Cigarette Smoking

CHAPTER I: THE PROBLEM AND ITS BACKGROUND
INTRODUCT ION Lung disease and cancer is threatening to kill our nation 's hopes. This is the present concern of health experts because of the alarmingly high number of Filipino youths addicted to smoking and other tobacco products. (Buenavista, 2001). Smoking is very common worldwide but even more so in the Philippines," according to Dr. Dante Morales, former president of the Philippine Heart Association (PHA) and Philippine College of Physicians (PCP). More importantly, it is the most common cause of death from heart and brain attack and blood vessel diseases in the country. According to the Philippine Global Youth Tobacco Survey (GYTS) of the DOH, that among kids aged 13 - 18 years old, 57% of the boys and 27% from the girls are already smoking. Four out of ten kids overall (43%) have already tried cigarette smoking. (Buenavista, 2001). According to the WHO, the Philippines ranks number one in terms of youth smokers compared to the data from other countries in the Western Pacific and Southeast Asian region. For this reasons, the researchers, focus the study about the perceptions of teenagers ages 15 – 18 years old in smoking. This will also enable them to determine what the influences are surrounding the teenagers in order to smoke. The researchers formulated a questionnaire for gathering data. The questionnaire is composed of seven questions; include the frequency of smoking, the influential factors, family and friends consent, different perceptions, and quitting. More importantly, the gender and the age are asked. Only aged 15-18 year old nursing students are chosen as a sample population of the study.
REVIEW OF RELATED LITERATURE This chapter discusses both conceptual and research literatures. The literatures related to this study were gathered from books, journals, other periodicals, and unpublished materials. The information gathered from these sources provided the researcher with the necessary background knowledge which was significant to the study.

Foreign Studies Recent research indicates related factors that influence smoking habits that: The motivation for any adolescent behavior is complex. The reason they smoke are no less so but may include: peer pressure, imitation of their parents, boredom, cigarette advertising, the need to experiment, and self-image. All these factors affect an adolescent’s decision to begin smoking. They continue to smoke because cigarettes are highly addictive.
A recent study by Dr. Alan Moran in Drogheda looked at the issues of peer/parent/sibling pressure on smoking and the reasons teenagers stop smoking. He surveyed pupils from three male secondary schools in the North and East and found that if a sibling smoked, the adolescent was 3.5 times more likely to smoke. If a close friend smoked, their risk of smoking is 11.5 times more. Of the boys surveyed, 79% reported enjoying smoking, 80% reported having tried to stop smoking and 70% wanted to stop. The reasons why they wanted to stop were: ill-health-22%, cough – 9%, the fact that it was illegal under the age of 17 years -2.6%, and medical advice – 1.2%. The reasons they stated for smoking were: stress -34%, to feel cool – 15%, to feel confident – 11%, enjoyment – 10, addiction -9%, and because friends smoked – 3.3%.

The interesting area in this study is to note that only 9% smoked because they were addicted but 34% because the reason of being “stressed”. In spite of legislation banning the sales of cigarettes to under 16 years old, all the adolescent smokers stated they were able to buy cigarettes when asked where they got them from. (Moran, Alan – 1995) From a book entitled “Global Aggression: The Case for World Standards and Bold US Action Philip Morris and RJR Nabisco” by Derek Yach stated that: being adult is very important to teenagers. Teenagers crave to be adults, to take their place in society and to be a full adult member of the tribe. The real reason teenagers smoke to be more adult is because rebelling is the sign of being adult. Adults make their own choices. Children have to do what their parents tell them to do. Parents tell their children not to smoke. Teenagers smoke to prove to their parents they have the authority to make their own choices.
One mistake that parents make is that they don’t teach their children how to make good choices. They just tell them what to do and expect them to learn the pattern. (Yach, Derek of World Health Organization, Geneva – 2000). The study is similar to the book “The Teenager 's Guide to the Real World” by Marshall Brain, it is said that the teenager mind is much different from the adult mind. All teenagers eventually figure this out that is the point at which they start to become adults. But until a teenager turns on his or her adult brain and begins thinking like an adult, he or she is stuck with a teenage brain. The key concept here is that being a teenager is a temporary state meant to be outgrown. In other words, being a teenager can be equated to being a child at some level. The idea is for a teenager to outgrow and become an adult. The teenage mind tends to be extremely non-rational and very reactive. Every single person who starts smoking is doing it because they are using their teenage mind to make the decision, rather than an adult mind. The difference is that the teenage mind reacts, while the adult mind asks and considers options. The teenager gets to choose exactly what appears on their slate by making choices from a nearly infinite pool. In other words, they get to design your life. (Brain, Marshall -2000)

Local Studies A study conducted by Belle Bondoc, “Filipino smokers starting at a very young age” stated that in the Philippines, smoking remains acceptable. This is why despite the anti-smoking lobby and mounting proof of cigarette smoking health risks, the number of young smokers is still rising. It is natural for teenagers to try something new. In many cases, teens smoke because of the feeling of belongingness and for the sake of friendship. Others think smoking is glamorous when you smoke. But once they are on cigarette smoking, they find it hard to quit. (Bondoc, B. Philippine Daily Inquirer- 2001) It has been shown that adolescents who smoke are less knowledgeable about the negative consequences of smoking, and hold more favorable attitudes and beliefs toward smoking than nonsmoking adolescents. The type of smoking that is perceived as being harmful to a youth’s health seems to be unrelated to his or her own smoking habits. Some adolescents with attention deficit/hyperactivity disorder see smoking as a form of self-treatment. Others are swayed by the misguided belief that smoking helps lose weight. Smoking can be a way to express personality traits such as wanting to act more mature or more grown-up, being tough or “cool”, rebelliousness or having sensation- seeking tendencies. Smoking can be a manifestation of a behavior that departs from the normal children who display antisocial behavior at a young age have been shown to be the adolescents who are at risk for problem behavior, including cigarette smoking. Situations that place youth and adolescents at high risk from smoking consist of having parents and siblings who smoke and have a positive attitude toward smoking; peer pressure and a high degree of involvement in social activities; positive attitudes toward smoking; and negative attitudes toward school.

Foreign Literature Cigarette smoking is the leading cause of preventable disease and death in the US, where it is estimated that there are more deaths each year resulting from smoking than from alcohol, cocaine, heroin, AIDS, suicide, homicide, motor vehicle accidents and fires combined (US Department of Health and Human Services 2000). Since 1980, approximately 3 million US, women have died prematurely from smoking related to neoplastic, cardiovascular, respiratory, and pediatric diseases, as well as cigarette-caused burns. Each year during the 1990s, US women lost an estimated 2.1 million years of life due to these smoking attributable premature deaths. Additionally, women who smoke experience gender specific health consequences, including risk of various adverse reproductive outcomes. Three factors are particularly important in the initiation of smoking and its maintenance. These are (i) normative influences, (ii) beliefs regarding the consequences of smoking and (iii) social bonding factors. Normative influences are defined as an individual’s perceptions of social pressures and specifically of the extent to which significant others prescribe or proscribe a particular behavior. Several studies have shown that young smokers perceive greater social support for smoking and less social pressures against smoking than non-smokers. Two distinct types of norms may be important in determining smoking behavior: perceived approval and behavioral norms. Perceived approval consist of beliefs about the approval or disapproval of others for a particular behavior will have specific personal consequences.
Parental attitudes carried the greatest weight when it came to approval. Peer group example has a profound impact on smoking, while peer group approval is less important. The pattern of influences of parents is largely mediated through their perceived approval, while the example of parents seems to be a relatively unimportant factor. (Morgan, Grube -1989).
There are a lot of reasons why children start to smoke. Some children may begin to smoke if they have low self-esteem. Smoking may get them in with the “in crowd” and help them to make friends. If they smoke, then they will be accepted by their peers. Some children believe that they appear older and more grown up especially if they are surrounded by young adults who smoke. Others are only experimenting and just want to try and see what all the fuss is about. Whatever the reason that the teenager has for starting to smoke, it is apparent that no matter how much you try to tell them that smoking is bad for you a great number of them are going to try it anyway. The mass media (TV, radio, newspapers, magazine) have become increase popular as a strategy for delivering preventive health messages and are seen as particularly appropriate method for delivering anti- smoking messages to young people. Television is thought to influence young peoples’ perceptions of the real world and acceptable social behavior, and also to help define cultural norms.
Mass media contribute to the acceptance of a smoking environment by portraying smokers as attractive, outgoing, popular and sexy. Although cigarettes are not advertised on television, viewers are still exposed to cigarette company logos on billboards and banners in televised sports events. Print advertising campaigns also contribute to a pervasive acceptance of cigarettes. (Michael Siegel, MD, PH, 2007)
Myriad examples of tobacco ads and promotions targeted to women indicate that such marketing is dominated by themes of social desirability and independence. These themes are conveyed through ads featuring slim, attractive, athletic models, images very much at odds with the serious health consequences experienced by so many women who smoke.
Many adults have their own reasons for continuing to smoke. A lot of people think that they need cigarettes in order to cope with stress or nerves. However, nicotine is a stimulant. It makes your heart beat faster and raises your blood pressure, so in fact, smoking does not really relax you at all or help you cope with unpleasant situations. Other smokers say that their habit relaxes them. This is also erroneous because if you think about it in a lot of the situations were you would light up a cigarette, you are actually carrying out relaxing and enjoyable activities such as sitting down and having coffee with friends, watching television or having a break from work. People probably think that smoking relaxes them, when in reality, smoking a cigarette just stops the withdrawal symptoms that have begun to kick in after not having one for a while.
As with the adolescent smokers, they use smoking as a social tool. Smoking may be a way of talking to different people and making new friends. Asking someone for a light or a cigarette may be a way of starting a conversation or an ice breaker.
Contrary to the peoples’ perceptions, Nicotine actually have beneficial effects on our body. It is surprising to know that several pharmaceutical companies (notably Abbott Labs, SIBIA, and Astra Arcus) are concentrating on nicotine research. So, the companies are working to design drugs which will mimic the good effects and avoid the bad ones. Nicotine has a lot of good effects to the body and its health. First of all, it can be used as an analgesic and anti psychotic. It can also lower anxiety level and help cognitive enhancement. Cerebrovasodilation which dilates the blood vessels in the brain and Neuroprotection which protects the cells of the nervous system from certain types of degenerative disease. No one knows for sure quite why, but a history of smoking seems to be protective against some of the neuronal loss in Alzheimer’s disease. On the other hand, nicotine has also bad effects to the body. Nicotine is an emetic and is a substance which can induce vomiting. It can also cause gastrointestinal distress, respiratory distress, seizure and hypothermia. Having said these effects caused by nicotine, what more if you smoke cigarettes which not only contain nicotine but other harmful components. Other research has shown that adolescents who smoke also tend to have weaker ties to parents and school and have more school behavioral problems and lower levels of self-esteem, acadaemic achievements and educational attainment. (Bryant et al.2000; Centers for Disease Control and Prevention 1998; Conrad, Flay , Hill, 1992; Shculenberg et al, 1994; US Department of Health and Human Services, 1994; White Pandina, Chen, 2002; US Department of Education, 2005). Smoking related diseases like lung cancer, Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD), cardiovascular disease have become one of the top leading causes of mortality among different countries. (Phyllis C. Pugh, 1998).
Researchers are finding that it may be easier for teenagers to become addicted to cigarettes than adults because teens seem to react differently to nicotine, the addictive substance in cigarettes."The more nicotine you take as a teenager, the more likely you are to become a smoker," says George Koob, professor of neuropharmacology at the Scripps Research Institute.
Koob says there have also been studies "showing that young animals actually will self-administer more nicotine, not less nicotine, and show bigger arousal effects from nicotine." So not only does nicotine seem to be less repellant for teens, it also appears to be more rewarding. "Whatever nicotine does initially to the organism, it has less of the negative effects in adolescents and in teenagers, and more of the positive effects," says Koob. "And as a result, it 's much easier for teenagers to smoke more and more."
And potentially become addicted. "An addiction almost requires that you take a lot of the drug," Koob explains. "The idea that you become addicted to one cigarette is really pretty false. To become addicted to cigarettes, you have to do a lot of cigarettes. And if the brain is constructed in such a way in a young animal or young person that it allows them to easily do a lot of cigarettes, then it 's logical that they 're going to do a lot of cigarettes, which means that ultimately, it could lead to the addictive state."
Koob says that, like other drugs, nicotine produces a withdrawal state. When smokers stop taking cigarettes, they are very uncomfortable. They 're irritable, they have a malaise, like a fatigue, they are cranky, they are dysphoric, they don 't feel good about themselves, they have trouble thinking properly, their work performance deteriorates, and they 're basically in a state that we call a motivational withdrawal state.

Previous investigations of adolescents’ attitudes towards smoking have found that, although both smokers and nonsmokers generally expressed negative attitudes, smokers expressed more favorable attitudes than others (Bhatia, Hendricks & Bhatia,1993) Beliefs about social consequences of smoking may be more influential than health-related beliefs. In one study, it was found that beliefs about the physical consequences of smoking (getting lung disease, heart trouble) were not significantly related to future smoking (Collins et al.,1987)

Local Literature
The Philippines is one of the countries where smoking has reached epidemic proportions. Statistics indicate that almost three quarters of the country’s adult male population are smoking, exceeding the recorded level for the Third World countries in general. The high prevalence of smoking in the country has not spared the younger sector of the population. Despite an almost universal (97%) belief that smoking is harmful to their health, Filipino adolescents still try and continue the habit. Findings reveal that Filipino adolescents 15-24 years old is currently smoking with a higher percentage among males compared to females (37.3% vs. 6.3%) (Berja, Cruz; 2004) This literature emphasizes the significant role of parents in protecting adolescents from engaging in smoking. The positive association between smoking of parents and offspring validates the findings of past studies that relates parent’s cigarette smoking with increased likelihood of their children’s smoking behavior. (Tyas, S.L., Pedersin, L.L., 1998) Such strong influence of parents on their adolescent children is expected given the fact that the majority of Filipino adolescents look up to their parents as role models. The parenting style is also associated with adolescent smoking. An authoritative, positive parenting style lessens the predisposition to adolescent smoking. Those with permissive parents are more predisposed to adolescent smoking. (Melby, JN, Conger, KJ, et al;1993) More importance is given to father than mother’s parenting style. An adolescent is influenced more by perceived permissiveness of his mother than that of his father. This implies greater authority of fathers in the family. On the contrary, mothers are typically perceived as permissive which often leads their children to treat them as their friends or just their equals.
Another factor that can contribute to adolescent smoking is engaging in leisure activities. Leisure activities are usually done without parental supervision. This is also the time when adolescents experiment on things together as a “barkada.” (Berja, Cruz,2004) Males are more at risk than female because society allows higher tolerance to male smoking. Thus, focused attention should be given to male adolescents because Filipino parents tend to be more lax with boys than girls. People that live in a city or urban area are more likely to smoke than those living in rural areas. This may be explained by the adolescent’s predisposition to leave home to study or work in urban areas. Again, this means that most of them are not personally supervised by parents.
Given these factors mostly on parental influences on their children, their challenge is to ensure the positive transmission of values that would protect the young from situations that predispose them to smoking. After all, adolescents still look up to their parents as their role models.

STATEMENT OF THE PROBLEM
The purpose of this study is to identify different perceptions of nursing students about cigarette smoking. This study aims to answer the following questions:
1. What is the perception of nursing students aged 15-18 about cigarette smoking?
2. What is the level of understanding of 15-18 year old nursing students about smoking?
3. What are the influences of 15 – 18 year old nursing students to smoke?
4. What varies in the perception between male and female nursing students aged 15 – 18 year old about cigarette smoking?
5. How often do nursing students, age 15-18 years old smoke cigarettes?

OBJECTIVES OF THE STUDY
In addition to the problems stated above, the study has the following objectives:
• To determine what are the perceptions of nursing students about cigarette smoking.
• To determine the level of understanding of nursing students have about smoking
• To determine the factors that influences why nursing students to smoke.
• To determine the perception nursing students aged 15 – 18 year old about cigarette smoking
• To determine how often nursing students smoke

THEORETICAL FRAMEWORK
The researchers used the Theory of Reasoned Action which was developed by Fishbein and Ajzen. Fishbein and Ajzen specify that an individual behavior is driven by behavioral intentions where behavioural intentions are a function of an individual’s attitude toward the behavior and subjective norms surrounding the performance of the behavior. Intention is the best predictor of behavior, where intention is the cognitive representation of a person’s readiness to perform a given behavior and the immediate antecedent of behavior.
Attitude → Intention → Behavior

The intention to perform or not perform a behavior is determined by three factors:
a. Attitude toward the behavior is the individual’s belief or feelings in doing a behavior, and the associated evaluation of the belief.
b. Subjective is a person’s perception of what others around them believe that the individual should do. These people may include friends or a peer group, family, co-workers, church congregation members, community leaders and even celebrities.
c. Perceived behavioral control refers to a person’s perception of their ability to perform a given behavior.

CONCEPTUAL FRAMEWORK Figure 1: Conceptual paradigm on the reasons of an individual’s behavior.

Using the Theory of Reasoned Action, the researchers were able to apply the framework in understanding how teenager’s perceive cigarette smoking and the different factors that would greatly influence the teenagers to smoke and the variation of perception in between men and women. The theory of reasoned action helps the researcher to manage the person’s perception in cigarette smoking and compare the subjective norms to what the person view about cigarette smoking. The theory of reasoned action also helps the researcher to evaluate the given perception of the person in cigarette smoking.

OPERATIONAL DEFINITION OF TERMS
The following terms are defined operationally as:
 Socio-demographic characteristics
a) Age refers to the years in life the respondents have.
b) Sex refers to the biological identity of the respondents.
 Nursing students refers to individuals whose age is between 15-18 years old.
 Perception refers to an individual’s apprehension of certain topics or subjects.
 Cigarette Smoking is the act of smoking a finely rolled paper containing shredded tobacco.
 Non-smokers are individuals that do not smoke cigarettes at the present. Regardless of whether they have smoked before and have already quit smoking.
 Smokers are individuals that smoke cigarettes at the present. Regardless of the number of cigarettes they smoke in a particular time frame.

SIGNIFICANCE OF THE STUDY
The study aims to provide healthcare professionals an assessment on how nursing students perceive cigarette smoking. The study will contribute in the formulation of better, more effective and gender specific health teachings. The study will also widen the understanding of nurses on to why nursing students engage to smoking despite the consequences that they may face. The study will contribute to the nursing students’ knowledge about cigarette smoking, particularly its effects to teenagers. It will contribute to the nursing students’ better understanding of the problems brought about by cigarette smoking. The study will also contribute to the improvement of a nursing student’s abilities in handling or caring for a smoking patient.
The study will benefit the nursing society by giving the latest insights of nursing students, within the age bracket of 15-18 years old, about cigarette smoking. In addition to this, an increased awareness of the influences that makes nursing students to smoke could help healthcare providers give out more appropriate health teachings. The study will provide the nursing society an idea of how the perception of male nursing students varies from female nursing students.
The study will also be available to other researchers as a guide in making further research on the perceptions of nursing students about smoking. The result of this study will help future researchers better understand the influences that triggers a nursing student, aged 15-18 years old to smoke. The study will provide information in enhancing the effectiveness of health teachings about cigarette smoking that are to be given to nursing students.

SCOPE AND LIMITATIONS Due to limited time, the study focuses on determining the factors that influences teenagers to smoke cigarettes, their perceived effects of cigarette smoking and their awareness of the effects of cigarette smoking. The respondents will only include nursing students aging from 15 – 18 years old from the freshmen and the sophomores of San Lorenzo Ruiz School of Health Sciences of Mapua Institute of Technology, Makati campus. The study will not consider respondents from higher year levels because there are a lot of factors that will affect the study, like the availability of the junior and senior students are limited due to their hospital duty, and could be considered as biased because the researchers are part of the higher level. The study will not include students from a different course or from a different school to ensure that there will be respondents who are readily available. The study will not include students whose age is not included in the age bracket that was set for this study. The study will not consider other aspects such as alcohol drinking and drug-abuse in determining the perception of teenagers on cigarette smoking for this will require more time and a wider range of respondents. The study will not include the difference of perceptions of non-smokers and smokers regarding in smoking due to the complexity of the variation between their perceptions.

CHAPTER II: METHODOLOGY
RESEARCH DESIGN The study will make use of a non-experimental descriptive research design in determining the perception of teenagers on cigarette smoking. This type of research design aims to describe the factors that influence teenagers to smoke cigarettes. It can also be a tool used in measuring the awareness of the respondents about the effects and the factors that influence them in smoking. In addition to this, the variation of the perception of male teenagers from female teenagers will be shown with the use of this type of research design.

SETTING
The study will be conducted in Mapua Institute of Technology, Makati campus located at the former RCBC building at the corner of Sen. Gil Puyat Ave. and Nicanor Garcia St. In 2002, due to space constraints on the Intramuros Campus, the old RCBC Building was bought and converted into the Mapúa Makati Campus, where the School of Information Technology was moved. The campus offers the following courses: Schools of Information Technology, Health Sciences, Business & Management and Hotel and Restaurant Management program.

SUBJECTS AND SAMPLING The study will make use of 60 respondents out of a population of 130 students, from both the freshman and sophomore year level. The criteria of the respondent to be included in the study are as follows:
 The respondent should be a freshman or sophomore student.
 The respondent should be within the age bracket, which is 15 to18 years old.
The respondents will be selected by use of non-probability convenience sampling. This type of sampling is utilized to cope with the limited time to gather information. This type of sampling also enables the researchers to gather the necessary information in the fastest possible manner. Furthermore, this type of sampling offers the researcher to analyze the data immediately since it requires minimal time and is inexpensive.

DATA COLLECTION TOOL The researchers formulated a questionnaire for gathering data. The questionnaire is composed of seven questions. The demographic data, the age and gender, are obtained before any questions are answered. The first question focuses on the frequency of smoking of the respondent. The second, third and fourth question focuses on the factors that the respondent consider as an influence to smoking. The fifth question focuses on the perceived effects of the respondents, whether it is positive or negative. The sixth and seventh question focuses on the respondent’s belief on smoking. These seven questions will asses the perceptions of teenagers about smoking. Thus, in determining the effectiveness of the questionnaire, a pilot study will be conducted where areas of improvement will be noted.
DATA COLLECTION PROCEDURE Out of the total population, both freshman and sophomore, of 130, 60 respondents were selected. During the respondent’s free time, they were initially interviewed at different locations inside the campus. A verbal consent was obtained before administering the questionnaire. The respondents are then divided into two groups, the freshman and the sophomore group. Within the two groups, a further division was made based on their gender. The further division of the group was to ensure that there will be an equal number of male and female respondents. To protect the respondent’s identity, the researchers made use of numbers to select the respondents. Upon gaining rapport and full cooperation of the respondent, the questionnaires were given to them to answer. Upon completion of the questionnaires, the researchers tallied the data. The tallied data will then be interpreted by the researchers.

STATISTICAL PROCEDURE AND DATA ANALYSIS The researchers made use of descriptive statistics to determine the respondent’s demographical data. The use of bar graph is utilized in determining the factors that influence the respondents’ perception about the effects of cigarette smoking and the variation between male teenagers and female teenagers in their perception of smoking. The use of pie graph is utilized in determining factors that influence teenagers to smoke cigarettes as well as their beliefs in smoking. For the data analysis, the researchers conducted a pilot study to test the effectiveness of the data collection tool and to have a basis in interpreting the data that is going to be gathered for the actual paper. Thirty students were selected randomly from the junior year level of San Lorenzo Ruiz School of Health Sciences. Of the 30 students, 15 are males and the other 15 are females. Out of the 15 males, seven are smokers who consider their friends as their influence in smoking. Out of the 7 male smokers, 3 smokes cigarettes more than once a day, another 3 smokes cigarettes once a day and 1 of them smokes cigarette once a month. When asked if they have considered quitting smoking, 6 of them replied that they have, and only 1 said that he hasn’t tried quitting. However, a big difference could be seen when the male respondents are compared with the female respondents. Out of the 15 female respondents, only three are smoking, where two of the respondents smoke cigarettes twice a month and one smoke cigarettes more than once a day. They admit that their friends are their primary influence in smoking but they still consider their family as a factor since their families approve of cigarette smoking. Only one of the smoking female respondents said that she had tried quitting smoking while the other two have not considered quitting. This shows that there are more male than female smokers are where both sexes are influenced by their peers to smoke cigarettes. Of the choices given as to what they consider as an effect of smoking is, the following have the highest score, having bad smell, harming one’s health and fitness, having stained teeth and relief from stress. While losing weight, personal enjoyment and looking cool have the least scores. Therefore, cigarette smoking, as perceived by the respondents does not give any positive effects to an individual besides providing them relief from stress. Cigarette smoking, for them, only provides an individual harm. The respondents do not see cigarette smoking as a good part of a diet to lose some weight nor have personal enjoyments.

CHAPTER III: RESULTS AND DISCUSSION This chapter contains the results and interpretation of the questionnaire that was accomplished by the respondents. The following are the data that were tallied and interpreted from the accomplished questionnaires.

Table 3.1: Number of Smoking and Non-Smoking Nursing Students

Frequency
Percentage

Smoker
34
57%

Non-smoker

26
43%

Figure 3.1 Number of smokers and non-smokers Among the 60 respondents, 26 respondents are non-smokers which comprise 43% of the target population while 34 respondents admitted that they are smokers which comprise 57% of the target population. This shows that out of the 60 respondents from the first year and second year, more than half are smoking. Most of the smokers in the population compose of male nursing students and only a few of them are female nursing students.

Table 3.2: Comparison of male and female smoker and non smoker

Gender
Frequency
Percentage

Male – Smoker
19
32%

Male - Non-smoker
11
18%

Female – Smoker
15
25%

Female – Non-smoker
15
25% Figure 3.2: Comparison of male and female smoker and non-smoker Out of the 60 respondents, 19 male respondents are smokers (32%) while 11 male respondents are non-smokers (18%). On the other hand, 15 female respondents are smokers (25%) and 15 females are non-smokers (25%). This signifies that there are more male nursing students who smokes compared to female nursing students. The data proves that the study done last 2004 by Berja, Cruz indicates that males are more prone to smoking than females.
Table 3.3: Male smoking frequency

Number of times smoking
Frequency
Percentage

Once a month
0
0%

Twice a month
1
5%

Once a week
0
0%

2-3 times a week
2
11%

Once a day
5
26%

More than once a day
11
58%

Figure 3.3: Male smoking frequency More than half of the male respondents who smoke are smoking cigarettes more than once a day, this comprise 58%. Some male respondents smoke once a day (26%). And other respondents smoke 2-3 times a month (11%) or twice a month (5%). The male population has the greater tendency to smoke cigarettes more than once a day.
Table 3.4: Female smoking frequency

Number of times smoking
Frequency
Percentage

Once a month
1
6.67%

Twice a month
3
20%

Once a week
7
46.67%

2-3 times a week
1
6.67%

Once a day
2
13.33%

More than once a day
1
6.67%
Figure 3.4: Female Smoking Frequency From the 15 female respondents who smoke, 7 respondents smoke once a week (46.67%), 3 respondents smoke twice a month (20%), 2 respondents smoke once a day (13.33%), 1 respondent smoke once in a month, 2-3 times a week and more than once a day (6.67% for each). The female population has a lesser tendency to smoke cigarettes.

Table 3.5: Smoking Frequency of Smoking Nursing Students

Number of times smoking
Frequency
Percentage

Once a month
1
2.94%

Twice a month
4
11.76%

Once a week
7
20.59%

2-3 times a week
3
8.82%

Once a day
7
20.59%

More than once a day

12
35.29%
Figure 3.5: Smoking Frequency of Smoking Nursing Students Out of the 34 respondents who smoke, 12 respondents smoke more than once a day (35.29%), 7 respondents smoke once a day or once a week (20.59 for each), 4 respondents smoke twice a month (11.76%), 3 smoke 2-3 times a week (8.82%), and 1 smoke once a month (2.94%). Half of the population smoke cigarettes a lot often.

Table 3.6: Factors that Influence Male Nursing Students to Smoke

Influence
Frequency

Family
0

Friends / Peers
15

Advertisements
6

Others
1

Figure 3.6: Factors that Influence Male Nursing Students to Smoke The male respondents consider their friends or peers as the leading factor that influences them to smoke. Media also influence them to smoke. Although there are billboards around the streets that advertise smoke, the friends of the male respondents are more influenced by their friends. Study done by Dr. Alan Moran informs that there is a larger percentage for a person to smoke if one of their close friends smoked.

Table 3.7: Factors that Influence Female Nursing Students to Smoke

Influence
Frequency

Family
2

Friends / Peers
14

Advertisements
3

Others
0

Figure 3.7: Factors that Influence Female Nursing Students to Smoke The female respondents consider their friends or peers as the leading factor that influences them to smoke. Their family and media also influence them to smoke. Derek Yach author of “Global Aggression: The Case for world Standards and Bold US Action Phillip Morris and RJR Nabisco” stated that being adult is important to teenagers, most of our data collected aged female 15-18 years of age probably fall out to the category of being adult is important.
Table 3.8: Factors that Influence Nursing Students to Smoke

Influence
Frequency

Family
2

Friends / Peers
29

Advertisements
9

Others
1

Figure 3.8: Factors that Influence Nursing Students to Smoke The primary factor that influences nursing students to smoke is their friends or peers. Family and media is only a small factor that influences teenagers to smoke. In general, Friends and peers greatly influence nursing students to smoke cigarettes. The total data proven to have a great influence of smoke due to friends because they want to be part of the barkada as stated also by Berja,Cruz in 2004.
Table 3.9: Family’s Approval to Smoking

Family’s Influence
Frequency
Percentage

It okay to smoke
32
53%

It is not okay to smoke
28
47%

Figure 3.9: Family’s Approval to Smoking Among the 60 respondents, 32% or 32 respondents think that it is okay for the family for them to smoke. 47% or 28 of them think that it is not okay for the family to smoke. This shows that more families of the population increase the chance of influencing the nursing student to smoke. In the statement of Berja,Cruz; fathers tend to influence their Childs smoking behavior because they see their parent as their role models, even so with their mother smoke, fathers who smoke has a positive look on the child because he has greater authority than the mother.

Table 3.10: Family’s Approval to Smoking with Male Nursing Students

Family’s Influence
Frequency
Percentage

It okay to smoke
19
63%

It is not okay to smoke
11
37%

Figure 3.10: Family’s Approval to Smoking with Male Nursing Students
More male respondents think that smoking is okay for the family, as seen in the chart 63% or 19 of the family of the male population agree, the other 37% or 11 think that smoking is not ok for the family. Greater number of the families of the male population influences them to smoke.

Table 3.11: Family’s Approval to Smoking with Female Nursing Students

Family’s Influence
Frequency
Percentage

It okay to smoke
13
43%

It is not okay to smoke
17
57%

Figure 3.11: Family’s Approval to Smoking with Female Nursing Students
The female population on family’s perception on smoking shows more than half of them 57% or 17 of them think it is not ok for their family to smoke, but it shows 43% or 13 of them that their family influences them to smoke. More families of the female population do not influence them to smoke.

Table 3.12: Friends/Peers’ Approval to Smoking

Friends’/ Peer’s Influence
Frequency
Percentage

It okay to smoke
36
60%

It is not okay to smoke
24
40%

Figure 3.12: Friends/Peers’ Approval to Smoking
More than half of the total population influences them to smoke because of their friends or peers perception on smoking. 60% or 36 answered that their friends think it is okay to smoke. Only 40% answered that their friends think it is not okay to smoke. 11.5 times increase adolescent to smoke if their friends smoke, stated by Dr. Alan Moran, only 3.5 times increase to smoke if their sibling smoke. Moreover leisure time is mostly done together with friends, if one of their friends smokes; it is more likely their other friends and that person will smoke.

Table 3.13: Friends/Peers’ Approval to Smoking with Male Nursing Students

Friends’/ Peer’s Influence
Frequency
Percentage

It okay to smoke
22
73%

It is not okay to smoke
8
27%

Figure 3.13: Friends/Peers’ Approval to Smoking with Male Nursing Students
Male population contributed most to the influence of smoking by their friends or peers, 22 out of 8 of the male population. Males have more influences in smoking because, one of which is most of the parents of males are more loose than female, they are more prone to smoking due to friends if their friends smoke.

Table 3.14: Friends/Peers’ Approval to Smoking with Female Nursing Students

Friends’/ Peer’s Influence
Frequency
Percentage

It okay to smoke
14
47%

It is not okay to smoke
16
53%

Figure 3.14: Friends/Peers’ Approval to Smoking with Female Nursing Students
Almost half of the female population thinks that smoking is not okay for their friends but still has almost the same number of the other female population who answered that it is not okay for their friends to smoke. Females are less to be influenced due to familial status and thus this creates stricter rules for the female.

Table 3.15: Perceived Effects about Smoking of Nursing Students

Effects
Frequency

Relief stress / feel relaxed 12

Personal enjoyment 9

Look cool 8

Reduce appetite and help in weight loss 9

Bad breath 19

Spend a lot due to the cost of cigarettes 16

Cause harm to health and fitness 22

Risk of becoming an addict 21

Get stained teeth and fingers 20

Cause harm to others through passive smoking 16

Smell Bad 23

Figure 3.15: Perceived Effects about Smoking of Nursing Students
The least perception of effect of the total population was looking cool, together with their perception of personal enjoyment and reduction of their appetite, other perception of the nursing students made relevant information about their idea of the effects of smoking. Most of the answer was the effect of having a bad smell of the person. According to the related local literature in the study done by Berja, Cruz, 97% believed that smoking for them is harmful to one’s health; the data that was gathered showed to be second in the ranking.

Table 3.16: Comparison of the Perceived Effects about Smoking of Male and Female Nursing Students
Effects Frequency Percentage

Relief stress / feel relaxed 6 6

Personal enjoyment 6 3

Look cool 5 3

Reduce appetite and help in weight loss 5 4

Bad breath 12 7

Spend a lot due to the cost of cigarettes 9 7

Cause harm to health and fitness 12 10

Risk of becoming an addict 11 10

Get stained teeth and fingers 11 9

Cause harm to others through passive smoking 8 8

Smell Bad 15 8

Figure 3.16: Comparison of the Perceived Effects about Smoking of Male and Female Nursing Students
More male nursing student answered many perceptions about smoking. Most of the answer was the perception of smelling bad. This shows that the male nursing students have a higher background about the effects of cigarette smoking. The perceptions mostly indicated above are from the book of Derek Yach, some of which is relief stress and to look cool, some other effects that are mentioned in the book of Derek Yach is not included in the table. Nicotine as stated in the related study, it really does not create a good effect to the person, nicotine is included in the component of cigars. The perception of having a relief from stress is merely psychological rather than physiological. Nicotine increases, heart rate and increases your blood pressure, meaning that it does not really relax one person.
Table 3.17: Desire of Smoking Nursing Students to Quit Cigarette Smoking

Quit smoking cigarettes
Frequency
Percentage

Yes
18
53%

No
16
47%

Figure 3.17 Desire of Smoking Nursing Students to Quit Cigarette Smoking
Total population shows 53% or 18 or them tried to quit smoke, 47% of them didn’t try. This information defines that people who smoke has chance to quit. Being under the influence in smoke, there is hard to quit as said by Belle Bondoc a Filipino researcher. The data above tell us that half of the population tried to quit, but still some of them still has not yet thought about quitting smoke.

Table 3.18: Belief Desire of Smoking Male Nursing Students to Quit Cigarette Smoking

Quit smoking cigarettes
Frequency
Percentage

Yes
10
53%

No
9
47%

Figure 3.18: Desire of Smoking Male Nursing Students to Quit Cigarette Smoking

The male smoker reflected the same percentage of the total population; this refers to the chance of quitting smoking when one person is still under the influence of smoke. Same data from the data collected and from the related literature reveals that more than 50% of the smokers wanted to quit as stated in the literature of Maziak W, et al. 2004.

Table 3.19: Desire of Smoking Female Nursing Students to Quit Cigarette Smoking

Quit smoking cigarettes
Frequency
Percentage

Yes
8
53%

No
7
47%

Figure 3.19: Desire of Smoking Female Nursing Students to Quit Cigarette Smoking
The population of the female students also reflects the male’s and total population’s percentage. This data perceives the female has also a high chance of quitting in smoke when under it. Only 47% tried not to quit smoking. Female has less chance of smoking cigarettes than male because smoking cessation in females create a weight gain about 6-12 pounds a year and this creates a masculine pattern seen in the study found at www.edwardtufte.com/tufte/women-smoking.

Table 3.20: Belief that Smoking as an Addiction or as a Habit

Situation
Frequency
Percentage

Addiction
53
88%

Habit
7
12% Figure 3.20: Belief that Smoking as an Addiction or as a Habit
The total population shows 53% or 18 of them of respondents that it is hard for a person to quit smoking when he or she is smokes as a habit, only 47% or 16 of them do not believe that it is easy to quit when smoking. Therefore the population has an idea that it is hard to quit smoking to quit smoking when addicted to it or making it as a habit. Nicotine has good effects on the body, some of which are it is used as an analgesic, neuro-protection, cognitive enhancement and others not very useful. Bad effects of the nicotine in the cigar are GI distress, Emesis or induced vomiting, respiratory distress and others that make a person DOB. These effects of nicotine were stated by Phyllis C. Pugh in 1998 in his study.
Table 3.21: Belief of Male Nursing Students that Smoking as an Addiction or as a Habit

Situation
Frequency
Percentage

Addiction
27
90%

Habit
3
10%

Figure 3.21: Belief of Male Nursing Students that Smoking as an Addiction or as a Habit
The male nursing population has almost half of the population cut to two in equal parts, because 90% of the population or ten of them answered that it is harder to quit when addicted. Mostly creating the impression of the male nursing population that they believe it is harder to quit when addicted to smoke. Most male nursing student believe that if you are addicted to smoke you have less chance of quitting, maybe because these male nursing students know the effect of nicotine in the person.

Table 3.22: Belief of Female Nursing Students that Smoking as an Addiction or as a Habit

Situation
Frequency
Percentage

Addiction
26
87%

Habit
4
13%

Figure 3.22: Belief of Female Nursing Students that Smoking as an Addiction or as a Habit
The female nursing student population was cut almost into two equal populations, 8 of them or 87% of them answered that they believe it is harder to quit smoking and 13% or 4 of the female respondents answered its easy to quit smoking when addicted to smoke. Because of the cut of population, this can show the female nursing population that they believe it is harder to quit smoke when addicted to it.

CHAPTER IV: SUMMARY, CONCLUSION AND RECOMMENDATION
SUMMARY
The study aimed to identify the perception of 15 – 18 years old nursing students in smoking. It aimed to determine the different influential factors that these respondents started to smoke. It also focuses in determining any variation in the perception between male and female respondents. The study utilized a non-experimental descriptive research. Data came from a self-administered survey of 60 respondents from 130 male and female freshman and sophomore nursing students. Non-probability convenience sampling is used to select the potential subjects participating in the study. In the benefit side, the perception we gathered from smoking were the relieving from stress, personal enjoyment, to look cool, reduce appetite and help in weight loss. In the harmful side, the perception we got were bad breath, spend a lot of money due to cost of cigarettes, cause harm to health and fitness, risk of becoming an addict, get stained teeth and fingers, cause harm to others through passive smoking and acquiring bad odor.
Male and female nursing students differed markedly in their perceptions about smoking. Male dominantly perceived that a habit of smoking could acquired a foul body odor while female were more conscious on the health risk they cold acquired from smoking. Aside from the disadvantage they could inhibit from smoking, both of them also benefit by using it to relieve their stress.
Males were as likely as females, that their influential factor to smoke was their friends/peers. The family’s consent is also an important role in smoking. Most parents of the males gave their consent while a few for the female respondents don’t. Both of them wanted to quit because of fear from being addicted with smoking.

CONCLUSION The perception of the male and female respondents is that cigarette smoking is bad for the health. They might have some satisfying perception in smoking like being relieved by stress but the harmful effect they could get couldn’t ease their mind. The fact that most of them are having a hard time in quitting it might be the effect of the nicotine substance in cigarette. They understood that even in a short exposure of cigarette smoking they are in great risk of severe diseases like. The most influential factor of cigarette smoking among the respondents is coming from their friends/peers. There is no large variation in the perception between the male and female respondents.

RECOMMENDATION Based on the findings of the researchers, the following recommendations are suggested to further studies of the perceptions of teenagers in smoking:
• Use a larger sample population of teenagers starting from age 13 – 19 years old. In it, it could expand the knowledge of the researchers about the common and rare perceptions of the teenagers.
• It is in greater use if the researchers will also know the perceptions of non-smoker towards smoking and compare it to the perceptions of the smokers. It could be helpful to establish a program against smoking.
• It is highly recommended to establish a clinical research about variation of studies in different places not just in one to avoid biases to the result. With these, the prevention of smoking in teenagers could be applied in different places.
• It is also advised to know the perceptions of parents and friends towards smoking. It is important to determine their perception to be able to assess more about the influential factors of teenagers.
• Since, nurses’ main focus in prevention of diseases they are encouraged to give health education. Health teaching among adolescent about smoking is a big step in preventing major diseases that they could acquire from smoking.
• Encourage the government or have a partnership with them to establish a program in cessation of smoking.
• Advertisement is also a good factor to influence adolescents in smoking. Establishing a prohibition for these advertisements could lessen the prevalence for the adolescence to smoke.

BIBLIOGRAPHY
Books:
Moran, A.1995. Issues of peer/parent/sibling pressure on smoking and the reasons teenagers stop smoking. Smoking: risk, perception, & policy. 24, 337-349.

Yach, D.2000. Derek of World Health Organization. “Global Aggression: The Case for World Standards and Bold US Action Philip Morris and RJR Nabisco”. 71, 59-69.

Bondoc, B. 2001. “Filipino smokers starting at a very young age”. Philippine daily inquirer. 48, 164-177.

Cecconi, J. 2000. Factors that influence smoking habits. Effects of parent smoking habits on their child’s smoking habits. 38, 25-42.

Bryant, A.L., Schulenberg, J., Bachman, J.G., O’Malley, P.M., and Johnston L.D. 2000. Understanding the Links Among School Misbehaviour, Academic Achievement, and Cigarette Use: A National Panel Study of Adolescents. Prevention Science, 1 (2):71-87

Center for Disease Control and Prevention. 1998. Tobacco Use Among US Racial/Ethnic Minority Groups. Atlanta Georgia: National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health

White , H.R., Pandina, R.J., Chen, P.N. 2002. Developmental Trajectories of Cigarette Use from Early Adolescence into Young Adulthood. Drug Alcohol Dependence, 65 (2): 167-178.

Conrad, K.M, Flay, B.R. and Hill, D. 1992. Why Children Start Smoking Cigarettes: Predictors of Onset. British Journal of Addiction, 87:1711-1724

Schulenberg, J., Bachman., O’Malley, P.M., Johnston, L.D. 1994. Highschool Educational Succes and Subsequent Substance Use: A Panel Analysis Following Adolescents into Young Adulthood, Journal of Health and Social Behaviour; 35(1):45-62

US Department of Health & Human Services. 1994. Preventing Tobacco Use Among Young People. Report of the Surgeon General. Atlanta Georgia: National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health

Maziak W, Hamal F, Rastam S, Asfar T, Eissenberg T, Bachir M.E., Fouad M.F., Ward K.D. 2004. Characteristics of Cigarette Smoking and Quitting Among University Students in Syria. Preventive Medicine 39 (2): 330-336

Tufte E. 2002. Supplement to Center for Disease Control and Prevention, Women and Smoking: A Report of the Surgeon General. Morbidity and Mortality Weekly Report, 2-8

Morgan. G., J.W. 1989. “Adolescent cigarette smoking: A developmental analysis of influences” British Journal of Development Psychology, 179-189

Online:
Moran, A. 1995. Factors that influence smoking habits. Retrieved from: http://www.irishhealth.com/index.html?level=4&id=439&ss=teenage%20smoking on November 20, 2007

Brain, M. 2000. The Teenager 's Guide to the Real World. Retrieved from: http://www.bygpub.com/books/tg2rw/smoking.htm on December 11, 2007

Siegel, M. MD, PH. 2007 Mass Media Antismoking Campaigns: A Powerful Tool for Health Promotion. Retrieved from: http://www.annals.org/cgi/content/full/129/2/128 on December 11, 2007

Koob. 2003. Adolescent Brain Development
Retrieved from: http://www.science central.com/articles/view on December 11, 2007

Pugh P.C. 1998. Effects of Nicotine. Retrieved from: http//www.geocities.com/CapeCanaveral/2257/niceffcts.html. on December 11, 2007

Age: ___ Gender: _______ Batch: _____

1.) How many times do you smoke?

___ Once in a month ___ Once a day
___ Twice a month ___ More than once everyday
___ Once a week ___ Non-smoker
___ 2-3 times a week

2.) What influenced you to smoke?

___ Family
___ Friends / Peers
___ Advertisements
___ Others, specify:__________

3.) Does your family think that smoking is okay? Yes / No

4.) Do the majority of your friends think it is okay to smoke? Yes / No

5.) Which among the following do you consider as an effect of smoking?

___ Relieve stress / Feel relaxed ___ Cause harm to health and fitness
___ Personal enjoyment ___ Risk becoming addicted
___ Look cool ___ Get stained teeth and fingers
___ Reduce appetite and help in weight loss ___ Cause harm to others through passive smoking
___ Bad breath ___ Smell bad
___ Spend a lot due to the cost of cigarettes

6.) Have you ever tried to quit smoking? Yes / No
If not, do you have any plans to quit smoking? Yes / No

7.) Do you think people who think smoking as an addiction will have less success quitting smoking than those who view it as a bad habit?
Yes / No

Bibliography: Bondoc, B. 2001. “Filipino smokers starting at a very young age”. Philippine daily inquirer. 48, 164-177. Cecconi, J. 2000. Factors that influence smoking habits. Effects of parent smoking habits on their child’s smoking habits. 38, 25-42. White , H.R., Pandina, R.J., Chen, P.N. 2002. Developmental Trajectories of Cigarette Use from Early Adolescence into Young Adulthood. Drug Alcohol Dependence, 65 (2): 167-178. Conrad, K.M, Flay, B.R. and Hill, D. 1992. Why Children Start Smoking Cigarettes: Predictors of Onset. British Journal of Addiction, 87:1711-1724 Schulenberg, J., Bachman., O’Malley, P.M., Johnston, L.D Tufte E. 2002. Supplement to Center for Disease Control and Prevention, Women and Smoking: A Report of the Surgeon General. Morbidity and Mortality Weekly Report, 2-8 Morgan Brain, M. 2000. The Teenager 's Guide to the Real World. Retrieved from: http://www.bygpub.com/books/tg2rw/smoking.htm on December 11, 2007 Siegel, M Koob. 2003. Adolescent Brain Development Retrieved from: http://www.science central.com/articles/view on December 11, 2007 Pugh P.C. 1998. Effects of Nicotine. Retrieved from: http//www.geocities.com/CapeCanaveral/2257/niceffcts.html. on December 11, 2007 Age: ___ Gender: _______ Batch: _____