EFFECTIVENESS OF EDUCATIONAL INTERVENTION ON

HEALTH EFFECTS OF SMOKING AMONG ADOLESCENT

Research proposal submitted for the partial fulfillment of requirements for

Master Of Business Administration

Submitted To:
Excel Business College
Affiliated to: Pokhara University
Lakhechaur Marg, Kathmandu

Submitted By:
Pankaj yadav
MBA, 3rd Trimester
5th Batch
(2076/09/25)

1
 Table of contents
Chapter 1: Introduction
1.1 Background of the study
1.2 Conceptual Framework of the study
1.3 Statement of the Problem
1.4 Rational of the study
1.5significance of the study
1.6 Objectives of the study
1.61 General objectives .
1.62 Specific Objectives
1.63Research questions/hypothesis
1.7 Conceptual framework of the study variables
1.8 Operational Definition
.

Chapter 2: Literature Review

A. Chapter 3: Methodology
3.1 Study method
3.2 Study Design
3.3Study Area
3.4Study population
3.5Data collection methods
3.6Instrumentation
3.7Data collection
3.8Data processing
3.9Data analysis
3.10delimitation of study
3.11Ethical consideration

2
 Timeline
Budget
References

3
 APPROVAL SHEET
This research proposal entitled “Effectiveness of Educational Intervention Regarding Health
Effects of Smoking Among Adolescents ” submitted by Mr. pankaj yadav, student of Master of
Business Administration for the partial fulfillment of Degree of Master of Business Administration
from Pokhara University, Nepal.

……………………………
Date:
Dilla ram Bhandari
Excel Business College

4
 Acknowledgement:
This small scale research was implemented through the joint effort of several individual to whom I
would like to express my great gratitude.
First of all, I would like to express my great appreciation to Pokhara Universityy, Excel Business
College for providing me this golden opportunity to conduct this research as a partial fulfillment of the
degree of Master of Business Administration.

I would like to express my great appreciation to my research supervisor Mr. Dilla ram Bhandari for his
continual encouragement unbound inspiration, timely guidance, valuable cooperation and support and
also for the crucial comments in various ways during the research work.

A special thanks to the college administration and the library staffs for their valuable help and support
in the research period. At last but definitely not the least I would express my thanks to all my
classmates and friends for their valuable cooperation, suggestion and support during my research
period.

Pankaj Yadav

5
 CHAPTER I
[Link]
1.1 Background
Smoking is the practice in which a substance is burned and the resulting smoke is breathed and
absorbed into the blood stream. Most commonly the substance is the dried leaves of the tobacco plant
which have been rolled into the small square of rice paper to create a small round cylinder called
“cigarette” .(a more broad definition may include taking tobacco smoke into the mouth, and the
releasing it, as is done by some with tobacco pipes and cigars). Smoking is on the rise on the most
developing countries and developed countries as well. Tobacco smoking is being common among all
the population including male and female and all settings as human setting, industrial setting, etc.
Tobacco smoking is the practice of burning tobacco and inhaling smoke.
Cigarettes contain about 600 ingredients, many of which can also be found in cigars and hookahs.
When these ingredients burn, they generate more than 7,000 chemicals. Many of those chemicals are
poisonous and at least 69 of them are linked to cancer (Henningfield, Rose, & Hilton, July, 2019).

Some of the risk factors that influences adolescent to use tobacco use are: Relatively low socio-
economic status, high accessibility and availability of tobacco products, Perceptions by adolescents that
tobacco use is normative, that is, usual or acceptable behavior, Use of tobacco by significant others and
approval of tobacco use among those persons, Lack of parental support, Low levels of academic
achievement and school involvement, Lack of skills required to resist influences to use tobacco,
relatively low self-efficacy for refusal, Previous tobacco use and intention to use tobacco in the future,
Relatively low self-image.

The Effects of Smoking on the Body:

Smoking can lead to a variety of ongoing complications in the entire body, as well as long-term effects
on the body systems. Smoking can increase the risk of a variety of problems over several years, while
some of the bodily effects are immediate.
One of the ingredients in tobacco is a mood-altering drug called nicotine. Nicotine reaches brain in
mere seconds and makes a person feel energized for a while. But as that effect wears off, we feel tired

6
and crave more. Nicotine is extremely habit-forming, which is why people find smoking so difficult to
quit. Physical withdrawal from nicotine can impair cognitive functioning and make feel anxious,
irritated, and depressed. Withdrawal can also cause headaches and sleep problems.
When we inhale smoke, the substances of smoking damages the lungs. Over time, this damage leads to
a variety of problems. Along with increased infections, people who smoke are at higher risk for chronic
nonreversible lung conditions such as: emphysema, chronic bronchitis, asthma, COPD, lungs cancer
and coughing, wheezing, pneumonia due to second hand smoke. Smoking also raises blood pressure
and peripheral artery disease. This raises the risk of stroke. Smoking also has an effect on insulin,
making it more likely to develop insulin resistance which increases risk of type 2 diabetes and its
complications, which tend to develop at a faster rate than in people who don’t smoke. (Judith , may 9,
2017)

Smoking is associated with variety of negative consequences, including school failure, and poor
judgments which may put adolescents at risk for accidents, violence. These dangerous consequences of
substance abuse on human life intensify the need for the prevention of drug abuse.

Smoking is one of the emerging problem, which denotes a big challenge to the overall development of
adolescents and the nation as well. Since the young people of today are tomorrow’s adults so the
behavior of adolescents is potential determing factor for characteristics and behavior of adults in the
future. It is of paramount importance to create an environment and adequate support to enable
adolescent to develop their potential and enjoy a healthy and responsible adulthood
In developing countries 80 percent of young people are enrolled in schools. They spend their important
time period in school. They can learn and develop own belief, value and vision from the information
received and the activities they get involved in college. Therefore, the risk behaviors like drug abuse
can be prevented by the necessary education at college.

Cigarette smoking is leading causes of death in the United States and the leading causes of death were
heart disease (597,700 deaths), cancer (574,700 deaths), chronic lower respiratory diseases (138,100
deaths), 100,600 COPD deaths.
Furthermore, parental smoking is estimated to cause approximately 600 deaths per year from prenatal
conditions and 400 deaths per year from sudden infant death syndrome (HHS,2014).

7
The tobacco epidemic is one of the biggest public health threats the world has ever faces, killing more
than 7 million people a year. More than 6 million of those deaths are the result of direct tobacco use
while around 890,000 are the result of non-smokers being exposed to second hand smoke .(WHO,
2017)

In 2015, over 1.1 billion people smoked tobacco. Far more males than females smoked tobacco.
Although it is declining worldwide and in many countries, the prevalence of tobacco smoking appears
to be increasing in the WHO Eastern Mediterranean Region and the African Region. (GYTS,2015)

Nowadays, around one-third of adults are known to be smokers, and smoking rates are increasing
among the female population. It is estimated that deaths attributable to tobacco use will rise to 10
million by 2025, and one-third of all adult deaths are expected to be related to cigarette smoking. The
association between cigarettes and lung cancer has been proven by large cohort studies. Tobacco use
has been reported to be the main cause of 90% of male and 79% of female lung cancers. 90% of deaths
from lung cancer are estimated to be due to smoking. The risk of lung cancer development is 20-40
times higher in lifelong smokers compared to non-smokers.

(OzluT, 2005)

Adolescents’ knowledge of health effects associated with cigarette smoking showed that 596 (63.1%)
of 944 students had good knowledge while 348 (36.9%) had poor knowledge of health effects
associated with cigarette smoking (Chikere, 2014)

A randomized intervention conducted in a sample of schools of Pelotas, a city located in Southern

Brazil done on effectiveness of educational intervention on smoking among adolescents students of the
7th and 8th grades, showed that the intervention was not effective to produce behavioral changes, but led
to an increase in knowledge about health effects smoking (Malcon,etal, 2011)

Although the links between tobacco use and both psychiatric comorbidities and disorders of substance
abuse have been investigated in adults, they have not been rigorously examined in adolescents. one
study of youth, conducted in U.S.A, examined the cross-sectional relationship between cigarette use
and the use of other substances as well as with psychiatric disorders and found that daily cigarette

8
 smoking was associated with a 70% increase in the likelihood of diagnoses of anxiety and of disorders
of mood and disruptive behavior (Kandel, et al., 1997).

1.2 CONCEPTUAL FRAMEWORK:

Study Issue Research Theme Status

Desired Status
Inadequate Effectiveness of Pretest knowledge:
Adequate
knowledge regarding educational Yes
knowledge
health effects of intervention on  Adequate
regarding outcome:
Immediate health
smoking health effects of  Inadequate
effects
Increaseof smoking
awareness about
smoking No
health effects of Educational Intervention

smoking

Post-test knowledge:
Intermediate outcome: Yes
Decrease smoking rate  Adequate
 Inadequate
No

Ultimate outcome:
Implementation
 Reduction of smoking
related morbidity and
mortality
 Improved adolescent health
Recommendations
Findings on the basis of post-
and quality of life
On the basis of findings
test

9
Description of conceptual framework:

Conceptual framework is a frame which clarifies the concept of the study. The research theme of
my study is effectiveness of structured program on health effects of smoking. Main issue of topic
is inadequate knowledge regarding health effects of smoking. Adequate knowledge regarding
health effects of smoking is the desired status of my topic. If the desired status is fulfilled the
immediate effect among the students would be increase in the knowledge about effects of
smoking, intermediate will be decrease smoking rate and ultimate effect will be improvement in
quality of life. Status of my research theme is done by pretesting about the knowledge regarding
health effects of smoking the student may or may not have knowledge which they answer as yes
or no or adequate or inadequate . Educational intervention will be carried out by developing
educational packages .Posttest will be done after intervention to find out the effectiveness of
educational intervention. Finding is based on the educational intervention implementation based
on findings of research and recommendation based on implementation

10
1.3Statement of problem:

Global scenario:

Smoking is the most popular form of tobacco use being practiced by over one billion people globally,
of whom the majority are in the developing countries. Smoking caused over five million deaths a year
from 1990 to 2015. Most substances in cigarette smoke trigger chemical reaction in nerve ending which
heighten the heart rate. Smoking harms not just the smoker but also family members, colleagues and
others who inhale the smoke (i.e. second-hand smoking).Smoking harms nearly every organ of the
body. Cigarette smoking causes 87% of lung cancer deaths. Approximately one person dies every six
seconds due to smoking cigarette (WHO, 2013)

National scenario:

A cross-sectional survey of 1157 young individuals between the ages of eight and 19 years living in a
rural community of the hill region of Nepal carried out by a health assistant especially trained in
smoking survey technique for young people with the help of the WHO standardized smoking survey
questionnaire for young people revealed that the overall prevalence of daily smoking was found to be
12–6 per cent (17–3 per cent for boys and 6–7 per cent for girls). The prevalence increased with age for
both sexes. In addition there were a large number of weekly and experimental smokers especially in the
younger age groups. Young persons constituted a vulnerable group. ([Link], 2011)

Discrepancy:
• Ideally none of the adolescent should smoke and should have knowledge on health effects of
smoking but in fact this condition is not happening. But the adolescents smoking rate is in an
increasing trend due to inadequate knowledge. There is gap between the desired status and study
issue. There should be adequate knowledge among adolescent. This gap will be fulfilled by this
kind of study.
Tentative questions:
• Do educational interventions help to increase the level of knowledge on health effects of smoking
among adolescents ?

11
Tentative answer:
• Educational interventions may help to increase the level of knowledge about health effects of
smoking among adolescents.

1.4Rational of the study:

Smoking is an addiction. It is a major health concern. Cigarette smoking harms nearly every organ of
the body, causes many diseases, and reduces the health of smokers in general
Health problem includes such as lung disease, heart problems, brain damage and death. There are also
social, financial and academic consequences. This clearly explains why there is a greater need to spread
awareness among adolescent who are prone to try out things that are not good for health. In developing
countries, 80%of the young people are enrolled in college. Therefore, the risk behaviours like smoking
can be prevented by the necessary education at college. More importantly, it is important to encourage
the adolescents to spread these facts among peers. So this study aims to find the effectiveness of
educational intervention regarding health effects of smoking in college going adolescents.

1.5Significance of the study:

Personal significance:
• For the fulfillment of academic requirement of academic requirement to achieve the degree of
Master Of Business Administration.
• To develop research skills by utilizing my theoretical knowledge in practical
• To gain in depth practical and theoretical knowledge about research
Institutional significance:
• The study findings can be utilized during teaching learning process
• The study findings can be used as baseline data for further research study
• The institute can use the information for training purpose
• Indication for further study

12
1.6Objectives of the study:
General objective:
• To find the effectiveness of the educational intervention on level of knowledge regarding health
effects of smoking among adolescents at Caribbean College, Manbhawan, Jawalakhel

Specific objectives:
• To find out level of knowledge among adolescents regarding health effect of smoking before
educational intervention.
• To identify level of knowledge regarding health effects of smoking after educational
intervention.
• To find out difference between pretest and posttest level of knowledge regarding health effects
of smoking among adolescents.

1.63Research questions:
• Do the adolescent have adequate/inadequate knowledge regarding health effects of smoking
before educational intervention?
• Do the adolescent have adequate/inadequate knowledge regarding health effects of smoking
after educational intervention?
• Is there any difference between pretest and posttest level of knowledge regarding health effects
of smoking adolescent?

13
1.7Study variables:
Dependent variable:
 Level of knowledge on health effects of smoking
Independent variable:
 Educational intervention on health effects of smoking
Conceptual framework of study variables:
Dependent variable Independent
variable

Level of knowledge on health

Educational intervention on health
effects of smoking
effects of smoking

1.8Operational definition of terms of variables:

S.N Variables Conceptual definition

Contextual definitionOperational definition

1 Knowledge The psychological Knowledge Adequate knowledge:

Regarding health
result of regarding students who will report
effects of perception and health effects of more than 6 positive
smoking learning and smoking answer regarding smoking
reasoning Inadequate knowledge:
students who would
report less than 4 positive
answers regarding smoking
2 Health Acquaintance with In present context of upon asking about the health
facts, truth about the the study the effects effects of smoking to the
effects of
effects of smoking of smoking refers to respondent, the respondent
Smoking the health effect, will be able to answer the
social effect, and following:
economic effect. • Health effect
physical
(Yes/No)
Psychological

14
 (Yes/NO)
• Social effect
(Yes/No)
• Economic effect
(Yes/No)

3 Educational it to
will be conducted in three
It is the new In this study it refers
intervention phase
the teaching program
program,
pretest: In this phase
used to teaching group
course, knowledge of the
of adolescents
curriculum that respondend regarding
that will help
health effects of
seek to reform older
them to gain new
smoking will be assessed.
system and
knowledge on
Educational intervention
practice. prevention of After pretest, education

smoking will be given to the same

group of respondent in
another school.
Posttest:
Knowledge regarding
health effects of
smoking will be assessed.
4. Adolescent Adolescent is the
In my study In my study
period of rapid
adolescent group from
adolescent group from age 10-
physical, age 10-19 will be 19 will be taken
intellectual , taken
emotional, and social
growth.

15
 CHAPTER-3
Literature review

A literature review is a comprehensive summary of previous research on a topic.

The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more
than 7 million people a year. More than 6 million of those deaths are the result of direct tobacco use
while around 890,000 are the result of non-smokers being exposed to second hand smoke (WHO,
2017).

Cigarette smoking is leading causes of death in the United States and the leading causes of death were
heart disease (597,700 deaths), cancer (574,700 deaths), chronic lower respiratory diseases (138,100
deaths), 100,600 COPD deaths. Furthermore, parental smoking is estimated to cause approximately 600
deaths per year from prenatal conditions and 400 deaths per year from sudden infant death syndrome
(HHS,2014).

Smoking is the most popular form of tobacco use being practiced by over one billion people globally,
of whom the majority are in the developing countries. Smoking caused over five million deaths a year
from 1990 to 2015. Smoking harms not just the smoker but also family members, colleagues and others
who inhale the smoke (i.e. second-hand smoking).Smoking harms nearly every organ of the body.
Cigarette smoking causes 87% of lung cancer deaths. Approximately one person dies every six seconds
due to smoking cigarette (WHO, 2013).

In 2015, over 1.1 billion people smoked tobacco. Far more males than females smoked tobacco.
Although it is declining worldwide and in many countries, the prevalence of tobacco smoking appears
to be increasing in the WHO Eastern Mediterranean Region and the African Region. (GYTS,2015)

Around one-third of adults are known to be smokers, and smoking rates are increasing among the
female population. It is estimated that deaths attributable to tobacco use will rise to 10 million by 2025,
and one-third of all adult deaths are expected to be related to cigarette smoking. The association
between cigarettes and lung cancer has been proven by large cohort studies. Tobacco use has been
reported to be the main cause of 90% of male and 79% of female lung cancers. 90% of deaths from

16
lung cancer are estimated to be due to smoking. The risk of lung cancer development is 20-40 times
higher in lifelong smokers compared to non-smokers. (OzluT, 2005)

A survey of smoking behaviour and smoking-related knowledge and attitudes was administered to 24
000 youths (students and non-students of middle school age) in in China. The prevalence rates of
experimenting were 47.8% for boys and 12.8% for girls. The prevalence of regular smoking among
non-students was higher (8.3%) compared with students (5.2%). The majority of youths were aware
that smoking was a cause of several diseases and addictive; however, non-students were less aware than
students. (Gonghuan, Ma, Chen, Brown, & Jonathan, 2004).

A cross-sectional study investigated 305 adolescent students from the Northern Soudi Arabia
population, their ages ranging from 11 to 19 years old revealed that Of the 287 respondents,
56/287(19.5%) were found to be current smokers. Of the 56 current smokers, 14/52 (27%), 29/52
(55.8%), and 9/52 (17.2%) smoked 1-3, 4-10 and 11+ cigarettes/day, respectively. For duration most
had smoked for 26-36 months which indicate indicate that cigarette smoking use is still an important
risk behavior among adolescent students (Ahmed, et al., 2016).

A randomized intervention conducted in a sample of schools of Pelotas, a city located in Southern

Brazil done on effectiveness of educational intervention on smoking among adolescents students of the
7th and 8th grades, showed that the intervention was not effective to produce behavioral changes, but led
to an increase in knowledge about health effects smoking (Malcon, etal, 2011)

A cross sectional survey was carried out by self-administered questionnaire adapted from Global Youth
Tobacco Survey to assess tobacco use among the representative sample of 1540 adolescent students
selected by stratified random sampling Overall prevalence of ‘ever users’ of tobacco products was
25.3 %. Prevalence among boys and girls was 31 and 14.4 % respectively. Mean age at initiation of
using tobacco was 13.38 ± 1.62 years. The correlates of tobacco use were: sex, ethnicity, family
members and friends using tobacco products, and students exposed at home and public place.

School based interventions and tobacco education are necessary to prevent initiation and cessation of
tobacco use. Legislations related to tobacco control should be enforced to decrease availability,
accessibility and affordability of tobacco products. Social norms of tobacco use among parents and

17
others at home as well as at public place should be modified to curb the tobacco use among school
students.
A descriptive cross-sectional study conducted among male population of Dharan municipality using
random sampling revealed that the prevalence of smoking was 41.7%. Sixty eight percentage of the
respondents had started smoking at the age of 11 to 20 years and most of them initiated smoking due to
peer pressure. Forty three percentage of former smokers and 52% of current smokers had experienced
different kinds of health problems like cough and troubled breathing which they perceived as smoking
related which shows that young people are more vulnerable to start cigarette smoking so there should
be frequent positive reinforcement of antismoking campaign focusing more on youth and as well the
smoking advertisements should be discouraged. (Sabitra, 2013)

A cross-sectional survey of 1157 young individuals between the ages of eight and 19 years living in a
rural community of the hill region of Nepal carried out by a health assistant especially trained in
smoking survey technique for young people with the help of the WHO standardized smoking survey
questionnaire for young people revealed that the overall prevalance of daily smoking was found to be
12–6 per cent (17–3 per cent for boys and 6–7 per cent for girls). The prevalence increased with age for
both sexes. In addition there was a large number of weekly and experimental smokers especially in the
younger age groups. ([Link], 2011)

A descriptive cross-sectional study was carried out among 944 randomly selected in-school male
adolescents in Owerri, southeast Nigeria, using a self-administered questionnaire revealed a prevalence
of 15.3% for ever smoked adolescents and 11.2% for current smokers. The mean age at cigarette
smoking initiation was 14 years. Sixty-three percent had good knowledge of health problems associated
with cigarette smoking. Lung cancer was the most reported associated health problem. Fifty-two
(36.1%) indicated that they were initiated by their friends who offered them their first stick of cigarette.
Poor knowledge of health effects of smoking was statistically associated with cigarette smoking (X 2 =
26.82, p-value < 0.001). (Chikere Ifeanyi Casmir Ebirim1*, 2014)

A randomized control trial conducted to assess the prevalence of tobacco use and the
effectiveness of tobacco cessation behavioral intervention offered to degree students of Oxford
institutions in Bangalore city by selecting randomly total of 2165 students were administered the

18
questionnaire, of which 248 (11.5%) students were tobacco users and 1917 (88.5%) students
were non-users of tobacco. Of the 248 tobacco users, 68.5% of students were smokers, 19.4% of
students used smokeless tobacco, and 12.1% of students used both forms of tobacco (smoking
and smokeless). Out of 248 students, only 115 (46.4%) students were willing to participate and
thus were included in the study. The effect of intervention of tobacco cessation in group A
showed an increase of 29.1% students who stopped using tobacco completely after intervention
compared to 15% in group B, and the highest reduction of 21.8% change was noticed in the
students using one to five tobacco products per day and the least reduction in percentage (1.8%)
change was noticed in the students using one tobacco product per day. (Reddy, Divakar, &
Acharya, 2015)

A cross-sectional study, sixty adolescents (41.7% smokers, 28.3% ex-smokers and 30% never
smokers) attending the secondary level of a public school (Botucatu, São Paulo, Brazil) were
interviewed using a standardized questionnaire to contribute to the development of prevention
tools by identifying the pattern of tobacco use, knowledge about tobacco-related diseases among
adolescents . This study showed that the mean age was 15.8 ± 1.1 years old, and 65% were
female. A very low proportion of the adolescents associated smoking with cardiovascular disease
(1.7%), neurological problems (1.7%), heart disease (5%), dental problems (5%), skin aging
(5%) and even cancer (36.7%). (Andre, Thias, Minamoto, & Irma, 2015)

.
A cross-sectional descriptive study was conducted in Soudi Arabia to assess the prevalence of
tobacco smoking among health colleges' students at Najran University, and to investigate the
students' attitude, practice and knowledge towards smoking and its [Link] using A pre-tested
validated questionnaire based on the Global Adult Tobacco Survey was answered by 433
students (22 males and 207 females).
This study showed prevalence of current cigarettes smokers was 30.1% for males and 0.5% for
females. Females had a better knowledge than males regarding the hazardous effects of smoking
on health (87.1% vs. 99.5%) and as a risk factor of brain thrombosis (67.2% vs. 94.2%), heart
attack (78.3% vs. 95.7%) and lung cancer (82.3% vs. 99.5%). (AlQahtani 2017)

19
A cross sectional study done in Jalthal & Maheshpur Village Development Committee of Jhapa
district using simple random sampling method among 200 participants. Interview methods with
semi-structured questionnaires were used as tool for data collection to identify the reason of
initiation of smoking, explore the pattern of smoking and to assess the health knowledge among
the smokers regarding effect of smoking which reported that, 63% of them started to smoke at
the age of [Link] health effects of smoking majority of them knew about lungs
cancer (40%) followed by heart disease, bronchitis and tuberculosis. (Uprety, et al., 2014)

Although the links between tobacco use and both psychiatric comorbidities and disorders of substance
abuse have been investigated in adults, they have not been rigorously examined in adolescents. one
study of youth, conducted in U.S.A, examined the cross-sectional relationship between cigarette use
and the use of other substances as well as with psychiatric disorders and found that daily cigarette
smoking was associated with a 70% increase in the likelihood of diagnoses of anxiety and of disorders
of mood and disruptive behavior (Kandel, et al., 1997).

20
 Chapter III Methodology

3.1Study Method

The study will be conducted by using Quasi- experimental study method and to find out if
college Students have knowledge regarding health effects of smoking and will they have
increased knowledge after educational intervention regarding smoking.

3.2 Study Design:

One group pretest and posttest study design will be used to collect data

3.3 Study Area

The study will be conducted in one of the college in Jawalakhel Kathmandu

3.3 Study Population

The population of the study will be adolescents studying in class 11 and 12

Sampling Size

 The sample size will be all the students

3.4 Sampling Technique

The sampling technique of study will be non- probability purposive sampling

21
3.5 Instrumentation Technique

Self-administered standardized questionnaire will be designed specifically to collect data.

3.6Tools

 Semi-structured questionnaire

 Educational package: The educational Package will be included the following information:

- Meaning of health effects of smoking

- Risk factors of smoking

- Health effects of smoking

-management of health effects of smoking

3.7 Validity and reliability

3.71Validity

The validity of the instrument will established by:

 Extensive Literature review will be done.

 The questionnaire will developed on the basis of objectives of the research study in order to
maintain the content validity; the researcher will further consult with concerned teacher, key
informants and review the literature.

 Questionnaire will be developed on the basis of research variables and objectives of the study

 Consultation with supervisor, expert and subject teacher.

22
 3.72Reliability

The reliability of the questionnaire will established by:

 Pretesting of the tool will be done at 10% of the sample population

 The tools will be pretested in a similar setting but another school and necessary correction will be
done.

 Data will be rechecked to ensure its completeness.

 Use of simple and clear language.

3.8 Data collection Process

 Prior to the data collection, formal written approval from campus chief of Nepal Institute
of Health Sciences will be obtained.

 Research study will be conducted in four different phases

1. Preparatory phase

2. Pre-test

3. Education intervention

4. Post-test

1. Preparatory phase
Respective school will be visited for permission to conduct research for data collection from
school authorities.

2. Pre-test phase

The self-administered questionnaire will be used to assess the knowledge of the students on health
effects of smoking after informing them about the purpose of study and obtaining consent.

23
3. Education Intervention

Educational intervention will be conducted on the basis of the predesigned educational package
which consisted of:

 Definition of health effects of smoking

 Risk factors of health effects of smoking

 Health effects of smoking

 Management of health effects of smoking

4. Post test phase

• Post- test will be conducted on the same group using same method as used before for pre-
test and collect primary data.

• Questionnaire will be checked immediately for the completeness, consistency and valid
information.

3.9Data processing and analysis

 The collected raw data will be checked and rechecked, coded and tabulated

 Data will be entered and analyzed using SPSS 16 version

 Descriptive statistics such as frequency table, average and standard deviation will be used.

 Inferential statistics will used.

Inclusive Criteria

The research includes:

 Secondary school students who will be willing to participate in this study.

 Students who are available during the data collection.

24
Exclusive Criteria

 Students who will be unwilling to participate in this study.

 Students who will be absent during the data collection time.

3.10Limitations of the study

 This study will conducted only among the secondary school students.

 The sample size of the study will be limited

 Since the study design was pretest and posttest without randomization, many extraneous
variables will not be controlled.

3.11Ethical Consideration

 Prior to research conduction the approval letter will be taken from NIHS and the principal
of School during the Study.

 Consent will be taken from the adolescents.

 Strict confidentiality and privacy will be maintained by not disclosing the identification of
the respondents

 Purpose and aim of the research will be explained before filling the questionnaire

 Respondents/participants unwilling to participate will not be included.

 Students will not be forced to fill the questionnaire

25
 WORK PLAN

1st week2nd week3rd week4rth week5th week6th week7th week 8th 9th week
S.N ACTIVITIES
week
Selection of topic
1.

2. Topic presentation

Literature review
3.

Proposal writing
4.

Proposal presentation
5.

Proposal submission
6.

Ethical Consent
7.

Data collection
8.

Data analysis and

9.
interpretation

10. Final report

Presentation

11. Report Submission

26
 Budgeting

S.N Activities Total amount (NRs)

1. Literature review

 Information collection 1000

 Net searching 1000

2. Proposal writing

2500

 Printing

3. Stationary 1000

4. Transportation 100

500

5. Logistics 1500

6. Tabulation and analysis 1000

Questionnaire 1000

Total 9600

27
References

 (2018). Global status report.

 Ahmed, H., Alsaif, M., Almuzaini, F., Alfayez, A., Alghuraymi, A., Alateeq , M., et al. (2016).
Prevalence of Cigarette smoking usage among adolescent students in northern saudi arabis.

 Andre, L. B., Thias, G., Minamoto, S., & Irma, G. (2015). Tobacco in Adolescence: Importance
to Knowledge the Health Hazards and Preventive Measures. Journal of addiction and research
therapy.

 Chikere Ifeanyi Casmir Ebirim1*, A. N. (2014). the prevalence of cigarette smoking and
knowledge of its health implicationamong adoledcent. health.
 Gonghuan, Y. J., Ma, A. P., Chen, S., Brown, C. E., & Jonathan, S. M. (2004). Smoking among
adolescents in China. International Journal of Epidemiology.
 Henningfield, J., Rose, C. A., & Hilton, M. J. (July, 2019). Smoking Tobacco.
 Judith , M. (may 9, 2017). the effects of smoking on the body. healthnews.
 Kandel, D., Johnson, J., Bird, H., Canino, G., Goodman, S., Lahey, B., et al. (1997). Psychiatric
disorder associated with substance use among adolescents and children. Journal of abnormal
psychology.
 OzluT. (2005). smoking and lung and lung cancer.
 [Link]. (2011). epidemiology study of tobacco smoking behaviour among young people in
rural community of hilly region of nepal. journal of public health.
 [Link]. (2011). epidemiology study of tobacco smoking behaviour among young
people in rural community of hilly region of nepal . journal of public health.
 Reddy, U. K., Divakar, D. D., & Acharya, L. G. (2015). Effectiveness of health education and
behavioral intervention for tobacco de-addiction among degree students. journal of international
societyof preventive and community dentistry.
 Sabitra, P. (2013). prevalence of smoking and perceived health problems among male population
of dharan municipality. journal of medical college.
 Vaibhav, j., & Swamy, P. (Sep.-Oct. 2014)). Effectiveness of planned teaching programme on
knowledge. journal of Nursing and Health Science (IOSR-JNH, 6.

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