IUBAT – International University of Business

Agriculture & Technology

Final Research Proposal

Research Topic: The Impact of Smoking Among Senior Citizens

Course Name: Research in Nursing

Course Code: NUR 451

Submitted By

Student Name ShaikatTaka

ID 17212001

Program BSc in Nursing

Submitted To

Instructor Name Prof. Dr. Hasnat M Alamgir

Program BSc in Nursing

Faculty College of Nursing

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 Date of submission: September 26, 2021

Abstract: Smoking is the inhalation and exhalation of burning tobacco. It leads to illness and
impairment and most parts of the human organ. Adult citizens are most vulnerable and
sufferers from smoking and its impact are more serious to the adult citizens than the other
aged people. The practice of smoking cigarettes covers most of the countries and the morbidity
and mortality rate is too high that it affects society very badly. The IHMES studied that every
year about 8.7 million people early from tobacco use. In June 2021 this is the newest evaluation
and mentions the death cases in 2019. Approximately 7.7 million death occurs from smoking
and the people who are a second smoker there death number is 1.3 million. Most death rates
cover Asia and Eastern Europe (Hannah et al., 2013). Broad Objective: Broad Objective: To find
out the knowledge, perception, and practice about the impact of smoking among senior
citizens. Specific Objective:1. Identify the impact of smoking. 2. Find out the knowledge about
smoking. 3. Discover the perception of smoking 4. Identify the practice of smoking 5. Identify
the reason for smoking. This study will conclude in the Uttara and Savar areas and will cover
almost 200 adult citizens based on age, sex, education, occupation, and types of smoking
practicing. The following study will take almost one month from the starting of the
investigation. Collected data will be checked, in need, it will be changed and reevaluate. this
research will also cover risk mitigation, benefits, risks, ethical consideration, and ethical
clearance.
Smoking is an alarming issue. Every year thousands of people die due to smoking. Smoking is a
great threat for the all ages of people. There are thousands of awareness program that use to
create awareness among people but generation after generation people continue use this
deadly product and suffering from the disease. There are social, biological and environmental
factor which influences the older people to do smoking. Nearly all cigarette smoker started
smoking at their childhood and adulthood. Gradually they develop chronic diseases and long

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term suffer from this. Their suffer depends on how long they smoke, are they active or inactive
smoker, in each day cigarette they use to smoke and its brand and their smoking style.
Research Question:

1. what are knowledge, perception, and practice about the impact of smoking among
senior citizens?
2. What is the impact of smoking among senior citizens?

3. What is the perception of the senior citizens’ family members about smoking?

Rational: cigarette is very harmful to all ages of people. Smoking causes numerous diseases bu
cancer, heart diseases, stroke, lung diseases, diabetes, and chronic obstructive pulmonary
diseases, which include emphysema and chronic bronchitis. It also increases the risk for
tuberculosis different types of eye diseases, it affects the immune system and occurs bone
diseases. These diseases can occur n any age but mostly occur in old ages people and also they
suffer more than the adult ages people. Because they have a very weak immunity system, they
are less strong and sometimes they are inactive, have no support, and have economical
problems. So when the old person gets diseased from smoking tobacco and suffers that time
cope out with life is the biggest challenge for them. If we look into the other studies that time
we will be able to see that the older people above 50 ages death rate is high than the other
ages of people in the world. Studies showed the in the year 2017, the maximum number of
people who died prematurely were older people, and 93% of people from around 50 years
old(Hannah et al., 2013). The practice of smoking can be started from a very early age. Most
people learn to smoke from groups or are influenced by others. An early smoker cant able to
understand the dangerous effect of smoking, it takes 10-15 years to observe or sense the sign
and symptoms. But at an early age the effect is almost latent and when it gets chronic, that
time it damages the organ function. From that time people use to suffer and with aging the
effect gets higher and the consequence is death. In the older ages, people usually face disease
or usually get sick and the old people who smoke that time suffer get double burden. On the
other hand, the economic burden for the medicine, checkup, follow-up care, surgery, and for
the other measure it is very costly and high for the old patients. In some cases, the old patient
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remains ignored by the family and society. From this perspective, I want to study and research
older smokers and want to find out the knowledge, perception, and perspective about smoking
why they were interested in smoking, what is the consequences in their life, how they continue
their life will illness.

Literature review:

Cancer is a chronic disease when the abnormal cells are growing and divide very fast with the
lymph and blood circulation than the normal ratio within the human body. There are more than
100 types of cancer in the world. Smoking weakening the human body’s immune system so the
body cant fight against it. It destroys the lymph cells, white blood cells, red blood cells, platelets
so the immune defense mechanism gets weak, the body can not compensate. The body can not
absorb the energy, vitamin, fats from the food so as a result, people do starvation as a result of
shrinking of the parts of the body, weight loss, bleeding, vomiting, malaise, and infections.
Smoking sometimes affects the DNA mechanism and forming of congenital diseases. Later time,
it spread into the next generation, the baby born with several types of cancer or the cancer
form at a stage of the age (Center for Disease Control and Prevention., 2021)

Tobacco and smoking cigarettes in the top 1 contributor to cancer and it is the highest cause of
mortality in older age. The older people who are current smokers or former smokers and stop
smoking between 60-70 years old, used to complain about very poor health and presence with
COPD. Most of the current smokers have a heart attack and compare with the 28.8% of
smokers who have to leave smoking at the age between 60%-70%, 27% who use to smoke
before the of 60 years have similar effects cancer, smoke, and hypertension. The study shows
that the women smoker has the less mortality rate than the man at every level of practice
smoking. The study proves the risk of mortality and illness is more than 3X higher in the current
smoker than the former smoker. The former smoker who quit smoking after the age of 50 they
took part in the cessation program but they have the risks of death and recurrent illness. the
current smoker and the former smoker both have the risk of death during the follow-up care.

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(Sarah et al., 2017)

The patient who has diabetes is at risk of a microvascular and macrovascular problem, this
problem is very common with people who are heavy smokers. Smoking increases the risk of
developing type 2 diabetes, where the pancreas is able to secret the insulin or the patient takes
the insulin injection but the cell and tissue aren’t able to take use the glucose from the blood.
Smoking causes coronary heart diseases with vascular problems including atherosclerosis. The
study informed that the nicotine of cigarette decreases the sensitivity of insulin which result in
hyperglycemia and decrease in the control in the metabolic system. The nicotine stops cell
function and growth and also decreases the islet B- cells of the pancreas (Xi-tao et al., 2009).

The following studies informed about how kidney diseases have a relation with chronic kidney
disease. The study suggests that the heave smoker has the greatest risk of developing CKD with
several hypertensive diseases and also diabetic nephropathy. Urinary albumin is a unique
marker for the CKD diagnosis. when renal damage is occurring time albumin and other proteins
are lost with the urine because the glomerules can filter the protein due to impairment. After
the result, this study found that the risk is very high for CKD by heavy smoking in hypertensive
nephropathy and diabetic nephropathy and weakness. Smoking is also related to polycystic
kidney diseases and lupus nephritis (Rabi et al., 2010).

This study showed the different types of tobacco use and several factors related to tobacco
products in married men in Bangladesh. The higher rate of tobacco use in smoking than tobacco
use for chewing. The most practiced people are businesses, less educated, and the poorest
people. Tobacco and Smoking is a major problem for mortality and morbidity in low economic
countries. The tobacco products include cigarettes, bidi, hookah, mostly made in India and
Bangladesh. In Bangladesh 28.30% of men and 0.20% of women smoke cigarettes. The study
found that the primary forecaster's age, gender, and influence by friends who use to smoke.
Smoking and tobacco-related diseases have very bad effects on society and consequences and
costs are very high in Bangladesh (Shafiur et al., 2015).

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This article studied the relation between smoking and late age osteoporosis above the age of 50
years old women. This study covers the age between 40-48 years old women and is related to
osteoporosis at the age of 60 years old. The research found that the incidents of osteoporosis
and fracture are more in chronic and heavy smokers than in people who didn't smoke in their
lifetime. Some women quit osteoporosis at the age of 40s, because of preventing osteoporosis.
The investigator found that osteoporosis is not common for every woman, sometimes heavy
smokers at the age of 80 don’t have osteoporosis or fracture problems. In the way, the study
runs through a question of how and why 8 years (40-48) related to osteoporosis, and the study
of this research demonstrates in a two way based on that question. Some researcher found that
the several demographics factor such as age, income, education level and stress has the strong
relationship with decreasing bone tone. (J.S. et al., 2012)

This research article studied the relation between the pattern of smoking and different stage of
lung cancer in men. The relation between lung cancer and cigarette smoking has a deep
connection with the duration of smoking, the number of smoking cigarettes smoking per day,
the cigarettes brands, and the inhalation pattern. The research found that the Swedish people
have fewer lung diseases than the other European countries because a cross-sectional study
visualized that Swedish people start to smoke after at a later age than the other European
countries men. Swedish people have a less mortality rate than the other European countries.
The person who has quit smoking at the age of 40,45 and 47 they have less risk to build lung
cancer at an older age. (Crispo et al., 2004)

Smoking is an alarming issue in the current world. The investigator, researcher, and the
organization all most cover all the studies about smoking. So it’s very hard for me to develop a
new and unique study about smoking and the associated problem with smoking. So, my
research studies would like to cover so unique studies.

The Impact of smoking between low-income labor and high-income employer- I am interested
to know the knowledge, perception, and practice about smoking between the 2 types of

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workers based on their income source, high-income people and low-income people. Financial
status has a strong association with smoking. Older people who have low-income status those
old people can not support his or her family and stress is occur in their life which stimulates
them to practice smoking. On the other hand, the higher-income people might have some
business-related issues which might force them to do smoking. So my find will be why they do
smoke, from when, what is the benefits, how many cigarettes they smoke in a day, what is the
knowledge about smoking and the information about the illness.

Comparison between urban and rural areas older smokers to know what are the differences
between them- There are some differences between the smokers of urban and rural areas
older smokers, pattern, knowledge, practice, and perception. Rural and urban people have
some differences in the choice of selecting the brand, I would like to be interested to know why
their brands have the differences and their effects on their health.

Comparison of the impacts of smoking between physically active and physically inactive older
people- there are two types of people physically active and inactive. In this option, I would
study very broadly. What is the pattern, sequences of smoking has difference between this two
groups of people and for the inactive people how they manage money to buy the cigarettes?
What are the effects of smoking and is there any differences has or not

Methodology:

Study design: I have decided to develop my study by following

1. Chosen method: Mixed method (Quantitative and Qualitative)

2. Selected Sampling: Convenience Sampling, stratified random sampling.

I would like to design my study with a mixed-method ( Quantitative and Qualitative). I will
develop the question in such a way that includes both open-ended and close-ended questions.
So that people feel comfortable in the question and answering session and also they can

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independently participate in the session. The Qualitative question assists me to understand the
participant’s knowledge and perception about cigarette smoking and also its effects on their
overall health issues. It will be easier for me to recognize the factors and reasons for their
wishes to do smoke. On the other hand, the quantitative method will help me to discover the
level of knowledge about smoking cigarettes. The quantitative questions will help me to judge
numbers and percentages. Finally, the two methods will help me to analyze and interpret the
data.

In my future cross-sectional study, I would like to deal with the participants only one time to
gather the information from the individual group of participants. The information will be
accumulated based on participants’ knowledge, perception, and practice of old age people,
based on their economical status (low income and high income), their physical ability ( active or
inactive), and the location (URBAN and RURAL).

In my research, I will assess the participants, knowledge, perception, and practice, the
perception of their family members and also impacts separately. I choose the “Convenience
sampling” method “Convenient sampling is a type of nonprobability sampling where the
researcher collects the sample from a convenient place” (Paul., 2008). In this way, I can collect
the information very easily within a short period of time, also it will be very cost-effective.

Study Sittings: I have fixed my study sitting in two places, Uttara and Savar. For rural sites, the
Savar area will be a more convenient place and for the urban area, I have chosen the Uttara
(10,11 sector).

Study Population: The study population will be only old citizens between ages 40-80 years old.
Due to some cultural and religious barriers, I will not able to cover the old female person. Note
it that, my all of participants will be active and inactive old smoker person. But when I will
gather the information from a smoker person’s family member, I will count all ages people to
know their perception and knowledge about a particular family member who use to smoke.

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Sample size and sample selection: the total number of old people is about 500. In this section I
will do random sampling because it will be very hard for me to cover all the numbers, I will
make groups in mutuality. I will use stratified random sampling to follow the people who have a
mutuality then I will use simple random sampling to choose members from the group.50 people
in each group and will draw 15-20 people from this 50 people of each groupI will collect the
sample without informing. I will cover the market, shops, roads site, tea stalls, fields, job
sectors, and family to collect my sample.

Ethical Consideration: I will follow all of the ethical issues during dealing with the study sample.
I will take permission from the participant and also I will request them to help me. Permission is
important because smoking is a sensitive issue and as my participants are seniors, so it will be
cover the respect. I will not force them, I will tell them if they feel comfortable at any point,
they can remove themselves from the program. All the data will be confidential in the research
article. Privacy and Confidentiality are important to mitigate the risk for the participants.

Ethical clearance: Ethical issue of this research article will be reviewed and approved by Prof.

Dr. Hasnat M Alamgir and Senior Adviser Dr. Karen Lund.

Research risk: smoking is a sensitive issue and as dealing with the senior citizen so, there might
be some facts that can be considered as the research risk. So, below I am describing some of
the risks regarding this research issues:

● The participants might think that the researcher can spread information. Some smokers
do smoking secretly, that time they will think my behavior will be revealed. So, they will
lose their respect in society.
● Some people will develop a defense against me, they will find this issue is very sensitive.
They will not receive easily if they are smokers.
● Sometimes participants will not attend, because of the corona pandemic, so that time
they can not agree to listen to the speech of the researcher.

Risk Mitigation: Risk mitigation is very important otherwise the researcher might face problems

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during research time or in the future. As I am the author of this research, so I will be very
conscious and clear about the purpose of this research to my participants. I will be clarifying all
the issues and I will assure them that there will be no chance of leaking information or they will
not lose their dignity. I also assure them that the interview paper will keep to me and your
identity will not be published in the research article. I have some known friends from this
convenient area, I will take their help so that people can trust me and feel comfortable. As is it
COVID 19 situation, I will use musk, gloves, gown, etc., so that I can protect myself.

Research Benefits: There are some direct and indirect benefits describing below:

Direct Benefits: This research has no direct benefits because the participants will not get any
teaching and education.

Indirect Benefits: This research has long-term benefits. In the future when my research will be
published time the entire society can get help from my research. My research will follow the
awareness program by The Ministry of Health, NGOs, Heart Foundation Organization, etc so
that the overall society is able to know the dangerous effect of smoking.

Data collection materials: In this research, there will be open and close-ended questions and I
shall avoid the non-judgmental and leading questions. I will clear the statement of the question
paper so that there will be no misleading, confusion, and conflict. My interview style will be
semi-structural style so that the participants can think independently and answer the question
comfortably. However, instruments are the essential parts of any research. So I will use pens,
paper, pencils, and notes, cell phones, laptops, etc.

After collecting all answers and information from the participants, I shall enroll them in
Microsoft Excel Shit finally. I will use tables, diagrams, different types of charts, different types
of patterns. I will convert the sum into percentages and organize them into graphs, tables,s, and
charts.

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References:

Brook, J. S., Balka, E. B., & Zhang, C. (2012). The smoking patterns of women in their forties:
their relationship to later osteoporosis. Psychological reports, 110(2), 351–362.
https://doi.org/10.2466/13.18.PR0.110.2.351-362

Crispo, A., Brennan, P., Jöckel, KH. et al. The cumulative risk of lung cancer among current, ex-
and never-smokers in European men. Br J Cancer 91, 1280–1286 (2004).
https://doi.org/10.1038/sj.bjc.6602078

Hannah Ritchie and Max Roser (2013) - "Smoking". Published online at OurWorldInData.org.
Retrieved from: https://ourworldindata.org/smoking

Lavrakas, P. J. (2008). Encyclopedia of survey research methods (Vols. 1-0). Thousand Oaks, CA:
Sage Publications, Inc. https://doi:10.4135/9781412963947

Nash, S. H., Liao, L. M., Harris, T. B., & Freedman, N. D. (2017). Cigarette Smoking and Mortality
in Adults Aged 70 Years and Older: Results From the NIH-AARP Cohort. American journal of
preventive medicine, 52(3), 276–283. https://doi.org/10.1016/j.amepre.2016.09.036

Rahman, M. S., Mondal, M. N., Islam, M. R., Rahman, M. M., Hoque, M. N., & Alam, M. S.
(2015). Determinant factors of tobacco use among ever-married men in Bangladesh. Drug,
healthcare and patient safety, 7, 77–85. https://doi.org/10.2147/DHPS.S80864

Xie, X. T., Liu, Q., Wu, J., & Wakui, M. (2009). Impact of cigarette smoking in type 2 diabetes
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development. Acta pharmacologica Sinica, 30(6), 784–787.
https://doi.org/10.1038/aps.2009.49

Yacoub, R., Habib, H., Lahdo, A., Al Ali, R., Varjabedian, L., Atalla, G., Kassis Akl, N., Aldakheel, S.,
Alahdab, S., & Albitar, S. (2010). Association between smoking and chronic kidney disease: a
case control study. BMC public health, 10, 731. https://doi.org/10.1186/1471-2458-10-731

Questionnaires

Date of interview

……………..................................

(DATE-MONTH-YEAR)

NAME:

SEX: Male

PARTICIPENTS NUMBER:

EDUCATION:

AGE:

OCCUPATION:

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TYPE OF SMOKER:

LOCATION:

1.May I know your Education background? আমি কি আপনার শিক্ষ্যাগত যোগ্যতা সপমর্কে জানতে

পারি?

> Yes ( হ্যা)...................................................... Please fill it up( দয়া করে এটা পূরন করুন)

>No

2. Could you share how did you learn to smoke and from when? ( আপনি কী কীভাবে এবং কখন

সিগারেট পান করা শিখেছিলেন?

..................................................................................................................................................

3. How many times a day do you smoke? আপনি ১ দিনে কতগুলো সিগারেট পান করেন?

.......................................................................................................

4. Which factor influences you to smoke? কী আপনাকে সিগারেট পান করার জন্য বাধ্য

করে?

......................................................................................................

5. How do you mange money to buy cigarettes? সিগারেট ক্রয় করার টাকা আপনী কিভানে

ব্যাবস্থা করেন?

....…….....................................................................................

6. Could you share your feelings after Smoking? সিগারেট পান করার পর আপনার অনুভূতি

কী হয়?

....................................................................................................................................................................
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 7. What do you think cigarettes smoking harms human body? আপনি কী মনে করেন

সিগারেট খাওয়া শরীরের জন্য ক্ষতিকর?

 Yes(হ্যা)how(কিভাবে).....................................................................................................................................
..............................
 না

8. What is your family response about your smoking? আপনার সিগারেট পান করার

ব্যাপারে আপনার পরিবারের অনুভূতি কী?

...................................................................................................................................................................
9. Can you write about the diseases you affected and is there any current diseases?
আপনি আগে কী কী রোগ হয়েছিলো এবং বর্ত মানে কী আপনার কোন রোগ আছে?

..................................................................................................................................................................

10. Will you stop smoking or you will continue? আপনি কী সিগারেট পান করা বন্ধ

করবেন অথবা চালিত রাখবেন?

..........................................................................................................

THANK YOU FOR YOUR PARTICIPATION AND COOPERATION

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