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E-ISSN No : 2454-9916 | Volume: 3 | Issue: 5 | May 2017 


USE OF TOBACCO AMONG ADOLESCENT? A REVIEW 
BASED ON AVAILABLE LITERATURE 





Mr. Firoz Qureshi’ | Dr. Nageshwar. V~ 


‘M.Sc Nursing, Teerthanker Mahaveer College Of Nursing, TMU, Moradabad U.P. 
* PG- Tutor, Teerthanker Mahaveer College of Nursing, TMU Moradabad, U.P. 


ABSTRACT 





INTRODUCTION: In 2004 World health organization, projected (58.8) million deaths globally, out of which (5.4) million were Tobacco - attributed; (4.9) million in 
2007 whereas 70% of this in 2002 in developing countries like India only. GLOBAL YOUTH TOBACCO SURVEY (GYTS 2006) reported a prevalence of 13.7 % of 
tobacco user among school going youth of age group in between 13 to 15 yrs. whereas, in(GYTS 2009), the prevalence these consumptions were 14.6% among youths 
of 13—15 years. A recent survey conducted in LUCKNOW, by the Union Ministry of Health And Family Welfare, emphasized a 7% rise in the prevalence of male 
Tobacco use in Uttar Pradesh, on the basis of which health survey committee confirmed that 13% of the U.P population are smokers. METHODS: An electronic 
search of 50 published articles were started on PubMed, EBSCO, BMC Public Health, Sage journal. Out of which 38 articles were removed and 12 full text articles 
were selected on the bases of inclusive criteria of narrative review. RESULT: All these studies were successful in exploring adolescent's awareness of substances and 
associated harm to health from their use of tobacco. “65% of all men use some different forms of tobacco 35% use tobacco by smoking, were 22% use tobacco by 
smokeless tobacco and 8% both. The age of participants ranged from 12 to 18 years old. Participants were school students. Most important factors seem to be peer 
influence, parental attitudes, easy access to tobacco and symptoms of dependence. CONCLUSION: Based on all these studies which included in this narrative review, 
the people who uses tobacco facing major challenges in their entire life. Hence, findings suggests that multifactorial prevention programs that address social norms, 
gender role, image religion, family, school and incorporated drug policy would be more effective and would have better protective outcomes. 


KEY WORDS: “Tobacco, Adolescents”. 


1. INTRODUCTION: 

Tobacco is the leaf of a plant found commonly in Asia and Brazil. It is usually 
used in its dry form. Regular use of tobacco not only affects the dental health, but 
also the rest of the body. Tobacco in different forms is used by people all over the 
world. Consumption of tobacco is a complex, multidimensional problem faced 
by the country. The production, sale, and use of chewed and smoke form of 
tobacco in India have increased, particularly during the past two to three decades. 
There is no stigma but in fact positive sanction for the use of chewed tobacco. It is 
popular among men and women and even used by children. 


Tobacco use is a leading cause of the preventable deaths and diseases, world- 

wide. According to worldwide tobacco use is claiming the lives of nearly 6 mil- 

lion people a year worldwide, including more than 600,000 nonsmokers who die 

from exposure to tobacco smoke. The first tobacco manufacture in India Gujrat 

of Sixteenth Century, Tobacco manufacture can scarcely have started in India dur- 
ing Akbar's Regin. Gujarat, UP, Karnataka, Andhra Pradesh, over 90% of the 

total Tobacco production in the country. 


Tobacco use among adolescents in India is a matter of concern. The Global Youth 
Tobacco survey (GYTS 2006) reported a prevalence of 13.7 % of ever use of 
tobacco among school going youth in the age of 13 to 15 yrs. And, Global Youth 
Tobacco Survey (GYTS 2009), the prevalence of consumption of, Tobacco and 
smoking was reported to be 14.6% and 12.5%, respectively, among the 13—15 
year age groups. 


LUCKNOW: In a recent survey conducted by the union ministry of health and 
family welfare, 1t was found that there has been a 7% rise in the prevalence of 
male Tobacco in Uttar Pradesh. The health survey also confirmed that 13% of the 
UP population are a smoker with most of them located in Sitapur district where 
every third man is asmoker. While in chewing tobacco, Banda is the leader where 
around 67 % men consume Tobacco, In addition, the aim, scope and need of the 
study, Assessing participants' awareness of types of available substance in their 
community, route of administration, means of obtaining substance and conse- 
quences of their use on health. Exploring their views on factors related to sub- 
stance use among adolescent. Recommending effective prevention strategies tar- 
geting adolescents in schools and communities. 


Aim: The aim of this review is to identify how, where, when use of tobacco 
among adolescent. 


OBJECTIVES: To explore the use of Tobacco among adolescent. 


2. MATERIAL METHODS: 

2.1. Search Strategy methods: 

An electronic search of articles published in various journals publication period 
of 2002 — 2016 was conducted. The papers which were in the English language 
only. The database search done was PubMed, EBSCO, BMC Public Health, Sage 


journal. Articles containing following key search terms were retrieved. 


2.1.1 Types of Interventions: 

¢ Tobacco, Adolescents, Smoking, Health literacy, Health Promotion, 
Tobacco Packaging, Health Warnings, Hookah, Narghile, Shisha, Water 
Pipe, Substance use, Alcohol, Drugs, Perceptions, Floating population. 


2.1.2 Types of Studies: 

¢ Qualitative Descriptive Study, Focus Group Discussions (FGDs), Snowball- 
ing Technique, Conventional Content Analysis, Phenomenological Study, 
Qualitative Content Analysis of the Interviews, Purposive Sampling, Non- 
probability purposive sampling. 


2.1.3 Type of Participants: 
¢ Tobacco consumption among adolescent, female non-smokers and occa- 
sional, Early school leavers. 


2.1.4 Settings: 
¢ Schools, college, Informal community venues, residing, drivers. 


2.1.5 Outcomes: 
¢ Decrease the prevalence rate of tobacco consumption among adolescent. 


2.1.6 Delivery of Interventions 

This narrative review was intended to explore the use of tobacco among adoles- 
cent. The initial workout starts with the qualitative research review literature. 
The qualitative studies are suitable to explore feelings, thought, beliefs, idea per- 
ceived and provide life experience. A literature review was searched from the 
database search done was PubMed, EBSCO, BMC Public Health, Sage journal, 
using key words such as tobacco and adolescent. These studies are focusing from 
2002-2016. Around 50 articles are investigating the use of tobacco among ado- 
lescent, from which 12 article excluded (not full text article), again 26 Full text 
article excluded, with reason. Remaining studies quantitative and some study's 
not support to my study, so around 50 article, Out of which 38 articles were 
removed and 12 full text articles were selected on the bases of inclusive criteria 
of narrative review. 


All studies collected the data through the in-depth interview or semi-structured 

interviews either face to face interviews with used a audio tape recorder. In con- 

ducting the interviews they are using the open ended questionnaires. The dura- 

tion of the interviews, mostly taken 5 to 20 minutes of each member, each study. 

The majority of studies conducted the interviews with the maintenance of confi- 

dentiality and privacy. Non-probability purposive sampling techniques are used 

in most of the studies. After data collection, most of the study's data should be ana- 
lyzed by the thematic analysis. All the studies were ethically approved. 


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International Education & Research Journal [IERJ] 


E-ISSN No : 2454-9916 | Volume: 3 | 










3. RESULTS: 
3.1. PRISMA FLOW CHART 
8 Record identified through data base Additional record identified 
g searching. through other sources. 
A (n=50) (n=0) 
Record after duplicates removed 
z (n=50) 
= 
re 
4 
A 


Record screened Record excluded (not full text 
article) 
=5 
— (n=12) 


Full text articles assess for Full text article excluded, with 
eligibility criteria. reason. Remaining studies 
(n = 38) quantitative and some study’s 
not support to my study 
(n=26) 
Studies included 
qualitative synthesis. 


(n =12) 


(Meta-Analysis was not done) 


3.2. Table no.1: Data Extraction table 


Issue: 5 | May 2017 





Problem Statement/ Objective Place Of Variables Tools Time Outcomes Remark 
Author Research & Duration 
Year 


study was successful the 








“Adolescents' perception} To gainadeeper | Abu Dhabi, Perception of | Focus groups | 10 to 15 | Perception of 
of substance use Understanding of UAE substance use min. the substance 
And factors influencing | _ the attitudes and 2015 And factors use associated 
its use: a qualitative perceptions of influencing its a harm and 
Study in Abu Dhabi” adolescents use: factors. 
In the United Arab 
Layla Alhyas. et al. Emirates regarding 
substance. 
“A qualitative study of |-A study of smoking} Shanghai, Study of Focus groups | 10 to 15 | behavior of 
smoking behavior behavior among China smoking min. Smoking 
among The floating The floating 2014 behavior among among 
population in Shanghai, population. The floating floating 
China” population population 
Ji-Wei Wang, et all. 


“The Role of Family on -A Family on Tehran, Iran |Hookah Smoking} Interview 10 min. Hookah 

Hookah Smoking Hookah Smoking Initiation in Each Smoking 
Initiation in Women: | Initiation in Women. Women member. Family on 
A Qualitative Study” Initiation in 

Women 
Azam Baheiraei, Shirin 


Shahbazi Sighaldeh, 


“Motivations for -To determine the | Saudi Arabia Tobacco Discussion 5 to 10 |Motivations for 
tobacco consumption motivations 20 11 consumption min. tobacco 
among adolescents in an} (attitudes, beliefs among consumption 
urban high school” | and experiences) for adolescents among 
tobacco adolescents 
Pérez-Milena A, et al. | consumption among 
adolescents. 


“An exploratory study -To explore the Scotland, |Perceived impact} Qualitative | 15 min. | Perceived the 
of the perceived impact | perceived impact 2009 of Cigarette interviews | For each impact of 
of raising” among a group. purchase on member. | raising the age 










exploring of adolescents and 
Awareness about substances, 
associated harm to 
Health. 


This study is a Smoking 
cessation behavior of male 
floating population of China's 
would need to incorporate 
Comprehensive information 
and education about why 
smoking is dangerous. 


Prevention of tobacco use 
and 
Interventions should be 
focused on targeting the 
family. 


This study is most important 
factors seem to be easy 
available, same age group, 
religion and parental 
attitudes, to tobacco and 
symptoms of dependence. 


The study was an exploratory 
about the extent and nature of 
the impact of 





young 
Problem Statement/ Objective Place Of Variables Tools Time Outcomes Remark 
Author Research & Duration 
Year 
“age of cigarette -Scottish 16- and smokers in cigarette raising the age of sale on 
purchase on young 17-year-old school Scotland purchase on young smokers' access 
smokers in Scotland” | leavers of the recent young smokers cigarettes to ability to 
increase in age of purchase 
Borland T; et al. sale of cigarettes. 
an a ae a a ea oe 








International Education & Research Journal [[ERJ] 


Research Research Paper 


-To explore patterns} US, 2007 
of tobacco uptake 
stress and 


trajectories of use. 


“Reconsidering stress 
and smoking: a 
qualitative study among 
College students” 


Mark Nichter, Mimi 
Nichter, 


Cuba and 
Mexico, 
2013 


-Identify prevalence 
of tobacco and 


“Tobacco and alcohol 
consumption among 
health sciences students | alcohol use in health 
in Cuba and Mexico” | sciences students in 

Mexico and Cuba. 
Fabelo JR, Iglesias S, 





“Asthma, tobacco 





-To identify the Moradabad, 
prominent factors | (UP) India, 


Reconsidering Semi 
stress and 
smoking 


Alcohol 
consumption self- min. 
among health 

sciences students | questionnaire 








Tobacco use in 
adolescent 
students 


E-ISSN No : 2454-9916 | Volume: 3 | Issue: 5 | May 2017 








When is a feeling stressed 
than used to smoking and get 
a relax, serves as an 
the idiom of distress as well 
as an opportunity to bond 
socially with 
Another. 


-students of 
highlights 
multiple 
responses 
functions 
Served by 
smoking, 


15 to 20 
structured min. 
interviews 


10 to 15 | Tobacco and | use in Mexican students, was 
alcohol seventy percent classified as 
consumption at-risk users in Mexican 
among health students of Prevalence 
sciences alcohol and seventy four 
students percent, Prevalence of 
alcohol use in Cuban students 
was with three and half 


percent classified as at risk. 


Anonymous 


administered 


Make a one Policies to reduce 


Favored the 


-Asthma is common] USA, 2014 | Tobacco smoke | Focus groups | 15 to 20 IC] 
smoke and the indoor |in homeless children and the indoor min. Each] staff smoking |the environmental exposures, 
environment: a with an incidence of environment member ban on the like ban smoking, 
qualitative study of 28-40%. shelter property 
sheltered homeless 
families” 
Buu MC, et al. 


Structured | 05 to 10 | By the use of | Parental counseling, School 
questionnaires |min. Each} tobacco parents} based educational programs, 
member | isinfluence | to regulate the influence use 
adolescents and| tobacco on their children and 
they perceived | these programs to protect 
positive adolescents from being 
behavior about | exposed to others of tobacco 
tobacco. use. 





Problem Objective Place Of 
Statement/Author 










Research & 


-To explore 
perceptions of 2016 


“Adolescent girls and 
young adult women's 
perceptions of super- super-slims 
slims cigarette packaging, 
packaging: a qualitative | including compact 
study” ‘lipstick’ packs. 


Ford A, Moodie C 


“Smoking Initiation and 
Continuation A 
Qualitative Study among 
Bruneian Male 


-A study on Brunei 
smoking initiation | Darussalam, 
and continuation 2016 
among adolescent 


Adolescents” male. use 


Perception of | Focus groups 
substance use 

And factors 
influencing its 


Determinants of | Focus groups eae to a Adolescent- 
tobacco-related oriented and 
health literacy determinants of| literacy have a separate early 
insight on the | adolescents' and descriptions 
health literacy. according to recognized 


Talip T, Kifli N, 


-To Determinants of| South of 
tobacco-related Finland, 
health literacy. 2016 


“Determinants of 
tobacco-related health 
literacy: A qualitative 

study with early 

adolescents” 


“Factors attributing to 

initiation of tobacco use 

in adolescent students” | leading to initiation 2009 
of tobacco use 

Ravishankar T L, among adolescents 

Nagarajappa R. of Moradabad. 

: Parisod H, Axelin A 

3.3. Summary of findings: 

The available literature refined to get 12 qualitative article. 


Out of 12 articles, 6 articles are supported Comprehensive education and infor- 
mation about why smoking is dangerous and the benefits of stopping tobacco 
use, focused on targeting the family to prevention and interventions should be as 
well. Most important factors seem to be, parental attitudes, peer influence, easy 
access to tobacco and symptoms of dependence. 


Other 6 articles were successful in exploring adolescent's awareness of sub- 
stances and associated harm to health from their use of tobacco in any form. 


3. DISCUSSION:- 

This narrative review of the literatures observed that student who are using a 
tobacco in different forms like smokeless form of tobacco and smoking forms of 
tobacco is used by people. All over the world consumption of tobacco is a com- 
plex multidimensional problem faced by the country. According to Global Adult 


International Education & Research Journal [IERJ] 


Variables Tools Time 
Duration 
Year 


's | Focus groups pee to ia 
perceptions of increase appeal |'lipstick'-style, cigarette packs 
super-slims of super slims | and it's a Warnings in the EU 
cigarette to 
mislead with 
level of harm, 


Scotland, UK,| Adult women's 


cigarette 
packaging 


Outcomes Remark 


Found that -This study provide ban 


The study three themes 
identified under the core 
construct of 1- overt pressure 
activities from peers, 2- factors 

should be influencing smoking 
embedded in a | initiation, family as teachers 


Recommended 
that prevention 
of the future 


comprehensive | and 3-perceived smoking has 


approach, many advantages 
stakeholders 
involving all 
within a 
community 





The study was determinants 
that influence on health 


According to based 
findings based 





Tobacco Survey (GATS) survey, 56% males consume Tobacco in Uttar Pradesh 
and 34 % men chew Tobacco in different forms like plain Tobacco, khaini, 
gutkha, pan masala while 22 % use cigarettes, hookah, chilam and bidis. Most 
people start smoking when they are in their teens and are addicted by the time 
they reach adulthood. Some have tried to quit but have returned to cigarettes 
because smoking is such a strong addiction. It is a habit that is very difficult to 
break. 


The results of this narrative review are some parts are similar to one of the other 
review i.e. “association between smokeless tobacco use and pancreatic 
adenocarcinoma” Possible risk factor for developing pancreatic 
adenocarcinoma by the Smokeless tobacco. Is there an association between 
smokeless tobacco use and pancreatic adenocarcinoma diagnosis? A review of lit- 
erature” (D Matthew. Burkey, Shari Feirman et, al 2014). This systematic review 
observed that. Based on this review, found that the evidence for an association 
between smokeless tobacco use and pancreatic adenocarcinoma is inconclusive. 
Association between smokeless tobacco use and pancreatic adenocarcinoma, 





E-ISSN No : 2454-9916 | Volume: 3 | Issue: 5 | May 2017 


were not able to analyze the results in a way that may have produced a more 
definitive picture of the 


Future studies would get the benefit from more detailed assessments of smoke- 
less tobacco exposure like frequency, intensity, and timing in relationship to pan- 
creatic adenocarcinoma diagnosis, given strong confounding effect in the rela- 
tionship between smokeless tobacco use and pancreatic adenocarcinoma. 
Understanding the health effects of smokeless tobacco will help determine how it 
should be regulated, and how governments should respond to the increase in 
smokeless tobacco use. 


4.1 Importance in Education:- 

Based on all these studies which included in this narrative review, the people who 
uses tobacco facing major challenges in their entire life. Hence, findings sug- 
gests that multifactorial prevention programs that address social norms, image 
religion, school and gender role family incorporated drug policy would be more 
effective and would have better protective outcomes. Educate the adolescent 
about use of tobacco complication, suggestion to quit as soon as possible and safe 
life. 


4.2 Future Significance:- 

How to Peer group influences on adolescent smoking, there are some theoretical 
explanations for how social influence works? To what extent does peer smoking 
predict adolescent smoking? Are adolescents influenced by their friends (social- 
ization) or do adolescents select friends with similar interests (selection) with 
respect to smoking? Are close friends, best friends, or crowd affiliations more 
important? Do positive parenting behaviors buffer the effects of peer influence? 


4.3 Limitations:- 
This study had certain limitations too. This literature review was limited to — 
¢ Only five databases were used to carry out this literature review. 


¢ Thesearch that was carried out within a publication period of 2002-2016. 
¢ The papers which were in the English language only. 
e Articles included were required to be free and in full text. 


CONCLUSION 

Use of tobacco is prevalent in adolescent. The factors contributing to the use of 
tobacco are easy availability, peer influence and after the use of tobacco they are 
feeling relax. 


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