THE EFFECTS OF ABUSING TOBACCO

UNIVERSITY OF CHUKA
SCHOOL OF NURSING SCIENCES
A RESEARCH PROPOSAL SUBMITTED IN PART FOR THE FULFILLMENT FOR THE AWARD OF THE DEGREE OF BACHELOR OF SCIENCE IN NURSING AT CHUKA UNIVERSITY
RESEARCH TOPIC:
TOBACCO ABUSE BY CHUKA UNIVERSITY STUDENTS
AUTHOR: GITONGA KARANI INNOCENT
REGISTRATION NO: HBS1/33795/17
SUPERVISOR: MRS MUTUNGA
SCHOOL OF NURSING SCIENCES
UNIVERSITY OF CHUKA
JANUARY 2021
 
INTRODUCTION
1.1 Background information
Tobacco use describes any habitual use of the tobacco plant leaf and its products (AlIbrahim & Gross, 1990). The predominant use of tobacco is by smoke inhalation of cigarettes and cigars. Other forms of tobacco include dissolvable products that do not require disposal of the product remains and are often sold as lozenges, hookah, or shisha, where flavored tobacco is smoked through water pipes. Traditional forms of tobacco are packaged as gum that can be chewed or snuff, which is powdered tobacco that is snorted or placed between the lip and gum.
Tobacco use is the leading cause of preventable illness, disability, and premature deaths worldwide in half of the chronic tobacco users. According to WHO estimates, over 1.3 billion people smoke cigarettes globally, with death attributed to tobacco-related illnesses occurring every 6 seconds(WHO,2011), with 70% in low and middle-income countries. Statistics indicate that in the 20th century, 100 million people died from tobacco-related diseases, mainly in the developed countries where its use was prevalent. Presently, the mortality rate has shifted to the underdeveloped and developing countries in the 21st century(ASH,2007), implying that while the developed countries are increasingly ceasing their use, people in the underdeveloped countries are increasingly taking up the habit. the former statistics have been directly attributed to unregulated marketing and vigorous advertising campaigns by tobacco companies and social-economic factors of this population(ASH,2007)
The global prevalence of tobacco usage was estimated at 22.1%(36.9% males and 7.3% females) and 12.8%(23.2% males and2.5% females), with trend estimates suggesting a decrease in global prevalence but an increase in Africa to around 18.9% according to WHO. The Kenya Demographic and Health Survey (KDHS) 2008/9 revealed that 19% of males and less than 2% of females aged 15-49 years were consuming tobacco products (KNBS, 2008). GATS 2014 puts prevalence at 11.6%(19.1% males and 4.5% females) in Kenya. According to the GYTS conducted in 2007, among the youth aged 13-15 years, 15.1% were using tobacco products (MOH, 2007), with prevalence in boys at 15.9%, edging girls by 0.5%, an increase in uptake by the youth. The report also noted increased exposure to second-hand smoke in public places (48.5%) than in households (24.7%). Statistics conducted in 2008 revealed gutting results. Regionally central province led with prevalence at 30.4% closely followed by Eastern at 26% with Coast, Nairobi, North Eastern, Rift Valley, Western and Nyanza provinces at22.6%,17.1%,15.6%,14.3%,11.2%, and 7.9% respectively. Presently these numbers are estimated to be higher, especially in Nairobi, Coast, Central and Eastern provinces, due to urbanization and adoption of what is perceived as foreign cultures. According to GATS 2014, the prevalence of smokeless tobacco increases, with men at 5.8% and females at 3.8%, and estimated to be higher due to increased availability and accessibility to tobacco products.
Analysis of data shows that the prevalence based on gender is consistent with global rates, with men being predominantly the primary users of tobacco products. The youth have hugely taken up the habit, as is the case in Africa and other low and middle-income countries. In Kenya, this marked increase has been exacerbated by weak legislative laws and policies and a lack of public health education and mass media campaigns to sensitize the population on tobacco abuse’s health impacts. Kenya enacted the Tobacco Control Act in 2007 to fulfill its obligation to Framework Convention and Tobacco Control(FCTC) under WHO. The legislation has been carped to be weak due to big tobacco companies’ influence by sponsoring legislators to shoot down, procrastinate, or include clauses in the bill that favor them (Nargis et al.).
Furthermore, these companies contribute large amounts in the form of corporate tax to the government. In 2019 BAT claimed it paid around 80 billion in taxes, thus the shuffling of feet by anti-tobacco enforcers when going after these companies. The government has also failed to implement its guidelines in TCA 2007 by failing. Sensitization campaigns next to none, companies have been compelled to display danger messages on cigarette packets, but this has not been fully enforced. Tobacco product prices have not significantly increased, and specific smoking areas have not been established to reduce passive smoking. Mass media campaigns through digital and analog means on the impact of tobacco prevalence are less than satisfactory. NACADA has many a time complained about underfunding, which has impeded its supervisory and regulatory arms. The government has been leaky in fighting counterfeit tobacco products that are cheaper, low in quality, and with far more devastating health effects.
Cessation of tobacco use and discouragement of use among would-be users is paramount in reducing burgeoning prevalence rates. This central to promoting individual health and easing the economic burden due to tobacco-related diseases. Cessation has many benefits to the user; according to a study, smoking cessation increases the average user’s life expectancy by up to 10 yrs. In the short term, blood circulation and lung function improve. The risk of coronary heart disease, stroke, and most conspicuous is the risk for cancer decreases, especially lung cancer.  In women difficulty getting, pregnant premature births and miscarriages are significantly reduced. The risk for passive smokers to disease incidence decreases such respiratory infections in children. Economically money that would be used in the treatment of tobacco-related diseases is used in other ways to improve family and community living standards.
This dissertation, therefore, wishes to explore the prevalence rates of tobacco use, determinants that influence the abuse, and gather knowledge and attitudes of abusers towards use and interventions that promote cessation.
1.2 Statement of the problem
According to a surgeon general report at the NCCDP, CDC 2012 88% of all adult tobacco users started before they were 18yrs and a staggering 99% before aging 26yrs. This report, therefore, wishes to understand agents that influenced tobacco use, why they currently use or stopped, and their knowledge and attitude on tobacco use and cessation among students. Though attempts have been made by Chuka University and Ndagani community to discourage tobacco use, their success has been meager and non-impactful. Tobacco use has increased, which is evident in the number of tobacco products spread out on the ground. The health effects of tobacco on the youth are numerous and well documented in later stages of life. This mainly due to them starting to abuse early. This research focuses on students and the effect of the evolving environment due to new interactions with lifestyle and culture. This sets it apart from other research centered around adults. It also seeks to understand factors that lead to starting use, maintaining use, and its perceived benefits to the user to develop better interventions that impact discouraging use among present students among nonsmokers. Failure to deter use among youth and promoting interventions encouraging cessation are humongous to the individual. Nationally the population remains productive, and an economic and healthcare burden is not shouldered by society. The relevance of this research cannot be understated. Trends show that tobacco use among youth communities interacting in centers for learning has been gradually and consistently rising. This projects an adult smoker society if strategies advocated and implemented are not aimed at the youth where habits can be stopped before addiction. The strategies drawn from research findings can also be applied to other student communities to promote target measures to curb tobacco use.

Aims and objectives

The main aim of this study is to determine the factors that drive Chuka university students to take up and maintain the behavior of using tobacco,
Specific objectives
1.To determine the level of knowledge of students on the adverse effect of tobacco use.
2.To assess the attitude of students towards smoking.
3.To explore the socio-demographics of students who smoke.
4.To examine the impact of tobacco on behavior
5.To determine the environmental and social factors that drive students to smoke.
6.To assess the knowledge of students on interventions that lead to cessation of tobacco use.
 
 
 
 
1.4 Scope and limitation of the study
This study focuses on students who are currently enrolled and presently have active programs at Chuka University. It wishes to explore their level of knowledge concerning tobacco products, the associated risks with use, and their general attitudes towards smoking. Also, the factors that drive tobacco users and their information on cessation interventions will be determined.
This study is based on a university environment and is thus only applicable only to similar settings. Since tobacco use is discouraged by the university, respondents may withhold truthful answers since many may fear being users’ disciplinary consequences. Therefore, data will be collected in the absence of any school authority, and the identity of all respondents will be private and confidential. Anonymity will also be a choice during data collection, but this will make verification and confirmation of data impossible. Ethical principles will also limit the research. Firstly, participation is voluntary. During this investigation, to attract respondents for this research, participants may be given remuneration upon involvement, but it may be used to buy tobacco products. Secondly, some participants might be below 18yrs, and obtaining consent from a guardian may be an arduous task. Furthermore, general attitudes do not favor tobacco users thus may fear their status being disclosed, especially since keeping confidentiality while being a local enumerator is a tough ask.
 
Literature review
Chuka University is a public university located in Ndagani along the Nairobi-Meru highway, Igambang’ombe constituency, Tharaka Nithi County, Kenya.  Like other low and middle-income countries, Agriculture in Kenya is both a driver for economic growth and a challenge for the country in the long run (Clark et al., 2020). In Kenya, agriculture contributes to 30% of its gross domestic product, with tobacco growing contributing 0.03% of the country’s GDP and the whole tobacco industry contributing to 7% of the economy (Clark et al., 2020). The strategies and structure of tobacco farming have changed from contractual obligations during the colonial era to a more modernized voluntary agriculture.  During the post-colonial period, British American Tobacco rolled out vigorous campaigns targeting consumers, which led to a sharp increase in tobacco production from 209 tons in 1975 to 4034 tons in 1982(Clark et al., 2020). production of tobacco peaked in 2005 at 2500 tons, but recently the output decreased to 9711 tons in 2018.
According to a global youth survey study, tobacco use is most prevalent in urban areas of Nairobi and Mombasa compared to rural areas. According to the data analysis, males predominantly have a higher incidence of both lifetime and spontaneous abuse when compared to women. The incidence of tobacco abuse in rural areas was directly attributed to farming and the production of tobacco(GYTS,2007). Tobacco in Kenya is mainly produced in the rural areas of the country’s western and southeastern parts. Tobacco is a labor-intensive exercise that requires labor input by people of all ages, which increases the exposure of the children in these areas to tobacco abuse (Clark et al., 2020). Exposure of children to tobacco massively increases the probability of these children taking up the habit, which increases the prevalence of tobacco abuse among the population.
According to Muendo, 2015, social and demographic factors also play a role in developing and maintaining tobacco use. In Kenya’s rural areas, children are more likely to take up tobacco abuse due to the availability of the tobacco leaf and the expansive nature of the land where the children can hide and smoke the tobacco. In urban areas, children are more exposed to tobacco and its products due to different cultures’ interactions (GYTS,2001). This was especially evident in Mombasa and Nairobi, where the prevalence rates were attributed to the rapid change in culture and tourism. The initiation of tobacco abuse among students was frequently commenced during the adolescent years (form 2 and form 3) with an incidence of 17% among students of Kangemi high school (Muendo, 2015),
A student’s income was also found to be an indicator of potential tobacco abusers (GATS, 2014). In this case, income describes the amount of money that a student has at any particular time. According to Muendo, 2015, students who regularly received pocket money from their parents or guardians reported a prevalence rate of 16% as opposed to 1% in students who do not receive pocket money from their parents. This reveals that students with an increased disposable income are more likely to initiate and maintain tobacco use. Religion is also considered a social demographic characteristic that influences tobacco (Lenucha et al., 2016). According to his study, the majority of smokers are of the Christian faith, followed by Muslims.  This figure may be biased since Muslims are a minority group in Kenya and because the Muslim faith has a culture of smoking tobacco primarily via pipes(shisha). Previous research has not paid the required attention to (KNBS,2015).
According to GATS statistics, 2014, education affects individual tobacco and the abuse of its products. People with no education are more susceptible to the adoption of tobacco use than people with primary education (Magati et al., 2018). This report also states that the lower the education level, the less incidence, and prevalence of smoking among the general population. This is supported by statics that evidence the highest consumption of tobacco products among illiterate p
eople(GATS, 2014).
The level of accessibility can explain the difference in smoking habits to information about the adverse effects of tobacco abuse (GYTS,2001). According to its statistic, smokers are likely to encounter literature and events discouraging habitual use in urban areas than in rural areas. This represents the elevated portion of smokers who have tried to quit smoking in urban than rural areas (Kurgat, 2019).
In light of the determinants as mentioned earlier, the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) provides guidelines
that help developing countries to come up with comprehensive tobacco control policies.
The World Health Organization Framework Convention on Tobacco Control
(WHOFCTC)
The WHO FCTC is the first global treaty negotiated under WHO, and it was developed in response to the increased prevalence of tobacco abuse globally. It is a treaty that is based on the evidence on economic and health burden on tobacco users, and it aims to tackle causes that have led to the tobacco pandemic (WHO, 2013). This treaty came into force on 27th February 2005 after being adopted in 2003. This represented a milestone in curbing tobacco-related morbidity and mortality, which has become a global problem. The WHO FCTC, in summary, consists of 6 central policies enacted with the objective of formulation and implementation of effective strategies to reduce consumption of tobacco and its related products (WHO, 2013). The six WHO FCTC policies are further summarized to an MPOWER mnemonic that emphasizes on 1. Monitoring tobacco use. 2.Protection of the general population from second-hand smoke. 3. Offer interventions to aid in tobacco abuse cessation. 4. Warning people about the effects of tobacco use 5. Enforcing bans on tobacco advertising, promotion, and sponsorship. 6. Raising taxes on tobacco and its products (WHO, 2013).
Tobacco control act 2007
Following the WHO FCTC, Kenya’s legislature passed the tobacco control act(TCA) in 2007 to regulate the production and consumption of tobacco and its products according to the afro mentioned guidelines. This tobacco control act is the chief law governing tobacco production and consumption in Kenya (Mohammed et al., 2018). To mitigate against the rising prevalence rates, Kenya enacted the Finance Act in 2012, which attempted to raise the exercise duty on tobacco products (Mohammed et al., 2018). The tax increase in tobacco products is geared at making these products less affordable to the general population, thus reducing tobacco use prevalence (Nargis et al., 2015). The raising of taxes also discourages potential users and encourages the users to quit and maintain tobacco abuse cessation. Though the increase in taxes immediately reduced tobacco consumption, this has since changed due to the change in tactics employed by players in the tobacco industry.
According to Nargis et al., 2015, tax evasion policy bore little fruit due to tobacco companies understating their total tobacco production to avoid taxes. He also notes that tobacco companies export the tobacco and then re-import the products since there are no taxes on tobacco exports. Once they are in neighboring countries, they can be imported due to the absence of import duty on trade in the eastern regional block. There have also been gaps in the control of advertising, sponsorship, and promotion(TAPS), leading to failure in implementing the law (CTCA, 2013). For example, Mastermind Tobacco Kenya (MTK) is a major sponsor of the Mater heart run. At the same time, BAT Kenya contributed 10 million shillings during a charity initiative to help hunger-hit communities (CTCA,2013). Tobacco companies also lobbied politicians to shoot down the TCA and covertly offered monetary incentives to facilitate the legislation of a weak bill that would serve their interests (CTCA, 2013). These instances show the interference of tobacco companies in policy which has further hampered the implementation of WHO FCTC guidelines.
The TCA’s implementation, 2007, has further been impeded by inadequate financial and human resources (Mohammed et al.,2018). Lack of financial resources has been attributed to the slow development and implementation of this act. The Kenyan finance ministry also shuffled its feet in allocating financial resources to tobacco control programs which further dented the law’s implementation (Mohammed et al., 2018). The lack of resources has impaired the establishment of smoking areas in large cities, increasing nonsmokers’ exposure to second-hand smoke (Lenucha et al.,2016). The lack of adequate human personnel has also affected the enforcement of the TCA policies (Lenucha et al.,2016). The Tobacco Control Board (TCB) has also reported instances where they have received partial funding or funding has been absent altogether (Mohammed et al., 2018).
 
references
Clark, M., Magati, P., Drope, J., Labonte, R., & Lencucha, R. (2020). Understanding alternatives to tobacco production in Kenya: a qualitative analysis at the Sub-National level. International journal of environmental research and public health, 17(6), 2033.
Muendo, Joseph N. Knowledge, attitude and practice of tobacco use among secondary school students in Nairobi: the case of students in Kangemi high school. Diss. University of Nairobi, 2015.
Magati, P., Drope, J., Mureithi, L., & Lencucha, R. (2018). Socio-economic and demographic determinants of tobacco use in Kenya: findings from the Kenya Demographic and Health Survey 2014. The Pan African Medical Journal, 30.
Kurgat, C., Kibet, J., Mosonik, B., & Opuru, F. (2019). Trends in Cigarette Smoking in Kenya and the Challenges Impeding Cessation. American Journal of Biological and Environmental Statistics, 5(1), 7-15.
World Health Organization. (2013). WHO Framework Convention on Tobacco Control: Guidelines for Implementation of Article 5. 3, Articles 8 To 14. World Health Organization.
Mohamed, S. F., Juma, P., Asiki, G., & Kyobutungi, C. (2018). Facilitators and barriers in the formulation and implementation of tobacco control policies in Kenya: a qualitative study. BMC Public Health, 18(1), 1-14.
Nargis, N., Michal, S., Drope, J., Ongango, J. R., Fong, G., & Kimosop, V. (2015). Cigarette taxation in Kenya at the crossroads: evidence and policy implications. Waterloo, ON: University of Waterloo.
Center for Tobacco control Africa 2013. http://ilakenya.org/wp-content/uploads/2015/10/Ti_interference_in_Kenya.pdf
Lencucha, R., Magati, P., & Drope, J. (2016). Navigating institutional complexity in the health sector: lessons from tobacco control in Kenya. Health policy and planning, 31(10), 1402-1410.
 

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