TOBACCO USE KNOWLEDGE, ATTITUDE AND PRACTICE AMONG STUDENTS IN TERTIARY INSTITUTIONS IN KOGI STATE, NIGERIA

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ABSTRACT


The purpose of the study was to determine tobacco use knowledge, attitude and practice among students in tertiary institutions in Kogi State, Nigeria. Nine specific objectives with nine corresponding research questions were formulated. Six null hypotheses were postulated which guided the study. Demographic variables of age and gender were also investigated. Descriptive survey research design was used for the study. The population for the study comprised of 31,600 students drawn from the four selected tertiary institutions in Kogi State, while the sample for the study consisted of 395. A-40 item researcher designed questionnaire comprising of four sections (A, B, C and D) was the instrument used for data collection. The instrument was validated by four experts from the Department of Health and Physical Education and one from the Department of Statistics all of the university of Nigeria, Nsukka. Percentages and means using Ashur’s (1977) critension, slightly modified by Okafor (1997) were utilized for answering the research questions bothering on knowledge, while modified 4-points scale by Osuala (2005), were used to answer research questions on attitude. Frequency and percentages were utilized to analyze the responses on practice questions. The t-Test statistics was used to test the null hypotheses one to four at .05 level of significance, while Chi-square statistic was employed to test the null hypotheses five and six at .05 level of significance. Results of the study showed that students in tertiary institutions had very high level of knowledge of tobacco use. Students in tertiary institutions had negative attitude towards tobacco use. Majority of the students in tertiary institutions had practiced tobacco use. Students in tertiary institutions aged 18 years and above had very high level of knowledge while those aged 16- 17years had high level of knowledge regarding tobacco use. Male and female students in tertiary institutions had negative attitude towards tobacco use. All age groups of students in tertiary institutions had practiced tobacco use. Female and male students in tertiary institutions had practiced tobacco use. There was no significant difference in the level of knowledge possessed by both male and female students in tertiary institutions regarding tobacco use. There was no significant difference in the level of knowledge possessed by both male and female students in tertiary institutions regarding tobacco use according to age. There was no significant difference in tobacco use attitude of the students in tertiary institutions according to gender. There was no significant difference in tobacco use attitude of the students in tertiary institutions according age. There was no significant difference in tobacco use practice of the students in tertiary institutions according to gender. There was no significant difference in tobacco use practice of the students in tertiary institutions according to age. Following from the findings of the study, the following recommendations were made: Education regarding smoking should begin early in the primary school. Parents, teachers and other adults are to supervise and educate the children that smoking is an unfavourable habit which should not be attempted.

TABLE OF CONTENTS

Title Page
Table of Contents
List of Tables
List of Acronyms
Abstract

CHAPTER ONE: Introduction
Background to the Study
Statement of the Problem
Purpose of the Study
Research Questions
Hypotheses
Significance of the Study
Scope of the Study

CHPATER TWO: Review of Related Literature
Conceptual Framework
Tobacco and tobacco use
Constituents of tobacco
Reasons for tobacco use
Harmful effects of tobacco in the body
Knowledge, attitude and practice
Socio-demographic factors associated with tobacco use knowledge, attitude and practice
Measurement of knowledge, attitude and practice of tobacco use
Schematic Representation of the Conceptual Framework
Theoretical Framework
Social learning theory
Theory of Reasoned Action (TRA)
The Theory of Planned Behaviour (TPB)
Self-efficacy theory (SET)
Schematic representation of theoretical frame work
Empirical Studies on Tobacco Use Knowledge, Attitude and Practice among Students in Tertiary Instructions
Summary of Literature Review

CHAPTEER THREE: Methods
Research Design
Area of the Study
Population for the Study
Sample and Sampling Techniques
Instrument for Data Collection
Validity of the instrument
Reliability of the instrument
Method of Data Collection
Method of Data Analysis

CHAPTER FOUR: Result and Discussion
Results
Summary of Major Findings
Discussion
Tobacco use knowledge among students in tertiary institutions
Tobacco use attitude among students in tertiary institutions
Tobacco use practice of students in tertiary institutions
Differences in tobacco used knowledge, attitude and practice of students in tertiary institutions

CHAPTER FIVE: Summary, Conclusions, and Recommendations
Summary
Conclusions
Recommendations
Suggestions for further study
References
Appendices

CHAPTER ONE

Introduction

Background to the Study

Tobacco use cuts across not only age but religion, occupation, social and economic levels. According to World Health Organization, WHO (2001) tobacco use is the single most important preventable cause of disease and premature death in the world today and that more people smoke today than any other times in human history. The report maintained that prolonged smoking is a leading behavioural cause of disability and premature mortality resulting in approximately four million deaths annually worldwide. Centre for Disease Control and Prevention-CDCP, (2001) reported that although smoking kills more people than AIDS, alcohol, drug abuse, car crashes, murders, suicides and fires combined each year, approximately one-third of the global adult population or 1.1 billion have chosen to smoke.

This astonishing figure includes many young and school-aged users in the world. This figure may include Nigerians. The WHO (2001) further stated that in the United States (US), 80 per cent of adult smokers started smoking before the age of 18 years and nearly 3000 young people in the same age-bracket become regular smokers every day, and that if nothing is done to stop current trends, more than five million students living today will die prematurely because of a decision they make to smoke cigarettes when they are adolescents.


WHO (2002) stated that tobacco is a known cause of about 25 diseases and its impact on global disease burden is increasing continuously, and that tobacco kills nearly 10,000 people worldwide every day. Mackay and Ericksen (2002) opined that tobacco kills half of all life time users, half die in middle age between 35 and 69 years old. According to them, no other consumer product is as dangerous as tobacco. They further stated that tobacco is the only legally available consumer product which kills people when it is entirely used as intended. Furthermore, they maintained that while the most serious effects of tobacco use normally occur after decades of smoking, there are also immediate negative health effects for younger smokers. However, they asserted that most smokers especially teenagers are already addicted during adolescence and that the younger a person is when he/she begins to smoke, the greater the risk of eventually contracting smoking related diseases such as cancer, or other heart diseases.

Kvis, Clark, Crittenden, Warnekke, and Freels (1999) found that younger smokers (18-29 years of age) are less concerned about health outcomes associated with smoking, than older' adults. Similarly, Steptoe and Wardle (2001) opined that younger smokers, such as students in tertiary institutions do not heed smoking - associated health warning. Kear (2002) submitted that although cigarette smoking among adults has steadily declined over the past decade, smoking among students in tertiary institutions has risen sharply. Mackay and Ericksen (2002)/ opined that the overwhelming majority of smokers begin tobacco use before they reach adulthood and that among those young people who smoke, nearly one-quarter smoked their first cigarette before they reached the age of ten.

Sinha, Gupta, and Pednekar (2002) and WHO (2002) opined that tobacco use is often initiated during adolescence. According to American Lung Association (2002), approximately 90 per cent of smokers begin smoking before the age of 21 years. The National Statistics (2002) reported that by the age of 11 years one-third of students, and by 16th year, two-thirds of students have experimented with smoking. Although there is conflicting opinion as to the age of initiation into tobacco smoking, the truth is that most adolescents start smoking before they reach adulthood.

Spear and Kulbok (2001) pointed out that youths who smoke and drink have an increased risk of having difficulties at school, delinquency, and use of other drugs. WHO (2002) stated that tobacco affects adolescents in a number of ways; that active smoking by young people is associated with significant health problems. The report further stated that as with alcohol, adolescent cigarette smoking is strongly associated with illicit drug use. Youths who consistently smoke throughout adolescence are at significantly greater risk of marijuana and drug abuse and dependency. The report further asserted that tobacco and alcohol, often referred to as "gate way drugs", are among the first substances consumed by adolescents. Orlando, Tucker, and Ellickson (2005) pointed out that adolescents who report consistent smoking and drinking have higher rates of deviant behaviour and violence and are more likely to have legal and substance use problems in their 20s than those who consistently drink but not regular smokers. The researchers noted further that while it is common during adolescence to drink but not smoke, it is very unusual to smoke and not drink, suggesting that smoking is a reliable marker of adolescent alcohol use.

Mackay and Ericksen (2002) remarked that several factors increase the risk of youth smoking; these include, tobacco industry advertising and promotion, easy access to tobacco products, and low prices, peer pressure and sibling smoking. Other risk factors associated with youth smoking mentioned by the authors include having a lower self-image than peers, and perceiving that tobacco use is normal or "cool". Factors that commonly play a role in the initiation of smoking among adolescents include social factors (high level of social acceptability, marketing efforts, role modeling by parents and other family members (Avenevoli & Merikangas, 2003; Komro, McCarty, & Forster, 2003).

Hala, Al-Sahab and Akkay (2007) opined that from age 10 to 19 years, adolescents pass through a transitional phase in life in which their future personalities and bahaviours are sharpened or modified and set for years to come. Furthermore, it is believed that adolescents, who make up around 1.2 billion of the world's 6 billion inhabitants, are facing a form of tobacco intimidation at an early point in their lives. According to the authors, the association of health problems with cigarette smoking has been established, and smoking has been proven to be a major cause of lung cancer, chronic obstructive lung disease, and coronary heart (CHD) disease among others. There is sufficient evidence to conclude that tobacco smoking is strongly linked to tuberculosis (TB) and a large proportion of TB patients may be active smokers (WHO, 2008). The report noted that a previous analysis had suggested that a considerable proportion of the global burden of TB may be attributable to smoking. Pai, Mohan, Dheda, Leung, Yew, Christopher and Sharma (2007) stated that TB and tobacco use are regarded as two colliding epidemics of public health importance. According to them, recent estimates have shown that the two formidable epidemics kill more than six million people worldwide annually. Furthermore; in recent years, there has been a global explosion of interest on the association between TB and exposure to tobacco smoke (WHO, 2008).

Ewuzie (2005) reported that the habit of cigarette smoking was introduced into Nigeria around 1902 by European traders and that local manufacture of cigarette started in 1935 suggesting that tobacco use has gained firm root in Nigeria already. Hahn and....

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