaign was mostly perceived by either non smokers,
quitters or smokers with intention to quit smoking. This stated that only those people who
had propensity to quit perceive anti smoking advertisements as an effective advocate,
whereas the majority of smokers may have more awareness of smoking’s harmful effects
but would not change their behaviors . However McVey, D. and J. Stapleton studied the
effectiveness of anti smoking television campaign with a controlled trial in England, and
find out that Ekiti anti smoking advertisement has a significant negative effect on
smoking prevalence through motivating current smokers to quit and preventing former
smokers from relapsing
According to the WHO, 6 million people die because of tobacco smoking and an
estimated 600,000 individuals lose their lives due to second-hand smoke globally each
year. A recent study found that smoking is related to about 20% adult mortality around
the world. It is projected that smoking will cause the death of 8 million people every year
by 2030 and 80% of these deaths will occur in low- and middle-income countries.
Smoking is associated with increased the risk of cardiovascular and chronic respiratory
diseases, stroke, and cancers of many organs of the body such as mouth, larynx, lungs,
kidneys, cervix, and pancreas.
There are significant negative impacts of smoking on health-care system and society
causing huge direct health-care expenditures and indirect costs in the form of the loss of
productivity and income for families. The economic burden of smoking accounts for 15%
of health care costs in developed countries, and 1% of gross domestic product is
consumed for direct health care costs and US$151 billion for indirect expenses every year
in the United States. Tobacco consumption is alarming in Saudi Arabia as it is ranked
fourth worldwide in terms of tobacco sale, and high proportion of males students (32.7%)
smoke in the country.
Large body of epidemiological evidence reveals that smoking is related to oral conditions
which include periodontal disease, gingival recession, tooth loss, dental caries, staining of
teeth, halitosis, benign mucosal conditions, and precancerous and malignant oral lesions.
Smokers live approximately 10 years lesser than never smokers and smoking cessation
efforts can reduce 97% risk of death associated with continuing smoking before the age
of 30 years. This underscores the importance of increasing the awareness about the
negative consequences of smoking among adolescents so that morbidities, mortalities,
and oral and systematic health inequalities resulting from smoking can be prevented at an
earlier age.
Adolescents are vulnerable to starting smoking and becoming addicted to nicotine
because they go through rapid hormonal and cognitive changes during their adolescence
and they are influenced by cultural, social, familial, and behavioral factors. It is estimated
that about 5.6 million American adolescents will die prematurely due to diseases caused
by smoking. Adolescent smokers are likely to become addicted to nicotine, and about
90% of adult smokers used to smoke regularly during their adolescence.
The factors that lead adolescents to start smoking include advertising of cigarettes, stress,
low self-esteem, poor academic performance, and occurrence of smoking among parents
and other family members, friends, and staff at school. Moreover, research indicates that
initiation of smoking is associated with the perception of risks and benefits of smoking It
was found that adolescents with low perception about the long term risks related to
smoking were 3.64 times more likely to smoke compared with those who had high
perception of smoking related risks. However, the question that whether the awareness
about the adverse effects of smoking on oral health has any influence on smoking
behaviors among schoolchildren was unclear.
Therefore, the aim of the present study was to evaluate an association between the
awareness about smoking effects on oral health and probability of smoking among school
children.
CHAPTER FEUR
4.3 Discussion:
Smoking is one of these issues and many teenagers don’t understand how dangerous just
one cigarette can be, and the health effects it can have now, and later on in life. As a
parent, it is important to know how can prevent teenagers from smoking and how to help
them if they have a smoking problem (Narain, et al., 2020). Cigarette smoking during
childhood and of teenage school students about risk of smoking on health in slums
Regarding Demographic characteristics of the studied teenage school students; The
current study revealed that more than half of the studied students were aged from 13 -15
years old, were at preparatory stage, and had sufficient weekly pocket money. Also,
nearly half of them were the second ranking among their brothers, and were working with
studying.
This result was in agreement with Khan, et al., (2018) who studied the prevalence and
determinants of smoking among adolescent boys in Dhaka City, and found that more than
half of participants had ages more than 15 years, more than one third of them were
worked with studying. Conversely, this result was in disagreement with YADAV, et al.,
(2019) who studied the tobacco use and oral health status among adolescents in an Urban
Slum, and found that majority of participants had ages ranged from 10:12 years, more
than half of them were the first regarding order in the family.
CHAPTER FIVE
5.1 Summary
In the same line, this result was congruence with Jayakrishnan, (2019) who studied the
effectiveness of school based awareness Programmers against tobaccoamongusers and
non-users in India, and found that more than half of participants were usedmoreone
method to avoid smoking. In contrast, this result was in disagreement with Katende,
(2019) who studied the stress, peer pressure and substance abuse among adolescents in
Bwaise, and found that more than half of participants exposed for smoking, and not want
avoid smoking to overcome on family stress. Regarding total attitude, the current study
clarified that less than two thirds of the studied sample had negative attitude toward
smoking cessation compared to more than one third had a positive attitude. From the
researcher point of view, this result may be due to smoked student couldn’t remove
smoking, and they hadn’t ability to quit smoking.
5.2 Recommendation:
In the light of results of this study, the following recommendations were suggested:
Periodic assessment for teenage school students about risk of smoking on health in
slums
Providing health awareness of teenage school students about risk of smoking on health
in slums
Enhance behaviors and information of teenage school students about risk of smoking
Promote teachers with suitable training about how deal ideal with teenage school
students that risk of smoking
Develop and enforce a school policy on tobacco use.
Provide instruction about the short- and long term negative physiologic and social
consequences of tobacco use, social influences on tobacco use, peer norms regarding
tobacco use, and refusal skills.
5.3 CONCLUSIONS
The findings of the study suggest that schoolchildren with raised awareness of smoking
effects on oral health were less likely to smoke. The adolescents who believed that
tobacco consumption can adversely affect their oral health had lower probability of
smoking than those who were not aware of the negative consequences of tobacco use on
oral tissues. The results of our study also show that attaining higher academic scores can
help students devote more time to their studies and avoid smoking behaviors. Moreover,
smoking patterns among family members increase the probability of smoking in children.
Improving the academic environment in schools can further help reduce tobacco use
among adolescents and minimize its economic burden on the society.
Saudi Arabia has a national tobacco control program that aims at evaluating the
prevalence of smoking and its adverse health effects including economic impact, and
preventing the epidemic of smoking complications. In addition, there are policies about
controlling smoking in educational institutions, health-care facilities, public
transportation, and banning tobacco commercial advertisements.
It is suggested that antismoking policies aimed at enforcing the control of tobacco use
and improving oral and systemic health should consider the support of family members
particularly parents. Supportive environment for developing healthy life styles among
children should be created utilizing possibilities of interaction among teachers, parents,
and health-care providers in schools. Educating students about the complications of
smoking on oral health should be the part of smoking cessation programs and policies.
Future research should evaluate if the effects of tobacco use lead students to perform
poorly at schools. Moreover, to reduce smoking related health inequalities among
schoolchildren, the role of academic achievement should be investigated in future studies.
REFERENCES
1. World Health Organization. WHO Global Report on Trends in Tobacco Smoking
2000-2025. [Last cited on 2016 Sep 12]. Available
from: http://www.who.int/tobacco/publications/surveillance/reportontrendstobaccosmoki
ng/en/
2. Rentería E, Jha P, Forman D, Soerjomataram I. The impact of cigarette smoking on life
expectancy between 1980 and 2010: A global perspective. Tob Control. 2016;25:551–
7. [PubMed] [Google Scholar]
3. World Health Organization. Tobacco Free Initiative (TFI). Tobacco Control
Economics. [Last cited on 2016 Sep 12]. Available
from: http://www.who.int/tobacco/economics/en/
4. Csikar J, Kang J, Wyborn C, Dyer TA, Marshman Z, Godson J. The self-reported oral
health status and dental attendance of smokers and non-smokers in England. PLoS
One. 2016;11:e0148700. [PMC free article] [PubMed] [Google Scholar]
5. Chung CW, Wang JD, Yu CF, Yang MC. Lifetime medical expenditure and life
expectancy lost attributable to smoking through major smoking related diseases in
Taiwan. Tob Control. 2007;16:394–9. [PMC free article] [PubMed] [Google Scholar]
6. Hoang Anh PT, Thu le T, Ross H, Quynh Anh N, Linh BN, Minh NT. Direct and
indirect costs of smoking in Vietnam. Tob Control. 2016;25:96–100. [PMC free
article] [PubMed] [Google Scholar]
7. Ekpu VU, Brown AK. The economic impact of smoking and of reducing smoking
prevalence: Review of evidence. Tob Use Insights. 2015;8:1–35. [PMC free
article] [PubMed] [Google Scholar]
8. Salama R. Challenges facing smokers in Saudi Arabia. Int J Health Sci
(Qassim) 2012;6:V–VI. [PMC free article] [PubMed] [Google Scholar]
9. Warnakulasuriya S, Dietrich T, Bornstein MM, Casals Peidró E, Preshaw PM, Walter
C, et al. Oral health risks of tobacco use and effects of cessation. Int Dent J. 2010;60:7–
30. [PubMed] [Google Scholar]
10. Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, et al.
21st-century hazards of smoking and benefits of cessation in the United States. N Engl J
Med. 2013;368:341–50. [PubMed] [Google Scholar]
11. Pirie K, Peto R, Reeves GK, Green J, Beral V. Million Women Study Collaborators.
The 21st century hazards of smoking and benefits of stopping: A prospective study of one
million women in the UK. Lancet. 2013;381:133–41. [PMC free
article] [PubMed] [Google Scholar]
12. Towns S, DiFranza JR, Jayasuriya G, Marshall T, Shah S. Smoking cessation in
adolescents: Targeted approaches that work. Paediatr Respir Rev. 2005:pii: S1526-
054200039-1. [PubMed] [Google Scholar]
13. Singh T, Arrazola RA, Corey CG, Husten CG, Neff LJ, Homa DM, et al. Tobacco use
among middle and high school students – United States, 2011-2015. MMWR Morb
Mortal Wkly Rep. 2016;65:361–7. [PubMed] [Google Scholar]
14. 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; [Last cited on 2016 Sep 13]. U.S.
Department of Health and Human Services. Available
from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/?
_ga=1.85329114.252217801.1464102713.#execsumm . [Google Scholar]
15. Hanewinkel R, Isensee B, Sargent JD, Morgenstern M. Cigarette advertising and teen
smoking initiation. Pediatrics. 2011;127:e271–8. [PubMed] [Google Scholar]
