Patterns Of Smoking And Health Risk Perception Of Out-Of-School Youths

Project and Seminar Material for Public Health

Patterns Of Smoking And Health Risk Perception Of Out-Of-School Youths


Abstract


The impact of smoking and tobacco use on health cannot be over emphasized. Cigarette smoking remains a gigantic public health problem and is still regarded as one of the leading preventable causes of morbidity and mortality worldwide. Over the past four decades, tobacco use has caused an estimated 12 million deaths in the world, including 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases and 94,000 infant deaths related to mothers smoking during pregnancy and on average cigarette smokers lose about 15 years of their life. It has been found that, knowledge about the health hazards of smoking has not always helped to prevent people from smoking. The objective of this study is to assess the pattern of smoking among out-of-school youth and their health risk perception.

This research was a cross-sectional survey which was carried out among 137 out-of-school youth in selected motor parks in Oshodi Local Government Area of Lagos State, Nigeria. A semi-structured instrument (questionnaire) was used for data collection. Data collected were analyzed using Statistical Package for Social Science (SPSS) version 21 with levels of significance set at 0.05.

The findings of this study revealed that mean age of respondents was 25.80 ± 8.585 ranging between the ages of 23-38years. Findings showed that there were more male respondents (88.3%) than there were female respondents (2.2%), indicating that majority of out-of-school youth at the motor parks are male. Prevalence of smoking among respondents was average at 56.2%. It was revealed that the rate of smoking was highest among respondents who initiated smoking at age 25 years old (13.94 ± 4.28) at 69.7%. It was also found that respondents’ perceived susceptibility to effect of smoking on health was very low at 15 point rating scale (4.57 ± 2.38).

Also findings shows that respondents’ perceived severity/seriousness of the effect of smoking on health was very low at 15 point rating scale (5.18 ± 2.50) and that respondents’ perceived benefit of quitting smoking was below average at 15 point rating scale (6.11 ± 3.06). Findings revealed that there was significant difference in the level of smoking prevalence across the age of respondents (df = 16; F = 6.448; P < 0.05). Result showed that there is a significant association between prevalence of smoking and health risk perception of respondents (df = 3; r = 0.432; P < 0.05) and that there is no significant association between prevalence of smoking and health risk knowledge of respondents (df = 1; r = 0.089; P = 0.301).

This study concluded that out-of-school youths’ low health risk perception increased their smoking rate. The findings of this study suggest implementation of educational intervention towards improving out-of-school youths’ health risk perception of smoking.


Table Of Contents


Preliminary Page(s)

  • Content Page
  • Title page
  • Certification
  • Dedication
  • Acknowledgment
  • Abstract
  • Table of Contents
  • List of Tables
  • List of Figures
  • Abbreviations

Chapter One:

Introduction

  • 1.1 Background to the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the study
  • 1.4 Research Questions
  • 1.5 Justification for the Study
  • 1.6 Hypotheses
  • 1.7 Operational Definition of Terms

Chapter Two:

Review Of Literature

  • 2.1 Introduction
  • 2.2 Prevalence and Pattern of Tobacco Use
  • 2.3 Knowledge about smoking
  • 2.4 Attitude towards smoking
  • 2.5 Perception of smoking
  • 2.6 Theoretical Model
  • 2.7 Construct of the Health Belief Model used for this Study
  • 2.7.1 The modifying factors
  • 2.7.2 Individuals perceptions
  • 2.7.3 Likelihood of action
  • 2.7.4 Conceptual Model

Chapter Three:

Methodology

  • 3.1 Research Design
  • 3.2 Population
  • 3.3 Sample size and Sampling Technique
  • 3.4 Study Variable and Test of Hypotheses
  • 3.4.1 Study Variable
  • 3.4.2 Test of Hypotheses
  • 3.5 Instrument for data collection
  • 3.6 Validity and Reliability of Instrument
  • 3.6.1 Validity
  • 3.6.2 Reliability
  • 3.7 Method of Data collection for the study
  • 3.8 Ethical Consideration
  • 3.8.1 Informed consent
  • 3.8.2 Confidentiality
  • 3.8.3 Anonymity
  • 3.8.4 Right to withdraw
  • 3.8.5 Compensation
  • 3.8.6 Post Research Benefits
  • 3.9 Method of Data Analysis

Chapter Four:

Data Analysis, Results And Discussion Of Findings

  • 4.1 Demographic Characteristics
  • 4.2 Research Questions
  • 4.2.1 At what level is the prevalence of smoking among respondents?
  • 4.2.2 What is the pattern of smoking among respondents?
  • 4.2.3 Do respondents have a good health risk perception of smoking?
  • 4.3 Hypotheses Testing
  • 4.3.1 There will be no significant difference in level of smoking prevalence across the demographic characteristics of respondents.
  • 4.3.2 There will be no significant association between prevalence of smoking and health risk perception of respondents.
  • 4.3.3 There will be no significant association between prevalence of smoking and Health risk knowledge of respondents.

Chapter Five:

Summary, Conclusion And Recommendations

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendations
  • 5.4 Implication to Health Promotion and Education
  • 5.5 Limitations of the Study
  • References
  • Appendices

Chapter One


Introduction

1.1 Background to the Study

The impact of smoking and tobacco use on health cannot be over emphasized. Cigarette smoking remains a gigantic public health problem and is still regarded as one of the leading preventable causes of morbidity and mortality worldwide (Can, Topbas, Ozuna, Ozgun, Can & Yavuzyilmaz, 2009; Mpabulungi & Muula, 2004; Salawu, Danburam, Desalu, Olokoba, Agbo & Midala, 2009; World health Organisation, 2015). It is well-known that many smokers start before the age of 18 years, however, it is of great interest to know that the increasing trend in smoking prevalence amongst youths and the likelihood that many of these young people who begin to smoke at an early age, will continue to do so throughout adulthood (Adebiyi, Faseru, Sangowawa & Owoaje, 2010).

Although tobacco use has declined in many high income countries such as the United States and United Kingdom, it is increasing in many low and middle income countries (Boutayeb & Boutayeb, 2005; Warren, Jones, Eriksen & Asma, 2006) and in current situation, tobacco smoking is by far the most popular form of smoking and is practiced by over one billion people in the majority of all human societies (Akinpelu, 2015). Tobacco is the most common hazardous substance and this is aided by its legally availability, heavy promotion and wide consumption and has been revealed to be problematic including other forms of use other than cigarettes, which is on the rise among adolescents in many countries, and is likely to jeopardize progress in reducing chronic diseases and tobacco-related mortality (CDC, 2010; Warren et al., 2006).

The constant increase in the consumption of tobacco among adolescents is emerging as a complex and multidimensional problem (Soni & Raut, 2012). Melgosa (2006) rightly considers tobacco as a drug with the lowest risk, in the short term but one which takes away health and life from the greatest number of people in the long term.

Cigarette smoking is said to be responsible for over 25 diseases in humans some of which include: ischemic heart disease, chronic bronchitis and cancers of the lung, oral cavity, urinary bladder, pancreas, and larynx (Desalu, Olokoba, Danburam, Salawu & Issa, 2008). Over the past four decades, tobacco use has caused an estimated 12 million deaths in the world, including 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases and 94,000 infant deaths related to mothers smoking during pregnancy (WHO, 2009; Centers for Disease Control and Prevention, 2002; Ekrakene & Igeleke, 2010) and on average cigarette smokers lose about 15 years of their life (The global tobacco survey collaborative group, 2002; Raji, Abubakar, Oche & Kaoje, 2013).

It is estimated that number of deaths due to tobacco will increase from 3 million per year worldwide to 70 million per year by 2025 (Reddy & Arora, 2005; US Department of Health and Human Services, 2012). It has been said that adolescents are especially vulnerable to these effects and may be more likely than adults to develop an addiction to tobacco (Chakraborty, 2009). In addition, it has been predicted that if the pattern currently seen among youth continues, a lifetime of tobacco use would result in the deaths of 250 million children and young people alive today, most of them in developing countries (WHO, 2012).

Like other developing countries, the most susceptible age for initiating tobacco has been found between the ages of 15-24 years as evident in the study by Gboyega, Adesegun and Chikezie (2013) identifying youths as a major group involved in smoking over the last two decades, an age group where most are expected to be in school. Educational attainment is widely regarded as an important health risk factor because of how strongly it has been associated with health outcomes, health-related behaviors, and other risk factors (National Center for Health Statistics, 1999). For the past 30 years, smoking prevention programmes have been focused almost exclusively upon youth, mainly within the school setting (Backinger, 2003; Ekanem, 2008; Salawu, Danburam & Isa, 2010; Fawibe & Shittu, 2011; Hammond, 2005; Nwafor, Ibe & Aguwa, 2012; Odukoya, Odeyemi & Oyeyemi, 2013; Okagua, Opara & Alex-Hart, 2015) despite School dropouts being more likely to smoke heavily than students (Aloise-Young, Cruickshank & Chavez, 2002). In Nigeria, the prevalence of tobacco use among youth tends to be higher than among adults (Odukoya, Odeyemi, Oyeyemi & Updhyay, 2013).


1.2 Statement of the Problem

Smoking among youths has been on an increase worldwide (Pomara, Cassano, D’Errico, Bello, Romano & Riezzo et al, 2012) with values ranging from 721 million in 1980 to 967 million in 2012 (Marie, 2013). Studies have revealed that there has been a high increase in the prevalence rate of smoking among youth in sub-Saharan Africa (Shafey, Dolwick & Guindon, 2012) and Nigeria precisely (Drope, 2011; Yahya, Hammangabdo & Omotara, 2010), with statistics showing that youths form over 40% of the Nigerian population and 18% of the youths smoke, identifying youths as a major group involved in smoking over the last two decades (Gboyega, Adesegun & Chikezie, 2013).

Smokers’ low perception of the negative effects of their smoking behavior on their health also results in many of them being unwilling to quit smoking with most of them expressing a sense of invincibility to the hazards of smoking (Fawibe & Shittu, 2011). Studies have shown that individuals who perceive fewer risks and greater benefits of smoking are more susceptible to initiation (Song, Morrell, Cornell, Ramos, Biehl, Kropp & Halpern-Felsher, 2009). Literatures have shown that perceptions about health risks influence cigarette smoking among youths (Aryal, Petzold & Krettek, 2013; Mantler, 2013). Further studies have also shown that each day, more than 3,200 people under 18 smoke their first cigarette, and approximately 2,100 youth and young adults become daily smokers.

Furthermore, studies have indicated that as at 2012 it was noted that death as a result of non-communicable diseases (respiratory tract infection inclusive), accounted for 2.7 million deaths in sub-Saharan Africa with the inclusion of Nigeria as a result of smoking (WHO, 2000-2012). Also literature has shown that nearly 9 out of 10 lung cancers are caused by smoking and smokers today are much more likely to develop lung cancer than smokers were in 1964 (Siegel, Miller, Jemal, 2016). In Nigeria and worldwide smoking causes many types of cancer, including cancers of the throat, mouth, nasal cavity, esophagus, stomach, pancreas, kidney, bladder, and cervix, as well as acute myeloid leukemia (Jha, Ramasundarahettige & Landsman, 2013). Also studies still shows that 8 out of 10 COPD (Chronic Obstructive Pulmonary Disease) deaths are a result of smoking and currently, there is no cure for COPD (Madu, Matla, 2014).

In spite of the passage of the National Tobacco Control Bill by the National Assembly in Nigeria, a bill aimed at domesticating WHO Framework Convention on Tobacco Control (FCTC) to avert the unimaginable disaster associated with smoking many youth are still caught in the web of the act, thereby endangering their lives. It will therefore be of immense benefit to investigate patterns of smoking and health risk perception of out-of-school youths in selected motor parks in Oshodi local government area of Lagos state, Nigeria.


1.3 Objective of the Study

The general objective for this study is to assess the pattern of smoking among out-of-school youth and their health risk perception.

The specific objectives are to:

  1. Measure the level of smoking prevalence among respondents;
  2. Assess the pattern of smoking among respondents and
  3. Determine if respondents have a good health risk perception of smoking.

1.4 Research Questions

  1. At what level is the prevalence of smoking among respondents?
  2. What is the pattern of smoking among respondents?
  3. Do respondents have a good health risk perception of smoking?

1.5 Justification for the Study

Smoking harms nearly every organ of the body and gradually reduces quality of life (Abdulahi, 2014). Studies revealed the Nigerian population to be more inclined to smoking with majority of smokers being youths (Ogunmola, Adegboyega, Oluwafemi, 2015) indicating that Nigerian smokers are more likely to be predisposed to its health risks. Over 4.5 million adult Nigerians are tobacco addicts and about 5.4 million deaths occur yearly due to smoking compared to 3 million and 1 million deaths caused by AIDS and malaria respectively (Global Health Sector Strategy, 2011). The unavailability of the tar contents of the recent cigarette produced in Nigeria may also be another area of concern (Egbe, Petrerson & Mayer-Weitz, 2016). According to an Independent Tobacco Control Activist, Olusegun Owotomo, available statistics show that about 93 million sticks of cigarette are produced and consumed yearly in Nigeria which has led to respiratory infections among 150,000-300,000 children under the age of 18 months as a result of passive smoking.

With the trend of tobacco use seen among youth in Nigeria and studies indicating about half of all lifelong smokers will die prematurely, losing on average about 10 years of life (Gholamreza, Mostafa, Mahmoud, Hadi, Masoud & Atena, 2015). It is anticipated that a huge epidemic of tobacco-related diseases might occur and with the long term consequences of smoking on health (Melgosa, 2006). It is of great importance that its reduction should be upmost interest in public health promotion and education as not only the smokers but also non-smokers are predisposed to these hazardous effects. As there is neither a safe tobacco product, nor a safe level of tobacco use, the best way to prevent tobacco-related deaths is to avoid using it.

Studies conducted in Nigeria to examine smoking among youths are few, and these studies have concentrated on describing pattern of use among in-school youths in urban areas (Osungbade & Oshiname, 2013) leaving out-of-school youths unattended to.This study intends to describe the pattern of smoking and health risk perception amongst a set of youths who are more likely to be overlooked by program planners. The findings will give an insight to the current situation of out of school youth smoking habit with the result aimed at giving recommendations towards health program interventions that will reduce to the simplest minimum the smoking habits among out-of-school youths in Lagos, Nigeria. Also the results emanating from it would provide adequate guidance and a benchmark for program planners to include these set of youths in smoking prevention intervention programs in Nigeria. This will go a long way to improve the health of youths in Nigeria and by extension people in Sub-Sahara Africa.


1.6 Hypotheses

H1: There is a significant difference in level of smoking prevalence across the demographic characteristics of respondents.

H2: There is a significant association between prevalence of smoking and health risk perception of respondents.

H3: There is a significant association between prevalence of smoking and health risk knowledge of respondents.


1.7 Operational Definition of Terms

Smoking:

This is one of the most common forms of recreational drug use.

Out-of-school youths:

They are described as several groups of young people, those who have dropped out of school, those who never attended school, or those who participate in non-formal school programs (August, Claudia, William, Erin, Rosemary & Jane). These youths are a diverse group who may have completed elementary school (but lack basic skills to progress to high school or vocational training), dropped out or never started school. Those who drop out of school may fail to acquire fundamentals of basic education and life skills (Fatoye, 2013).


Chapter Five


Summary, Conclusion And Recommendations

5.1 Summary

The aim of this study was to assess the patterns of smoking among out-of-school youth and also their health risk perception, to determine if they feel susceptible to the health hazardous effects of smoking, if they feel these effects are serious or severe and also the benefits they believe comes with quitting smoking. There were one hundred and thirty seven (137) respondents for this study, comprising of majorly male participants (88.3%), there were 91 non-married respondents coupled with majority being of Yoruba ethnicity. Findings revealed that 87.6% of the respondents are smokers.

Major findings of this study indicated that there was a 56.7% prevalence of smoking among respondents, this were individual with smoking rate above 50% which can be denoted as regular smokers who have developed an addiction, this was similar to the works of Ebenezer et al. (2013) who deduced that majority of smokers were male and had a prevalence of 71%, also, Decio et al. (2016) had a similar finding where prevalence of cigarette smoking was given at 51% among youth, however, a lower prevalence was determined by Margherita et al. (2013) and Awopeju et al. (2013) they determined prevalence of smoking among school students to be 38.2% and 17.9% respectively, showing a lower prevalence of smoking among school students compared to out-of school youth as they are more prone to peer influence than youth in a controlled environment like the school (Adebiyi et al. 2010).

Findings on the pattern of smoking among respondents revealed respondents had their age of initiation to smoking at early as 15 years old which might be attributed to their non enrollement in school as said by Kotwal et al. (2005) who stated that “Early initial consumption of tobacco has been regarded as a serious health problem not only because it is believed to open the way for subsequent drug use, but also because of its linkage to reduced school involvement”. It was also found out that older respondents had the highest rate of smoking, indicating that rate of smoking among respondents increases with their age and the more years respondents spent smoking the higher the rate of smoking, indicating that higher smoking rate was found among responds with the most number of years spent smoking. It was also gathered that female respondents had a higher smoking rate than their male counterparts, a finding similar to that of Kwaku et al. (2015) where more female were found to smoke more than males, however contrary to Ebenezer et al. (2013) and Ali et al. (2010) where more male were found smoking.

Health risk perceptions of respondents were measured; it was revealed that respondents had a very low (4.57 ± 2.38) level of susceptibility, very low (5.18 ± 2.50) level of severity and seriousness of the effects and an average level (6.11 ± 3.06) of benefits of quitting smoking, it was gathered that they feel invincible to the health effects of smoking and other smoking related illnesses and this has been found to influence smoking (Aryal et al., 2013) this was similar to findings of Fawibe et al. (2011) where it was found that smokers had low perception of the negative effects of their smoking behavior on their health and this has led to many of them being unwilling to quit smoking with most of them expressing a sense of invincibility to the hazards of smoking, Song et al. (2009) also highlighted that smokers’ low perceived susceptibly puts them at risk of initiation. Also, Omar et al. (2016) found that perception of the severity of the smoking-related illness among Iraqi smokers was low.

It was also found out that respondents’ health risk perception has an influence of the smoking rate and prevalence (df = 3; r = 0.432; P < 0.05) with an R Square value of 0.187, however their low level of health risk perception can led to the high rate and high prevalence of smoking among these group of people, this link was evident in the study by Chritiani et al. (2008), Omar et al. (2016) and Umesh et al. (2013).


5.2 Conclusion

Evidences have shown the impact of smoking on health especially with smoking being attributed to over 25 diseases in human (Can et al., 2009; Desalu et al., 2008; Mpabulungi et al., 2004). Smoking prevalence among out-of-school youth has been revealed to be high putting them at risk of these diseases, this however was not attributed to their lack of knowledge as there seem not to be a significant relationship (df = 1; r = 0.089; P = 0.301). However, this study have shown that out-of-school youths’ health risk perception has an influence of their quitting of smoking, it must be said that their health risk perception is very low and this has led to an increase in the smoking rate and also smoking prevalence among this community of people. It was also gathered that older youths and youths with more years spent smoking are higher smoker putting them at higher risk of smoking related illnesses.


5.3 Recommendations

Findings from this study have informed the following recommendations:

  1. There is need for implementation of educational intervention towards improving out-of-school youths’ health risk perception of smoking; this has been proven to influence quitting or reduction in the rate of smoking among these individuals.
  2. It is also important that accessibility to cigarettes and other substances need to be controlled by relevant bodies especially in motor parks and other cluster areas of out-of-school youths.

5.4 Implication to Health Promotion and Education

Smoking a public health behaviour of concern has it has been shown to predict many diseases with high morbidity and mortality rates, it is in light of this that there is need to design an intervention towards reduction of the prevalence of smoking, efforts have been made towards this by relevant bodies but none has had a well-documented positive results. This study has brought to light the influence of health risk perception on reduction and quitting smoking among out-of-school youths, this has provided an open window into the reduction of smoking in the nation. It is as a result of this that health promotion intervention tailored towards reduction of smoking should be based on the goal of improving health risk perception of individuals which will in turn help in modifying their behaviour by reducing the prevalence of smoking.


5.5 Limitations of the Study

This study is not without limitations. Firstly, respondents for this study were not willing to partake in the study without compensation. Therefore, the compensation given might have influence or affected their answers. Secondly, results based on ethnicity may be favorable to the Yorubas since they comprise of the larger ethnic proportion in the study location. Thirdly, this study was carried out in motor packs in Oshodi local government area of Lagos state, therefore the result cannot be generalize for Lagos state in total and Nigeria as a whole given the limited area covered.


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