INTRODUCTION:

Cigarette smoking in children and adolescents is reaching pandemic levels. The World Bank has reported that nearly 82,000–99,000 children and adolescents all over the world begin smoking every day. About half of them would continue to smoke to adulthood and half of the adult smokers are expected to die prematurely due to smoking related diseases. If current smoking trends continue, tobacco smoking will kill nearly 250 million of today's children. Adolescence is a developmental period where behaviour is influenced by emotional and social functions. An adolescent once initiated into tobacco use will continue using it lifelong, with very low quit rates. The rate of adolescent addiction to cigarettes is high in India. Nearly one in 10 adolescents in the age group of 13–15 years have ever smoked cigarettes.¹ Frequently, smoking initiation occurs during adolescence and continues into adulthood. Given the early age of initiation of smoking, prevention initiatives should target youth with particular emphasis on school-based prevention education.^2,3In addition, the current generation of children in low and middle-income countries will be the largest population in history to make transition to adolescence and adulthood.^4,5,6,7 The nexus between tobacco consumption and poverty is well-documented; however, the tobacco control measures are uniformly applied, without due consideration for the high-risk target group. In India, nearly 300 million people live in extreme poverty.⁹About 28.6% of the population consume tobacco.¹⁰Health care costs involve not only direct medical costs but also indirect morbidity and mortality costs.¹¹ India is a low- and middle-income country (LMIC).Government expenditure on health has continuously declined and public spending on health is 1.15% of gross domestic product.^12,13 In India, socio-economic and health inequalities are rampant.¹⁴Tobacco-related diseases are a cause and consequence of poverty. It is not only merely a social and cultural problem but it is also multifaceted and encompasses biomedical, economic, and geopolitical.¹⁵ Tobacco use in India is projected to have devastating consequences.

NEED OF THE STUDY:

Around 80% of the 1.1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death the heaviest. Such statistics are increasing day by day with the increasing use of cigarette smoking, so there is a prime need to study the level of awareness adolescents have regarding the ill effects of smoking. These type of data will help us to find out the current scenario of adolescents knowledge about this issue.¹⁶Cigarette smoking harms the health, the treasury, and the spirit of India. Every year, more than 932600 of its people are killed by cigarette-caused disease. Still, more than 625000 children (10-14 years old) and 89486000 adults (15+ years old) continue to use tobacco each day. Complacency in the face of the cigarette smoking epidemic insulates the cigarette industry in India and ensures that smoking death toll will grow every year. Tobacco control advocates must reach out to other communities and resources to strengthen their efforts and create change.¹⁷ The above stated facts and information indicates that the regular studies are conducted on the issue and to reveal about the present scenario of smoking and its knowledge in adolescents regarding ill effects the researcher wants to conduct study on this phenomenon.

PROBLEM STATEMENT:

A descriptive study to assess the knowledge regarding the ill effects of smoking among adolescents in selected school, Jalandhar, Punjab

OBJECTIVES:

1. To assess the knowledge regarding ill effects of smoking among the adolescents.

2. To find out the association of knowledge with socio- demographic variables.

OPERATIONAL DEFINITIONS:

ASSESS: It refers to gathering information regarding knowledge of smoking among adolescents.

KNOWLEDGE:

It refers to the awareness of adolescents regarding smoking

ADOLESCENTS:

Adolescents refers to the age group between 13-19 years.

ASSUMPTION:

Adolescents will have knowledge with regard to the ill effects of smoking.

REVIEW OF LITERATURE:

In this study the review of literature is divided into following parts:

1 Smoking and its prevalence

2 Smoking and adolescence

3 Smoking and its ill effects on health.

MATERIAL AND METHODS:

A descriptive exploratory design and analysis and interpretation of data done by using descriptive statistics.

Subjects:

The sample for the present study are adolescents of N. C. Model school Jalandhar Cantt.sample of the study selected by using Non Probability purposive sampling technique Sample Size constitutes 100 adolescents in N.C. Model school area of Jalandhar Cantt. In this study, independent variables are Age in year, Gender, religion, Type of family, Area of residence, Educational status of adolescent, Father’s occupation, Mother’s occupation, Monthly income of the family, Family history of smoking, Source of information regarding ill effects of smoking and prevention and dependent variables refers to assess the knowledge regarding ill effects of smoking among adolescents. The sample selection was based on the following inclusion and exclusion criteria. Inclusion Criteria were Adolescent of 13-19 years, who are willing to participate, who are available at the time of data collection. Exclusion Criteria were Adolescents who are not willing to participate, those who are available at the time of data collection, below 12years of age. To conduct research study in N.C. Model Sr Sec School Jalandhar Cantt, a formal written permission letter is prepared and sign of the principal is taken on the permission letter for research study. The data gathering process was 20 days. Data were collected from 100 samples who met the inclusion criteria of the study. In this study knowledge regarding ill effects of smoking and its prevention assessed with the help of structured knowledge questionnaires provided to adolescents (school children) who were available at the time of data collection.

Selection and Development of Tool:

Data collection tools are the procedure or instruments used by the researcher to observe or measure the key variables in the researcher to observe or measure the key variables in the research study.

Description of the tool:

The tool consists of three sections:

Section A: Socio-demographic variable data:

It consists of selected socio-demographic variables such as Age in year, Gender, religion, Type of family, Area of residence, Educational status of adolescent, Father’s occupation, Mother’s occupation, Monthly income of the family, Family history of smoking, Source of information regarding ill effects of smoking and prevention on students.

Section B: Self structured knowledge questionnaire.

It consists of self structured knowledge questionnaire to assess the knowledge regarding ill effects of smoking and its prevention.

Validity of Tool:

Content validity of the tool was established by experts. The experts requested to give their opinion and suggestions regarding the relevance of the tool for the further modification to improve the clarity and content of the items. Section A consists of 11items. After considering the experts and guide suggestion modifications, the tool was finalized and Section A consisted of 11 items of socio-demographic data, Section B were consisted of 25 structured knowledge questionnaire regarding ill effects of smoking and its prevention.

RESULTS ANALYSIS AND INTERPRETATION:

SECTION 1 Frequency and percentage distribution of socio-demographic variables.

In this section demographic variables of the respondents has been displayed to show frequency distribution of the various attributes of demographic variables.

· Distribution of respondents according to their ages shows that most of respondentsi. e 53% are between the age group of 13-16 years and 47% are between 16-19 years.

· Distribution of respondentsaccording to theirsex shows that most of the respondents are male i.e. 80% and 20% are females.

· Distribution of respondents according to their religion shows that most of respondents i.e 83% are hindu,7% Christian,7%sikh, others 3%and 0% belong to Muslims.

· Distribution of respondents according to their type of family shows that the most of respondents i.e 50% belong to nuclear family,35%belong to joint family, 11% belong tosingle parent family and 4%extended family.

· Distribution of respondents according to their area of residence shows that most of the respondentsi. e 38% belongs to rural area and 62% belongs to urban area of residence.

· Distribution of respondents according to their education level shows that most of respondents i.e. 37% are in class 12th, 28% in 11th, 20% in 9th and 15% in 10th.

· Distribution of respondents according to their father’s occupation shows that most of the respondent’s fathers i.e 66% are self employed,16% are daily wage earner, 12% are government employees and 6% are unemployed.

· Distribution of respondents according to their mother’s occupation shows that most of the respondent’s mothers i.e.61% are home maker, 15% are daily wage earner,15% are self employed and 9% are government employee.

· Distribution of respondents according to their monthly income of the family shows that most of respondents family income i.e57% is between 5000-10000 rs,16% is between10001-15000rs,16% is between 15001-20000rs and11% is above 20000rs.

· Distribution of respondents according to their family history of smoking shows that the most of the respondent’s i.e.80% have no family history of smoking and 20% have family history of smoking. Distribution of respondents according to their source of information regarding ill effects of smoking and prevention shows that most of the respondents i.e 50%get information from mass media,25% gets information from newspaper,18%gets information from parents/friends /relatives and 7% gets information from magazines.

SECTION 2: Assess the level of knowledge among adolescents regarding ill effects of smoking and its prevention

Table: 1 This section deals with assessment of knowledge among adolescents regarding ill effects of smoking and its prevention. N=100

Sr No.	Grade	Score	Frequency	%
1.	Poor Knowledge	0-8	25	25%
2.	Average Knowledge	9-16	72	72%
3.	Good Knowledge	17-25	3	3%

SECTION 3:

Association between the knowledge of adolescents in relation to selected socio-demographic variables.

Knowledge score: Of 100 samples: Degree of Freedom: Df = (r-1) (c-1)

Median = N+1= 50.5th observation

2Median for knowledge score =1

Fig 1. Pie Chart Depicts the Level of Knowledge among Adolescents Regarding the Ill Effects of Smoking which is 25% Have Poor Knowledge,72% Have Average And 3% Have Good Knowledge

Table-2 depicts the association of the knowledge of adolescents with the selected socio-demographical variables

Sr. No	Variables	Scores which fall at median and above	Scores which fall below the median	Total	X²	DF	Level of significance
1.	Age				55.61	1	S^*
	A	31	22	53
	B	8	39	47
	Total	39	61	100
2.	Sex				0.04	2	NS
	A	30	50	80
	B	9	11	20
	C	0	0	0
	Total	39	61	100
3.	Religion				1.44	4	NS
	A	29	54	83
	B	4	3	7
	C	0	0	0
	D	4	3	7
	E	2	1	3
	Total	39	61	100
4.	Type of Family				6.26	3	NS
	A	20	15	35
	B	15	35	50
	C	2	2	4
	D	2	9	11
	Total	39	61	100
5.	Area of Residence				22.3	1	S^*
	A	26	12	38
	B	13	49	62
	TOTAL	39	61	100
6.	Educational Status				1.31	3	NS
	A	16	4	20
	B	10	5	15
	C	8	20	28
	D	5	32	37
	Total	39	61	100
7.	Father’s Occupation				1.86	3	NS
	A	01	5	6
	B	7	9	16
	C	26	40	66
	D	5	7	12
	Total	39	61	100
8.	Mother’s Occupation
	A	24	37	61	1.83	3	NS
	B	6	9	15
	C	7	8	15
	D	2	7	9
	Total	39	61	100
9.	Monthly Income				0.95	3	NS
	A	21	36	57
	B	8	8	16
	C	6	10	16
	D	4	7	11
	Total	39	61	100
10.	Family History				0.37	1	NS
	A	9	11	20
	B	30	50	80
	TOTAL	39	61	100
11.	Source of Information				0.34	3	NS
	A	10	15	25
	B	7	11	18
	C	20	30	50
	D	2	5	7
	TOTAL	39	61	100

Table No. 2 shows the association between knowledge of adolescents with selected socio-demographic variables (age, gender, religion, type of family, area of residence, education, father’s occupation, mother’s occupation, monthly income of the family, family history of smoking, source of information).

The obtained chi square for the variable sex of adolescents (X2=0.04), religion (X2=1.44), type of family (X2=6.26), educational status (X2=1.31), father’s occupation (X2=1.86), mother’s occupation (X2=1.83), monthly income (X2=0.97), family history (X2=0.37), source of information (X2=0.34) was less than the table value at 0.05 level of significance .

DISCUSSION:

1. To assess the knowledge regarding the ill effects of smoking among the adolescents of selected schools of Jalandhar Cantt., Punjab.

The findings of the present study showed that out of 100 samples of adolescents 25(25%) had poor knowledge regarding the ill effects of smoking, 72(72%) had average knowledge regarding the ill effects of smoking whereas 3(3%) had good knowledge regarding the ill effects of smoking.Similar findings were supported by Mrs. Rosamma Thomas, the aim of the study was to assess the effectiveness of structured teaching programme regarding ill effects of cigratte smoking and its prevention among adolescent boys in a selected college in Madurai. Sample size was 100. The result of pre test showed that majority (57%) of adolescent had average knowledge, (43%) had poor knowledge and no one scored (above 75%) marks in pre test.

2. To find out the association between the knowledge and socio-demographic variables.

The findings of the present study showed that the obtained X2 value in all variables are less than the table value that is 0.05 level of significance. Hence the obtained X2 value is not significant. There is no association between selected demographic variables and the knowledge score among the students of age 13-19 years of N.C Model School, Jalandhar Cantt. except the age and residence of the adolescents.Similar findings were supported by Ira Sharma,and Sanjeeta Chalise (2015) conducted a study to assess the knowledge and attitude regarding the health effect of smoking among secondary level students in Nepal.All the students who were studying in class 8, 9 and 10 were included in the survey. There were total of 95 students. More than 59 % of the students had inadequate knowledge about the health effects of smoking. More than 61% of the respondents had a view that peer group influenced the adolescents to begin smoking and almost 30% of them had already experienced smoking. They viewed that smoking could be controlled by either teachers (45%) or the guardians (43.2%). Nearly 93% had understood smoking as an addictive behaviour and 96% knew that it mostly caused lung cancer. Almost 59% had inadequate knowledge about the effects of smoking and statistical association was found between level of knowledge and use of mass media (p=0.006). However no association was found between level of knowledge with age (p=0.729) and gender (p=0.338).

CONCLUSION:

The study shows that the majority of the adolescents i.e. 72(72%) have an average knowledge regarding ill effects of smoking, whereas 25(25%) of adolescents have poor knowledge and 3 (3%) have good knowledge. The average level of knowledge score is 9-16, poor level of knowledge is 0-8 and good level of knowledge is 17-25. Hence assumption of the study is accepted that the adolescents have knowledge regarding ill effects of smoking.

IMPLICATIONS OF THE STUDY:

Findings of the study provide several implications in nursing practices, nursing administration, nursing education and nursing research.

Nursing Practice:

· The study can guide the nurses to educate the patients in clinical areas and in community areas regarding ill effects of smoking and the ways to prevent these effects.

· The study results that majority of the adolescents i.e. 72(72%) have average knowledge regarding ill effects of smoking, whereas 25(25%) of adolescents have poor knowledge and 3(3%) have good knowledge.

· The nurses play a major role in health promotions. Health information is the process of assisting people to learn and incorporate health related behaviour into everyday life.

Nursing Administrations:

· Nursing administrators may organise programmes for nurses to update knowledge regarding ill effects of smoking.

· Nursing administrators should organise programmes in community areas like schools, colleges, community centres etc to spread awareness regarding smoking.

Nursing Education:

· It will help to prepare dedicated nurses to impart their education in both community and clinical areas by using varies method of educational technology to improve knowledge of people regarding ill effects of smoking.

· These findings can be used in seminars, workshops and conferences etc.

· Hence, nursing curriculum for all level of nursing courses should provide in depth knowledge regarding ill effects of smoking.

Nursing Research:

· The present study can be valuable source of data for future researchers.

· The study can be replicated and the data can be used to disseminate knowledge regarding ill effects of smoking and prevention among adolescents in community.

· The future researches can be done on knowledge regarding prevention of ill effects of smoking and factors provoking adolescents towards smoking.

LIMITATIONS:

· The size of the sample was 100, hence it becomes difficult to generalise the study.

· Only one school was selected from the community area, which makes the study restricted to be generalised.

· The study was limited to one age group i.e adolescents (13-19 years) of only the selected school in the community, present at the time of study and willing to participate in research study.

· Self structured-knowledge questionnaire tool was used hence chances of error may be there.

· Purposive sampling technique was used, which restricts the generalization of study findings.

RECOMMENDATIONS:

· The following recommendations were made on the basis of the study:

· The study can be replicated to large sample so as to validate and generalise its findings.

· The present was conducted on small sample, a more extensive study on larger sample is recommended for wider generalisation.

· A true experimental study can be conducted to evaluate the effectiveness of information

· A comparative study can be done among adolescents in urban and rural areas.

· This study will be reference for research scholars.

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Received on 28.09.2019 Modified on 25.10.2019

Int. J. Nur. Edu. and Research. 2020; 8(1): 85-90.

DOI: 10.5958/2454-2660.2020.00017.4