Smoking and health have become a concept that has increasingly interested the research worker and public health organization the world over. At first it was the relationship between smoking and lung diseases that excited interest, and particularly lung cancer and chronic bronchitis, but more recently there has been concern about the possibility that smoking is in some measure responsible for the great increase.

Physiological changes resulting from inhalation of tobacco smoke maybe of importance the nicotine absorbed in tobacco uses and lipid metabolism, after smoking 1-2 cigarettes it causes an increase in the pulse rate, a slight rise on blood pressure and through catecholamine liberation, an elevation of free fatty acids.

There may, however be quiet other factors associated with smoking that are responsible for the excess mortality of smokers from cancer and cardiovascular diseases. The significance of the constitution is stressed the American committee. “If it could be shown the cigarette smokers and non-smokers had significant constitutional difference apart from any differences that might be caused by smoking itself, then a possibility would exist that some predisposition of smokers to particular disease might also be of constitutional origin and not caused by smoking.

NEEDS OF THE STUDY:

Smoking prevalence- Males (%of adults) in India was last measured at 36% in 2015 according to World Health Organization. According to World Health Organization (WHO), India is home to 12% of world smokers. Approximately 900,000 people die every year in India due to smoking. As of 2015, the number of men smoking tobacco in rose to 108 million. A survey conducted by international institute of population science and the ministry of health and family welfare reveals that 26.6% in Jammu and Kashmir smoke the highest rate in the country. The highest number of beedi smokers in Utterkhand.

Cigarette smoking contributes to the deaths of more than 400,000 Americans annually. Each day >3000 children and adolescents become regular smokers. Cigarette smoking contributes to premature deaths of an estimated 443,000 Americans annually resulting in 193 billion in direct health care expenditures and productivity loses every year. For the period of January through June 2008 20.8% of adults aged 18 years and over were current smokers which was higher than the 2007 estimates 90.8% over 90%.

That is something written on all cigarette packs to want the customers globally, approximately 47% of males. In developing countries 48% of males and in developed country 42% have smoketive diseases. Each year a great amount of money have being wasted in smoking. All though it is quiet, obvious that smoking habits is dangerous and injurious to health but still large number of people are getting involved in smoking habits day by day. It can be positive and negative aspect.

According to WHO Estimates 194million mens are used tobacco in smoked and smokeless from India. There are approximately 5million deaths due to tobacco conception which is expected to reach 10million by 2025.

The World Health Organization (WHO) reports, that using tobacco in any form has always been seen as socially accepted in India. Smoking related illness is already major problem in most of the countries in the South East Asian region. Approximately half of all cancer in men is tobacco related, while over 60% of those suffering from heart disease below the age of 40 years are smokers. There is an estimated 12 million cases of preventable tobacco related illness each year in India. Tobacco smoke can cause almost all the major tobacco related diseases in non-smokers for example (episode of respiratory disease asthma and sudden infant death syndrome). Passive smoking is linked with cancer, heart disease, respiratory illness and it is the leading source of indoor air pollution. Smoke- free work places not only protect non smokers, they also create an environment that encourages smokers.

Smoking is one of the leading preventable cause of death in all over the world tobacco related it is essential that nursing personnel practice healthy activities and give up smoking. If they have to educate public about the importance of non-smoking they themselves should be non smokers. To give health education to public, nursing personnel must possess adequate knowledge about ill-effects of smoking and also should possess unfavorable attitude towards smoking. Therefore investigator who aims to continue her teaching carrier felt the need for evaluating knowledge and attitude of smoking among adults.

In PIMS 132 hospital attendants are working. They work in health care industry but are not aware of ill effects of smoking. Educating them would create awareness about ill effects of smoking. In the ward or the outside of the hospital any person have the habits of smoking, they can give health education regarding ill effects of smoking.

STATEMENT OF PROBLEM:

A descriptive study to Assess the level of knowledge and Attitude regarding Ill Effects of Smoking among hospital attendants at PIMS hospital”

A. OBJECTIVES OF STUDY:

1. To assess the level of Knowledge and Attitude regarding ill effects of smoking among hospital attendants in P.I.M.S hospital, Puducherry.

2. To find out the association between the level of knowledge and attitude regarding ill effects of smoking with selected study variables among hospital attendants in P.I.M.S hospital, Puducherry.

B. RESEARCH HYPOTHESIS:

H1- There is significant association between the knowledge and attitude regarding smoking among hospital attendants and their selected socio demographic variables.

C. OPERATIONAL DEFENTIONS:

KNOWLEDGE:

In this study it refers to information and facts obtained from adults on the aspects such as courses, effects and treatment regarding smoking using self administered questionnaire.

ATTITUDE:

An attitude is an expression of favour or disfavour towards a person, place, thing or event. In this study, it refers to ideas or opinions expressed by the hospital attendants regarding ill effects of smoking; assessed by 4 point Likert Scale.

SMOKING:

Smoking is the inhalation of the smoke of burning tobacco encased in cigarettes pipes and cigars.

HOSPITAL ATTENDANTS:

A medical (also known as a ward assistant or nurse assistant) is a hospital attendant whose job is to assist medical and nursing staff with various works.

D.DELIMITATION:

· This study is limited to only male hospital attendants between age group 21 to 65 years.

· Sample size is limited to 48 samples.

· The study is limited to the n P.I.M.S

METHODOLOGY:

RESEARCH APPROACH: Descriptive Approach

RESEARCH DESIGN: Non experimental descriptive design

STUDY SETTING: PIMS Puducherry

TARGET POPULATION: 20-60 years of male hospital attendants

SAMPLE SIZE: 48 hospital attendants

SAMPLING TECHNIQUE: Convenient Sampling Technique

SAMPLING CRITERIA:

Inclusion criteria:

The study included attendants workers who were;

· Male workers available at the time of data collection.

· Willing to participate in the study.

· Can read and write tamil language

Exclusion criteria:

The study excluded attendant workers who are

· Sick during the data collection procedure

TOOLS AND INSTRUMENTS:

Closed structured interview questionnaire was prepared after the extensive review of literature and getting opinion from the experts. The tool was formulated to assess the level of knowledge and attitude on ill-effects of smoking and it consist of three parts:

Part I: Socio-demographic characteristics such as age, education, locality, family history and source of information regarding ill-effects of smoking.

Part II: Structured Questionnaire to assess the knowledge regarding ill-effects of smoking.

It consisted of 10 items related to the knowledge regarding ill-effects of smoking Each questions has 4 options. One score was allotted to each correct answer and Zero score was wrong answer. Maximum score was 10.

SCORING PROCEDURE:

10 multiple choice questions were used to assess the knowledge level on ill-effects on smoking. Each item had four responses with only one correct answer. The correct response to each item was given a score “one” and “zero” for all wrong response. So the total score ranged from 0 to 10. The scores were converted into percentages and interpreted as follows:

SCORE INTERPRETATION:

KNOWLDEGE:

LEVEL OF KNOWLEDGE

SCORE

PERCENTAGE

Adequate

Moderately adequate

Inadequate

8-10

6-7

0-5

75-100%

50-74.9%

<50%

Part III: A four point Likert scale towards the attitude regarding ill-effects of smoking smong hospital attendants.

A four point Likert scale was used to assess the attitude regarding ill-effects of smoking smong hospital attendants.It consist 10 items.

The score graded as

· Favourable(>75% of score)

· Moderately favourable(50-75% of score)

· Unfavourable((<50% of score)

SECTION 1: Distribution of socio demographic variables of hospital attendants

Table 1:- Socio Demographic Characteristic of hospital attendants.

n=48

SI. NO

DEMOGRAPHIC VARIABLES

FREQUENCY

PERCENTAGE

Age (in year)

a) 21-30

b) 31-40

c) 41-50

d) 51-60

31.3

45.8

22.9

Gender

a) Male

b) Female

100.0

Education

a) Primary education

b) Secondary education

c) Hr. Sec. education

d) Degree

6.3

47.9

20.8

25.0

Source of Information regarding ill effects smoking

a) Television

b) News paper

c) Friends

d) Health worker

47.9

10.4

16.7

25.0

Does anyone in your family have the habit of smoking?

a) Yes

b) No

No, if yes, specify who is it?_________

37.5

60.5

Section-2: Distribution of hospital attendants according to level of knowledge regarding smoking

Table-2: Percentage and frequency distribution of level of knowledge of hospital attendants Regarding smoking.

LEVEL OF KNOWLEDGE	CLASSIFICATION OF HOSPITAL ATTENDANTS
LEVEL OF KNOWLEDGE	NUMBER	PERCENTAGE(%)
Inadequate(<50%score)	15	31.25
Moderate(50-75% of score)	23	47.92
Adequate(>75% of score)	10	20.83
Total	48	100

Fig.1 : Distribution of Hospital attendants according to level of knowledge regarding smoking

SECTION 3: Distribution of level of Attitude on ill effects smoking among hospital attendants

Table 3: Distribution of hospital attendants Regarding Attitude on ill effects smoking

LEVEL OF ATTITUDE	CLASSIFICATION OF HOSPITAL ATTENDANTS
LEVEL OF ATTITUDE	NUMBER	PERCENTAGE(%)
Undesirable(<50%score)	0	0
Neutral(50-75% of score)	25	52.08
Desirable(>75% of score)	23	47.92
Total	48	100

Fig. 2: Distribution of Hospital attendants according to level of Attitude regarding smoking

Table 4: Mean, Standard Deviation and mean percentage of knowledge and attitude of hospital attendants regarding smoking.

SI. NO.	ITEMS	NO. OF STATEMENTS	MAX. SCORE	RESPONDENTS KNOWLEDGE
SI. NO.	ITEMS	NO. OF STATEMENTS	MAX. SCORE	MEAN	SD
1	Knowledge	10	9	6.23	1.547
2	Attitude	10	40	30.19	5.039

SECTION 4:- Association of Knowledge Level on ill effects of smoking with socio demographic variables

Table 4:-Association of Knowledge Level on ill effects of with socio demographic variables

S. No.

Socio Demographic Variables

No.

Knowledge level

p value

Moderately Adequate (50-70%)

In Adequate

(≤ 50%)

Adequate

No.

Age in years;

a) 21-30

b) 31-40

c) 41-50

18.75

33.33

10.42

2.08

4.16

10.41

8.33

2.08

7.940

Education

a) Primary

b) Secondary

c) Hr. Secondary

d) Degree

2.08

12.5

2.08

4.1

22.9

14.5

20.8

12.5

6.25

2.08

7.347

Locality

a) Urban

b) Rural

6.25

10.41

27.08

35.41

10.41

.377

Source of information recieved regarding ill effects of smoking from

a) Television

b) Newspaper

c) Friends

d) Health worker

2.08

8.33

4.16

2.08

33.33

10.41

14.5

2.08

6.25

10.41

5.464

Does anyone in your family have the habit of smoking?

a) Yes

b) No

14.5

2.08

33.33

29.1

14.5

6.25

3.230

SECTION 5:- Association of Attitude Level on ill effects of smoking with socio demographic variables

Table : 5 Association of Attitude Level on ill effects of smoking with socio demographic variables

SI.

DEMOGRAPHIC

VARIABLES

ATTIDUDE OF RESPONDENTS

CHI- SQUARE VALUE

Desirable

Neutral/ undesirable

Age in years;

a) 21-30

b) 31-40

c) 41-50

18.78

8.33

12.5

27.08

14.5

.461

Education

e) Primary

f) Secondary

g) Hr. Secondary

h) Degree

4.1

31.25

8.33

2.08

16.68

12.5

14.5

.446

Locality

c) Urban

d) Rural

14.5

39.5

29.1

16.68

0.11

Source of information recieved regarding ill effects of smoking from

e) Television

f) Newspaper

g) Friends

h) Health workers

2.08

22.91

8.33

22.91

4.16

12.5

2.08

.010

Does anyone in your family have the habit of smoking?

c) Yes

d) No

35.41

18.75

27.08

18.75

.440

1.547