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Tobacco Use Knowledge, Attitude and Practice Among Students
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 Payne (1997) stated that tobacco use remains a significant problem for college students. Similarly, Olufemi (1999) opined that tobacco use has been identified as being among the topical problems confronting the nation’s schools. Based on the above information, it has become necessary to investigate tobacco use knowledge, attitude and practice (KAP) among students in tertiary instutions.
Tobacco, according to Ewuzie (2005) is an herb which has been smoked, chewed, and or sniffed for more than five hundred years. The author further stated that tobacco plant belongs to the Nicothiniana genus. It can be consumed, used as an organic pesticide and, in the form of nicotine tartrate, used in some medicine. Tobacco is a nervous system stimulant that triggers complex biochemical and neurotransmitter disruptions (Basic Facts about Drugs 2010). It elevates heart rate and blood pressure, constricts vessels, irritates lung tissue, and diminishes one’s ability to taste and smell. Basic Facts about Drugs (2010) stated that tobacco is a plant that comes in two varieties, nicotiana tabaccum and nicotiana rustica. The latter is the most cultivated of the two and the source of the entire tobacco produced world over including Nigeria. This study adopts the definition of tobacco given by Basic Facts about Drugs (2010). When people use tobacco in any form, it is referred to as tobacco use.
Tobacco use has been described by Mackay and Ericksen (2002) as the consumption of tobacco product by burning, chewing, inhalation, sniffing, and sucking. Moronkola (1999) defined tobacco use as the use of tobacco generally. Philip (2008) stated that tobacco can be processed, dried, rolled and smoked as cigarettes, cigars, bidis (thin-rolled cigarettes imported from South East Asia) and clove cigarettes. Another form is Kreteks (cigarettes imported from Indonesia that contain cloves and other addictive). Loose-leaf tobacco can be smoked in pipes and hookahs (an Asian smoking pipe with a long tube that passes through an urn of water). The two most common forms of smokeless tobacco are chewing tobacco and snuff (finely ground tobacco placed between the gum and lip). In this present study, tobacco use refers to any form in which tobacco is taken into the body by man. This study was interested in cigarette smoking, chewing tobacco and snuffing as may be found among students in tertiary institutions which could be influenced by their knowledge of tobacco use and its corresponding dangers or reasons why they consume the products.
Kirikhan (1984) defined knowledge as expertise/ and skills acquired by a person through experience or education; the theoretical or practical understanding of a subject or what is known in a particular field or in total; facts and information; or to be absolutely certain or sure about something. Omeregbe (1998) asserted that knowledge is that fact of understanding, relevant issues, or objects .that is acquired either through learning or experiences. Kant (2000) opined that one needs sense perception as well as reason to produce knowledge. The author made this clear by projecting three things that are involved in the act of sense-perception that give rise to knowledge/ namely: the object perceived, the sense organ with which it is perceived, and the ego or consciousness or the subject that interprets what is perceived and gives it meaning. Furthermore, the author asserted that the senses in themselves cannot give meaning to the objects of sense-perception without the ego. Knowledge means information, understating and skills that one gain through education or experience (Hornby, 2009).
Knowledge can be classified into various kinds: empirical knowledge, inferential knowledge, intuitive knowledge and prior knowledge (Omeregbe, 1998). Empirical knowledge according to Omeregbe (1998) is the knowledge acquired through sense perception that is through any of the five senses. Inferential knowledge is the type of knowledge that is acquired by inference (Kant, 2000). The intuitive knowledge is knowledge gained by feelings rather than considering the facts, (Hornby, 2009). This implies that it is knowledge that is acquired directly by an immediate contact of the mind with the object without going through the process of reasoning. Kant (2000) described prior knowledge as knowledge acquired prior to experience and independent of experience. In other words, it is knowledge acquired by reason without experience. From the above description of knowledge, the present study is interested in empirical knowledge because students acquire knowledge of tobacco use as a result of the interaction with the social environment, peer groups, family members books and other role models, actors and actresses and teachers who may use tobacco. When knowledge relates to tobacco use, it is called tobacco use knowledge. Tobacco use knowledge as used in this study refers to the understanding of the constituents of tobacco and the potential dangers or health hazards of tobacco including physiological, psychological and social problems of its use. This knowledge has influence on the attitude of students regarding its use.
Attitude has been variously defined by authors or scholars Anderson (1981) defined attitude as a moderately intense emotion that prepares or predisposes individual to respond consistently in a favourable or unfavourable manner when confronted with one’s feeling with a particular object. Meyers (1996) maintained that attitude is a favourable or unfavourable evaluative reaction towards something or somebody exhibited in one’s beliefs, feelings or intended actions. The author went further to report that attitudes are learned through environment by the genes. Moghaddam (1998) refers to attitude as the evaluations of other people’s events, issues and material things, with degree of favour or disfavour. Lambert and Lambert (2007) refers to attitude as an organized and consistent manner of thinking, feeling and reacting to people, groups, social issues or any event in one’s environment. Hornby (2009) defined attitude as the way that one thinks and feels about somebody or something; the way that one behaves towards somebody or something that show how he or she thinks and feels. When attitude relates to tobacco use, it is termed tobacco use attitude. The present study, adopts the definition of attitude given by Moghaddam (1998), as the various ways students in tertiary institutions feel or response to tobacco use which can either be favourable or unfavourable. The attitude students in tertiary institutions have towards tobacco and its use can influence their practice or use of tobacco.
Practice according to Brainy (2009) is defined as the way to carry out things, act upon, to communicate, to execute or to do something. Hornby (2009) defined practice as a way of doing something regularly, a habit or custom. Practice simply means action. It is a process or procedure of doing things. In the context of the present study, practice refers to the actual use or consumption of tobacco by students in tertiary institutions.
Students in tertiary institutions are those people studying in the higher institutions of learning. Hornby (2009) described students in tertiary institution as those studying or undergoing training in the University or college of education or technology after secondary school. In this study, students in tertiary institutions refer to students studying in the tertiary institutions or post-secondary schools like university, college of education and polytechnics. Students’ knowledge, attitude and practice are being affected by some demographic factors.
There are some socio-demographic factors that may be capable of influencing or affecting the knowledge, attitude and practice of students to tobacco use. They include, gender, age, smoking status of parents, smoking status of siblings and peer pressures (Mackay & Ericksen 2002; Avenevoli & Merikagas, 2003; Komro, McCarty, & Forster, 2003). This present study took into cognizance only gender and age as socio-demographic factors.
Gender is a variable that has received consistent attention among researchers (Arcury & Christianson, 1993). The common reason advanced for gender differences is the difference in socialization patterns between boys and girls (Raudsepp, 2001). Mackay and Ericksen (2002) mentioned that smoking behaviour of females differs from that of males and that females are more highly motivated to smoke than males. Females are more likely than males to practice protective health behaviours, whereas male gender is a significant predictor of smoking initiation among adolescents (Boehm, 1993).
Reports from researchers have indicated that age has influence on knowledge, attitude and practice of tobacco use among students in tertiary institutions. Escobedo, Anda, Smith Remington and Mast (1990), and Escabedo, Marcus, Holtman and Giviano (1993), have reported that majority of adult smokers started smoking before the age of 18 years. Knowledge, attitude and practice of students in tertiary institutions towards tobacco use anchor on theory.
The study was anchored on four theories. These theories include; the Theory of Planned Behaviour (TPB), the Theory of Reasoned Action (TRA) Self Efficacy Theory (SET) and Social Learning Theory (SLT). These theories were used as theories of anchor on knowledge, attitude and practice of students in tertiary institutions towards tobacco use in the present study in Kogi State.
Kogi State came into being as a result of the state creation on 27th August, 1991 with its administrative headquarters in Lokoja. The state is structured into 21 local government areas (LGAs) comprising of three major ethnic groups of Igala, Ebira and Okun (Yoruba). Other minor groups include Ogori-Mangongo, Bassa-Komo, Bassa-Nge and Gwari. The state is bordered by nine other states and is the most centrally located state in Nigeria. It is the confluence state with River Niger and Benue meeting at Lokoja the state capital. It has been observed that the extents to which students in tertiary institutions in Nigeria portray their level of knowledge, attitude to and practice of tobacco use do not seem to have received adequate research attention. This cannot be less true about the students in tertiary institutions in Kogi State. Finding out these, certainly, will represent a positive step forward in the effort to prevent adolescents from taking the habit of tobacco use. To this end, one is then inclined to ask, what is the level of knowledge of students regarding tobacco use? What is the attitude of students toward tobacco use? And what is the practice of tobacco use? The above in essence represent the reason for this study.
Statement of the Problem
From earliest time, man had sought for substances that would not only sustain and protect him but would also act on his mind to produce various effects. Tobacco is one of such substances. Equally, individuals when faced with certain health problems usually resort to measures calculated at helping them to solve the problems. This is because life is very precious regardless of age or status. Life should be preserved, maintained and promoted. Consequent upon this, people adopt certain measures or strategies for achieving these goals. One of these strategies is tobacco use.
Ideally, medications are used for preventive, diagnostic, curative and therapeutic purposes and physicians are expected to prescribe drugs. Unfortunately, people including students in tertiary institutions who engage in tobacco use do so without medical advice, and most time the reasons for their use are more psychological and social, and rarely for medicinal values. The effects are often manifested in the feeling which smokers have, namely reduction of boredom and fatigue, enhancement of pleasure of moment and in some instances, smoking provides an escape from the realities of existence. All such use of tobacco to satisfy psychological or personal needs also carry with them a high price such as dependency due to addictive effects of nicotine, and the predisposition to serious, and sometimes fatal disease and untimely death.
Studies conducted on tobacco use knowledge, attitude and practice among students in tertiary institutions in many parts of the world including Nigeria indicate that tobacco use now constitute a problem. The quest for tobacco products seems to be on the increase and it would likely reach an alarming proportion in Nigeria because people now turn to these chemical substances as means to cope with social and personal problems. Umeh (1991) reported that hospital statistics have it that the population involved in tobacco use cuts across socio-economic levels as both the poor and the rich, illiterate and literate get involved and that students in tertiary institutions are most likely to be involved in tobacco use.
Most of the earlier studies on tobacco use, knowledge, attitude and practice among students in tertiary institutions were carried out in other parts of the world and some parts of this country other than Kogi State. Therefore, this present study sought to determine tobacco use knowledge, attitude and practice among students in tertiary institutions in the State.
Purpose of the Study
The purpose of this study was to determine tobacco use knowledge, attitude and practice among students in tertiary institutions in Kogi State, Nigeria. Specifically, the study seeks to determine;
- level of knowledge possessed by students in tertiary institution regarding tobacco use in Kogi State;
- attitude of students in tertiary institutions towards tobacco use in Kogi State;
- practice of tobacco use by students in tertiary institutions in Kogi State;
- level of knowledge possessed by students in tertiary institutions regarding tobacco use according to age;
- level of knowledge possessed by students in tertiary institutions regarding tobacco use according to gender;
- attitude of students in tertiary institutions towards tobacco use according to age;
- attitude of students in tertiary institutions towards tobacco use according to gender;
- practice of tobacco use by students in tertiary institutions according to age;
- practice of tobacco use by students in tertiary institutions according to gender.
The following research questions have been posed to guide the study.
- What is the level of knowledge possessed by students in tertiary institutions regarding tobacco use?
- What is the attitude of the students in tertiary institutions towards tobacco use?
- What is the practice of tobacco use by students in tertiary institutions?
- What is the level of knowledge possessed by students in tertiary institutions regarding tobacco use according to age?
- What is the level of knowledge possessed by students in tertiary institutions regarding tobacco use according to gender?
- What is the attitude of students in tertiary institutions towards tobacco use according to age?
- What is the attitude of students in tertiary institutions towards tobacco use according to gender?
- What is the practice of tobacco use of students in tertiary institutions according to age?
- What is the practice of tobacco use of students in tertiary institutions according to gender?
The following null hypotheses were postulated and tested at. 05 level of significance:
- There is no significance difference in level of knowledge possessed by male and female students in tertiary institutions regarding tobacco use.
- There is no significant difference in the knowledge possessed by the students in tertiary institutions regarding tobacco use according to age
- There is no significant difference in tobacco use attitude of the students in tertiary institutions according to gender
- There is no significant difference in tobacco use attitude of the students according to age.
- There is no significant difference in tobacco use practice of the students in tertiary institutions according to gender.
- There is no significant difference in tobacco use practice according to age.