views and attitudes of nursing students towards smoking

VIEWS AND ATTITUDES OF NURSING STUDENTS TOWARDS SMOKING Dr. Fouka G., Mantzorou M., MSc, RGN, Babatsikou F., MSc, RN, Mastroyannis D., MSc, RGN, Dr. Varthaki Z. Nursing Department, HTEI of Athens, Greece

Abstract: Objective: the aim of the study is the clarification of the views and attitudes of the nursing students of TEI of Athens with regard to smoking, as well as the examination of the factors related to the establishment of that habit, with the final target of preventive intervention. Material-Methods: 350 students were the sample of the study. The collection of the data was based on an epidemiologic research which was carried out from February until June 2003. We utilized the Strategic Analytic System program for the statistical analysis of data. We used x test for statistical control. Outcomes: 43.4% of the students were found to be smokers. The age of onset was 15-18 years of age. There was a statistically significant difference among various age groups (p=0,002). A

significant raise was noted among student smokers at the senior year of studies (52%). The existence of another smoker in the family was found to influence significantly the onset of smoking (p=0,001). The influence of peers was also found to influence significantly the onset of smoking (p=0,001). Conclusions: there is an urgent need of developing and implementing health education programs in adolescence and adult life aiming at preventing the onset as well as stopping smoking.

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Key words: smoking, attitudes, knowledge, health education

INTRODUCTION

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moking appears to be the most widely spread habit in the last five centuries which used to cause and still produces the most wide variety of harmful effects to man1,2,3. The cigarette smoke is nowadays the only legal lethal product in the free market. Since the first publication of “Surgeon General Report” in 1964 in the United States until recently, the battle of Public Health against smoking has been focused on the establishment of the view that cigarette smoking is a dangerous threat for health. The pandemic of cigarette smoking today in the beginning of the 21st century and the start of the third millennium is the most serious concern of science compared to other habits of the powerful habitant of earth4. Research studies prove everyday that cigarette is a factor causing cancer, cardiovascular, respiratory and other diseases5,6,7,8,9,10,11,12,13. Generally, both the direct and indirect expose to the smoke of the cigarette cause an epidemic of early morbidity and mortality which can however be prevented 14,15,16. Cigarette smoking causes on an annual basis, the death of the same number of people as those who die of Aids, drugs, alcohol, fires, homicides, suicides and car accidents altogether6,16. By evidence of the World Health Organization about mortality on the 21st century due to smoking

products, it is estimated that, overall, there have been 100.000.000 deaths. Especially in Europe, deaths are estimated to be 1.200.000. This number as presented by WHO, will rise in 2002 to 2.000.000 while in the period 20202050 will rise up to 500.000.00017. Greece is the first country in Europe and the third country in the world with regard to the number of smokers, since a percentage of 43% of the population is smoking. Moreover the Greek people aged 15-24 years old hold the first position between men of that age in Europe with a percentage of 59 % of smokers. The relevant percentages in France and Portugal are 51% and 52% respectively. With regard to the deaths in Greece, it has been estimated that in 1990 20% of deaths in men of all ages and 3% of deaths in women were attributed to smoking. In 1995 the respective percentages were 10% for men and 2% for women20. These worrying findings suggest that there is an urgent need for immediate planning of appropriate programmes against smoking in Greece. The objective of the present research study was the examination of the views and attitudes of nursing students of TEI of Athens towards smoking. This clarification was carried out alongside with the examination of other smoking related factors such

ICUS NURS WEB J │ ISSUE 21│JANUARY – MARCH 2005 (NURSING.GR)

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as habits and lifestyle, smoking habits of parents and close friends along with demographic data,. The endmost goal of the present study is the development and evaluation of methods of preventive interventions, generally or especially, for young students. Material and methods The present study is based on an epidemiologic research which was carried out from February to June 2003 at the Nursing Department of the Health and Vocational Educational School of TEI of Athens. The inclusion criteria for the study were the proof of attendance in any of the eight semesters of the School including students on graduation year. Closed ended anonymous questionnaires were used (with the exception of one open ended question). Several choices corresponded to each question to help the respondent choose the most convenient answer. In all cases, answering the questions was done most willingly, with all questionnaires being filled out correctly. The collection of the questionnaires was carried out in the classrooms; 350 students participated in the study. The questionnaire comprised of four parts. In the first part demographic data of the study population was examined. The second part recorded data about the general views of the population under study (i.e. smoking and health). The third part examined the non smoking students’ views and the fourth part the smoking students’ views. The 350 questionnaires were coded and then they were inserted in a computer in order to be processed. By the end of data insertion and before the analysis, a quality test was carried out in order to exclude possible errors during typing. The Strategic Analytic System (S.A.S.) computer statistical program was used in order to analyze data. We created tables and in order to evaluate the statistical significance of any potential relations we utilized the x2 statistical test. The significance of the any potential relation was determined by the p value, that is the result of the x2 test. A p value equal to or smaller than 0,05 was considered the measure of characterizing a relation as statistically significant. Outcomes The overall population of the study was 350 students (53 males and 297 females). The majority of the participants (39,4%) aged between 20 and 21 while the smaller age group in number (9,4%) was over 24 years of age. With regard to the place of birth, almost half of the population (49,4%) was born in large towns while the rest of the population

(50,6%) was born in provincial cities. The majority of the participants (56,6%) belonged in four person families (table 1). Almost half of the students (43,4%) were smokers. The majority of the participants (68,9%) had a smoking person in their family. In addition, the majority of the respondents (45,4%) has a friend who smokes (table 2). Nearly all of the students (96%) agree that smoking influences other people’s health and the majority state that smoking causes cancer, respiratory and cardiovascular diseases. A large percentage (35,4%) of the respondents expressed no view on the question with regard to whether smoking causes duodenal cancer (table 3). During the examination for any potential discrepancies among demographic data of the students we noted that the percentage of smokers gradually rose with advancing age. Students under the age of 20 smoke less than students over the age of 24 (32,9% to 57,6% respectively). It appears that the same applies to the academic year, where 32,9% of the students were smokers in the first year in contrast to 57,6% in the senior year. We also noted that the percentage of smokers rose with relation to the parental education level. To be more specific, the percentage of smoking students whose parents attended only primary school is 39% while 56% of the students whose parents had higher education, are smokers (table 4). With regard to the smoking habits of the family and friends of the respondents, as well as the smoking habits of the students, it was found that students who had at least one smoker in their family, were smokers themselves in 49,8 %. In addition, the percentage of smoking students is bigger in cases where both parents are smokers (52%). Finally, students who have close friends who smoke, adopt this habit themselves (64,8%, table 5). The majority of smokers (66,4%) smoke more than 24 months. The age of onset is 15-18 years of age for the 71% while 16% started at an age of over 19. With regard to the number of cigarettes per day, 36 students (23,7%) smoke less than 10, 47 students (31%) smoke 10-19 cigarettes, 42 students (27,6%) smoke 20 cigarettes while 27 students (17,8%) smoke more than 21. A 73,1% of the students always inhale the smoke and 38,8% use to smoke the first cigarette of the day in the first half hour after awakening in the morning. More than half of the students (57,2%) wish to quit smoking and 83 students have tried quitting (54,6%) while the majority of those students (73,2%) had tried more than twice with no success. It is important that only 48 students (31,6%) would quit smoking because of a loss a close relative. Finally, only 2 students would encourage another person to start smoking (table 7).


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After studying several factors that may relate to smoking, it was found that 71,7% of the 152 smoking students use to smoke when they discuss with friends, while most of them (69,7%) smoke when they are stressed. The majority (92,8%) smoke at their leisure time, while anger, moments of tension and frustration are contributing factors for most of them. Finally, the smoking habit is adversely affected by the presence of a non smoking family member (table 8). Discussion The present epidemiologic study presents a large number of data, some of which was found to be statistically significant with regard to the views and attitudes of the nursing students of TEI of Athens towards smoking. In particular, it was found that the majority of the respondents (84,9%) were females, a fact that is in accordance with the proportion of the two sexes in the Nursing Department. A 36% were first year students, 26,3% were second year, 20,6% were third year and 17,1% seniors. Among the 350 students, 152 were smokers (43,4%). 241 of the students have a smoking family member (68,9%) while nearly half of the students (45,4%) have a smoking friend. Almost all of the students agree that smoking affects the state of health. The level of knowledge of the students about smoking and the impacts of smoking on the cardiovascular and respiratory systems is adequate, since, 99,7% and 98,6% believe that smoking causes respiratory and cardiovascular diseases, respectively. The percentage of the students who believe that smoking causes cancer is high (88,6%), a finding that is in accordance with the results of an older study21 and possibly denotes that this particular knowledge is well founded in the Greek society. The same does not apply to whether smoking causes duodenal cancer, where, a 35,4% of the students appear that do not state an opinion, a fact that suggests that there is inadequate information on less discussed on public diseases. Almost half of the male and female students are smokers (45% and 43% respectively). The difference is too small and statistically non significant. While examining the age groups we found a statistically significant difference (p=0,002): one third of the smoking students are under 20 (32,9%) while more than half of the students over 24 smoke (57,6%). Similarly, there was a statistically significant result while examining the academic year of study: 32% of freshmen smoke while 57% of the seniors are smokers.

Both results which are both statistically important could be attributed to the growing influence of peers during their studies away from home as well as the growing stress they experience for their studies as well as their worries for the future. Regarding the level of education of the parents, it was found that the higher the level, the higher was the percentage of smoking students. More specifically, 39% of the students whose parents are elementary school graduates smoke while 56% of the students whose parents have received higher education. This difference, though, was not found to be statistically significant. Looking at the family members of the students, it was found that in families that included at least one smoker, students smoked at 49,8%, while in the cases of non smoking families the percentage of smoking students was 29,4% (a statistically significant difference, p=0,001). It appears that the existence of other smokers in the family has an important influence on other family members with regard to starting smoking22. There was another statistically significant finding; the students whose close friends are smokers, tend to smoke at 64,8%. The adoption and continuation of the smoking habit seems to be directly related to the social environment of the smoker. It appears that having smoking friends and parents, creates an environment that promotes and encourages the adoption of the smoking habit by younger people. These findings are similar to the finding of other studies23,24,25. The results of the above mentioned studies are in accordance with ours; it seems that the close family members make smoking appealing to younger people along with the stance of friends and parents towards smoking that plays a significant role in establishing and continuing this habit. Interesting data came up with regard to smoking and the impacts of smoke on other people’s health. It was found that 42% of the students who believe that smoking affects other people’s health are smokers, while 75% of the students who don’t believe that smoking affects other people’s health, are smokers. It could be argued that those who do not believe that smoking affects other people’s health are smokers in a higher percentage because they underestimate in general the influence of cigarette smoking on health. There were no statistically significant differences between the views of smoking and non smoking students regarding the impact of various diseases. On the basis of numerous analyzed variables regarding the study of habits, rate and environment of the 152 smokers, it was found that 101 students (66%) smoke for over 24 months, a finding that is in accordance with the findings of Dardavesis et al’s study26.


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The number of cigarettes per day was less than 10 for 36 smoking students (23,7%), 47 students (31%) smoke 10-19, 42 students (27,6%) smoke 20 while 27 students (17,8%) smoke more than 21. A 73,1% of the students always inhale the smoke. More than half of the 152 students (57,2%) wish to quit smoking while the rest of the smoking students (42,8%) do not wish to quit or do not express an opinion. A 54,6% of the smokers have tried quitting more than twice without success. This finding is similar to the findings of Kromidas et al’s study27. They found that more than 44,7% of the students under study had tried quitting smoking but they didn’t make it. It is interesting that only 48 students (31,6%) would quit smoking because of a loss a close relative. It is reassuring that a 94,1% of the students would never encourage another person to start smoking. Another important finding is that the majority of the students (71%) started smoking between the age of 15 to 18, a finding which corresponds to the findings of various studies: Fragidis X & Marselos M., Salber E.J. et al, Mc Kennell A.C., Dardavesis T. et al28,29,30,26. Finally, various, related to smoking, factors were noted and analyzed. More specifically, it was found that 71,7% of students always smoke in the presence of friends, at their in leisure (64,5%) and when stressed (69,7%). Moments of tension and anger drive 66% of the students to smoking as well as frustration that affects 61,2% of the smoking students.

It is interesting that 57,2% of the students are adversely affected by the presence of a non smoking family member while is encouraged by the presence of a smoking family member. The last results could be attributed to the need for social acceptance and conformation. Conclusions The percentages of smokers among nursing students are notably high. This behavior is not consistent with the future function of public health and must be immediately confronted with more systematic and effective information plans. Suggestions Reinforcement of the active participation of the people involved while offering them the possibility of planning, implementing and evaluating the activities against smoking resulting in an increased concern on the smokers’ part. Presentation of the direct effects of smoking to the human body. Integration of antismoking messages in a complete health education program by using methods of value clarification and decision making that allow young people to examine their personal stances and values and making decision accordingly. Promotion of multidimensional antismoking programs which will include the media, the family, the youth organizations e.t.c.


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Table 1. Demographic and other characteristics of the 350 students who have been questioned. Variables Sex Male Female Age