CHAPTER 1

Introduction

As college students, curiosity and mixed feelings about smoking is unavoidable. School
officials made many efforts to educate students about the health hazards of smoking and that
cigarettes contained addictive and carcinogenic substances. However, trying new things and
taking risks is a classic college behavior, accompanied with peer pressure and the desire to fit in.
While many did not smoke, many students also think the impression that smoking is a “cool
thing to do.” As nursing students the interest gained in science and medicine, allowed us to see
firsthand the damaging effects of smoking, smoking practices and fully understand the risk of
addiction. Though it is surprising to see that many college students especially at Surigao
Education Center (SEC) have been seen smoking. Watching groups of SEC college students
share cigarettes and blow smoke rings into the air, we grow more and more curious about their
decision to smoke. Do these students fully understood the risks, or if they had started smoking as
teenagers and were now addicted, unable to quit what they knew to be a bad habit. When
questioned, many were assured that they only smoked on occasion and were not addicted, while
others shared anecdotes about family members who had smoked their entire lives and were still
healthy at age ninety. These responses only increased our curiosity.

According to World Health Organization as of 2007, among the college students 18.3%
reported having ever tried or experienced with cigarette smoking. The overall prevalence of
cigarette smoking was 9.8% with significant differences in prevalence rates by gender, 17.6%
among males and 4.2% among females. Starting and continuing smoking was significantly
correlated with the family cigarette consumption habits. The most common reason to start
smoking was friends (24.9%) and the most important reason to continue smoking was personal
life distress (17.6%). The majority of participants (92.3%) reported that they were aware of the
hazards of smoking. A significant difference regarding awareness of smoking hazards was
observed between smokers and non-smokers. The most important preventive factor for cigarette
smoking was religious beliefs (69.1%)
 This study emerged as a result of our desire to more fully understand how and what
fellow college students motivated them to smoke. It was approached from the standpoint of a
future doctor who seeks to learn more about the public health issues and their solutions and feels
a responsibility to effectively promote good health policies.

The purpose of this study in relation to our problem aims to help researchers, teachers,
and program heads on how to address smoking practices among SEC college students in our
current generation.
 REVIEW OF RELATED LITERATURE

The purpose of this review is to know the cigarette smoking behavior of college students
in Surigao Education Center (SEC) and find means of managing it.

Cigarette smoking, as it exists in the world today, is the most remarkable phenomenon. It
is a habit of the most widespread proportions, and a product of the twentieth century. Today,
cigarette smoking has ramifications in almost every area of knowledge -- in politics, economics,
psychiatry, psychology, sociology, anthropology, pharmacology and pathology. It is strange that
people should go to such lengths to burn and then inhale some vegetable matter. Cigarette
smoking in college campuses has become an important public health issue and there has been
increase in campus wide smoking bans and other preventive programs to reduce the rates of
students smoking (Jarvik, 2008)

Secondhand smoke also poses a threat to non-smokers, causing an estimated 46,000 heart
disease deaths and 3,400 lung cancer deaths annually in the United States (Smoking-Attributable
Mortality 2008). In addition, 8.9 million Americans used smokeless tobacco and 2.2 million
smoked tobacco in pipes in 2010 (Results from the 2010 National Survey). Smokeless tobacco
contains 28 known carcinogens; it also has negative effects on oral and reproductive health
(“Smokeless Tobacco Facts” 2011). Likewise, cigars, cigarillos, little cigars, and pipe tobacco
contain the same toxic and carcinogenic compounds found in cigarettes. They have also been
found to increase the risk of oral, respiratory, and cardiovascular diseases (Burns et al. 2005).
Regardless of the method used to ingest tobacco, this lifestyle choice is a prominent cause of
preventable disease and death, and as such is an important topic for healthcare providers and
educators

College students are close in age to high school students, their social structure differs and
their mental capacity for decision-making and risk-assessment are more developed. As a result, it
is necessary to study university students separately to determine how peer pressure and
perception of risk influence this age group. In addition, college students tend to face greater
stress levels and a higher prevalence of alcohol use. It is worth investigating how these factors
affect students’ tobacco use. Several studies have shown that key differences do in fact exist
between the two groups with regards to smoking behavior and opinions. (Villanti et al. 2011)
Stages of Smoking Initiation

Young people progress through a series of stages of smoking onset (Leventhal &
Cleary,2005; Flay, D'Avemas, Best, Kersell, & Ryan, 2004; Flay, 2003). During the preparatory
or pre-contemplation stage, attitudes and beliefs about smoking are formed. The young person
may begin to view smoking as serving some function, such as a way to appear mature, cope with
stress, bond with a peer group, or show independence (Perry, Murray, & Klepp, 2007). The
trying stage includes the first few times a young person smokes; encouragement of peers is
usually involved in this stage (Conrad, Flay, & Hill, 2006). Experimentation includes repeated
but irregular smoking and is generally in response to a particular situation (such as a party) or to
a particular person (such as a date). The fourth stage, regular use, occurs when a young person
smokes regularly (usually weekly) and smokes in a variety of settings and with a variety of
people. Physiological need characterizes the last stage of addiction. This need includes tolerance
of nicotine, withdrawal symptoms if the adolescent tries to quit, and a high likelihood of relapse
if the person does quit (Flay, 2009). Generally, it takes an average of 2 to 3 years from the time
of the initial try of a cigarette to the stage of regular use (Leventhal et al., 2006). This implies
that it is important to study the risk factors related to first use as well as to regular use. If a young
person can become a regular smoker in 2-3 years, then secondary school is the critical time in the
life span for intervention programs (Evans et al., 2002). A primary goal of these efforts should be
to encourage, support, cajole, and expect non-smoking until at least age 18.

Smokeless Tobacco Use

Various forms of advertising have promoted the benefits of smokeless tobacco with the
implication that the use of these products is without danger. This is clearly not the case. The
health consequences of smokeless tobacco use among young people are becoming better known.
The primary adverse consequences among adults include bad breath, discoloration and abrasion
of teeth, dental caries, gum recession, leukoplakia, nicotine dependence, and oral cancer
(USDHHS, 1996, 1992; World Health Organization, 2004). Smokeless tobacco use may also be
associated with cardiovascular disease and stroke by increasing blood pressure, vasoconstriction,
and irregular heart beat (Hsu, Pollack, Hsu, & Going, 1990; Gritz, Baer-Weiss, Benowitz, Van
Vunaikis, & Jarvik, 1981; Schroeder & Chen, 1995). Early indicators of all of these conditions
are found among young people who use smokeless tobacco (USDHHS, 1994). Smokeless
tobacco users also develop nicotine dependency. The level of addiction is similar to that of
smokers (Benowitz, Porchet, Sheiner, & Jacob, 1998), since smokeless tobacco users absorb at
least as much nicotine as smokers do (Russell, Jarvis, & Feyerabend, 1995). The high pH of
saliva allows efficient absorption of nicotine through the oral mucosa. Adolescents develop
physical dependence from smokeless tobacco use as shown by documented withdrawal
symptoms when they try to quit (Hatsukami, Gust, & Keenan, 1998). Young people who use
smokeless tobacco products are at greater risk to smoke cigarettes than are non-users. Among
smokeless tobacco users, 12 to 30% also smoke cigarettes (Eakin, Severson, & Glasgow, 1999;
Williams, 1992; CDC, 2001). For young people who use both smokeless tobacco and cigarettes,
cessation of one may lead to an increase in the other. Smokeless tobacco use is also predictive of
other drug use. Smokeless tobacco users are significantly more likely to use cigarettes,
marijuana, or alcohol than non-users (Ary, Lichtenstein, & Severson, 2000).

Smoking Location

College students were more likely to smoke in social settings than in private. Some
students smoke at their homes, school, work, friend’s house, sports events, parties, dances, raves,
or other social events, public places and outdoors.

Cigars and Pipe Use

Pipe and cigar smokers often wave off worries that smoking is bad for their health. They
claim their habit is harmless and perpetuate the common misperception that pipes and cigars are
somehow safer than cigarettes. In reality, these tobacco products carry the same health risks as
cigarettes.

Cigars and pipes differ in design from cigarettes, which are made from tobacco wrapped in
thin paper. Cigars are wrapped in tobacco leaves, and unlike cigarettes, they don't typically have
filters. In pipes, the tobacco sits in a bowl at the end, and a stem connects the bowl to the mouthpiece.
Pipes can be equipped with filters however, another type of pipe, the water pipe, consists of a body
filled with water, a bowl in which the tobacco is placed, and an attached tube and mouthpiece
through which the pipe is smoked. Water pipes, or hookahs, originated in ancient Persia and India
about 400 years ago and are still popular today. Hookahs are filled with fragrant tobaccos in a variety
of flavors, such as cherry, apple, or mint (Chapman & Bloch, 2008)

Peer Behaviors

Conrad et, al. (1992) conducted a review of 27 prospective studies of the onset of
smoking. They found that the influence of peers, friends, and siblings is substantial in the
initiation of college students smoking; these influences are considered proximal environmental
factors. Peer associations and peer bonding in this age group; smoking may be a shared behavior
that certain groups use to differentiate themselves from other peers and from adults. College
students usually try their first cigarette with their peers; peers may then provide expectations,
reinforcement, and opportunities for continuation. (Bauman, Foshee, Linzer, & Koch, 1990;
Chass!n, Presson, Montello, Sherman, & McGrew, 1997; Sussman, Dent, Flay, Hansen, &
Johnson, 2000).

Alcohol Use

Alcohol consumption and tobacco use are closely linked behaviors. Thus, not only are
people who drink alcohol more likely to smoke (and vice versa) but also people who drink larger
amounts of alcohol tend to smoke more cigarettes.  In fact, smoking rates among alcoholics have
been estimated to be as high as 90 percent, with approximately 70 percent of alcoholics smoking
at least one pack of cigarettes per day (National Institute on Alcohol Abuse and Alcoholism
1998). 
Stress

College students note that smoking cigarettes reduces anxiety, and smoking often occurs
after stressful events or in stressful situations. Studies find that depressed college students are
more likely to smoke and have a more difficult time quitting than non-depressed college
students. College smokers attribute their smoking behavior as a means to alleviate their
depression. Depression is related to lower self-efficacy, and depressed individuals are considered
less able to resist smoking during times of low self-esteem, which leads to higher reports of
smoking among depressed individuals. Cigarette smoking on college campuses has become an
important public health issue and there has been increase in campus wide smoking bans and
other preventive programs to reduce the rates of students smoking (Jarvik, 2008)

Frequency of Cigarette Smoking

A person who smokes twenty cigarettes a day and takes ten puffs from each cigarette is
receiving two hundred hits of nicotine to the brain a day, each one taking only seven seconds to
get there. Because chronic smokers often continue smoking even when they are sick, a twenty-a-
day smoker consumes 7,300 cigarettes a year and gets 73,000 hits of nicotine to the brain. If that
person smokes for twenty years, he or she will consume 1.46 million cigarettes. Furthermore,
nicotine acts on the brain in smaller amounts than most other drugs.

Familial Smoking Status

Another proximal environmental factor, parental smoking, appears to have the strongest
influence for white and female college students, especially in the early stages of smoking
(Bauman, Foshee, Linzer, & Koch, 2001; Chass!n, Presson, Montello, Sherman, & McGrew,
1999; Sussman, Dent, Flay, Hansen, & Johnson, 2005). A review of the literature suggests that
this influence may also include other factors, such as parental approval or disapproval of
smoking, parental involvement in adolescents' free-time supervision, the style and extent of
parental communication on health-related matters, and whether or not parents promote academic
achievement for their children.
 The Philippines is a country in the Western Pacific Region with a moderate ‐to ‐high
burden of tobacco use among its youth and adult population. The 2015 Philippines Global Youth
Tobacco Survey (GYTS), a component of the Global Tobacco Surveillance System (GTSS)
which systematically monitors youth tobacco use, highlighted the following:16.0% of students,
22.2% of boys and 10.4% of girls, currently use any tobacco products, 14.5% of students, 20.5%
of boys and 9.1% of girls, currently smoke tobacco, 12.0% of students, 17.6% of boys and 7.0%
of girls, currently smoke cigarettes, 2.5% of students, 2.9% of boys and 2.1% of girls, currently
use smokeless tobacco, 79.4% of students who currently smoke cigarettes bought cigarettes from
a store, shop, street vendor or kiosk, 47.5% of students who currently smoke cigarettes were not
prevented from buying cigarettes because of their age, 10.9% current cigarette smokers reported
that their usual smoking place is in school, 35.9% of current smokers showed signs of smoking
dependence.
 CONCEPTUAL FRAMEWORK OF THE STUDY

This study is anchored on smoking practices among college students of Surigao Education
Center.

As illustrated in the diagram, Figure 1 shows the interplay of the dependent and
independent variables. Box 1 represents the profile of the participants such as age, civil status,
gender, ethnicity, religion, course and year level. These are important variables used in
determining smoking practices of college students. The way the college students handle the
smoking practices may depend on their age, gender, civil status, ethnicity, religion, and course
and year level.

The second box represents dependent variables on smoking practices among college
students of Surigao Education Center as this factors; Smoking initiation where young people
progress through a series of stages of smoking onset, Smokeless tobacco use where the health
consequences of smokeless tobacco use among young people are becoming better known and
various forms of advertising have promoted the benefits of smokeless tobacco with the
implication that the use of these products is without danger, Smoking location a certain area
where college students will likely to smoke, Cigars and pipe use they claim their habit is harmless
and perpetuate the common misperception that pipes and cigars are somehow safer than cigarettes. In
reality, these tobacco products carry the same health risks as cigarettes, Peer behaviors college
students usually try their first cigarette with their peers; peers may then provide expectations,
reinforcement, and opportunities for continuation, Alcohol use alcohol consumption and tobacco
use are closely linked behaviors. Thus, not only are people who drink alcohol more likely to
smoke (and vice versa) but also people who drink larger amounts of alcohol tend to smoke more
cigarettes, Stress college students note that smoking cigarettes reduces anxiety, and smoking
often occurs after stressful events or in stressful situations. Studies find that depressed college
students are more likely to smoke and have a more difficult time quitting than non-depressed
college students.
 This study outlined the smoking practices among college students of SEC as shown on figure 1:

Profiles of the Smoking Practices among

Respondents: college students of SEC in
terms in of:
 Age
Proposed Program
 Civil Status  Smoking Initiation
of Intervention
 Gender  Smokeless Tobacco
 Ethnicity Use
 Religion  Cigars and Pipes
 Course Use
and Year  Smoking Location
Level  Peer Behaviors
 Alcohol Use

Figure 1. Schematic Diagram of the Study

 THEORETICAL FRAMEWORK

With this study, we use the theory titled Social Cognitive Theory (SCT) started as the
Social Learning Theory (SLT) in the 1960s by Albert Bandura. SCT has been widely used in
health promotion given the emphasis on the individual and the environment, the latter of which
has become a major point of focus in recent years for health promotion activities. As with other
theories, applicability of all the constructs of SCT to one public health problem may be difficult
especially in developing focused public health programs.

The Social Cognitive Theory is a framework for focusing the emphasis on social
influence and its emphasis on external and internal social reinforcement . For example, Smoking
is influence of peers, friends, and siblings peer associations and peer bonding in this age group;
smoking may be a shared behavior that certain groups use to differentiate themselves from other
peers and from adults. College students usually try their first cigarette with their peers; peers may
then provide expectations, reinforcement, practices and opportunities for continuation.
 STATEMENT OF THE PROBLEM

The study is aimed to determine the smoking practices among college students of SEC.
Specifically, it sought to answer the following:

1. What is the profile of the respondent in terms of:

1.1 Age
1.2 Civil status
1.3 Gender
1.4 Ethnicity
1.5 Religion
1.6 Course and Year level

2. What are the smoking practices among college students of SEC as to:
2.1 Smoking initiation
2.2 Smokeless tobacco use
2.3 Smoking location
2.4 Cigars and Pipe use
2.5 Peer behaviors
2.6 Alcohol use
2.7 Stress

3. Based on the results and findings of the study, what proposed program of interventions
Would be implemented?
 SIGNIFICANCE OF THE STUDY

The findings of the study are beneficial to the following.

School Administration. The results of the study serve as additional information for the policy
makers and the school administrators for further formulation of consistent policies to all college
programs.

College Students. The results would guide the students to fully understand smoking practices and
its effects

College Instructors. The results would help guide them to alleviate the smoking practices among
college programs. It will also give instructors ideas on what kind of teaching style they will use
to provide their students the proper knowledge and skills for their behavioral and social growth.

Parents. The parents would be provided with information as to smoking practices and an idea
about the academic status of their children in school.

Future Researcher. It will also provide advance knowledge and guidance for the future
researcher.
 SCOPE AND LIMITATION OF THE STUDY

The study is focused on the smoking practices of college students of Surigao Education
Center. This study will be composed of selected students who have been smoking and are
qualified college students in all programs of all year levels officially enrolled in the second
semester of the academic school year in the 2019-2020.
 DEFINITION OF TERMS

Alcohol use - Alcohol consumption and tobacco use are closely linked behaviors. Thus, not only
are people who drink alcohol more likely to smoke (and vice versa) but also people who drink
larger amounts of alcohol tend to smoke more cigarettes.  

Cigars and Pipes Use - Cigars and pipes differ in design from cigarettes, which are made from
tobacco wrapped in thin paper. Cigars are wrapped in tobacco leaves, and unlike cigarettes, they
don't typically have filters. In pipes, the tobacco sits in a bowl at the end, and a stem connects the
bowl to the mouthpiece. Pipes can be equipped with filters, however. Another type of pipe, the water
pipe, consists of a body filled with water, a bowl in which the tobacco is placed, and an attached tube
and mouthpiece through which the pipe is smoked.

Peer behavior -  a peer group is both a social group and a primary group of people who have
similar interests (homophily), age, background, or social status. The members of this group are
likely to influence the person's beliefs and behaviour. Peer groups contain hierarchies and
distinct patterns of behavior

SCT – Social Cognitive Theory

Smoking - is defined as inhaling vaporized substances from tobacco or electronic cigarettes

through respiration.

Smoking Initiation - defined as a transition from being a never smoker to an ever smoker. 

Smoking Location – an area where the students usually smoke

Smokeless Tobacco use -  is a tobacco product that is used by means other than smoking.
Their use involves chewing, sniffing, or placing the product between gum and the cheek or
lip. Smokeless tobacco products are produced in various forms, such as chewing tobacco, snuff,
snus, and dissolvable tobacco products.

Stress - Stress is a feeling of emotional or physical tension. It can come from any event or
thought that makes you feel frustrated, angry, or nervous. Stress is your body's reaction to a
challenge or demand. 
 CHAPTER 2

RESEARCH METHODOLOGY

This chapter describes the methodology that shall be used in the study. This includes the
research design, participants, instruments, data gathering procedure and analysis.

Research Design

The researchers shall use the Descriptive Research method and uses primarily categorical
and quantitative data in the conduct of the study. According to Burns and Grove (2003),
descriptive research is “designed to provide a picture of a situation as it naturally happens”. It
may be used to justify making judgment and developing theories. This method will determine the
smoking practices among college students in Surigao Education Center.

According to Gay (1992: 217), descriptive research involves collecting data in order to
test hypotheses or to answer questions concerning the current status of the subject of the study. A
descriptive study determines and reports the way things are. Descriptive research is scientific
research that describes about event, phenomena or fact systematically dealing with certain area
or population.
 Participants

This study shall be conducted at Surigao Education Center. The participants of the study
are only those college students who are found out to be smoking in all programs of all year levels
officially enrolled in the second semester of the academic school year in the 2019-2020.

Instrument

The main tool that shall be used in gathering data is the researcher-made questionnaire
for the respondents.

The questionnaire for the respondents is composed of two parts:

Part I.

This entails the respondent’s personal profile. Name, age, civil status, gender, ethnicity,
religion, course and year level are the contents of this part.

Part II.

This entails the respondent’s possible smoking practices which includes Smoking
initiation, Smokeless tobacco use, Smoking location, Cigars and Pipe use, Peer behaviors,
Alcohol use, Stress.
 Data Gathering Procedure

The whole study shall be conducted within the bounds of Surigao Education Center
specifically the college students. Preceding to the conduct of the study, the researchers made a
letter of request to the College Deans of each programs for approval to conduct the study on their
students.

Data Analysis

The data analysis that will be used in this study are frequency and percentage count and
cross table reference.

Research Settings

The research shall be conducted at Surigao Education Center with the approval of the
College Deans of each programs.
 Ethical Considerations

1. Research participants should not be subjected to harm in any ways whatsoever.

2. Respect for the dignity of research participants should be prioritized.
3. Full consent should be obtained from the participants prior to the study.
4. The protection of the privacy of research participants has to be ensured.
5. Adequate level of confidentiality of the research data should be ensured.
6. Anonymity of individuals and organizations participating in the research has to be
ensured.
7. Any deception or exaggeration about the aims and objectives of the research must be
avoided.
8. Affiliations in any forms, sources of funding, as well as any possible conflicts of interests
have to be declared.
9. Any type of communication in relation to the research should be done with honesty and
transparency.
10. Any type of misleading information, as well as representation of primary data findings in
a biased way must be avoided.