The Effects of Quit Smoking Program on Adolescent Students

Transcription

1 t9riginal Articl 向 The Effects of Quit Smoking Program on Adolescent Students Su-Chen Wang' Albert Y. C. Hung 2.* ABSTRACT Objectives. The objective of this study was to evaluate the short and long tenn effect of a smoking cessation program for adolescents on their knowledge, attitude, practice, and self-efficacy with regard to quitting smoking. Methods. Two hundred current smokers were sampled and divided into an experimental group and a control group. The experimental group participated in a sixteen-week smoking cessation class. Both groups took post-tests immediately after intervention in order to evaluate the immediate effects. The follow-up tests were administered to evaluation long-tenn effect at the 32nd week. Results. We found a significant difference in knowledge, attitude, practice, and self-efficacy in the participants. There were significant differences in immediate and retained improvements after the quit smoking program. Conclusion. If the quit smoking program is not employed continuously, due to a prolonged time interval, the efficacy could be reduced. Health education reinforces and has a constant effect on the quit smoking program. Key words : Quit smoking program, Immediate improvement, Constant improvement, Adolescent student 'Department ofhealth Care Administration, Chung-Hwa University ofmedical Technology, Tainan, Taiwan (R.O.c.) 2Graduate Institute of Health Care, Meiho University, Pingtung, Taiwan (R.O.C.) 'Corresponding author: Albert Y. C. Hung, edu. 仰, Accepted : Jan. 24, Code: JMH Joumal ofmedicine and Health 2014, Vol. 3, No. 1 37

2 Su-Chen Wang Albert Y. C. Hung Introduction More than 3,000 young people begin to smoke each day, [11 and over 50% of these new smokers will smoke for at least 16 yearsy1 More than 90% of all individuals who ever smoked and 70% of all regular smokers began smoking before they were 18 years 0ldy1 Studies[ 的 ] show that the average age of first time tobacco smoking is years old. The exposure to a passive smoke environment is firmly associated with the behavior of tobacco smoking among adolescent students. The habit of tobacco smoking among adolescent students is related to the habits and attitudes of their parents, brothers and sisters. The first tobacco obtained by adolescents comes 企 om self-purchases and classmates)41 Tobacco smoking adversely affects the health of adolescents and sets the stage for illness and addiction in adulthood. If people do not start smoking in their youth, few will smoke as adultsy1 Taiwan has gone through rapid social and economic changes in the past several decades. Smoking in Taiwan, much like the rest of Asia,[8,91 is strongly related to gender. Smoking rates are generally higher among males than females Y1 Almost 20% of teens (age 12 to 19) currently smoke daily or occasionally. Teens give many reasons for why they start smoking: My friends' smoke," "1 just wanted to try it," 1 thought it was cool," and My parents smoke," One of the most important reasons teens start to smoke is peer inf1 uence, Teenagers are more prone to peer pressure)io, 1 11 Over 70% of teens say that having friends who smoke and/or peer pressure is the main reason they started to smoke. [l llthe distribution of the smoking population is concentrated in blue-collar workers or less-educated peop le. [ 1 月 A smoking habit formed during the teenage period will probably lead to sustained compulsive use in adulthood, The harm to one's health caused by early consumption becomes progressively worse. A World Health Organization report points out that tobacco causes the death of over 3 million people each year, and will cause the death of more than 10 million people annually between 2020 and 2030.[61 ln developing countries, 70% of deaths are associated with tobacco. Wen [71 discovered that tobacco caused 53 deaths each day, while 91 % of lung cancers and 30% of other cancers were directly related to tobacco. Tobacco smoking is the leading preventable cause of morbidity and mortality in our society and one of the most important public health problems today. Tobacco plays a major role in human disease and death and is an important public health problem that needs to be addressed. Chronic smoking behavior can cause severe health problems to Taiwanese people. [lolno matter on 巴 's age or how long he has smoked, quitting can improve one's life expectancy and hea1th, For decades the Surgeon General has reported the health risks linked to smoking. [13,141 Why is quitting and not relapsing so hard for so many people? The answer is nicotine. Between about 25% and 33% of smokers who take medicine can stay smoke-free for over 6 months 13, [ 1 Smokers must deal with both the physical and psychological dependence to quit and not relapse, Those who have smoked regularly for a few weeks or longer and suddenly stop using tobacco or greatly reduce the amount smoked will have withdrawal 38 Joumal ofmedicine and Health 2014, Vol. 3, No. 1

3 The Effects ofquit Smoking on Adolescent Students symptoms. These symptoms usually start within a few hours of the last cigarette when most of the nicotine Methods and its by-products leave the body. [ ] Quitting smoking represents the single most important step that smokers can take to enhance the length and quality oftheir lives. Quitting smoking is not easy, but it can be done. To have the best chance of quitting and not relapsing, a person needs to know what they are up against, what their options are, and where to go for help. One study reported that about 4% to 7% of people are able to quit smoking on any given attempt without medicine or other help. [1 3] Success rates in quitting, especia\ly on first attempts, are genera\ly rea\ly low. Only 5% to 8% of those who attempt to quit without any help succeed; the rest fail. There are many reasons why the percentage of succesfully quitting is so low. Sometimes, first time quitters cannot do it on their own and they lack information on how to get help. Support from family and friends and some behavioral therapies also contribute to success in quitting.l 17 ] Smokers often say, Don't tell me why to quit, tell me how." There is no one right way to quit, but there are some key elements in quitting with success. These four factors are: making the decision to quit, setting a quitting date, and choosing a quitting plan, dealing with withdrawal and not relapsing.l 16 ] Recently, the issue of tobacco smoking of adolescent students has become a serious problem in Taiwan. The purpose ofthis study was to explore the immediate and constant effects of the quitting program intervention in the knowledge, attitude, practice, and selιefficiency of quitting smoking, and empirically time-consistent preference of smoker's quitting decision for adolescent students. A. Samples A quasi-experimental design was employed in this study. Cluster sampling for current smokers (including the sporadic current smokers and usual current smokers) was employed by selecting two departments of the division of a medical technology school in Tainan City. Sampled adolescents were randomly divided into experimental and control groups. Two hundred adolescent students ( years old) were sampled for the study. Among them, 100 students were in the experimental group and were provided with a health education intervention plan while the other 100 students were in the control group. This data was collected between September 2011 and May B. Materials Before the quit smoking program intervention was given, both experimental and control groups were analyzed with a pre-test in order to set baselines. Then, continuous 16 weeks courses of the quit smoking program intervention with respect to preventing tobacco smoking were given to the experimental group. Right after the class, both groups were analyzed with post-tests in order to evaluate the immediate effect. Because the ultimate purpose of the quit smoking program is to build up a proper and healthy attitude and behavior, we evaluated the immediate improvement right after intervention was given. The follow-up-test was performed on both groups at the 32nd week to track the effectiveness of constant improvement Joumal ofmedicine and Health 2014, Vol. 3, No. 1 39

4 Su-Chen Wang Albert Y. C. Hung C. Questionnaire of the quit smoking program A questionnaire was designed for this study and tested and revised in advance. The content ofthe questionnaire was explained to the students prior to their answering it anonymously, and included: (1) general demographic characteristics, academic learning circumstances, the number of cigarettes that were smoked daily, and history of smoking; (2) the circumstances of tobacco smoking among family members, friends, and classmates; (3) the knowledge about quitting, which could cause a hazard in the living environme 凶, health, and society; (4) the attitude of quitting; (5) the practice of quitting; and (6) the self-efficacy of quitting. From the knowledge about quitting, the attitude of quitting, the practice of quitting, and the self-efficacy of quitting in the questionnaire. The higher the score, the better the evaluation. The questionnaire was introduced to assess the validity of specialist. With respect to Cronbach's Alpha of questionnaire, the reliability coefficient of knowled 阱, attitud 巴, practice, and self-efficacy of quitting was 0.85, 0.81, 0.78, and 0.90, respectively. D. The time schedule and contents of courses in the quit smoking program intervention 16-week quit smoking program intervention courses were carried out continuously. Each week courses lasted minutes as a whole. Pre-test" questionnaires were administered before the courses while Post-test" questionnaires and Follow 叩 -test" questionnaires were administered immediately after the courses (at the 16th week: at Jan. 2012) to evaluate immediate improvements and 16 weeks after the end of the courses (at the 32nd week: at May 2012) to evaluate constant improvements, respectively. The quit smoking program intervention for current smokers is shown as table 1. The topics such as What is tobacco smoking." The hazards of tobacco smoking," Solid evidence about tobacco smoking that could cause diseases/cancer," Reasons for quitting" Rewards of quitting," Dealing with withdrawal," Social acceptance," and How to quit smoking" which inc1uded "Pick a quit day," Making the d 巳 cision to quit," Making a plan," Choose two or more proven quit-smoking methods," Set up a support system," If you slip up, don ' t give up. Try quitting again," and Reward yourself' [8,\3,14,16] were employed in the course of the quit smoking program intervention. Meanwhile, a variety of teaching tools (e.g., films and post-cards) were used to activate and impress the contents of topics upon the students as well as to make it easier for them to understand. This quit smoking program intervention was performed without any medication and therapy. Table 1. Study design Group Pre-test Quit smoking Post-test Follow-up-test program mterventlon (at the 16 th week: (at the 32 0d week: (16 weeks: from Sep at Jan. 2012) at May 2012) to Jan. 2012) Experimental group l X Control group O Joumal ofmedicine and Health 2014, Vol. 3, No. 1

5 The Effects ofquit Smoking on Adolescent Students E. Statistical analysis The p 巳 rsonal data of samples were analyzed by descriptive statistics. Chi-square test was employed to analyze the homogeneity of the characteristics of personal data of experimental and control groups. The independent t-test was employed to analyze the results from pre-rest, post-test, and follow-up-test of the quit smoking program in knowledge, 的 titu 白, practlc 巴, and self-efficacy. record during school time, but 5 students received severe punishm 巴 nt from the school. There were about 50.0% of sample have average 4-6 cigarettes a day smoking, and 1-3 years smoking habit in the experimental and control group. As the samples of this study were not randomly distribut 叫, the subjects of the experimental group and the control group were examined with Chisquare which has no significant difference in the characteristics of personal data. Results In this study, three steps that includ 巳 d pre-test, post-test, and follow-up-test were used. The total number of students in the experimental group was 100 in the pre-test. During the experiment, two ofthem were unable to attend the entire course. Therefore, the number of students in the experimental group was 98 in both the post-test and the follow-up-test. The number of students in the control group was 100 in the entire program. Totally, the number of samples was 198. A. Descriptive analysis of pre-test samples In Table 2, the number of males and females in the experimental group was 91(9 1.0%) and 9(9.0%), respectively, and in the control group was 94(94.0%) males and 6(6.0%) females, respectively. Around 51.0% in average oftheir parent's education level was distributed in senior high school. The final academic grade of the students in the previous semester was 38.0% in 70~ 79 (grade B), 25.5% in 80~89(grade A), 24.0% in grade C or below. About 52.5% of the students had a discipline B. The influence of the quit smoking program intervention in knowledge, attitude, practice, and selι efficacy (A)The pre-test of the quit smoking program intervention analyses In Table 3, the results of the pre-test show that knowledge of hazards, attitude, practice, selιefficacy of the quit smoking program were not significantiy different between these two groups. In other words, the subjects in the groups were in good homogeneity before the quit smoking program was employed (B)Imrnediate improvement analysis In the post-test after courses, immediate improvements were investigated via post-test questionnaires. The results show that the values ofthe knowledge of smoking hazards, attitude, practice, and self-efficacy in the experimental group were better than the ones in the pre-test while the values in the con 仕 01 group lllcreas 巴 d as compared to the pre-test. However, the values of the post-test between both groups demonstrate a significant difference (knowledge: t=10.81, p<0.05 ; attitude: t=7.80, p<o.oi ; practice: t=-3.62, p<o.oo 1; selιefficacy: t=9.15, p<o.ooi) (Table 2) Joumal ofmedicine and Health 2014, Vol. 3, No. 1 41

6 Su-Chen Wang Albert Y. C. Hung Table 2. Descriptive analysis of pre-test samples Variance / Groups Experimental Control Total X 2 -Value N(%) N(%) N(%) (p value) Gender Male 91 (9 1.0) 94 (94.0) 185 (92.5) Female 9 (9.0) 6 (6.0) 15 (7.5) Education level of Above 只 raduate school 3 (3.0) 4 (4.0) 7 (3.5) father CollegelU niversity 41 (4 1.0) 37 (37.0) 78 (39.0) Senior high school 48(48.0) 50 (50.0) 98 (49.0) Under Junior hi 只 h school 8 (8.0) 9 (9.0) 17 (8.5) Education level of Above graduate school 3 (3.0) 3 (3.0) 6 (3.0) mother College/University 34 (34.0) 38 (38.0) 72 (36.0) Senior high school 55 (55.0) 51 (5 1.0) 106 (53.0) Under Junior hi 只 h school 8 (8.0) 8 (8.0) 16 (8.0) Academic grade of A+ 13 (1 3.0) 12 (1 2.0) 25 (1 2.5) prevlous semester A 25 (25.0) 26 (26.0) 51 (25.5) B 39 (39.0) 37 (37.0) 76 (3 8.0) C and Under C 23 (23.0) 25 (25.0) 48 (24.0) Records ofhaving None 48 (48.0) 47 (47.0) 95 (47.5) been punished in school Reprimand 35 (35.0) 32 (32.0) 67 (33.5) Small demerit 15 (1 5.0) 18 (1 8.0) 33 (1 6.5) Above large demerit 2 (2.0) 3 (3.0) 5 (2.5) Current-smoking Grandparents 24 (24.0) 21 (2 1.0) 45 (22.5) from family F ather/mother 30 (30.0) 32 (3 2.0) 62(3 1.0) Brothers/Sisters 24 (24.0) 22 (22.0) 46 (23.0) None 22 (22.0) 25 (25.0) 47 (23.5) Average the number l-3ci 只 arettes a day 30 (30.0) 32 (32.0) 62 (3 1.0) of daily smoking 4-6 cigarettes a day 51 (5 1.0) 50 (50.0) 101 (50.5) 7-9 cigarettes a day 11 (11.0) 13 (1 3.0) 24 (1 2.0) 全 10 cigarettes a day 8 (8.0) 5 (5.0) 13 (6.5) History of smoking 三至 1 years 19 (1 9.0) 15 (1 5.0) 34 (1 7.0) habit > 1 to 至 3 vears 49 (49.0) 50 (50.0) 99 (49.5) > 3 to 豆 5 vears 21 (2 1.0) 22 (22.0) 43 (2 1.5) > 5 vears 11 (11.0) 13 (1 3.0) 24 (1 2 0) 0.20 (p=0.33) 1.01 (p=o.27) 1.l3 (p=0.18) 1.92 (p=o.ii) 1.07 (p=0.23) 1.14 (p=o.l9) l.36 (p=0.15) 1.50 (p=o.l2) 42 Joumal ofmedicine and Health 2014, Vol. 3, No. 1

7 The Effects ofquit Smoking on Adolescent Students (C)Constant improvement analysis Furthermore, when the quit smoking program intervention was completed, the values of the knowledge of smoking hazards, attitude, practice, and self-efficacy in the post-test and follow-up-test, which were measured at the 16th week and the 32nd week, respectively, were slightly reduced in both groups. The values for the knowledge in hazard, attitude, practlc 巴, and self-efficacy of quitting smoking between both groups show a significant difference (knowledge: t=9.87, p<0.05; attitude: t=7.14, p<o.ol; practice: t=-3.40, p<o.ooi ; self-efficacy: t=8.19, p<o.ooi) (Table 3). Thus, the quit smoking program helped to increase knowledge of hazards, attitude, behavior, and self-efficacy of quitting smoking. Discussion Some similar studies[4,11, 19 l have indicated that the exposure to a passive smoke environment is firmly associated with the behavior of tobacco smoking among adolescent students. In KO'S[ 18 l s 仙 dy, peer pressure was found to play a m 吋 or role for the students who tri 巳 d tobacco and they usually combined it with betel nut chewing and alcohol consumption. Meanwhile, the interesting curriculum design should help adol 巴 scent students make the right decision and refuse to smoke Smoking rates are generally higher among males than females Yl Therefore, this study samples men more than women. According to this study, the knowledge, attitude, practice, and self-efficacy of quitting smoking, the Table 3. Analyses of pre-test, post-test, and follow-up-test in knowledge, attitude, practice, and self-efficacy of the quit smoking program intervention Variance Knowledge Group Pre-tests Post-tests Follow-up-tests 民!{ean S.D. t-test Mean S.D. t-test Mean S.D. t-test (p value) (p value) (p value) Experimental group l Control group (p=0.18) (p<0.05) (p<0.05) Attitude Experimental group l Control group (p=0.15) (p<o.oi) (p<o.oi) Practice Experimental group l l Control group (p=0.20) (p<o.ooi) (p<o.ooi) Self-efficacy Experimental group (p=o.ii) (p<o.ooi) (p<o.ooi) Control group Joumal ofmedicine and Health 2014, Vol. 3, No. 1 43

8 Su-Chen Wang Albert Y. C. Hung values of the pre-test and post-test, post-test and followup-test in the experimental group were significantly different compared to the control group. This result showed that the quit smoking program intervention had an irnmediate and constant improvement effect in the knowledge, attitud 巴, prac ti c 巴, and self-efficacy of quitting smoking. Namely, it helped improve knowledge of hazards, strengthen opposing attitudes towards srnoking, reduce the practice of smoking, and enhance quitter's self-efficacy We found that the values ofthe follow-up-test were lower than the values of the post-test for both groups. If the quit smoking program is not employed continuous 旬, Tobacco smoking has a striking impact on human health and self-efficacy and is a vital motivation to initiate preventive behavior. Smoking is less socially acceptable now than ever. Today, almost all workplaces have some type of smoking rules. Public buildings, concerts, bus, and ev 巳 n sporting events are largely smoke-free. [1 8] It is essential that the prevention of adolescent tobacco use and the protection of adolescents from the harmful effects of environmental tobacco smoke must be addressed by hea1th and education authorities. Certainly, the encouragement of smoking cessation among parents and peers should also be carried out simu1taneously through related authorities and through the media. due to a prolonged time interval, the efficacy could be reduced. These results were consistent with a study from Lin.[20] Even though significant differences were observed in these variances while the health education intervention was introduced, due to the discovery in the values of the follow-up-test being lower than the post-test, the effectiveness may decline if the health education intervention is not performed continuously. This study has an empirically time-consistent preference in the context of the smoker's quitting decision. As a result, if contact with hazardous substances can be isolated or reduced during adolescence, a ratio of occurrence in risky behavior should dec\ine. At the mornent, health education intervention is playing an important role in achieving that goal. The development of health education intervention has accumulated a wealth of experience and obtained good results. Consequent1y, it is necessary that certain courses should be given to the experimental group after a certain time to strengthen and make constant the effectiveness of the quit smoking program intervention. References 1. Centers for Disease Control and Prevention. Tobacco use among high school students-united States, MMWR Morb Mortal Wkly Rep 1998;47: Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Oavis RM: Trends in Cigarette Smoking in the United States: Projections to the Year JAMA 1989;261: Pierce JP, Gilpin E: How Long Will Today's New Adolescent Smoker be Addicted to Cigarettes? Am J Public Health 1996;86: Li CY, Lin RS: Risk assessment of active smoking: smokingattributable mortality and years of potential life lost in Taiwan, 1980 and Asia Pac J Public Health ; 9: Department of Health and Human Services. Preventing Tobacco Use among Young People: A Report ofthe Surgeon General. Washington, OC: Govemment Printing Office Joumal ofmedicine and Health 2014, Vol. 3, No. 1

9 The Effects ofquit Smoking on Adolescent Students 6. World Health Organization. The Risk oftobacco. Available at: Accessed December 7, Wen CP, Tsai SP, Yen DD: The health impact of cigarette smoking in Taiwan. Asia-Pacific J ofpublic Health 1994; 7: Amos A, Haglund M: From social taboo to "torch of freedom": the marketing of cigarettes to women. Tob Control 2000;9: No authors listed: Curbing the Epidemic:Curbing the epidemic: governments and the economics of tobacco control. The World Bank.1999;8: E-Quit Chinese. John Tung Foundation. Available at: Accessed June 17, The Lung Association. Available at: p ro tect -p ro tegez/to bacco-tabag i sme/facts-fai ts/teens-ad 0 s_e.php. Accessed June 14, Ko YC, Huang YL, Lee CH, Chen 恥釘, LinL 扎扎 Tsai CC: Betel Quid Chewing, Cigarette Smoking and Alcohol Consumption Related to Oral Cancer in Taiwan. J Oral Pathol 恥 1ed 1995; 24: The American cancer Society. Guide to Quitting Smoking. Available at: org/healthy/stayaway fromtobaccoiguidetoquittingsmoking/guide-to-quitting -smoking-why-so-hard-to-quit. Accessed August 10, US Department of Hea1th and Human Services Surgeon General's Report- Reducing Tobacco Use. Centers for Disease Control and Prevention (CDC), Office on Smoking and Hea1th Accessed at: tobaccol data _ statistics/sgr/2000/index. htm. Accessed September 4, Shiffman S, Ferguson SG, Gwaltney CJ: Reduction of abstinence-induced withdrawal and craving using high-dose nicotine replacement therapy. Psychopharmacology 2006; 184: The American cancer Society. Stay Away from Tobacco. Available at: 仕 omtobacco/ index. Accessed August 10, Articles base.success Rates in Quitting-AII About Quitting Smoking Success Rates. Available at: base.com/quit-smoking-articles/quitting-all-about-quittingsmoking-success-rates html. Accessed August 14, Ko YC, Chiang TA, Chang SJ, Hsieh SF: Prevalence of betel quid chewing habit in Taiwan and related sociodemographic factors. J Oral Pathol Med 1992;21: Zhu WH, Yang L, Jiang CQ, et al.: Characteristics of smokers and predictors of quitting in a smoking cessation clinic in Guangzhou, China. J Public Hea1th 2010; Lin 扎 1H: The effects of hea1th educational intervention for urban aboriginals' smoking and drinking behavior. Doctor thes 時, Research lnstitution ofhealth Education, National Taiwan University Journal ofmedicine and Health 2014, Vol. 3, No. 1 45

10 : 原著 j 青少年學生戒菸計劃之成效 玉素真 l 洪耀對 1) ν 摘要 目的 : 探討戒法計劃介入對台灣青少年學生在香畏的危害認知, 戒菸的態度 行為, 及 自我效能上之立即性 持續性效果的影響評估 方法 : 200 名目前有吸震行為的學生為樣本, 區分為實驗組與對照組 實驗組進行的週的戒菸計劃介入課程, 1 矣課程結束後二組立間接受後測, 以瞭解戒菸計劃介入後所產生的立即性影響效果, 在第 32 週二組再進行後後測, 追蹤評量其持續性效果 結果 : 戒菸計劃介入後對於香畏的危害認知, 戒菸的態度 行為, 及自我效能上之前測 後測 後後測得分都有顯著性差里, 表示戒菸計劃產生明顯的立即性 持續性效果 結論 : 本研究證實若無持續性戒菸計劃, 會因時間性而降低其效能 健康教育 能更增強和持續戒展計劃的成效 關鍵詞 : 戒菸計劃 立即性效果 持續性效果 青少年學生 l 中華醫事科技大學醫務暨健康事業管理系 2 美和科技大學健康照護研究所 * 通訊作者 : 洪耀鈔 接受日期 : 2014 年 1 月 24 日 xoooi0473@meiho.edu.tw 編碼 : JMH 醫學與健康期刊 年第 3 卷第 l 期