BEHAVIORAL EFFECTS OF THE GRAPHIC IMAGES ON

CIGARETTE PACKS IN QUITTING SMOKING OR NOT TO

SMOKE AMONG NURSING STUDENTS OF THE UNIVERSITY

OF THE CORDILLERAS

A Research Presented to

the Faculty of the College of Nursing

University of the Cordilleras

In Partial Fulfillment

of the Requirements for the Degree

BACHELOR OF SCIENCE IN NURSING

by

DANNY C. BENITO KRYZZA LEIZEL P. PAGUIRIGAN

LORRAINE GESMUNDO JACEZIEL KAYE D. PANGDA
CLARISSA MARIE P. LIMMANG JOY ANNE V. SAAVEDRA
NICALYN G. MAIGI IRISH P. TUCYAPAO
IA RYLYN C. PAGADIAN JAYSON L. VILLANUEVA

NOVEMBER, 2022
 APPROVAL SHEET

This research entitled “BEHAVIORAL EFFECTS OF THE GRAPHIC

IMAGES ON CIGARETTE PACKS IN QUITTING SMOKING OR NOT TO SMOKE
AMONG NURSING STUDENTS OF THE UNIVERSITY OF THE CORDILLERAS”
prepared and submitted by FIRST NAME MIDDLE INITIAL FAMILY NAME
in partial fulfillment of the requirements for the degree of
SCHOOL OF NURSING, has been examined and is recommended for
acceptance and approval for oral examination.

JUDE L. TAYABEN, RN, PHD

Faculty Research Promoter

__________________________________________________________

PANEL OF EXAMINERS

APPROVED by the Committee on Oral Examination on

_______________ with a grade of _________.

GILBERT BERNADINO, RN, PHD

Chairman

KEN FIAS-ILON, RN, MAN JOSEPHINE MINGER, RN, MAN

Member Member

ACCEPTED AND APPROVED in partial fulfillment of the requirements

for the degree of BACHELOR OF SCIENCE IN NURSING.

JUDITH ODANEE G. MAGWILANG, RN, MAN, MAEd-Nursing

Dean, Graduate School

 THESIS ABSTRACT

1. Title: BEHAVIORAL EFFECTS OF THE GRAPHIC IMAGES ON

CIGARETTE PACKS IN QUITTING SMOKING OR NOT TO SMOKE AMONG

NURSING STUDENTS OF THE UNIVERSITY OF THE CORDILLERAS

2. Researcher/s: Danny C. Benito, Lorraine P. Gesmundo, Clarissa

Marie P. Limmang, Nicalyn G. Maigi, Ia Rylyn C.

Pagadian, Kryzza Leizel G. Paguirigan, Jaceziel

Kaye D. Pangda, Joy Anne V. Saavedra, Irish P.

Tucyapao, Jayson L. Villanueva

3. Type of Document: Undergraduate Thesis

4. Type of Publication: Unpublished

5. Accrediting Institution: University of the Cordilleras

Governor Pack Rd., Baguio City

CHED

6. Keywords:

7. Abstract
7.1 Background of the Study

7.2 Summary

7.3 Findings

7.4 Conclusions

7.5 Recommendations
ACKNOWLEDGEMENT

DEDICATION
 TABLE OF CONTENTS

Page

TITLE PAGE...............................................

TABLE OF CONTENTS........................................

LIST OF TABLES...........................................

LIST OF FIGURES..........................................

CHAPTER

1. THE PROBLEM

Background of the Study................................

Theoretical Framework.................................

Statement of the Problem and Hypotheses................

2. DESIGN AND METHODOLOGY

Research Design and Methodology........................

Locale and Population of the Study.....................

Data Gathering Tools..................................

Data Gathering Procedure...............................

 Treatment of Data.....................................

Interpretation of.....................................

Ethical Consideration.................................

3. PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA

SOP 1.................................................

SOP 2.................................................

SOP 3.................................................

4. CONCLUSIONS AND RECOMMENDATIONS

Conclusion............................................

Recommendation........................................

REFERENCES...............................................

APPENDICES...............................................

A: Letter to the Head of Office/Director...............

B: Letter to the Panel Members.........................

C: Letter to the Participants/Informed Consent.........

CURRICULUM VITAE.........................................
 LIST OF TABLES

Table No. Table Title Page

1. Participant of the Study.........................

LIST OF FIGURES

Figure Page

1 Paradigm of the Study................................

5 Actual Data Gathering Procedure .....................

 Chapter 1

The Problem

Background of the Study

The World Health Organization YEAR CITATION (found that tobacco

smoking is to blame for six million avoidable deaths worldwide
each year, many of which happen early. It is predicted that
secondhand smoke exposure causes an additional 600,000 deaths
annually.

In Baguio City, tobacco use is currently prevalent among males

(30%), women (7%) and the general population (17%), according to
the Global Adult Tobacco Survey (GATS) Fact Sheet Baguio City
2019. In addition, the poll reveals that almost 80% of current
smokers intend to or are considering quitting, and 49% of
smokers have received quitting advice from a healthcare
professional in the last 12 months. In addition, 99.1% of adults
believe that smoking leads to significant sickness.

INSERT OBJECTIVES

Majority of healthcare professionals are nurses, and they may

help people quit smoking not only in hospitals but also in a
variety of community settings for health and welfare. As the
first line of cessation support, nurses are seen to be more
effective because they spend the most time with patients.

To educate smokers about the dangers of smoking and to provide

them with knowledge about how to improve their health, graphic
warnings are frequently placed on cigarette packs. In a survey
of 579 university students, three messages were found to be the
most successful in helping smokers stop, which are: "Smoking
when pregnant is dangerous to the baby," "Smoking clogs
arteries, causes heart attacks and strokes," and "Protect
children: don't breathe your smoke to them" (2013). According to
Bilir et al. (2013), the two statements "Smoking causes lethal
lung cancer" and "Smoking affects your baby" were the most often
highlighted by high school students. Obaner found that the
graphic warnings on cigarettes that link smoking to death and
cancer employed a high level of fear. People's concern and
anxiety about their own health as well as the health of their
partners and kids is a strong motivator for them to give up
smoking.

According to study on How Graphic Warning Labels Could Trigger

Thoughts of Quitting (2019) participants were shown sixty-four
images of a butt pack for four seconds each. Among the
photographs featured were ones displaying the graphic warning
label planned for implementation by the United States. Food and
Drug Administration that highlights the risks of smoking-related
respiratory organ illness, cancer, stroke, heart attack, and
shortened life length. Participants who viewed the graphic
warning images were a lot of probably to report they were
inspired to prevent smoking compared to those that failed to
witness graphic images. Researchers discovered that "plain
packaging" - packages with no whole names or pictures, admire
those employed in Australia - had no influence on participant
responses. Self-efficacy and willpower have been linked as
facilitator roles in nurses’ help for quitting smoking. The
relationship between conduct and intention to act is
significant, and the former is influenced by attitude toward the
behavior, self-efficacy for the behavior, and subjective norms.

According to Elshatarat et al. (2016) self-efficacy in the

context of quitting smoking is seen as a smoker's confidence in
their ability to abstain from smoking in the face of both
internal (intrinsic self-efficacy) and external stimuli
(extrinsic self-efficacy). Treating tobacco use and nicotine
dependency using behavioral therapies that include self-efficacy
and make it a key part of the quitting process is beneficial.
Similarly, Roberts (2013) discovered that increasing a smoker's
motivation to quit is an essential component of their overall
treatment for tobacco addiction because it enhances their zeal,
sense of purpose, and determination to do so. The necessity of
quitting and the degree of tenacity a smoker has to quit
effectively during a particular quit attempt are taken into
account when determining motivation to quit.

According to Bolman et al. (2002) they concluded that the need

to improve nurses’ attitudes and self-efficacy regarding smoking
cessation assistance are the elements that cause nurses to stop
smoking. It’s crucial to adopt a mindset that strongly pushes
nurses to give up smoking. It has been demonstrated that
attitudes regarding quitting smoking are positively connected
with the elements of smoking cessation counseling. This finding
highlights the necessity of encouraging and facilitating
opportunities for nurses to participate in training on quitting
smoking. Therefore, it is vital to take into account educational
programs that highlight the significance of assistance for
quitting smoking.
As healthcare providers smoking habit may deter us from helping
our patients, therefore cessation training for student health
professionals may be a significant contribution towards tobacco
use control. All of this could potentially have an impact on
future practice by helping patients who smoke quit by either
interviewing, simple advice or referrals to cessation clinics.
As can be seen in both our own study and other studies
conducted, graphic warnings were said to be more effective
compared to texts. In order to make graphic warnings on packs
more effective, it could be suggested that replacing striking
figures instead of texts, using figures of babies and children
affected from smoking, using figures showing harms of smoking
towards families, replacing figures instead of texts and using
figures including surgical operation on the cigarette packs.

Nurses add up to the largest occupational group among health

professionals and are employed in a variety of settings such as
the schools, colleges, the community and the mental health
settings (Provenzano, S., et al., 2019). As shown by systematic
reviews, the behavior of nurses influences the public's
perception of the profession which is a powerful vehicle for
promoting health which has been used to influence public health
worldwide. When nurses engage in behaviors that are
contradictory to health, they put their profession in a negative
light. In this case, they are the role models who are
influencing the public’s smoking cessation patterns. One of the
main motivational reasons to become a healthcare professional is
to assist people in achieving a full health potential. On the
contrary, smoking is the most hazardous and avoidable health
risk in our society.
The WHO Framework Convention on Tobacco Control defined
standards for the use of health warning graphic labels on
cigarette packs in Article 11 of the WHO Framework Convention on
Tobacco Control (WHO FCTC). This statute required graphic
warnings on cigarette packaging illustrating the health risks
and potential health consequences of smoking. Graphic labels
might be in the form of a picture or a symbol. A list of
chemicals discovered in tobacco and cigarette smoke has to be
made public as well. Furthermore, the warning labels had to
cover at least 30% of the front and back of the cigarette pack,
ideally 50% or more of the front and back.

(Sutton et al.,) identified a similar beneficial relationship

between fear and acceptance of prescribed response behavior.
Fear has been described as a motivation for behavioral change.
Pictorial health warnings on tobacco packaging have therefore
been used as a strategy to heighten people's fear and establish
bad attitudes toward smoking, as well as to persuade people to
quit smoking. Morgan et al., underlined that warning pictures
may also initiate talks about the harmful implications of
smoking habits, eventually leading to quit attempts.

Many experimental studies (Peters E. et al., the studies of

graphic cigarette warnings) include in the field of health
communication also concluded that negative affective reactions
provoked by health warnings cued further warning information
processing (Evans et al., 2018) and finally contributed to one’s
decision to permanently quit smoking behaviors. The study of Cho
et al. revealed that smokers who had stronger negative emotions
(e.g., fear, worry, and disgust) tended to make more quitting
attempts at follow-up than those who had lower negative
emotions. Smokers’ attention to smoking warnings and behavioral
responses to images mediated this relationship. Roles of smoking
warning labels in generating fear-related emotion and promoting
health awareness. Studies have also been conducted to
investigate the influence of warning graphic labels on smoker’s
attitudes toward health and quitting behaviors. In Thailand and
other countries, warning images have been demonstrated to help
promote smokers’ participation in quitting behavior (Macy JT, et
al., 2015). Some people avoided cigarette packs due to negative
feelings invoked by seeing the warning images. Morgan et al.
(year) added that such images could also foster conversations
about adverse impacts of smoking behaviors and could finally
lead to quit attempts.

According to the 2009 Global Adult Tobacco Survey's findings of

the Philippine Statistics Authority, 28.6%, or 17.3 million
Filipino adults aged 15 and over, currently smoke tobacco
(GATS). Adult male smokers make up nearly half of the population
(48 percent, or 14.6 million), while adult female smokers make
up 9%, or 2.8 million. Furthermore, 38 percent of men and 7
percent of women in the Philippines smoke tobacco every day.

On September 4, 2005, the Philippines ratified the WHO Framework

Convention on Tobacco Control and prohibited specified indoor
public places and workplaces, such as those used by the
government, healthcare and educational institutions, and
facilities popular with minors. However, in other public places
and workplaces, such as bars and nightclubs, smoking is
permitted in designated smoking areas. A rotating and combining
picture and text health warning is mandated to be placed on 50%
of each of the main display sections of tobacco product
packaging, and many kinds of tobacco advertising and promotion
are restricted. On tobacco product packaging, deceptive phrases
like "light" and "low" are prohibited, but other deceptive
packaging (such colors, numbers, and symbols) is not. Also, the
selling of tobacco goods, including small packets of cigarettes,
is banned within 100 meters of playgrounds, schools, and other
locations that are frequently facilitated by students.

There are impacts of visual and textual health warnings have on

smokers, in terms of their potential to quit smoking. Ratih and
Susanna (2015) concluded that visual health warnings are more
successful at preventing smoking among non-smokers and
encouraging smoking cessation among smokers. Brewer, N. et. al.,
concluded as well that pictorial warning on cigarette labels had
a significant impact on warning reactions. Viewers of pictorial
warning labels experienced immediate emotional responses that
included fear, sadness, guilt and disgust. They were also more
likely to think about the health risks of smoking. But while
these responses have proven effective in motivating smokers to
quit, pictorial warnings ultimately did not change viewer
beliefs about the likelihood or severity of negative health
consequences. Despite the fact that graphic warnings were more
successful at preventing people from smoking or helping them
quit than just claims from non-smokers, it is still necessary to
conduct additional research due to the uncertainty surrounding
the impact of warnings on risk assessments particularly among
nursing students.

Tobacco smoking is a serious public health problem worldwide

that is the leading preventable cause of morbidity and mortality
leading to the death of more than 7 million people each 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. Tobacco smoking, inclusive
of secondhand smoke, is a leading risk factor attributable to 6%
of global disability-adjusted life years. Similar to other
research findings, 72.1% of the smokers in this study reported
trying their first cigarette before the age of 18 years. Also
consistent with other research, they obtained their cigarettes
from family, friends, and by purchasing or stealing them; these
respondents seemed to have easy access to cigarettes. Not
surprisingly, smokers’ attitudes toward smoking were more
favorable than non-smokers, and they were less supportive of
policies that restricted smoking in restaurants, in bars, and on
school grounds or that taxed tobacco products. The findings of
this study support the theory that attitude and subjective norm
are predictors of smoking behavior. However, consistent with
the research by (Rosendahl et al.,) knowledge about the hazards
of smoking does not seem to influence smoking behavior once
smoking has been initiated. Almost 100% (43/44) said that they
agreed or strongly agreed that smoking cigarettes causes cancer
but they still smoked. This likely has to do with the addictive
properties of nicotine. Smokers reported failed attempts at
cessation and reported side effects of smoking consistent with
criteria for drug dependence. Of this sample, 46% had tried to
quit smoking and failed, 45% agreed they felt good when smoking,
43% said smoking gave them a high, 71% said that nicotine was
addictive, yet 49% said that they were not addicted.

Several studies have been conducted and most yield the same
results. (what are these studies and citation) Attitude and
norms plays a big role in the consumption of cigarettes. Even
with knowledge on the risks consuming cigarettes can bring, most
smokers do not seem to be affected and thus continue smoking.
Most smokers admitted to not stopping smoking as long as they
are not addicted, they see no reason to cease smoking. It is
said that smoking has become a habit of theirs that is not easy
to remove or stop.

Regarding to some several survey they conducted 100% (44/44)

nursing student, 45.06% of male nursing student are currently
smoking compared to 25.07% of female nursing student and those
of 49% smoking nursing student believes that warning graphics
designs cannot help to smoking cessation compared to the 13% of
smokers thinks the opposite. According from survey most of them
has family member that are smoking. The influence of family and
friends on attitudes of the young to smoking it has been widely
demonstrated especially in the evolutionary age and risk of
becoming a smoker is higher among those with a mother that
smoked (Provavenzano,2019)

In addition, this study cited motives for the adoption of the

habit of smoking were curiosity (53%) followed by relief of
stress (33%). It was also stated that mostly of smoking students
started at secondary level. (Abolfotouh et al in 1998). In
conclusion the prevalence of smoking among nursing students is
generally low but their knowledge and attitude need improvement.
Health education on facts, dangers and consequences of smoking
should start as early as the primary school, and should continue
throughout the education of future health professionals.
THEORETICAL FRAMEWORK

For this study, Theory of planned behavior predicts an

individual's intention to engage in a behavior at a specific
time and place. It posits that individual behavior is driven by
behavior intentions, where behavior intentions are a function of
three determinants. Theory of planned behavior states that
intention toward attitude, subject norms, and perceived
behavioral control, together shape an individual’s behavioral
intentions and behaviors. It extends the theory of reasoned
action by adding the concept of perceived behavioral control,
defined as an individual’s perception of the ease or difficulty
of performing the particular behavior (Douglas BM, Howard EP).
TPB has shown more utility in public health than other models,
such as the Health Belief Model. It is also more applicable when
the probability of success and actual control over the
performance of a behavior is suboptimal.

The decision to smoke, therefore, has its own intentions

influenced by these three factors. A person’s personal attitude
toward tobacco use, their perception of the people’s views on it
and their control over the use of tobacco work together to
formulate some kind of conclusion as to how they will engage in
the act of smoking. Negative attitudes toward smoking would
likely result in less engagement. Negative perception from the
views of friends, families and peers would also dissuade the
intention of smoking. However, if the positive attitudes were
paired with a social circle that encourages the behavior, the
person is more than likely to participate in the act. It is
perceived behavioral control, however, that carries a heavier
bearing on the longevity of the act. The Theory of Planned
Behavior assumes that the stronger the person’s belief in their
control is, the stronger the person’s intention to continue said
behavior. So, when a person believes themself capable of
controlling their smoking habits, they are not as easily
persuaded to quit them. Still, personal attitudes and subjective
norms may be modified in such a way that also affects the
perceived behavioral control.

A symptom is defined as a subjective experience reflecting

changes in the bio-psychosocial functioning, sensations, or
cognition of an individual. In contrast, a sign is defined
as any abnormality indicative of disease that is detectable
by the individual or others (Dodd et al., 2001). Signs and
symptoms are important aspects of health and illness that
disrupt physical, mental, and social functioning. Symptoms
can also be brought on by prescribed pharmacologic or
medical therapy. The presence of a symptom or a cluster of
symptoms may be the first indication to the patient or
clinician of a developing illness. Whether the goal is to
eliminate the symptom or to minimize the distress of the
symptom experience, the Symptom Management Theory (SMT)
provides a useful framework for organizing the relevant
concepts for research and practice.
Figure 1: Paradigm of the Study

INDEPENDENT VARIABLES DEPENDENT VARIABLES

Demographics are statistics regarding the characteristics

of a population. Characteristics include the age, gender year
level and others. They routinely collect this demographic data
to describe the sample of people in their study. Also, it
provides data regarding our research participants and is
necessary for the determination of whether the individuals in a
particular study (Lee, M., 2018).

Knowledge and attitude play a significant role because

these measures and determine the knowledge of nursing students
about smoking. Knowledge more likely influence smoking cessation
among non-smokers and smokers because if they are knowledgeable
to the graphical images in cigarette packs more likely they will
have smoking cessation because this shows that they know the
impact of smoking and having high attitude to the effects of
smoking more likely have high smoking cessation

Knowledge and attitude play a significant role because this

measure and determine the knowledge of nursing students about
smoking based on their gender, age, and year level. Smoking
cessation among smokers and non-smokers are more likely to quit
smoking if they are knowledgeable about the graphic images on
cigarette packs because this demonstrates their awareness of the
negative effects of smoking. They are also more likely to quit
smoking if they have a high and positive attitude toward these
negative effects.

*Differentiate knowledge, attitude, behavioral according to

demographics statistics

*last paragraph (what is the relationship of dependent variables

to independent variable)

Significance of the Study

Nursing students who are smoking already know the effects

of this to their health however there is something that
persuades them to continue even though the DOH already
implemented the graphic presentation of diseases in cigarette
packages. A lot of nursing students who are smokers do not seem
to care about these graphics. One of their reasons was they only
buy per piece and not the whole package. This research provides
other nursing students, clinical instructors, parents, and other
health care providers on the attitude and behaviors of nursing
students showing the graphic presentation of diseases in
cigarette packages. This can be their basis to enlighten their
thoughts on why these students still pursue smoking despite the
warnings on the packages. In addition, the majority of nursing
student’s coping mechanisms are smoking due to stress and work
overload.

This study aims to determine whether graphic images on

cigarette packs have an impact on nursing students' knowledge
about the risks and danger of smoking and the impact toward
their attitude and behaviors in relation to nursing practice.
Some nursing students tends to smoke after them

To the Community

Cigarettes don't just negatively impact the health of

individuals; it also endangers the health of the environment in
our community. When cigarette waste isn’t disposed of properly,
it makes its way into the environment where it ends up polluting
water, air, and land with toxic chemicals, heavy metals and
residual nicotine (Chudech & Janmaimool, 2021). When smoking,
people around will inhale the smoke you breathe out and the
smoke burning from the cigarette which is very harmful. As we
probably know, secondhand smoke means health risks for the
people around you. Even if you don’t smoke near them, they can
still breathe in the smoke (and the harmful chemicals it
contains) from hair, skin and clothes.

Thus, increasing consumer awareness of the environmental

toxicity and dangers posed on graphic images by discarding
cigarette related waste into landfills and encouraging smokers
to quit using these products altogether are the best ways to
protect the community from tobacco/cigarette product waste.
Additionally, stop smoking or quitting smoking is not only for
your health but it will protect loved ones from harmful
secondhand smoke especially in the community

To Nursing Education

The long challenging journey of being a nurse starts

through collecting knowledge about health which includes the
diseases that people acquire, the nursing management, and others
which will contribute to help save a life. With the help of this
study, this will be an additional knowledge for nursing
education which will help in the aid of health education as part
of the responsibilities of being a nurse. There are a lot of
studies regarding this topic already however the researchers are
trying to collate it with the nursing students.

Statement of the Problem

This study primarily aims to determine the behavioral

effects of the graphic images on cigarette packs in
quitting smoking or not to smoke among nursing students.
Specifically, it seeks to answer the following questions:

1. What is the knowledge, attitudes and subjective norms of

nursing students on the graphic images on warning signs of
possibility quitting smoking or not smoking among nursing
students?

2. What are the behavioral effects of the graphic images of the

possibility of quitting smoking among nursing students?

3. What is the difference on knowledge, attitude and subjective

norms on quitting smoking or not smoking among nursing students
when they are looking graphical images on warning signs when
group according to age, year level and sex?

4. What is the relationship of the knowledge and attitude to

smoking cessation
 Chapter 2

DESIGN AND METHODOLOGY

Research Design and Methodology

Locale and Population

In the study on behavioral effects of the graphic images on

cigarette packs in quitting smoking among nursing students this

will take place in the University of the Cordilleras College of

Nursing under the supervision of Mr. Jude Tayaben NCM 111A

Nursing Research RLE. The first paramedical degree program

offered by the university since the establishment of the

trimester system, the four-year Bachelor of Science in Nursing

Program, was launched by the College of Nursing on June 1, 2003.

There were 875 enrolled students, including graduates with

degrees, transfer students, and recent high school graduates.The

first Dean of the college was Ms. Norenia T. Dao-ayen and the

Instructors were Ms. Shirley G. Delos Santos, Ms. Judith Odanee

G. Magwilang, Dr. Mario G. Imson and Dr. Ma. Geraldine A. La

Madrid.

The study will be conducted in the University of the

Cordilleras, Baguio City. There are 2,300 student nurses from

first year to fourth year level who are enrolled in the academic

year 2022-2023. The number of nursing students for each year

level are the following: Level 1 for 1,120, Level 2 = 580, Level

3 = 320 and Level 4 = 280. The population is accessible and

feasible considering the researchers and participants are from

the University of the Cordilleras. The researchers will ask

permission to the Dean of College Of Nursing to get the nursing

students census per year level.For the selection of the

respondents per year level, the researchers will be using the

fishbowl technique, where the selected section of their ID

numbers of the student nurses are placed in a bowl per year

level (sure ba to? Madaming students hahahaha).

The respondents of the study will include University of

Cordillera -College of Nursing levels 1-4 student nurses

enrolled in academic year 2022-2023. It will include ages 18

and above student nurses in which informed consent shall be

asked from the respondents before proceeding in answering the

tool. The respondents should be willing to participate in an

online survey. The researchers adapted an English language

form of a survey questionnaire. There will be no other

language translations to be used, since the inclusion criteria

for the respondents include to be English literate which means

can read and comprehend English language.

Exclusion criteria include religion, race, creed, and 17

years old and below. Religion, race, and creed are no longer

necessary because these characteristics are not needed and are

not related to measuring the level of knowledge, attitude and

behavior.

The researchers will ask permission from the Dean of the School

of Nursing to obtain the UC email address of students to be used

during the invite to participate as a respondent in the online

survey. They will be asked to proceed with the online survey

if they consent to join. The students will provide their

informed consent to participate in this study. Ethical

consideration will prevent transgressing the students with the

R.A. 10173 or the Data Privacy Act of 2012. It will not

collect identification information from the students to ensure

privacy and confidentiality throughout the study.(eto ata ket sa

data gathering procedure un mga consent and letters)

Participants of the Study

Data Gathering Tool

The researchers will prepare an online survey

questionnaires in order to collect data related to our study ,

"BEHAVIORAL EFFECTS OF THE GRAPHIC IMAGES ON CIGARETTE PACKS IN

QUITTING SMOKING OR NOT TO SMOKE AMONG NURSING STUDENTS OF THE

UNIVERSITY OF THE CORDILLERAS". These questions will include

graphical images on cigarette packs to measure the participants

knowledge, attitudes and subjective norms the impact of

graphical images to the nursing students in smoking cessation on

behavior. The researchers will use Google form to create an

online survey questionnaires, this is an open-access tool for

public use, so personal consent from developers will not be

necessary. A request letter will be made to the registrar’s

office for the researchers to know how many nursing students

from 1st year level to 4th year level are currently enrolled in
the University of the Cordilleras. A request letter will be also

made to the Dean of College of Nursing to conduct our study. The

researchers will include a letter of informed consent and the

purpose of our sudy online for the participants for them to

choose whether to participate or not. With this letter the

researchers will enure each of the participants confidentiality.

The researchers will give the questionnaire to the

participants online. A secondary tool will be used to analayze

smoker to non smoker participants

Data Gathering Procedure

 In gathering the data, the researchers identified the

problem first before anything else. Next, primary and secondary

data were provided through the data. The researchers utilized

the used of an online survey questionnaire and secured ethical

clearance from UC-REC before distributing it to the respondents

which are the 1st to 4th year nursing student from University of

the Cordillera through google forms. After distributing the

questionnaires, the researchers waited for thorough responses

before collecting all of the fully completed questionnaires as

part of the data interpretation and analysis completion.

Treatment of Data

Ethical Considerations

Ethical considerations will be implemented and observed

throughout the study. The three broad ethical principles for

protecting the study participants and on which standards of

ethical conduct in research are based: beneficence, respect for

human dignity and justice. These ethical guidelines are

applicable in the current study and entirely taken from the

study of Belly et al. (2021). The idea of beneficence

encompasses doing some good while also protecting individuals

from physical and psychological harm and exploitation

(nonmalificence) (Polit, D.F. & Beck). Prospective participants

will voluntarily decide to participate in the study without risk

or prejudicial treatment. Participants had the right to ask

questions, refuse to give information, or withdraw from the

study. The researchers will also observe freedom from coercion.

There are no threats of penalty for failing to participate, no

excessive rewards from agreeing to participate, and no generous

monetary incentive.
The researchers ensured that the participants were not harmed or

abused, physically or psychologically, in any way. The

researchers imposed a duty to minimize harm and maximize

benefits. The participants had the right to freedom from harm

and discomfort.

Full disclosure. The participant’s autonomy to make his/her

decision was respected. Participants will have the right to

informed consent: prior to the conduct of the survey

questionnare, a soft copy of informed consent will be included

in the survey questionnare and will be explained to the

participants. Participants will make informed decisions about

whether they would participate in the study evaluation. The

informed consent process entails providing the participants with

sufficient information about the study, giving them ample time

to consider all the options.

Research should respect the dignity and rights of human research

participants; of individuals or groups connected either with the

research participants or the research topic; and of the

communities in which research is carried out. Research should

also respect the rights of non-human life, tangible and

intangible heritage, natural resources, and the environment.

(Nat H. B., 2022).Additionally, we require that all content

submitted for publication be respectful of the dignity and

rights of individuals and human groups. The researchers only

asked for information that is relevant to the study and was only

used for research purposes. The researchers will not use any of

their data in unrelated studies without the participant's

permission. Furthermore, during and after the study the

participant's dignity shall be respected. No harm or abuse shall

befall the participants or potentially damage their dignity. The

participant's data and answers shall not be altered, changed or

completely taken out of context.

The researcher additionally make sure that the study's

participants were chosen in accordance with a precise inclusion

and exclusion criteria. Justice was considered when selectung

the study's eligible participants, making sure that their safety

and protection was guaranteed. The concerns of research

participants should always take precedence over the goals of the

study, and researchers will always be fair to them. In addition,

the researcher will make sure that every group in society can

profit from taking part in the study, regardless of how

susceptible it may be thought that they are. Not involving, or

making it difficult to involve, any patient group in clinical

research could be described unjust (Gelling, 2015).

Additionally, the researchers constructed an informed consent

that will guarantee that all responses will be kept anonymous

and utilized only for the study. Without the participant's

consent and under strict privacy protection, the researcher will

not use or share unrelated context. Participants must be

safeguarded from any damage or abuse, whether physical or

emotional, during the data collection and study development.

 REFERENCES

A. BOOKS

B. JOURNALS

C. WEBSITES/ELECTRONIC RESOURCES

https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheorie

s/BehavioralChangeTheories3.html

https://psycnet.apa.org/record/2013-18986-007