ABSTRACT
The impact of smoking and tobacco use on
health cannot be over emphasized. Cigarette smoking remains a gigantic public
health problem and is still regarded as one of the leading preventable causes
of morbidity and mortality worldwide. Over the past four decades, tobacco use
has caused an estimated 12 million deaths in the world, including 4.1 million
deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1
million deaths from respiratory diseases and 94,000 infant deaths related to
mothers smoking during pregnancy and on average cigarette smokers lose about 15
years of their life. It has been found that, knowledge about the health hazards
of smoking has not always helped to prevent people from smoking. The objective
of this study is to assess the pattern of smoking among out-of-school youth and
their health risk perception.
This
research was a cross-sectional survey which was carried out among 137
out-of-school youth in selected motor parks in Oshodi Local Government Area of
Lagos State, Nigeria. A semi-structured instrument (questionnaire) was used for
data collection. Data collected were analyzed using Statistical Package for
Social Science (SPSS) version 21 with levels of significance set at 0.05.
The
findings of this study revealed that mean age of respondents was 25.80 ± 8.585
ranging between the ages of 23-38years. Findings showed that there were more
male respondents (88.3%) than there were female respondents (2.2%), indicating
that majority of out-of-school youth at the motor parks are male. Prevalence of
smoking among respondents was average at 56.2%. It was revealed that the rate
of smoking was highest among respondents who initiated smoking at age 25 years
old (13.94 ± 4.28) at 69.7%. It was also found that respondents’ perceived
susceptibility to effect of smoking on health was very low at 15 point rating scale
(4.57 ± 2.38). Also findings shows that respondents’ perceived
severity/seriousness of the effect of smoking on health was very low at 15
point rating scale (5.18 ± 2.50) and that respondents’ perceived benefit of
quitting smoking was below average at 15 point rating scale (6.11 ± 3.06).
Findings revealed that there was significant difference in the level of smoking
prevalence across the age of respondents (df = 16; F = 6.448; P < 0.05). Result showed that there
is a significant association between prevalence of smoking and health risk
perception of respondents (df = 3; r = 0.432; P < 0.05) and that there is no significant association between
prevalence of smoking and health risk knowledge of respondents (df = 1; r =
0.089; P = 0.301).
This study concluded
that out-of-school youths’ low health risk perception increased their smoking
rate. The findings of this study suggest implementation of educational
intervention towards improving out-of-school youths’ health risk perception of
smoking.
CHAPTER ONE
INTRODUCTION
1.1
Background to the Study
The impact of
smoking and tobacco use on health cannot be over emphasized. Cigarette smoking
remains a gigantic public health problem and is still regarded as one of the
leading preventable causes of morbidity and mortality worldwide (Can, Topbas,
Ozuna, Ozgun, Can & Yavuzyilmaz, 2009; Mpabulungi & Muula, 2004;
Salawu, Danburam, Desalu, Olokoba, Agbo & Midala, 2009;World health
Organisation, 2015). It is well-known that many smokers start before the age of
18 years, however, it is of great interest to know that the increasing trend in
smoking prevalence amongst youths and the likelihood that many of these young
people who begin to smoke at an early age, will continue to do so throughout
adulthood (Adebiyi, Faseru, Sangowawa & Owoaje, 2010).
Although tobacco
use has declined in many high income countries such as the United States and
United Kingdom, it is increasing in many low and middle income countries
(Boutayeb & Boutayeb, 2005; Warren, Jones, Eriksen & Asma, 2006) and in
current situation, tobacco smoking is by far the most popular form of smoking
and is practiced by over one billion people in the majority of all human
societies (Akinpelu, 2015). Tobacco is the most common hazardous substance and
this is aided by its legally availability, heavy promotion and wide consumption
and has been revealed to be problematic including other forms of use other than
cigarettes, which is on the rise among adolescents in many countries, and is
likely to jeopardize progress in reducing chronic diseases and tobacco-related mortality
(CDC, 2010; Warren et al., 2006).
The constant
increase in the consumption of tobacco among adolescents is emerging as a
complex and multidimensional problem (Soni & Raut, 2012). Melgosa (2006)
rightly considers tobacco as a drug with the lowest risk, in the short term but
one which takes away health and life from the greatest number of people in the
long term.
Cigarette
smoking is said to be responsible for over 25 diseases in humans some of which
include: ischemic heart disease, chronic bronchitis and cancers of the lung,
oral cavity, urinary bladder, pancreas, and larynx (Desalu, Olokoba, Danburam,
Salawu & Issa, 2008). Over the past four decades, tobacco use has caused an
estimated 12 million deaths in the world, including 4.1 million deaths from
cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths
from respiratory diseases and 94,000 infant deaths related to mothers smoking
during pregnancy (WHO, 2009; Centers for Disease Control and Prevention, 2002;
Ekrakene & Igeleke, 2010) and on average cigarette smokers lose about 15
years of their life (The global tobacco survey collaborative group, 2002; Raji,
Abubakar, Oche & Kaoje, 2013).
It is estimated
that number of deaths due to tobacco will increase from 3 million per year
worldwide to 70 million per year by 2025 (Reddy & Arora, 2005; US
Department of Health and Human Services, 2012). It has been said that
adolescents are especially vulnerable to these effects and may be more likely
than adults to develop an addiction to tobacco (Chakraborty, 2009). In
addition, it has been predicted that if the pattern currently seen among youth
continues, a lifetime of tobacco use would result in the deaths of 250 million
children and young people alive today, most of them in developing countries
(WHO, 2012).
Like other
developing countries, the most susceptible age for initiating tobacco has been
found between the ages of 15-24 years as evident in the study by Gboyega,
Adesegun and Chikezie (2013) identifying
youths as a major group involved in smoking over the last two decades,an age group where most are expected to be in
school. Educational attainment is widely regarded as an important health risk
factor because of how strongly it has been associated with health outcomes,
health-related behaviors, and other risk factors (National Center for Health
Statistics, 1999). For the past 30 years, smoking prevention programmes have
been focused almost exclusively upon youth, mainly within the school setting
(Backinger, 2003;Ekanem, 2008; Salawu, Danburam & Isa, 2010; Fawibe &
Shittu, 2011; Hammond, 2005; Nwafor, Ibe & Aguwa, 2012; Odukoya, Odeyemi
& Oyeyemi, 2013; Okagua, Opara & Alex-Hart, 2015) despite School
dropouts being more likely to smoke heavily than students (Aloise-Young,
Cruickshank & Chavez, 2002). In Nigeria, the prevalence of tobacco use
among youth tends to be higher than among adults (Odukoya, Odeyemi, Oyeyemi
& Updhyay, 2013).
1.2
Statement of the Problem
Smoking among youths has been on an
increase worldwide (Pomara, Cassano, D’Errico, Bello, Romano & Riezzo et al, 2012) with values ranging from 721
million in 1980 to 967 million in 2012 (Marie, 2013). Studies have revealed
that there has been a high increase in the prevalence rate of smoking among
youth in sub-Saharan Africa(Shafey, Dolwick & Guindon, 2012)
and Nigeria precisely (Drope, 2011; Yahya, Hammangabdo & Omotara, 2010),
with statistics showing that youths form over 40% of the Nigerian population
and 18% of the youths smoke, identifying youths as a major group involved in
smoking over the last two decades (Gboyega, Adesegun & Chikezie, 2013).
Smokers’ low perception
of the negative effects of their smoking behavior on their health also results
in many of them being unwilling to quit smoking with most of them expressing a sense of invincibility to the
hazards of smoking (Fawibe & Shittu, 2011). Studies have shown that
individuals who perceive fewer risks and greater benefits of smoking are more
susceptible to initiation (Song, Morrell, Cornell, Ramos, Biehl, Kropp &
Halpern-Felsher, 2009).Literatures have shown that perceptions about health
risks influence cigarette smoking among youths (Aryal, Petzold & Krettek,
2013; Mantler, 2013).Further studies havealso shown that each day, more
than 3,200 people under 18 smoke their first cigarette, and approximately 2,100
youth and young adults become daily smokers.
Furthermore,
studies have indicated that as at 2012 it was noted that death as a result of
non-communicable diseases (respiratory tract infection inclusive), accounted
for 2.7 million deaths in sub-Saharan Africa with the inclusion of Nigeria as a
result of smoking (WHO, 2000-2012). Also literature has
shown that nearly 9 out of 10 lung cancers are caused by smoking and smokers
today are much more likely to develop lung cancer than smokers were in 1964
(Siegel, Miller, Jemal, 2016).
In Nigeria and worldwide smoking causes many types of cancer,
including cancers of the throat, mouth, nasal cavity, esophagus, stomach,
pancreas, kidney, bladder, and cervix, as well as acute myeloid leukemia (Jha, Ramasundarahettige & Landsman, 2013). Also studies still shows that 8 out
of 10 COPD (Chronic Obstructive Pulmonary Disease) deaths are a result of
smoking and currently, there is no cure for COPD (Madu, Matla, 2014).
In spite of the passage of the National Tobacco
Control Bill by the National Assembly in Nigeria, a bill aimed at domesticating
WHO Framework Convention on Tobacco Control (FCTC) to avert the unimaginable
disaster associated with smoking many youth are still caught in the web of the
act, thereby endangering their lives.It will therefore be of immense benefit to investigatepatterns
of smoking and health risk perception of out-of-school youths in selected motor
parks in Oshodi local government area of Lagos state, Nigeria.
1.3 Objective
of the Study
The general
objective for this study is to assess the pattern of smoking among
out-of-school youth and their health risk perception.
The specific
objectives are to:
1. measure the level of smoking prevalence among
respondents;
2. assess the pattern of smoking among respondents and
3. determine if respondents have a good health risk
perception of smoking.
1.4 Research
Questions
1. At what level is the prevalence of smoking among
respondents?
2. What is the pattern of smoking among respondents?
3. Do respondents have a good health risk perception of
smoking?
1.5 Justification
for the Study
Smoking harms nearly every organ of the
body and gradually reduces quality of life (Abdulahi, 2014). Studies revealed the Nigerian population to
be more inclined to smoking with majority of smokers being youths (Ogunmola,
Adegboyega, Oluwafemi, 2015) indicating that
Nigerian smokers are more likely to be predisposed to its health risks. Over 4.5 million adult Nigerians are tobacco addicts and about 5.4 million deaths occur yearly
due to smoking compared to 3 million and 1 million deaths caused by AIDS and
malaria respectively (Global Health Sector Strategy, 2011). The unavailability of the tar contents of the
recent cigarette produced in Nigeria may also be another area of concern (Egbe,
Petrerson & Mayer-Weitz, 2016). According to an
Independent Tobacco Control Activist, Olusegun Owotomo, available statistics
show that about 93 million sticks of cigarette are produced and consumed yearly
in Nigeria which has led to respiratory infections among 150,000-300,000
children under the age of 18 months as a result of passive smoking.
With the trend of tobacco use seen among
youth in Nigeria and studies indicating about half of all lifelong smokers will
die prematurely, losing on average about 10 years of life (Gholamreza, Mostafa,
Mahmoud, Hadi, Masoud & Atena, 2015). It is anticipated that a huge
epidemic of tobacco-related diseases might occur and
with the long term consequences of smoking on health (Melgosa, 2006). It is of
great importance that its reduction should be upmost interest in public health
promotion and education as not only the smokers but also non-smokers are
predisposed to these hazardous effects. As there is neither a
safe tobacco product, nor a safe level of tobacco use, the best way to prevent
tobacco-related deaths is to avoid using it.
Studies conducted in Nigeria to examine
smoking among youths are few, and these studies have concentrated on describing
pattern of use among in-school youths in urban areas (Osungbade & Oshiname,
2013) leaving out-of-school youths unattended to.This study intends to describe
the pattern of smoking and health risk perception amongst a set of youths who
are more likely to be overlooked by program planners. The findings will give an
insight to the current situation of out of school youth smoking habit with the
result aimed at giving recommendations towards health program interventions
that will reduce to the simplest minimum the smoking habits among out-of-school
youths in Lagos, Nigeria. Also the results emanating from it would provide
adequate guidance and a benchmark for program planners to include these set of
youths in smoking prevention intervention programs in Nigeria. This will go a
long way to improve the health of youths in Nigeria and by extension people in
Sub-Sahara Africa.
1.6 Hypotheses
H1: There is a significant
difference in level of smoking prevalence across the demographic
characteristics of respondents.
H2: There is a significant association between
prevalence of smoking and health risk perception of respondents.
H3: There is a significant association between
prevalence of smoking and health risk knowledge of respondents.
1.7 Operational Definition of Terms
Smoking: This is one of the most common
forms of recreational drug use.
Out-of-school youths: They are described
as several groups of young people, those who have dropped out of school, those
who never attended school, or those who participate in non-formal school
programs (August, Claudia, William, Erin,
Rosemary & Jane). These youths are a diverse group who
may have completed elementary school (but lack basic skills to progress to high
school or vocational training), dropped out or never started school. Those who
drop out of school may fail to acquire fundamentals of basic education and life
skills (Fatoye, 2013).
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