Effectiveness of Planned Health Teaching on Awareness of Ill Effects of Tobacco Consumption and its Impact on Quality of Life among the adults of selected Slum Area, Pune City

Mrs. Jaya John Varghese

Associate Professor, Sadhu Vaswani College of Nursing, 10- 10/1 Koregaon Road, Pune- 411001

*Corresponding Author Email: jaya.varghese@yahoo.co.in

ABSTRACT:

Background: As early as I B.C. tobacco is used for religious and medicinal practices. Later it is proved that continuous use of tobacco in any form has ill effect and direct impact on epidemic and lethal effect on human health. 1985 lung cancer become first killer disease. United States centre’s for disease control andprevention describes tobacco use as the single most important preventable risk to human health in developed countries and an important cause of premature death.

Objectives: To evaluate the effectiveness of Planned Health teaching on ill effects of tobacco consumption and its impact on Quality of life and to correlate with the selected socio- demographic variables.

Design: quasi experimental one group per test post test design was adopted for the study

Setting: Urban slum community area of Tadiwala Road, Pune.

Participants : 60 adults were selected by simple random sampling technique

Methods: All participants were given a questionnaire related to demographic data, two semi structured questionnaire regarding the knowledge about ill effects of tobacco consumption and its impact on quality of life. After obtaining the informed consent pre test done, which took 30 minutes, planned health teaching done. Post test done with the same tool after 7 days of the intervention,

Results: The findings shows that the pre test score of awareness of ill effects of tobacco consumption ,65% of them are aware of availability and forms of tobacco in use but the ill effects and its impact on quality of life was poor, 30% had average knowledge and 5% had good Knowledge. Comparison of the knowledge score of pre test and post test after the planned teaching shows significant increase in the knowledge regarding ill effects of tobacco consumption (P < 0.05). Comparison of the knowledge score of pre test and post test after the planned teaching shows highly significant increase in the knowledge regarding ill effects of tobacco consumption on quality of life. (P < 0.001), There was a positive relationship between knowledge level and the demographic variables such as age, gender, marital status, education, occupation, economic status (P < 0.01).

Conclusion: After the awareness program the community people got adequate knowledge about ill effects of tobacco chewing. Ten percentage of the study population decided to get rid of this habit of use of mishree Which is most popularly used by females.

KEY WORDS: Awareness, ill effects, tobacco consumption, impact, quality of life.

INTRODUCTION:

As early as 1 B.C American Indians began using tobacco in many ways such as in religious and medicinal practices. The use of tobacco exploded during World war I (1914-1918), where cigarettes were called “ soldier’s smoke”. During World War II (1939-1945) Tobacco companies sent millions of cigarettes to the soldiers free, and when these soldiers came home the companies had a steady stream of loyal customers.¹

The first global adult tobacco survey reported that 274.9 million Indians consume tobacco. Nearly 0.9million tobacco related deaths occur in India annually as compared to 5.5 million worldwide (WHO)¹

In India the use of tobacco is more varied than in the most of other countries only 20% of total tobacco consumption is in the form of cigarettes. A common alternative is the bidi (hand rolled, unfiltered tobacco),which accounts 40%.other forms of tobacco are Hookah (piped smoke), pan masala or guthaka (chewing tobacco with areca nut), chutta (a clamp of tobacco smoked with the lighted end inside mouth and mishri (powdered tobacco on the gums as denitrifies. It is estimated that in India 65% of all men and 33% of all women use some form of tobacco.²

LITERATURE REVIEW:

Worldwide every year, tobacco consumption causes 3 million premature deaths and 300 million will die of smoking related causes later in life (WHO).³

Smelter Bare (2004) states that tobacco smoke thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths. Smoking is strongly associated with cancer of lungs, head and neck, esophagus, pancreas, cervix and bladder. Tobacco may act synergistically with other substances such as alcohol to promote cancer development. Chewing tobacco is associated with cancer of oral cavity and primarily occurs in men younger than 40 years of age.⁴

Gowri. N (2007) conducted a quasi experimental study for assessing the effectiveness of planned teaching program on knowledge attitude and practice regarding hazards of tobacco consumption in rural health setting of south India. One group pre-test post test design is used on 60 participants. Structured teaching program is used as intervention and post test was done after one month of the intervention. The major findings show significant in knowledge and attitude level and significant reduction in the practice of tobacco consumption. There was a positive relationship between knowledge and attitude level of the subjects and the demographic variables such as age, gender, marital status, education, occupation, economic status, religion and source of information⁵

United States centers for disease control and prevention describes tobacco use as the single most important preventable risk to human health in developed countries and an important cause of premature death.⁶

Lisa Hitchen (2008) conducted a study in john Hopkins research institute and the regional cancer centre in south India, regarding “smoking ban may reduce violent incidence” the results shows that some brand gutka have a cancer index of 13.75, Such products are banned in Europe and America .when tobacco products are kept in mouth, even if one does to swallow the juice, a great portion of the toxins get absorbed through the buccal mucosa.⁷

Rajan K (2010)states in her article “smokeless tobacco can be fatal” that smokeless tobacco users experience45% reduction in oral mucosal blood flow while chewing and the oral cancer risk for these users is about four times greater than non-users⁸.

Vaishali Sharma (2011) conducted a descriptive study on prevalence of oral cancer for National institute of public health,it has been revealed that 86% of world’s oral cancer cases occur in India and 90% of these are due to chewing tobacco. The study also came to the conclusion that the consumption is further facilitated by tobacco been easily available and the poor monitoring of restrictions on who purchases it. A significant proportion of these individuals intent only to experiment but land up in getting dependent and addicted before they even realize it. Making them prone to a variety of serious physical and psychological disorders. ⁹

World health assembly created World NO Tobacco Day in 1987 to draw global attention to the tobacco epidemic and lethal effects.¹

Bimla Kapoor (2006) states that tobacco use is associated with low esteem, anxiety and depression. It is also linked with poor school performance, truancy, low aspiration for future success and early school dropouts. Those who get used to easy and instant gratification are not generally left with the motivation to consistently work over something for a long period. Tobacco impairs mental health and decreases academic performances.¹⁰

Mc Dermott L, Dobson A, Owen N. (2008) conducted a 7-year prospective analysis on Smoking reduction and cessation among young adult women: Smoking by women is causally associated with an increased risk of developing and dying from myriad diseases, including many cancers, cardiovascular disease, and COPD, as well as increased risk of adverse reproductive health¹¹.

Women and the Tobacco Epidemic Women who smoke are more likely than non-smokers to experience primary and secondary infertility and delays in conceiving. Age-adjusted lung cancer mortality rates among women in the United States have increased approximately800% since 1950; by 1987, lung cancer had surpassed breast cancer to become the leading cause of cancer death among women in that country. During the latter half of the 20th century, tobacco- related diseases became epidemic among women in the industrialized world, following women’s adoption of cigarette smoking earlier in the century. Tobacco-caused diseases will threaten women in developing countries in the21st century unless sustained efforts are undertaken to curb tobacco use. Preventing an epidemic of tobacco-related diseases among women in the developing world presents¹²

Broms U, Korhonen T, Kaprio J (2008). Smoking reduction predicts cessation: longitudinal evidence from the Finnish adult twin cohort study shows risk of CHD is markedly reduced (by 25% to 50%) within one to two years of smoking cessation.¹³

Rani. M, Banu. S, Jha. P (2003) conducted a study on prevalence and predictors of smoking and chewing tobacco in a National cross sectional household survey. Adults aged 15 years and above From 91196 households 315598 participants were, involved in the study. The results shows that 30 % of the population of 15years and above (47% of men and 14% of women) either smoked or chewed tobacco .however the prevalence may be underestimated by 11% of men and 1.55 of women .The finding of the survey highlight that an agenda to improve health outcomes among the low economic status in India must include effective interventions to control tobacco use.¹⁴

Manual of smoking and children, Geneva,(1982)wrote on patterns of smoking among children in India, reported that despite the facts many young people start smoking during adolescence, largely because they believe that smoking will boost their social acceptability and image as their desire to appear like adults.¹⁵

To get the depth of the problem we conducted a survey on consumption of tobacco and its ill effect on quality of life in one of the urban slum area which accommodates approximately 25000 populations. it showed 62% of the population is not having adequate knowledge of ill effects of tobacco consumption. So the study of effectiveness of planed health teaching on awareness of ill effects of tobacco consumption and its impact on quality of life among the adults where planned to conduct.

STATEMENT OF PROBLEM:

A study to assess the effectiveness of planned health teaching on awareness of ill effects of tobacco consumption and its impact on quality of life among the adults of selected slum area, Pune city.

OBJECTIVES OF THE STUDY:

1. To assess the existing knowledge on ill effects of tobacco consumption and its impact on Quality of life

2. To evaluate the effectiveness of Planned Health teaching on ill effects of tobacco consumption and its impact on Quality of life.

3. To compare the on knowledge on ill effects of tobacco consumption and its impact on Quality of life with selected demographic variables.

ASSUMPTIONS:

The study assumes that:

· Tobacco Ill effects are a common habit among adults.

· Tobacco consumption has Ill effects on human heath

· Habitual consumption of tobacco is a leading cause of lung and oral cancers

DELIMITATIONS:

The study is limited to,

1. Study setting selected was urban slum community of Tadiwala road in Pune City

2. Adults who participated in the survey

3. Adults who were willing to participate in the study

MATERIALS AND METHODS:

Research approach:

This study was done as two phases. First phase for finding the intensity of the problem descriptive survey approach was used and in the second phase evaluative approach was used for finding the effectiveness of planned health teaching on ill effects of tobacco consumption and its impact on Quality of life.

Research design:

The research design selected for the present study was quasi experimental one group per test post test design. The present study attempts to evaluate the effect of planned teaching on the knowledge scores of ill effects of tobacco consumption and its impact on quality of life. Therefore one group pre- test post- test design was found to be an appropriate research design.

Variables:

Dependent variable: Knowledge on ill effects of tobacco consumption and its impact on Quality of life

Independent variable: Planned health teaching

Associate variables: Selected demographic factors

Research setting:

The study was conducted in urban slum community area of Lokseva Vashat Tadiwala Road, Pune city.

Population:

The population for the present study is all the adults residing in Lokseva Vashat Tadiwala Road, Pune city.

Sample:

The sample consisted of 60 adults of urban slum community area of Tadiwala Road, Pune city

Sampling technique:

Simple random sampling technique was used to select the samples for the study

Development of tool:

A structured questionnaire to collect demographic data, knowledge of tobacco consumption and it’s ill effects on health and rating scale for assessing the impact of tobacco consumption on health and quality of life lifestyle was prepared with the help of review of literature, personal experience and discussion with experts.

Description of the tool:

SECTION I: Questionnaire to assess demographic and socio-economic information

SECTION II

· Questionnaire to assess the knowledge regarding various ill effects of tobacco on health

· Questionnaire to assess the knowledge regarding impact of tobacco consumption on quality of life

· Checklist to assess the impact of tobacco consumption on quality of life

Tools are prepared in English and translated into Marathi,

Section I: demographic data: It contains items for obtaining information regarding as age, gender, marital status, education, occupation, monthly income type of family, number of members in the family, number of earning members in the family, family income. Age at which you started consuming tobacco, reason for initial consumption of tobacco your feeling on tobacco consumption, your feeling on not to consuming tobacco number of packets you consume daily

Section II A: Semi structured questionnaire. It consisted of 25 items on knowledge regarding consumption of tobacco and its ill effects .Each items consists of four options and ,scores one for correct answer and zero for wrong answer. The maximum score is 25 and the minimum score is zero

The scoring key is as follows:

0-12	Poor
13-19	Average
20-25	Good

Section II B: Rating scale on impact of tobacco consumption on Quality of life .

It consists of 30 items. Each item has four sub points which has grade rank, of one to four. Maximum score was 120 and minimum score was 30

The scoring key is as follows:

30-45	Poor
46-75	Average
76-120	Good

Data collection Procedure:

The data collection process had begun from 1.06.12 to 30.06.12. Prior permission from the administration of community leader was obtained. After obtaining the informed consent from the participant, pre test done with a semi structured questionnaire which took 30 minutes and intervention, planned health teaching done. Post test done with the same tool after 7 days of the intervention.

Plan for data analysis:

Data analysis was planned to include descriptive and inferential statistics in term of frequency, percentage, “t” test and co-efficient of co-relation are used, presented in the form of tables and graphs, based on the objectives and hypothesis to be tested.

Ø Demographic data of the samples were described by frequency and percentage distribution.

Ø Effectiveness of Planned Health teaching on ill effects of tobacco consumption and its impact on Quality of life. Were analyzed by “t” test

Ø Impact of tobacco consumption on Quality of life were analyzed by “t” test and co-efficient of co-relation “r” value.

Ø Comparison of knowledge on ill effects of tobacco consumption and its impact on Quality of life with selected demographic variables were analyzed by co-efficient of co-relation “r” value ‘

RESULTS:

Section I. Description of demographic variables.

Majority of the participants were in the age group of 46-50 (26%) and 24-29 (20%)18-24 (13%). Almost equal participation was shown in gender distribution, male (47%) and females (53%). Ninety three percentage of the participants are educated, primary level (50%)and secondary level (43%)and only 7% were illiterate. Majority (80%) of them were married and 47% of them were housewife and 37% is private employed .Majority of them are staying in nuclear family.

Section II.A Knowledge of ill effects of tobacco consumption:

In the pre test score of awareness of ill effects of tobacco consumption 65% of them are aware of availability and forms of tobacco in use but the ill effects and its impact on quality of life was poor, 30% had average knowledge and 5% had good knowledge.

Comparison of the knowledge score of pre test and post test of the sample shows that after the planned teaching there was significant increase in the knowledge regarding ill effects of tobacco consumption on quality of life. (P < 0.05).

Section II. B Knowledge of ill effects of tobacco consumption on quality of life

Section III. Co-relation of knowledge with selected demographic variables

There was a positive relationship between knowledge level of the subjects and the demographic variables such as age, gender, marital status, education, occupation, economic status (P < 0.01). There were no significant correlation between test scores and type of family, number of members in the family, number of earning members in the family. Age at which you started consuming tobacco, reason for initial consumption of tobacco.

DISSCUSSION:

Rani. M, Banu. S, Jha. P (2003) conducted a study on prevalence and predictors of smoking and chewing tobacco in a National cross sectional household survey. Adults aged 15 years and above From 91196 households 315598 participants were involved in the study. The results shows that 30 % of the population of 15years and above (47% of men and 14% of women) either smoked or chewed tobacco .however the prevalence may be underestimated by 11% of men and 1.55 of women .The finding of the survey highlight that an agenda to improve health outcomes among the lo economic status in India must include effective interventions to control tobacco use ¹⁴

In the present study , test score of awareness of ill effects of tobacco consumption also shows that 65% of them are aware of availability and forms of tobacco in use but the ill effects and its impact on quality of life was poor, 30% had average knowledge and 5% had good knowledge regarding availability of tobacco products and its ill effects on consumption Comparison of the knowledge score of pre test and post test of the sample shows that after the planned teaching there was significant increase in the knowledge regarding ill effects of tobacco consumption on quality of life. (P < 0.0001).

Present study also shows positive relationship between knowledge level of the subjects and the demographic variables such as age, gender, marital status, education, occupation, economic status (P < 0.01).There were no significant correlation between test scores and type of family, number of members in the family, number of earning members in the family. Age at which you started consuming tobacco, reason for initial consumption of tobacco.

CONCLUSION:

§ One of the alarming finding was that 53% of the tobacco chewing were females where as 46.66% are male. Prolonged use or habit of using tobacco have been proven ill effect on pregnancy and foetal wellbeing

§ Comparison of the knowledge score of pre test and post test of the sample shows that after the planned teaching there was significant increase in the knowledge regarding ill effects of tobacco consumption on quality of life.

§ After the awareness programthe community people got adequate knowledge about ill effects of tobacco chewing.ten percentage of the study population decided to get rid of this habit of smoking and use of mishree Which is most popularly used by the females.

RECOMMENDATIONS:

· Similar study can be done in different settings such as industries,college .

· A comparative study can be done on rural and urban population

· Astudy can be conducted with large samples to generalize the findings

REFERENCES:

1. Lifeline, May 2010,VOl8:7-9.WHO SEARO, New Delhi, India. (Department of Epidemiology and Biostatistics, Chittaranjan National Cancer Institute, Kolkata

2. The public health impact of tobacco current science Nursing journal of India Vol. LXXXIII No 6 June 2002

3. India www.to defeat tobacco

4. Smelter Bare (2004) “Medical Surgical Nursing “ 10 th edition, Elsevier’s Publications.

5. Gwori N. (2010) “Effective structured teaching program on knowledge, attitude and practices regarding tobacco consumption in rural health settings.” Nightingale’s Nursing Times, Vol. 6 , No.2

6. Stanhope Lancaster (2002) “Foundations of Community Health Nursing “ 1 st edition, St. Louis, Mosby

7. Lisa Hitchen (2008) “smoking ban may reduce violent incidence” Nursing times vol.104 No.31

8. Rajan K (2010) “smokeless tobacco can be fatal” Nightingale’s Nursing Times, Vol .6,No.7

9. The public health impact of tobacco current science ,Nursing journal of India, Vol LXXXIII, No. 6 June 2002

10. Bhimla Kapoor (2004) Textbook of Psychiatric Nursing ,Jaypee Publications

11. McDermott L, Dobson A, Owen N. Smoking reduction and cessation among young adult women: a 7-year prospective analysis. Nicotine and tobacco research: official journal of the Society for Research on Nicotine and Tobacco. 2008; 10(9):1457–66.

12. www.who.int/tobacco/.../en_tfi_gender_women_impact_tobacco_use_

13. Broms U, Korhonen T, Kaprio J. Smoking reduction predicts cessation: longitudinal evidence from the Finnish adult twin cohort. Nicotine and tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2008; 10(3):423–7.

14. www.Ijjasp.nova.edu/articles/volume 9,no 1

15. Patterns of smoking among children in India. Manual of smoking and children, Geneva, 1982.