CHAPTER I

INTRODUCTION
1.1 Background of the Study
Adolescence (from Latin meaning "to grow up") a transitional stage of physical and
psychological human development that generally occurs during the period from
puberty to legal adulthood. The period of adolescence is most closely associated with
the teenage years, though its physical, psychological and cultural expressions may
begin earlier and end late.
Smoking among adolescent is an issue that affects countries worldwide. Smoking and
smokeless tobacco use are initiated and established primarily during adolescence.
Nearly 9 out of 10 smokers in the United States started smoking by age 18, and 99%
started by age 26. In 2012, 6.7% of middle school and 23.3% of high school students
currently used tobacco products, including cigarettes, cigars, hookahs, snus,
smokeless tobacco, pipes, bidis, keteks, dissolvable tobacco, and electronic cigarettes.
Nearly 70% of the worlds smokers live in low- and middle-income countries. Nearly
two-thirds of the worlds smokers live in 10 countries, namely China, India,
Indonesia, Russian Federation, the USA, Japan, Brazil, Bangladesh, Germany and
Turkey.1 Unless a large number of current smokers in these countries quit, it is
estimated that smoking would be causing 10 million deaths per year worldwide by the
2020s or early 2030s.
The tobacco use among the youth, in both smoking and smokeless forms, is quite high
in the South East Asian region including Nepal. One of the reasons for such high use
could be the creative and targeted marketing strategies of various tobacco companies
and its weak regulation. Abundant tobacco production, weak enforcement of tobacco
control measures, easy accessibility and affordability of these products are other

factors leading to the rise of the epidemic of tobacco use in the youth.3 Although the
exact burden of tobacco use among the youth has not been studied extensively in
Nepal, a national Global Youth Tobacco Survey (GYTS) in 2007 reported that overall
7.9% of the students ever smoked cigarettes and 8% used other tobacco products.4
Some of the factors known to be associated with tobacco use among adolescents are
age, gender, having smoker friends or parents and the amount of pocket money.
The WHO has defined the adolescents as persons in the 1019years age group. It has
also estimated that 70% of premature deaths among adults are due to behavioral
patterns that emerge in adolescence including smoking, violence and sexual behavior.
Studies have shown that such risk-taking behaviors begin to manifest from the middle
adolescence (1415years of age) onwards. The present study therefore, focused on
the specific groups of middle (1415years) and late adolescents (1619years).
The Government of Nepal had signed the Framework Convention on Tobacco Control
on 3 December 2003 followed by its ratification by the House of Representatives on 7
November 2006. In what was regarded as a landmark in the nations campaign against
tobacco, the government finally assented to the anti-tobacco directives of Tobacco
Product Control and Regulatory Act 2010 on 4 November 2011. This has reflected a
strong will from the side of the government to comply by objectives set out in the
convention. A need was felt to estimate the prevalence of tobacco use among the
Nepalese youth who are the most vulnerable for adoption of this habit in the
background of recent endorsement of anti-tobacco directives by the government.
Statistics
The National Survey on Drug Use and Health estimates that each day, over 4,000
people under the age of 18 try their first cigarette. This amounts to more than 37,000
new smokers each year. Children and adolescents consume more than one million
cigarettes every year.

Alternative tobacco products:

Cigars
For decades cigar consumption among adolescents remained relatively
constant; however, since the 1990s cigar use has surged in adolescent
populations. This increase in consumption coincided with an increase
in cigar marketing.

Snus
Snus use among adolescent groups has worried many leading public
health officials; snus may aid youth in cessation of smoking or in harm
reduction, but it can also be used in conjunction with cigarettes and
thus increase risk for disease. Snus is smokeless tobacco product that
was first distributed in Sweden decades ago. Snus is a flavored and
moist tobacco contained in small teabag-like pouches sold in tin
containers of about 15. The packet is placed under the upper lip for
approximately 30 minutes and delivers nicotine directly into the
bloodstream.

Orbs
One of the newest tobacco products currently being tested on the
market is Orbs. Orbs are dissolvabele tobacco pellets with mint and
cinnamon flavoring, closely resembling breath mints.

Stages of adolescent smoking:

There are a series of stages that young smokers go through, each of which is
influenced by different factors. The stages can progress in any direction and restart
any number of times.

Pre-contemplation:
The child, while not yet considering smoking, has received messages
about it. At this stage, the child is powerfully influenced by family
members that smoke, advertising, films, television, and role models
3

Contemplation:
Information received from the media or from peer influence results in
curiosity and the desire to try a cigarette. At this stage, friends
behavior is added to the list of influences.

Initiation:
Most youths will try a cigarette, but the majority do not become
addicted or become regular smokers. Peers tend to exert the strongest
influence.

Experimentation:
This stage involves repeated smoking attempts which may result in
addiction to nicotine. At this stage, youths tend to become regular
smokers. Peers continue to exert the strongest influence.

Regular Smoking:
Additional influences join the initial set of addiction and habituation
including beliefs about the benefits of smoking, self-efficacy, selfperception, and coping. Societal factors also begin to play a role.

Maintenance:
The continuation of regular smoking involving all of the previous
influences with addiction being the primary driving factor.

Quitting:
This stage only happens once the importance of influences change and
the individual reaches a decision to stop smoking.

Hazards of Smoking:
1. Cardiovascular disease:

Coronary heart disease

Atherosclerosis

Abdominal aortic aneurysms

2. Respiratory Disease

Lung Cancer

COPD

3. Cancer

Acute myeloid leukemia

Bladder cancer

Cancer of the cervix

Cancer of the larynx (voice box)

Lung cancer

Cancer of the oral cavity (mouth)

Pancreatic cancer

Cancer of the esophagus

Kidney cancer

Cancer of the pharynx (throat)

Stomach cancer

Other Health Effects

1. Infertility
2. Preterm delivery
3. Stillbirth
4. Low birth weight
5. Sudden infant death syndrome (SIDS)

1.2 Rationale of the study:

Smoking is a global problem nowadays. Smoking usually starts from adolescent.
Smoking not only affects the individual but also his/herr social life. According to
economist Kenneth Warner, Ph.D., the tobacco industry needs 5,000 new young
smokers every day in order to maintain the total number of smokers. The US
Department of Health and Human Servicesestimates that 90% of smokers begin their
tobacco usage before age 20. Of these, 50% begin tobacco use by age 14 and 25%
begin their use by age 12. Many studies have been done on the youth smoking but
very few researches have been done to create an awareness regarding the hazards of
5

smoking.

1.3 Significance of the Study:

To create an awareness among the adolescent the hazards of smoking.

To inquire whether the adolescent knows the harmful effects of smoking.

To explain to them the negative impact smoking will be creating to their

health, to the social life and to their mental life.

1.4 Statement of the Problem:

The problem under consideration will be to assess the awareness regarding
consequences of smoking among adolescents among the age group 15-19 years in the
Moon Light Higher Secondary School.

1.5 Research Questions:

What are the existing awareness regarding consequences of smoking among
adolescents?

1.6 Objectives of the Study:

1.6.1 General Objective:

To assess the knowledge among adolescent the hazard of smoking.

1.6.2 Specific Objective:

To identify the factors that influences the adolescents into smoking.

To identify the knowledge of adolescents regarding the hazards of

smoking.

To identify the average age at which adolescents start smoking.

1.7 Operational Definition:

1. Adolescent: it refers to the youths going to the higher secondary schools from
age 15-19 years.
2. Smoking: Smoking is the inhalation of the smoke of burning tobacco encased
6

in cigarettes, pipes, and cigars.

3. Consequence of smoking: it is a situation that poses a level of threat to life,
health, property or environment.

1.8 Study Variable:

1.8.1 Independent Variable:
1. Age
2. Sex
3. Education level
4. Ethnicity
5. Religion
6. Exposure to media
1.8.2 Dependent Variable:
1. Awareness regarding consequences about smoking.

1.9 Conceptual Framework:

A conceptual framework will be developed to illustrate the key concepts of the study.
Each of these concepts will identify and place in the context of adolescent awareness
and consequences regarding smoking

Educational Level

Exposure to media

Sex

Ethnicity
SOCIODEMOGRAPHIC
VARIABLES

Age

Knowledge regarding
consequences of smoking

KNOWLEDGE
RELATED
VARIABLES

Hazards of
Smoking

Preventive
Measures

Religion

Fig.1 Conceptual Framework based on knowledge of consequences of smoking

CHAPTER II
LITERATURE REVIEW
2.1 Review of the Related Literature
During the course of literature review many books, journals, internet, news, bulletin
and articles were searched. Adequate concerned literature were found concerning the
study subject and are discussed below.
In a study conducted by Pranil Man Singh et al, published Feb 2013 about the tobacco
use and associated factors among adolescent students in Dharan, it was found that the
tobacco use among the youth, in both smoking and smokeless forms, is quite high in
the region. Their conclusion states that prevalence of ever use of any tobacco product
was 19.7% . More than half of the tobacco users (51.9%) consumed tobacco in public
places whereas almost a third (75.6%) of the consumers purchased tobacco from
shops. The study revealed that tobacco use is prevalent among the adolescent students
despite the existence of anti-tobacco regulations in the country. Late adolescence,
male gender, Janajati ethnicity, type of school and higher pocket money were
significantly associated with tobacco use.
In a previous study by Chandrashekhar T Sreeramareddy et al conducted in 2008 in
twin cities of nepal, it was found that overall prevalence of 'ever users' of tobacco
products was 13.9%. Prevalence among boys and girls was 20.5% and 2.9%
respectively. Prevalence of 'current users' was 10.2% (cigarette smoking: 9.4%,
smokeless products: 6.5%, and both forms: 5.7%). Median age at initiation of
cigarette smoking and chewable tobacco was 16 and 15 years respectively. Among the
current cigarette smokers, 58.7% (88/150) were smoking at least one cigarette per
day. Most (67.8%) 'Current users' purchased tobacco products by themselves from
stores or got them from friends. Most of them (66.7%) smoked in tea stalls or
restaurants followed by other public places (13.2%). The average daily expenditure

was 20 Nepalese rupees (~0.3 USD) and most (59%) students reported of having
adequate money to buy tobacco products. Majority (82%) of the students were
exposed to tobacco advertisements through magazines/newspapers, and advertising
hoardings during a period of 30 days prior to survey. The correlates of tobacco use
were: age, gender, household asset score and knowledge about health risks, family
members, teachers and friends using tobacco products, and purchasing tobacco
products for family members.
A small scale descriptive study was conducted to explore awareness regarding
consequences of smoking among adolescents of Gokarna VDC, Kathmandu district.
Non probability and incidental sampling method was adopted in this study. The
sample population was 50 respondents, among them 25 smokers and 25 nonsmokers.
The instrument used for this study was face to face interview schedules. The findings
of the study was that cigarette smoking was most common than other forms of
tobacco smoke among adolescents. Average 8 sticks were smoked per day, average
age of starting smoking was found 15 years of age. Most of respondents motivated to
smoke by peer pressure 80% and imitation 36%. Most of respondents 80% was
willing to quit smoking while 52% wished to get help to retain from smoking. All
respondents both smoker and non-smoker were well enough aware about health
consequences of smoking and had knowledge of smoking related diseases. There was
substantial support 84% or total ban of tobacco advertisement in all multi media.
Among smokers 84% respondents smoke very surreptitiously and their parents were
not knowledge able that their children smoking. The respondents expressed their
views to discourage smoking among adolescents as parents role is most crucial, health
education should be communicated with detail information, tobacco advertisement
should be banned, schools also play assertive role. Above all, government is most
responsible and powerful authority and has to control and regulate all concerned
matters. (RenukaSubba, 2009, IOM)
Similarly, a cross-sectional study was conducted among 816 students from five
colleges in western Nepal by Binu VS, et al. They found that prevalence of ever

10

smoking was 34.2% (males 47.6% and females 18.4%) and for current smoking was
17%. It was higher among youth belonging to 21 years or older as compared to
younger age groups. Mean age of initiation was 16.8 years (standard deviation 2.8
years) and the most common reasons cited for smoking were; like it, to feel more
relaxed, out of boredom and to look more mature. Proportion of youth who said they
felt they were addicted was 43.1% and 64.7% said that they had tried to quit the habit.
Most important predictors having independent effects on youth being ever smokers
were having three or more smoker friends (OR=18), their own chewing (OR=4.8) or
alcohol use (OR=4.2), male gender (OR=3.7) and the type of course they were
pursuing, with professional course students having higher risk. With almost one fifth
of college-going youth smoking and a higher prevalence in older age groups within
them, smoking is a serious concern for young people in Western Nepal.
A population-based cross-sectional study was conducted by Umesh Raj Aryal, Max
Petzold and Alexandra Krettek in October 2011 in Jhaukhel and Duwakot villages in
Nepal about the perceived risks and benefits of smoking. They found that among 352
eligible respondents, 49.7% of nonsmokers were susceptible to smoking. The
proportion of susceptibility to smoking among males and females differed
significantly (P=0.03). The age wise proportions of susceptibility were not
statistically significant (P=0.35). Similarly, the proportion of susceptibility was not
statistically significant for ethnicity, education status, and parental education.
Australians aged 15 and two thirds of Australians aged 17 had at least experimented
with tobacco (White & Hayman, 2004b). Knowledge of the health risks and negative
consequences associated with smoking may be mitigated by perceived social and
psychological benefits (Leventhal & Cleary, 1980; Mayhew et al., 2000). The
perceived social benefits are a strong and consistent theme throughout the wealth of
research regarding motivations to experiment with cigarettes. This is potentially
reflected in the increased prevalence of smoking among adolescents whose friends,
siblings, and parents smoke (Mayhew et al., 2000; Stanton, Mahalski, McGee, &
Silva, 1993; von Bothmer et al., 2002), and in the fact that most early smoking

11

experiences of adolescents are in the presence of smoking peers (Eissenberg &

Balster, 2000). In particular, smoking is seenas communicating an identity of being
cool, tough, and independent (Leventhal & Cleary, 1980; Mayhew et al., 2000;
Shadel, Shiffman, Niaura, Nichter, & Abrams, 2000). Furthermore, smoking is seen as
an activity permitted only for adults, so it is simultaneously considered grown-up
and rebellious (Mayhew et al., 2000; Rugkasa et al., 2001). Cigarettes can also
provide a sense of belonging to a group. An Australian study found that young people
who smoke cigarettes are just as likely to feel supported by their peers as nonsmoking students (White & Hayman, 2004a), providing evidence against the notion
that only socially excluded young people are drawn to cigarettes. As well as these
perceived positive characteristics, there is often also a perception of direct peer
pressure to initiate smoking among some groups (Siqueira, Diab, Bodian, &
Rolnitzky, 2000; Stanton et al., 1993; von Bothmer et al., 2002).
In the annual survey done by U.S. Department of Health & Human Resources, they
state that almost one out of every two high school students reports ever having taken
even one puff of a cigarette. However, in 2012 almost one in ten (9 percent) 12th
graders were regular, daily smokers a number that has declined dramatically from
its recent peak of 25 percent in 1997, but more slowly since 2002. Cigarette smoking
by adolescents (measured as use in the past month) in grades 10 and 12 combined has
declined by more than half since its most recent peak in the late 1990s. In 2012, about
one in eight adolescents (11 percent) reported smoking cigarettes in the past month,
compared with more than one in four (28 percent) in 1996-97.
In 1999, the Global Youth Tobacco Survey (GYTS) project was conducted in 13
countries and is currently in progress in over 30 countries. This report describes data
from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland, the Russian
Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela, and
Zimbabwe. The findings show that tobacco use in the surveyed age group ranged
from a high of 33% to a low of 10%. While the majority of current smokers wanted to
stop smoking, very few were able to attend a cessation programme. In most countries

12

the majority of young people reported seeing advertisements for cigarettes in media
outlets, but anti-tobacco advertising was rare. The majority of young people reported
being taught in school about the dangers of smoking. Environmental tobacco smoke
exposure was very high in all countries. These results show that the GYTS
surveillance system is enhancing the capacity of countries to design, implement, and
evaluate tobacco prevention and control programmes.

2.2 Summary of Literature Review:

From the above study the sample population had a good awareness regarding smoking
and they discouraged smoking and stated that parents role is most crucial and that
health education should be communicated with detail information, tobacco
advertisement should be banned, schools also play assertive role. And above all
goverment should implicate rules and regulations to control smoking.

13

Chapter III
Research Methodology
3.1 Research Design:

A descriptive research design will be used.

3.2 Study Area:

The study area will be Moonlight Higher Secondary School, Lagankhel,

Lalitpur.

3.3 Study Population:

The study population will be consisting of adolescent age group of a particular

selected areas.

3.4 Study Sample:

The study sample consist of adolescent age group between 15-19 years of age.

3.5 Sample Size:

The sample size will be fifty of the respondents.

3.6 Sampling Technique:

Non probability convenience sampling technique will be applied for the study.

3.7 Inclusion Criteria

Adolescents students age from 15-19 years of Moonlight Higher Secondary

School, Lagankhel, Lalitpur.

Those who will be willing to participate

14

3.8 Instrumentation:
Pretested structured questionnaire will be used as data collection tool. Questionnaire
will be based on objective with simple and understandable language. The
questionnaire will be developed according to objectives of the study.

3.9 Validity and Reliability

Content validity was established by the review of literature and consulting with the
research guide and experts and the necessary changes was done as per the suggestion.
3.9.1 Validity
The content validity of the tool will be established by consulting
related literature, advisor, concerned teacher and friends.
3.9.2 Reliability
The reliability of the instrument will be maintained by pre testing the
instrument in the 10 % of the population of selected adolescent
population.

3.10 Data Collection Procedure

Permission was obtained from Hope International College and Moonlight

Higher Secondary School with the concerned authorities to conduct the
research.

Purpose of the study was explained to the subjects. Informed consent was
obtained from subjects.

Data was be collected by questionnaire through interview method.

3.11 Data Processing and Analysis

The data was analyzed by using descriptive statistical techniques.

Interpretation of data was done on the basis of obtained data.

The findings are presented in the form of relevant tables

15

3.12 Ethical Consideration

Formal approval was obtained from the research committee.

Permission was granted from concerned authority.

The objective of the study was explained to the entire respondent.

There was no leakage of the information shared by the respondents without

their permission. Confidentiality and anonymity of the subject was strictly
maintained.

Verbal consent was obtained from each respondent.

16

CHAPTER IV
ANALYSIS AND INTERPRETATION OF DATA
This chapter consists and deals with the statistical analysis and interpretation of the
findings of awareness regarding consequences of smoking among adolescents. After
the collection of data, they were checked for completeness, organized and coded and
entered in SPSS (Statistical Package for Social Sciences) 16.0 version for the
statistical analysis. For the descriptive statistics percentage and frequency are
calculated for presenting the socio-demographic variables and awareness regarding
consequences of smoking. The findings of the study are represented using suitable
tables and statistical tests values have been presented based on the following
characteristics:
1. Socio-demographic characteristics of the Respondents.
2. Respondents' haibts in smoking.
3. Perception about anti-smoking campaigns.
4. Awareness regarding consequences of smoking.

4.1 Socio Demographic Characteristics of the Respondents.

The socio-demographic profile of respondents which were categorized according to
the age, sex, ethnicity and religion of respondent.
The table shows that 46 (92%) of respondents were of age group 15-19 years and 4
respondents (8%) were more than 20 years old. Among 50 respondents, 64%
respondents were from boys and the rest were girls. Likewise majorities (38%) were
Bhramin, (34%) were Chettri, (20%) were Newars and the rest were minorities (8%)
were of other ethnic group except Bhramin, Chhetri and Newar. Similarly two thirds
(66%) of the respondents were Hindu, (24%) were Buddhist, only (4%) were
17

Christian and the rest did not mention their religion.

TABLE 4.1
Distribution of Respondents by Socio-demographic Characteristics
n=50
Variables

Frequency

Percentage

Age
15-19

46

92

20

Male

32

64

Female

18

36

Brahmin

19

38

Chettri

17

34

Newar

10

20

Others

Hindu

33

66

Buddhist

12

24

Christian

Muslim

Others

Sex

Ethnicity

Religion

18

4.2 Respondents' Habits in Smoking

4.2.1 Number of students who have smoked at least once
Among 50 respondents most of the male respondents, 26 out of 32 boys (81.25%) had
tried smoking at least once. On the other hand only 2 out of 18 girls (11.11%) girls
had tried smoking at least once.
TABLE 4.2.1
TRIED SMOKING AT LEAST ONCE
n=50
Sex

Frequency

Percentage

Male

26

81.25%

Female

11.11%

Total

28

56.00%

4.2.2 Number of students who smoke daily

While there were occasional smokers among boys (who had at least tried smoking
once), there were only 5 boys who smoked daily (out of 32 boys) and no girls smoked
daily.)

TABLE 4.2.2
SMOKE DAILY
n=50
Sex

Frequency

Male

15.62%

Female

0.00%

Total

10.00%

19

Percentage

4.2.3 How students get cigarettes (person)

Table 4 shows how the respondents get their cigarettes. 2% got it from somewhere
else. 8% of the respondents said they got it themselves.
TABLE 4.2.3
SOURCE OF CIGARETTES (PERSON)
n=50
Source of Cigarettes

Frequency

Percentage

Did not get cigarettes

42

84.00%

By oneself

14.00%

From someone else

0.00%

Other ways

2.00%

Total

50

100.00%

4.2.4 How students get cigarettes (place)

Similarly, table 5 shows where the respondents got their cigarettes from if they got it
themselves. Among those who got the cigarettes themselves, Khudra pasal and
restaurant/coffee shop were the only places where the respondents could get
cigarettes.
TABLE 4.2.4
SOURCE OF CIGARETTES (PLACE)
n=50
Source of Cigarettes

Frequency

Did not get cigarettes

42

84.00%

Convenience store

0.00%

Department store

0.00%

Khudra Pasal

6.00%

Restaurant/coffee shop

8.00%

20

Percentage

Street

0.00%

Total

50

100.00%

4.3 Perception about Anti-Smoking Campaigns.

4.3.1 Do warning label discourage smoking
Respondents were asked their awareness and perception towards anti-smoking
campaigns. Many of the respondents who smoked (54%) thought warning labels on
cigarette packs did little or nothing to deter smokers from smoking.
TABLE 4.3.1
DO WARNING LABEL DISCOURAGE SMOKING
n=50
Do warning labels
discourage smoking?

Frequency

Percentage

I did not see a warning

label on a smokeless
cigarette product

12

24.00%

Yes

11

22.00%

No

27

54.00%

Total

50

100.00%

4.3.1 Can anti-smoking campaigns help to stop smoking

However, over 64% of the respondents agreed anti-smoking campaigns in the media
can help raise the awareness, while 10% were doubtful.
TABLE 7
CAN ANTI-SMOKING CAMPAIGNS HELP TO STOP SMOKING
n=50
Can anti-smoking
campaign help to stop
smoking?

Frequency

Percentage

Yes

32

64.00%

I am not sure, maybe

10.00%

21

No, I don't think so

13

26.00%

Total

50

100.00%

4.4 Awareness Regarding Consequences of Smoking

4.4.1 Awareness of the risks of smoking
When asked if they were aware of the consequences of smoking, all the respondents
unequivocally replied that they did.
TABLE 4.4.1
AWARENESS OF THE RISKS OF SMOKING
n=50
Are you aware of the
risks of smoking

Frequency

Percentage

Yes

50

100.00%

No

0.00%

Total

50

100.00%

4.4.2 Awareness of time it takes for smoking to affect the health

However, there were some misconceptions with their awareness of the risks of
smoking. For example, when asked how long does someone have to smoke before it
starts affecting their health, there were wildly different answers. Many respondents
(52%) had the misconception that smoking only harms after 20 years or more.
TABLE 4.4.2
AWARENESS OF THE TIME IT TAKES FOR SMOKING
TO AFFECT THE HEALTH
n=50
How long does someone
have to smoke before it
affects their health

Frequency

Percentage

Less than a year

10.00%

1 year

0.00%

22

5 years

4.00%

10 years

17

34.00%

20 years or more

26

52.00%

Total

50

100.00%

4.4.3 Awareness of harm to pregnant women

When asked if smoking was more harmful to men or women, 84% of the respondents
said it equally harmed both and 16% said it harmed women more. Similarly, when
asked if smoking was more harmful when women are pregnant, 90% of the
respondents answered yes and 10% were not sure.
TABLE 4.4.3
AWARENESS OF HARM TO PREGNANT WOMEN
n=50
Is smoking more harmful
to pregnant women

Frequency

Percentage

Yes, it can affect the child

at birth

45

90.00%

No, the child is not

affected

0.00%

I'm not sure, but maybe

10.00%

Total

50

100.00%

4.4.4 Knowledge about hazards of smoking

Respondents were asked to list the hazards of smoking. Most of the respondents
(94%) listed cancer. Only 56% of respondents listed heart disease, 34% listed
respiratory disease of various types (Pneumonia, Asthma, Chronic obstructive
pulmonary disease etc.). Very small percentage of the respondents mentioned blood
pressure and diseases of the immune system (18% and 6% respectively.)

23

TABLE 4.4.4
KNOWLEDGE ABOUT HAZARDS OF SMOKING
n=50
Hazards of Smoking

Frequency

Percentage

Cancer

47

94.00%

Heart disease

28

56.00%

Respiratory disease

17

34.00%

Blood pressure

18.00%

Immune system

6.00%

4.4.5 Awareness of most common cancer caused by smoking

68% of the respondents thought that lung cancer was the most common cancer caused
by smoking. 22% of the respondents thought the most common cancer was in the
neck regions. Only 4 % mentioned cancer in the reproductive organs and 2% in the
abdominal regions.
TABLE 4.4.5
AWARENESS OF MOST COMMON
CANCER CAUSED BY SMOKING
n=50
Most common cancer
caused by smoking

Frequency

Percentage

Lung Cancer

34

68.00%

Cancer in the neck region

11

22.00%

Cancer in the abdominal

region

2.00%

Cancer in the reproductive

organs

8.00%

Total

50

100.00%

24

4.4.6 Awareness about second hand smoking

Regarding second hand smoking, only 46% thought that it was equally harmful to
second hand smokers. 12% said second hand smokers were not at equal risk, and 42%
said they were not sure.
TABLE 4.4.6
AWARENESS ABOUT SECOND HAND SMOKING
n=50
Are second hand smokers
equally at risk?

Frequency

Percentage

Yes

23

46.00%

No

12.00%

I'm not sure but maybe

21

42.00%

Total

50

100.00%

25

CHAPTER V
DISCUSSION, CONCLUSION AND
RECOMMENDATION
5.1 Discussion
This is a descriptive study which was intended to find out the the awareness regarding
consequences of smoking among adolescents among the age group 15-19 years in the
Moon Light Higher Secondary School. A total of 50 respondents were included in the
study.
Socio demographic characteristics of the Respondents:
Regarding the age of the respondents, findings showed that 46 (92%) of respondents
were of age group 15-19 years and 4 respondents (8%) were more than 20 years old.
Among 50 respondents, 64% respondents were from boys and the rest were girls.
Likewise majorities (38%) were Bhramin, (34%) were Chettri, (20%) were Newars
and the rest were minorities (8%) were of other ethnic group except Bhramin, Chhetri
and Newar. Similarly two thirds (66%) of the respondents were Hindu, (24%) were
Buddhist, only (4%) were Christian and the rest did not mention their religion.
Respondents' habits in smoking
The findings showed that the most boys had tried smoking at least once (81.25% of
all boys) compared to only 11.11% of all the girls. However, only 15.62% of the total
boys were regular smokers compared to no girls who regularly smoked. Regarding
how respondents got thier cigarettes, the study found that it is very easy for
adolescents to get cigarettes from khudra pasal and coffee shops, where no body asks
them their age and ID cards. This also shows department stores and convenience
stores are doing a good job getting cigarettes off the hands of adolescents.

26

Perception about anti-smoking campaigns.

The study found that warning lables were not very effective to deter students from
smoking. Only 54% of respondents who smoked thought that warning labels worked
to quit smoking. However, over 64% thought that anti-smoking campaigns were
helpful to raise awareness.
Awareness regarding consequences of smoking
All respodents claimed to be aware of the consequences of smoking but in many cases
they did not have the correct information. For example, 84% of the respondents
agreed that smoking was equally harmful to both men and women and 90% agreed
that pregnant women were more at risk from smoking. However, regarding second
hand smoking only 46% of the respondents knew that second hand smoking was
equally harmful to people.
Regarding the hazards of smoking, most of the respondents (94%) correctly answered
cancer. But only few respondents knew of other hazards. Only 56% knew that
smoking can cause heart disease, and only 34% knew about respiratory disease.
Similarly, only 18% and 6% respondents knew about blood pressure and immune
system diseases respectively as hazards of smoking.
Similarly, 68% of the respondents thought that lung cancer was the most common
cancer caused by smoking. 22% of the respondents thought the most common cancer
was in the neck regions. Only 4 % mentioned cancer in the reproductive organs and
2% in the abdominal regions.

5.2 Conclusion
This study concludes that although most respondents have claimed to know the
hazards of smoking, but still most are lacking the adequate awareness regarding the
27

consequences of smoking. Most of the respondents only know about cancer as the
hazard but are not aware of other diseases which appear sooner and also cause death.
Some respondents have the negative information that the consequence of smoking
appears only after smoking for many years. Thus we can conclude that many
respondents don't have adequate knowledge about the consequences of smoking. This
may be due to the lack of understanding of other diseases and immediate
consequences because of smoking vs long term consequences of smoking.

5.3 Recommendation
On the basis of the findings of the study, the following recommendations can be
made:

A comparative study can be conducted between adolescents between urban

and rural setting.

A large scale study can be conducted on the awareness of consequences of

smoking among the adolescents of Nepal.

Similarly, a study can be conducted on the awareness of consequences of

smoking among older age groups in college and university.

Similar study can be done among general population

Similar study can be conducted in community covering wide range of

educational level and socio economic status of the respondents.

5.4 Limitation of the Study

The data was limited to knowledge of students attending Moon Light Higher
Secondary School only so the information gathered through the study may not
be generalized to other educational institutes of Nepal.

Sampling technique was limited to non probability purposive sampling and

sample size is only 50.

28

Duration of study was limited for 3 weeks.

REFERENCES
1. Tobaccos Industrys Targeting of youth, Minorities and Women, American
Heart Association, 2010.
2. Escobedo LG, Marcus SE, Holtzman D, Giovino GA. Sports Participation,
Age at Smoking Initiation, and the Risk of Smoking Among US High School
Students. JAMA. 1993;269(11):1391-1395.
doi:10.1001/jama.1993.03500110059035.
3. Anne Landman, BA, Pamela M. Ling, MD, MPH and Stanton A. Glantz.
Tobacco industry youth smoking prevention program: protecting the industry
and hurting tobacco control. 2009.
4. Delnevo, CD; Pevzner, ES; Steinberg, MB; Warren, CW; Slade, J. Cigar use in
New aaajersey among adolescent and adults. Am J Public Health 92 (6): 943
945.
5. U.S. Department of Health and Human Services. Preventing Tobacco Use
Among Young People: A Report of the Surgeon General. Atlanta: U.S.
Department of Health and Human Services, Centers for Disease Control and
Prevention, Office on Smoking and Health, 1994.
6. Perceived risks and benefits of cigarette smoking among Nepalese
adolescents: a population-based cross-sectional study, Umesh Raj Aryal, Max
Petzold and Alexandra Krettek, BMC Public Health 2013, 13:187
7. Campaign for Tobacco-Free Kids. The Path to Smoking Addiction Starts at
Very Young Ages . Washington: Campaign for Tobacco-Free Kids, 2009
8. Sreeramareddy CT, Kishore P, Paudel J, et al. Prevalence and correlates of
tobacco use amongst junior collegiate in twin cities of western Nepal: a crosssectional, questionnaire-based survey. BMC Public Health 2008;8:97.
9. Pranil Man Singh Pradhan, Surya Raj Niraula, Anup Ghimire, Suman Bahadur
Singh, Paras Kumar Pokharel et al. Tobacco use and associated factors among
29

adolescent students in Dharan, Eastern Nepal: a cross-sectional questionnaire

survey, 2013
10. Al-sadat, N., et al. (2010). Adolescent tobacco use and health in South-East
Asia. Asia Pac J Public Health 22 (3 Suppl): 175S-180S.
11. Arvaci L., Benowitz NL, Cigarette smoking and infection. Arch Intern Med.
2004; 164:2206-2216.
12. Binu VS, Subba SH, Menezes RG, Kumar Ganesh, Ninan J, Rana MS, Chhetri
Sovit Khadka, Sabu KM, Nagraj K. (2010) Smoking among Nepali youth
Prevelance and Predictors. Asian Pac J, Cancer Prev, 11, 221-226.
13. Brundtland GH. Pediatrics enlisted in fight against childhood killers. WHO
press Release, No. 59, August 1998.
14. Bellamy C. Tobacco undermines child rights, UNICEF says. Marketing World
No-Tobacco Day calls for concerted global action. Press release, New York,
UNICEF, May 1998.
15. Crockett L.J., Petersen, A.C., 1993. Adolescent development: health risks and
opportunities for health promotion. In: Millstein, S.G., Petersen, A.C.,
Nightangale, E.O (Eds.), Promoting the Health of Adolescents: New Direction
s for the Twenty-first century. Oxford University Press, New York, pp. 13-37.
16. Chattopadhayya A. Harmful effects of tobacco noticed in history. Bulletin of
Institute of History of Medicine, Hyderabad, 1993; 23: 53-58.
17. FHD/MOH. National Adolescent health and development strategy, Family
Health Department, Ministry of Health, 2000.
18. Greden JF. Caffeine and tobacco dependence. In: Kaplan HI, Freedman AM,
Sadock BJ (Eds.) Comprehensive Textbook of Psychiatry, 3rd edition.
Baltimore: Williams and Wilkins, 1980.
19. Gupta, Prakash C. (1992). Control of tobacco-related cancers and other
diseases: proceedings of and international symposium, January 15-19, 1990,
TIFR, Bombay pp. 29.
20. Hieshman SJ. Tobacco the once and future addiction: editorial. Addiction
2001; 96:1389-1390.
21. Hughes JR. Nicotine related disorders. In Sadock BJ, Sadock VI (eds.) Kaplan

30

and Sadock's Comprehensive Textbook of Psychiatry, 7th edition. Philadelphia,

Lippincott: Williams & Willkins, 2000.
22. Jacobsen B. Smoking and health: A new generation of campaigners. Br Med J
1983; 287:483-4.
23. Jha P, Chaloupka FJ. (eds.) Curbing the epidemic: Governments and the
economics of tobacco control Washington DC: The World Bank. 1999.
24. Kamboj, M. (2008). Bidi Tobacco British Dental Journal 205 (12): 639.
25. Karki, D, K D Pant and B R Pande (2003): A study on the economics of
tobacco in Nepal, HNP Discussion paper Economics of Tobacco Control
paper No 13, Tobacco-Free Initiative, World Health Organization.
26. Martini S, Sulistyowati M. The determinants of smoking behaviors among
teenagers in East Java province, Indonesia Health, Nutrition and Population
(HNP) Discussion paper. Washington DC: The International Bank for
Reconstruction and Development/The World Bank; 2005:1-47.

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32

APPENDIX A
ENGLISH QUESTIONNAIRE:
Serial No.:.....................
Date.:.....................

RESEARCH INSTRUMENT
SEMI-STRUCTURED QUESTIONNAIRE

This survey is about smoking. I would like to know about you and things you do that
may affect your health. Your answers will be used for programs for young people like
yourself.
SECTION A: Demographic Information of Respondent
1. Your age: _____________
2. Your sex: ______________
3. What is your ethnicity?
1. Brahmin
2. Chettri
3. Newar
4. Others
4. What is your religion?
1. Hindu
2. Buddhist
3. Christian
4. Muslim
5. Others
SECTION B: Questions related to smoking

33

5. Have you ever been curious about smoking a cigarette?

1. Yes
2. No
6. Have you ever tried cigarette smoking, even one or two puffs?
1. Yes
2. No
7. Who influenced you to cigarette smoking?
1. I have never smoked
2. I saw my family members smoking
3. My friends taught me.
4. I learned smoking myself.
8. If one of your best friends offers you a cigarette, would you smoke it?
1. Yes
2. No
9. How old were you when you first tried cigarette smoking, even one or two puffs?
1. I have never smoked cigarettes, not even one or two puffs
2. 15 years old
3. 16 years old
4. 17 years old
5. 18 years old
6. 19 years old or older
10. About how many cigarettes have you smoked till now?
1. I have never smoked cigarettes, not even one or two puffs
2. 1 or more puffs but never a whole cigarette
3. 1 cigarette
4. 2 to 5 cigarettes
5. 6 to 15 cigarettes (about 1/2 a pack total)
6. 16 to 25 cigarettes (about 1 pack total))
11. Normally how many cigarettes do you smoke per day?
1. I do not smoke cigarettes
2. Less than 1 cigarette per day
3. 1 cigarette per day
4. 2 to 5 cigarettes per day
5. 6 to 10 cigarettes per day
6. 11 to 20 cigarettes per day
7. More than 20 cigarettes per day
12. What brand of cigarettes do you usually smoke? (CHOOSE ONLY ONE
ANSWER)
34

1.
2.
3.
4.
5.
6.
7.
8.

I did not smoke cigarettes

Surya
Marlboro
Pilot
Khukuri
Gaida
Some other brand not listed here
Not sure

13. How do you get your own cigarettes? (CHOOSE ALL THAT APPLY)
1. I did not get cigarettes
2. I bought a pack of cigarettes myself
3. I had someone else buy a pack of cigarettes for me
4. I asked someone to give me a cigarette
5. Someone offered me a cigarette
6. I bought cigarettes from another person
7. I took cigarettes from a store or another person
8. I got cigarettes some other way
14. Where do you buy your own cigarettes? (CHOOSE ALL THAT APPLY)
1. I did not buy cigarettes
2. A convenience store
3. A department store
4. Khudra pasal
5. Restaurant or coffee shop
6. On the street
7. Some other place not listed here
15. Does anyone refuse to sell you cigarettes because of your age?
1. I did not try to buy cigarettes
2. Yes
3. No
16. How soon after you wake up do you want to use a cigarette product?
1. I do not use cigarette
2. Within 5 minutes
3. From 5 to 30 minutes
4. From more than 30 minutes to 1 hour
5. After more than 1 hour but less than 24 hours
6. I rarely want to use cigarette
17. How true is this statement for you? I feel restless and irritable when I dont use
cigarette for a while.
1. I do not use cigarette
2. Not at all true
35

3. Sometimes true
4. Often true
5. Always true
18. How easy do you think it is for kids your age to buy cigarette products in a store?
1. Easy
2. Somewhat easy
3. Not easy at all
19. When you read newspapers or magazines, how often do you see any ads or
promotions for cigarettes?
1. I do not read newspapers or magazines
2. Rarely
3. Sometimes
4. Most of the time
5. Always
20. When you watch TV or go to the movies, how often do you see actors and
actresses using cigarettes?
1. I do not watch TV or go to the movies
2. Rarely
3. Sometimes
4. Most of the time
5. Always
21. A warning label tells you if a product is harmful to you and can be either a picture
or words. During the past 30 days, how often did you see a warning label on a
cigarette pack?
1. I did not see a cigarette pack
2. Rarely
3. Sometimes
4. Most of the time
5. Always
22. During the past 30 days, to what extent did warning labels on cigarette packs
make you think about the health risks of smoking?
1. I did not see a warning label on a cigarette pack
2. Not at all
3. A little
4. Somewhat
23. To what extent do warning labels on tobacco products make you think about the
health risks of tobacco?
1. I did not see a warning label on a smokeless cigarette product
2. Not at all
3. A little
4. Somewhat
36

5. A lot

24. How do you feel when you see anti tobacco and smoking campaigns on various
media
1. Its just another advertisement
2. I feel it as good work
3. I feel nothing, i ignore them
25. Do you think this kind of campaign may stop youngsters like you to stop
smoking?
1. Yes
2. I am not sure but maybe
3. No I dont think so
26. Do you think smoking cigarettes makes young people look cool or fit in?
1. Yes
2. No
SECTION C: Questions related to Consequences of Smoking
27. Are you aware of the risks of smoking cigarette?
1. Yes
2. No
28. If yes, do you know the types of hazards? LIST ALL hazards you know:
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
29. How long do you think someone has to smoke before it harms their health?
1. Less than a year
2. 1 year
3. 5 years
4. 10 years
5. 20 years or more
30. Do you think smoking is more harmful to women?
1. Yes
2. No
3. Both Men and Women are equally in risk
37

31. Do you think smoking is equally harmful to person who always stay nearby a
smoker
1. Yes
2. No
3. Im not sure but maybe
32. Do you think smoking is more harmful when women are pregnant?
1. Yes, it can affect the child at birth.
2. No, the child is not affected.
3. I'm not sure, but maybe.
33. Do you know that smoking can lead to many different types of cancer?
1. Yes
2. No
3. I dont know, maybe.
34. Do you know what is the most common cancer caused by smoking?
1. Lung Cancer
2. Cancer in the neck region
3. Cancer in the abdominal region
4. Cancer of reproductive organs
35. Someone tells you only smoking occasionally (like in a party) will not harm a
person's health. What do you think?
1. Smoking occasionally is harmless
2. Any amount of smoking is harmful to health.
3. I do not know.
36. Have you ever witnessed or know someone who witnessed loss of relatives due to
smoking?
1. Yes, I have witnessed a loss personally.
2. Yes, I have heard of a loss from family/friends.
3. No, I do not know anyone die from smoking.
37. Which of the following areas in life is affected by smoking?
1. Health
2. Wealth
3. Personality
4. All of the above
5. None

38

38. Do you think regular smokers have a lower life expectancy than people who do
not smoke?
1. Yes, smokers have lower life expectancy.
2. No, smoking does not change life expectancy.
3. I don't know but maybe.
39. Do you discuss the harms of smoking with your family member?
1. yes very frequently
2. yes but rarely
3. No, never
40. Does your college organize any awareness programs for students about the effects
of smoking?
1. yes very frequently
2. yes but rarely
3. No, never

39

APPENDIX B
INFORMED CONSENT FORM
I understand that I am being asked in a research study at Moon Light Higher
Secondary School. This research study will assess knowledge regarding consequences
of smoking. If I agree to participate in the study, I will be provided a questionnaire in
presence of researcher and will be filled within approximately 30- 50 minutes about
my knowledge regarding consequences of smoking. I understand that there are no
risks associated with this study.
I realize that I may not participate in the study if I am not between the age of 15 to 19
years. I realize that the knowledge gained from this study may help either me or other
adolescents in the future. I realize that my participation in this study is entirely
voluntary, and I may withdraw from the study at any time I wish. If I decide to
discontinue my participation in this study, I will continue to be treated in the usual
and customary fashion.
The study has been explained to me. I have read and understand this consent form, all
of my questions have been answered, and I agree to participate. I understand that I
will be given a copy of this signed consent.
..

Signature of participant

Date

...

Signature of witness

Date

...

Signature of investigator

Date

40