PRoforma for registration of subject for
dissertation
SUBMITTED BY:
Mrs.SUJA PUNNOSE,
1ST yr M.Sc(NURSING),
MEDICAL SURGICALNURSING
2012-2014 BATCH.
ORIENTAL COLLEGE OF NURSING
BANGALORE – 10.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Mrs. SUJA PUNNOSE 1st Year M.Sc.( Nursing), Oriental College Of Nursing #43/52, 2nd Main , Industrial Town , West Of Chord Road , Rajajinagar , Bangalore – 10.
2. / NAME OF THE INSTITUTION / Oriental college of nursing
Bangalore- 10.
3. / COURSE OF STUDY AND SUBJECT / 1st Year M.Sc. Nursing,
Medical And Surgical Nursing
4. / DATE OF ADMISSION OF THE COURSE / 21/06/2012
5. / TITLE OF THE TOPIC / “A Study to Assess the knowledge and attitude regarding tobacco use among adults attending OPD in a selected hospital in Bangalore with a view to develop an information booklet”
6. / Brief resume of the work
6.0 Introduction
6.1 Need for the study
6.1.1 Statement of problem
6.2 Review of literature
6.3 Objectives
6.3.1 Operational definitions
6.3.2 Assumptions
6.3.3 Hypothesis
6.3.4 Sampling criteria
6.3.5 Delimitation / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / MATERIALS AND METHODS
7.1 Sources of data: Data will be collected among adults who are above 18 years and those who are attending OPD in selected hospital, Bangalore.
7.2 Method of data collection: Interview method.
7.3 Does the study require any investigations of interventions to be conducted on the patients or other human being or animals?
Yes.
7.4 Has ethical clearance been obtained from your institution?
Yes, the report is here with attached.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Mrs.SUJA PUNNOSE
1st Year M.Sc.( Nursing), Oriental College Of Nursing #43/52, 2nd Main , Industrial Town , West Of Chord Road , Rajajinagar , Bangalore – 10.
2. / NAME OF THE INSTITUTION / Oriental college of nursing.
3. / COURSE OF STUDY AND SUBJECT / 1st Year M.Sc nursing,
Medical And Surgical Nursing
4. / DATE OF ADMISSION OF THE COURSE / 21/06/2012
5. / TITLE OF THE STUDY / “A study to assess the knowledge and attitude regarding tobacco use among adults attending OPD in a selected hospital in Bangalore with a view to develop an information booklet”.
6. BRIEF RESUME OF INTENTED WORK
6.0. INTRODUCTION
“Smoking is a custom loathsome to the eye,hateful to the nose,harmful to the brain,dangerous to the lungs,and in the black,stinking fume there of nearest resembling the horrible stygian smoke of the pit that is bottomless”
King James 1 of England.
The word “Tobacco" is derived from the native American word "tabago". Tobacco is a tall, leafy plant, originally grown in south and Central America. It is now cultivated throughout the world. Nicotianatobacum is used to produce cigarettes.1
According to WHO "Tobacco is the second major cause of death in the world. It is currently responsible for the death of one in ten adults’ worldwide (about 5 million deaths each year).2
The most noxious components of tobacco smoke are tar, carbon monoxide and nicotine. The carcinogenic role of tar is well established. Nicotine and carbon monoxide contribute to increased risk of cardiovascular diseases through enhancement of blood coagulation in the vessels, interference with myocardial oxygen delivery and reduction of threshold for ventricular fibrillation.7
Tobacco contains many chemicals which are known to cause cancers. It is a risk factor in health problems as diverse as osteoporosis, ulcer disease, and low birth weight in babies. The easiest way to stop the effect of tobacco is to prevent its initiation. Tobacco has been found to cause many chronic diseases, acute respiratory diseases such as pneumonia and influenza, and a number of persistent respiratory symptoms such as wheezing and cough. Smoking causes damage to different part of the body such as mouth, teeth, skin, fingernails and hair.9
Adults are considered to be those people who are having above 18 years old range .They considered very important by our society because they represent the future of our nation. During this period of life they undergo transition from childhood to adulthood .They face many changes in life such as hormonal, emotional, psychological and physical maturation. They are living in a fast paced ever changing society where the demands are still high .During this period of time in one’s life that many health related beliefs, attitude and behaviours are adopted and consolidated. This stage of life young people have increased freedom and assess to health compromising behavior like tobacco use and certain life style decisions that will have long time influence on health in later years of life.8
According to American Cancer 2002 suggest that more than 85% of lung cancers are attributable to inhalation of carcinogenic chemicals, such as cigarette smoke. Lung cancer is ten times more common in cigarette smokers than non smokers. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer. The risk of lung cancer decreases as the duration of smoking increases. Bidi smoking appears to carry a higher lung cancer risk than cigarette smoking owing to the higher concentration of carcinogenic hydrocarbons in the smoke.5
Tobacco is a serious threat to health and ranks second as as a cause of death in the world taking its toll by killing some 5 million people globally. Tobacco use is an emerging pandemic marching forward relentlessly . Evidence accumulating since early 1950s indicate that more than 25 diseases are now known or strongly pattern is reversed ,tobacco will be responsible for 10 milllion deaths per year ,by the decade 2020- 2030,with 70% of them occuring in developing countries.3
In India tobacco kills 8–10 lakhs people each year and many of these deaths will occur in people who are very young. It has been estimated that an average of five-and-a-half minutes of life is lost for each cigarette smoked. Deaths attributable to tobacco are expected to rise from 1.4% of all deaths in 1990 to 13.3% in 2020. India, as per WHO projection, will have the highest rate of rise in tobacco-related deaths during this period compared to all other countries/regions.4
Youth in general and adolescents in particular fall prey to this deadly habit with severe physical, psychological, and economic implications. Among the youth, students are particularly involved due to increasing academic pressures and uncertain career .Encouragement from peer group, the lure of popularity, and easy availability of tobacco in different forms make a teenager an easy prey. In India, approximately 5500 children and adolescents start using tobacco products daily, some as young as 10 years. The majority of users have first used tobacco prior to the age of 18 years.10
Tobacco products may cause wrinkles, discoloration of skin complication and yellowing of fingernails when they enter the blood stream. Secondhand smoke may cause also result in cosmetic damage when it gets in contact with the body. The harm caused by smoking on a person's appearance may be cumulative and may take several years of smoking to create observable effects. Smoking makes people seen older than they actually are.6
6.1.NEED FOR THE STUDY
The tobacco epidemic is one of the biggest public health threats the world has ever faced. It kills nearly six million people a year of whom more than 5 million are users and ex users and more than 600 000 are non smokers exposed to second-hand smoke. Approximately one person dies every six seconds due to tobacco and this accounts for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease .Nearly 80% of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development.21
In some countries, children from poor households are frequently employed in tobacco farming to provide family income. These children are especially vulnerable to "green tobacco sickness", which is caused by the nicotine that is absorbed through the skin from the handling of wet tobacco leaves.23
A study conducted by school of community and global health about a study of tobacco use among young adult south Asians. This study shows that South Asians (SA), individuals from Bhutan, Bangladesh, India, Maldives, Nepal, Pakistan, and Sri Lanka, represent the third most populous Asian group in the U.S. While high rates of tobacco use, both cigarette smoking and smokeless forms of tobacco have been documented in certain South Asian countries .Over the two years of this proposed project ,they establish a community-university collaboration to study tobacco use among 176 Bangladeshi, Indian, Nepali, and Pakistani current and former tobacco users between 18 and 29 years of age. They identify that the cultural, social, environmental, and intrapersonal factors that impact smoking and quitting behaviors among South Asian participants. They disseminate their findings to South Asian communities through community meetings, webinars and other web-based distribution methods and to external audiences through scientific meetings and publications. Ultimately, the study results inform the development of future cessation strategies uniquely suited to young adults in South Asia.20
A study was conducted by journal of preventive medicine and public health in Korea .The aim of this study was to compare recent trends in cigarette smoking for young adults living in rural areas, small towns and metropolitan cities in Korea. Data were analyzed by using the method of complex survey data analysis considering complex sampling design. Logistic regression models were used to evaluate significant linear time trends in cigarette smoking.. Statistically significant increasing trends in current smoking rate and frequent smoking rate were observed and borderline significant increasing trends in heavy smoking rate were shown among rural boys. Among metropolitan city men, statistically significant increasing trends were also seen for frequent smoking. Statistically significant decreasing trends in current smoking rate were observed among small town and metropolitan city women\.Cigarette smoking prevalence among young adults in the rural areas has increased in the last five years especially among men. Our findings suggest that anti-tobacco program for young adults should be conducted primarily for those in rural areas.24
A cross-sectional study was conducted at Ghulam Mohammad Jokhio Goth, a small semi urban community of Gadap Town Karachi,among 2225 samples. About 157 people were interviewed regarding their tobacco consumption practices through a semi structured pre-tested questionnaire from June to August 2005. There were 314 households in the community and every alternate household was selected with a random start. The study subject was selected among all the adult members of 18 years age and above present at the time of interview in the household by lottery method and the questionnaire was administered to those who were resident of GM Goth after taking consent .In our study 110 (70%) people were tobacco consumers, 47% were knowledgeable about hazards of smoking, 22% were aware about passive smoking, and 90% started consuming tobacco below 20 years of age. The most popular form of tobacco was pan 40%, cigarette 39% and hookah 19%. Eighty four percent were regular smokers. Only 13.6% took counseling, 26.3% tried to quit smoking but none of them succeeded. About 23.5% smokers suffered from cough and headache due to smoking. When age, sex, marital status, income of the household, education and knowledge about hazards of smoking was compared, age and knowledge showed significant association while other variables did not show any significant association.22
The use of tobacco is widespread due to low prices, strong marketing, lack of education about its negative effects, and poor public policies against its use .So the investigator interested to assess the knowledge and attitude of tobacco use among adults and to develop an informational booklet.
6.2.REVIEW OF LITERETURE
A study conducted by Department of Statistics, Banasthali University,Jaipur. The objectives of this study is to determine the influence of smoking or tobacco use on ear diseases among men .They selected 11454 subjects of different age-groups there were 4143 men aged 20-60 years who were evaluated for demographic variables, smoking/tobacco use and middle and internal ear diseases.Among the 4143 men, 1739 (42.0%) were smokers or used tobacco. In smokers/tobacco users compared to non-users the age adjusted odds ratios and 95% confidence intervals for chronic suppurative otitis media were 1.13, acute otitis media 1.16,suppurative otitis media 1.21 , otosclerosis 0.97 and for overall middle ear diseases was 1.15. For internal ear diseases the age adjusted odds ratios were for sensorineural hearing loss 1.12 for vertigo and tinnitus and overall internal ear diseases were 0.97. Among men 40-60 years there was a significantly greater risk for both middle ear and internal ear diseases.The conclusion shows that Smoking/tobacco use is significantly associated with greater prevalence of middle and internal ear diseases among middle-aged men in India.17
A study conducted by department of Nursing Studies, L.K.S. Faculty of Medicine, University of Hong Kong .The purpose of the study is to identify Chinese nurses' tobacco-related knowledge, attitude, and practice (KAP), including perception of competency in smoking-cessation interventions; identify barriers and facilitators to smoking cessation interventions to patients; and assess the learning needs and smoking status of nurses. 2,888 registered nurses working in hospitals affiliated with five university schools of nursing in these cities were invited to complete a questionnaire.Only 2% of participants were current and 1% were former smokers; most had not received training for smoking-cessation interventions as part of their nursing education program. Two-thirds recognized smoking as a leading cause of preventable death and that smoking cessation was the most cost effective intervention, but only a third routinely assisted patients' quit attempts. Nurses who received training reported greater competence in providing smoking-cessation intervention, and more frequent practice of cessation interventions .The result shows that Chinese nurses had some knowledge about the health effects of tobacco use, but seldom practiced smoking-cessation interventions.18