Assessment Of Knowledge Of The Consequences Of Passive And Active Cigarette Smoking On Health And Neurocognitive Functions Among Secondary School Children In Abakaliki

Assessment Of Knowledge Of The Consequences Of Passive And Active Cigarette Smoking On Health And Neurocognitive Functions Among Secondary School Children In Abakaliki

Smoking can be referred to as the inhaling or taking of smoke resulting from tobacco. Tobacco occur naturally in the tropics and presently grown in most part of the world as an agricultural products. Tobacco leaves is the most utilized part of the plant and it could be used naturally (fresh) or processed (dry) systematically into other forms of products as it is being seen today e.g. Cigarette, snuff, pipes etc.

Oxford medical dictionary defined tobacco as the dried leaves of the plant niceties become or related species used in smoking and as snuff.  Originally of inhaling smoke can be traced back of 300Bc to the burning of these dried leaves and incenses in magical ceremonial and religious practice among the Egyptians and Maya India in South Africa, until the spread of tobacco smoking in the fifteenth century after Spanish explorer had been introduced to it by the Mexican and Caribbean India, taking in of smoke and   fumes had remained primarily, only a priestly and occasionally a medical function. After the introduction of smoking in Europe, Asia and Africa, the use of tobacco among ordinary people started from an alarming novelty to a common people habit.

Tobacco smoke contain poisonous substance such as nicofere, alkaline, carbondioxide (carbon monoxide) aerolein, ammonia prussic acid and a number of aldehydes and tars in all, tobacco contain some 4,000 chemicals, smoking is also found to be an important cause  various forms of cancers like nasophaynx, month, larynx, kidney lung and bladder as well as chronic obstructive pulmonary disease, emphysema and heart diseases, stroke and other cardiovascular risk associated with oral conceptive use and  to exposure the smoke. There have been numerous campaigns against cigarette smoking communicating that, tobacco smoking causes death. However, threat to health and life doesn’t seen to be a good reason for quitting anything people somehow block themselves and ignore all the information that is given to them. Smokers usually have smelling hairs, breath, clothes if they smoke indoors a smell room; the stench of cigarette smoke is very penetrating and hard to remove.

Cigarette smoking also stains the teeth yellow or sometimes brown but since this effect is long term, most people are not aware of it when they are smoking, smoking limits young people physical fitness in terms of both performance and endurance even among young people trained in competitive running (Abdulmohsen et al., 2015) www.scholar.viewat

Cigarette smoking is the commonest form of tobacco use, is an important health hazard and a major preventable cause of morbidity and mortality (Mpabulungi and Muula 2005). According to Andersen, Dewey, Letenneur, Brayne, cope land, et al (2005) and Bloch, Tong &Novotny, (2010), Smoking is the most preventable source of most non communicable diseases and has become a worldwide problem which contributes to premature deaths of an estimated figure of 4 million people around the world (Lynch and Bonnie 2006). This figure represents more deaths than from AIDS, Alcohol abuse, car accidents murders, suicides, drug usage and fire combined A relationship has been well established between active smoking and an increased risk of cognitive decline and dementia..

According to ‘Chaloupka, Wakefield, Johnston, Omalley, (2007).and US Department of Health and Human Services (2006), each year more than 3,000 children and adolescents become smokers. Studies have shown that the more teens are exposed to cigarette market, the more likely they are to smoke and the younger the age of initiation of smoking the greater the risk of habitual smoking. Argent, Beach and Dalton et al (2011) states that, exposure to smoking in films has been shown to be associated with smoking initiation among children (9-19 year) and the effect of seeing smoking incidents in films was also stronger in adolescents with non-smoking parents, exposure to tobacco smoke is harmful and is associated with ill health and mortality.

Smoking could be active or passive; it’s active when the individual is actually smoking directly from the cigarette stick  and  Passive smoking which also known as second-hand smoking (SHS) or environmental tobacco smoke, SHS is a combination of stream and smoke given off by a burning tobacco product and main stream smoke exhaled by a smoker (U.S. Department of Health and Human Service Public Health Service, National Toxicology Program 2004, 2006) exposure to SHS is associated with increased risk for acute respiratory infections middle ear disease, worsen asthma, respiratory symptoms and slowed lung growth (International Agency for Research on Cancer 2011). Worldwide 40% of children, 33% of non smoking male and 35% of female non smokers were exposed to second-hand smoke. Moreover, in the United Kingdom of Saudi Arabia, a national study conducted in 2008 reported a smoking prevalence of 36% and 33% among male and female adults respectively.

Secondary school period (9-18 years) correlates with the period of adolescent, adolescent here refers to the stage of maturation between childhood and adult hood, it usually between ages 9- 19years.

However, smoking epidemic has been on decline in most industrialized countries but in the developing countries data suggests that cigarette smoking is increasing by 3% per year. Also total number of deaths attributed to smoking worldwide will increase from 2-5million in 1995 to 12 million by the year 2050 (Peto, 2008). Block, Tong Novotny et al (2010), States that in developed countries, educating people on the hazard of smoking is a focus area for health educators.

Report from school survey across Africa show that use of drug starts with alcohol and cigarette smoking (Obot, 2005; Odejide, 2006).  According to Peltzer (2009), in a study on cigarette smoking among secondary school children in six African countries Kenya, Nambia, Swaziland, Uganda, Zanbia, and Zimbabwe indicates 6.6% of students surveyed are engaged in alcohol use and 10.5% engaged in illicit drug use including cigarette smoking.

In Nigeria, there is no age restriction on buying of cigarette; it is interesting to note that some adults prefer sending children to buy cigarette and alcohol for them. In a survey conducted on secondary school across Cross River State, it was found that 9% of the students smoke (9.7% males and 5.7% females). According to Omer, Layla, and Abas (2012), the prevalence of smoking among secondary school students was 21.110, more than half of the students have smoked in public place, with male student smokers higher than females.

Higher percentages in the age group were between 17-18 and higher percentage smoker students have smoked less than 20 cigarettes per day. Fatiregun and Tisa (2009) in a study conducted in Ibandan in South-west part of Nigeria discovered that only 6.3% and 10.6% of respondents who were students in military Secondary School show positive attitude towards acceptance of substance.

Aina and Dorunshok (2008) in their study found increasing trend in tobacco smoking among adolescents and young adults. This is attributed to the common us of cigarette.

Furthermore, Kim et al (2010) investigated the effects of peer association and parental influence on adolescent smoking and findings is supported both social learning theory and social bonding theory, suggesting that both peer and parental influence are significant in predicting the risk of adolescents smoking and that parental influence was slightly greater than peer factor, although the difference was negligible. Reducing secondary school children smoking is of essence therefore, this study based on assessing the knowledge of the consequences of active and passive smoking on health and neurocognitive functioning among secondary school children in Ebonyi State (Abakaliki Urban).

Statement of Problem

Tobacco is the only consumer product that when used as recommended by its manufacturers, eventually kills half its regular users. Tobacco smoking is the single most known preventable cause of death in many countries. 4.9 million Deaths to tobacco smoking occur annually with over 70% occurring in developing countries including Nigeria and this figure is expected to increase to 10 million by 2030 if preventive actions are not taken (WHO, 2009).

Smoking has a great economic burden by causing decrease in economic productivity and high health care expenditures in addition to the tobacco itself, the impact of smoking is not limited on the smokers but, it spreads to affect the non-smokers as well. Second hand smoking has an impact on birth outcomes represented in low birth weight (Adu-Baker et al., 2010) and contribute significantly to respiratory tract infections in infants (Jone et al., 2011).

In Nigeria, there are evident use of tobacco on road verges, motor parts as well as restaurants, bars and hangouts where adolescents coverage on daily basis to use tobacco and indulge in binge drinking.

Oshodi, Aina and Onajole (2010) studied the prevalence and associated factors of substance use among selected secondary school students in Lagos the result obtained showed that one reason for tobacco smoking is stress.

Tobacco smoking which starts at adolescence is an epidemic to the Nigerian society and the world at large as most continue this habit into adulthood when they will become fathers and mothers. To pregnant mothers exposed to smoking either passively or actively it results to low birth weight which is one of the causes of prenatal mortality. Mothers who smoke have increased rate of placenta prevail, placenta abruption alteration haemorrhage and preterm deliveries, thereby increasing number of stillbirths and neonatal deaths   from respiratory distress syndrome, asphyxia, pneumonia and immaturity (Kim and Yun, 2010) if cigarette smoking considered an epidemic as it causes up 4.9 million premature deaths annually, then the answer as in any other epidemic will be found in prevention not cure in addition to increase mortality, tobacco use also causes preventable diseases, poor health and disability reduced efficiency and productivity Bung, Warg Jin et al (2006).

Giving the availability, consequences of tobacco smoking in Nigeria, it is important to assess student’s knowledge on effect of active and passive smoking on health and Neurocognitive function in order to map out prevention strategies.


General Objective

To assess the knowledge of the consequences of passive and actives smoking on health and Neurocognitive function among Secondary school children

Specific Objectives

–                     To determined personal characteristics of the respondents.

–                     To determine factors predisposing secondary school students to tobacco smoking

–                     To asses their level of knowledge on the harmful effect of smoking on health.

–                     Assess the extent of cigarette smoking among secondary school students.

Significance of Study

The findings of this study, will help parents, teacher’s government, media and health practitioners and organizations like UNICEF and WHO, to further strategize campaign against cigarette smoking and encourage health education in secondary schools, thereby reducing the rate of cigarette smoking among secondary school student in Abakaliki urban.

Research Questions

This study was designed to address the following question

–                     What are the personal characteristics of the respondents?

–                     What are the factors predisposing secondary school students to tobacco smoking?

–                     Do the students have in depth knowledge of the harmful effect of smoking on health?

–                     What is the extent of cigarette smoking among secondary school children in Abakaliki urban?


–                        There is no significant relationship between age and life time smokers.

–                        There is no significant relationship between sex and life time smokers.

–                        There is no significant relationship between level of education and life time smokers

–                        There is no significant relationship between demographic characteristics and life time smokers

Scope of the Study

Scope of the is to assess the knowledge of the consequences of active and passive smoking on health and neurocognitive function among secondary school children.

Operational Definition

Knowledge: Acquaintance with facts or truths about the effect of active and passive smoking on health and neurocognitive functions

Active Smoking: Smoking of cigarette directly

Passive Smoking: Exposed to the smoke of cigarette

Consequences: The effect, result or outcome of passive and active smoking on health and neurocognitive functions.

Secondary school children: school children within ages 9-19 years.




Conceptual Review

Despite knowledge of the harmful effect of tobacco smoking among smokers and no smokers, it has been found that knowledge about the health hazards of smoking have not always served to prevent people from smoking (Hussain, Akande and Adebayo, 2009). Abeer and Ahmed (2013), in a research carried out in Jordan among Jordan secondary school students,found out that, about 86.79 students are aware of the harmful effect of smoking and at after average.

According to Omokhodion, Fseru (2007) states that majority of smokers start smoking in adolescence (secondary school age 9-18), with teenage smoking showing great increase over the years.

According to Vogli and Santinello (2005) factor affecting teenage smoking include predisposing factors, reinforcing factors and enabling factors. The factors predisposing secondary school children to smoke include; according to Park and June (2007), gender differences may be due to different perceptions communities have towards male and female adolescents smokers. Predisposing factors associated to smoking includes; Family socioeconomic status, low grade in class, students who reported low academic achievement and peer pressure. Family socioeconomic status, was  shown to be one of the predisposing factors, according to (Charu, 2010) economic status was measured by family income among students who smoke in Korean society, and the overall smokers reported lower family economic status compared to non-smoking students. Low family socioeconomics status which results to lack of parental care is one of the major predisposing factors that result to teenage smoking. Take a look at Nigeria, where most poor people send their children to hawk goods during their holidays (child labour). These children are off all day during in of search of money; their parents are not aware of what they are doing in order to correct or rebuke them when they go wrong. By this these children are exposed to smoking may be in the motor park or in shops where they buy and sell

Martins & Alexander, (2009), reported that, there is an association of self-reported academic achievement with smoking and it is consistent with previous results. Those who had the lowest school grades among the Jordan students were at higher risk of early smoking, unification of school performance was a strong determinant of becoming a smoker. In the Korean society 39.3% of students are in smoking group, and report of their academic achievement was below average before they started smoking. (Labid and Abeer, 2012) ( in another research on Jordan students, Ahmed (2013) also reported that, peer group is also a predisposing factor to smoking among secondary school children. The study conducted among Jordan students, findings showed that 19% of the smoking students said “smoking help them fit in a group of friends. For the females, 12% believe that smoking help them have more friends with 11% of students believe that smoking girls have stronger personality. 21% of male students believe that smoking makes them have more friends and keep them in charge over the non smoking students, as there were 12 % of students who believe that the smoking males have twice stronger personality as than the non-smoking males 20.1% of the smoking female students also believe that they become more attractive to males than the non-smoking students this regard, only 94% of students believed so. The male smoking students also believe they become more attractive to the females by smoking but only 12% of the students believe so.

Peer pressure is a phenomenon that exists for all ages in Nigeria; the phenomenon indicates high prevalence of tobacco use. It perhaps becomes perturbing and problematic as children grow seeing their peers as role model. Peer pressure directly or indirectly influences adolescent’s indulgence in risky behaviors such as smoking. Direct peer pressure according (Adeymo 2007) may occur in the form of encouragement dares, or actual offers of the cigarette. On the other hand “indirect peer influences can occur when youth associate with peer who drink and smoke, increasing the availability of these substances, providing role models, establishing cigarette smoking,  creating the perception that smoking might increase social acceptance”. Peer groups gives comfort to children, as it facilitates self-esteem in children and its makes acceptability. According to Kim, Kwak &Tun (2010), the feeling of belonging is a very powerful force that can outweigh ties to church, school, family or community.

Tobacco use is addictive and can cause several health disorders such as cancer heat, disease and respiratory disease among others. According to Makanjuola, Daramok and Obembe (2007), found smoking of cigarette among secondary school children to be on the increase, spreading into many African countries. According to them, substantial percentage of national budgetary health allocation is utilized for treatment and rehabilitation of people with smoking problems. This is attributed to industrialization, urbanization and increased exposure to western lifestyle. Other reasons given by them include: unhealthy family background, high social class, peer group influence and desire to remain awake at night, pressure to succeed in academic work, self reported poor mental health and easy remain awake at accessibility of drugs.

Earlier studies on the peer influence and tobacco use in Nigeria and elsewhere, identified peer pressure as one of the commonest factors associated with cigarette smoking among adolescent. For example, Adebiyi, Fasen, Sangowank and Owoaje (2010) studied tobacco use amongst out of school adolescents in a local Government Area.  in Nigeria. The study showed that peer influence is an important source of introduction to tobacco use.

Similarly, Oshodi, Aina and Onajole (2010) studied the prevalence and associated factors of cigarette smoking among selected secondary school students in Lagos. Result obtained show that reasons for alcohol and cigarette smoking includes relief from stress, self medication to illness, stay awake at night to study and peer pressure.  Omokhodion and Faseru (2007) asserted that, although studies examining smoking amongst in-school youths in urban areas have been documented in Nigeria. The study was skewed towards describing pattern of smoking amongst in-school youths in the urban area. They further reported that, many of these factors were associated with adverse health behaviours which may include; smoking initiation and persistence they known to be commonest amongst out of school youth. Because their aggregation in area lacking adult supervision. Franca, Daltzenberg, Falissard and Reynaud (2010) studied peer tobacco use overestimation among French university students. The result obtained showed that tobacco users are less likely to overestimate peer prevalence of smoking. A cursory look at the result of these among studies reveals that peer influence if not properly handled and checked and usually affect the future life styles of adolescents.

Furthermore, available studies have also shown that Calabar, one of the tourist hotspots in Nigeria, accompanied with the influx of people into the state for leisure, trade, education among other motives has not received much research attention in relation tobacco use among her youths (Ukwayi 2012).

Omer, Layla & Abas (2012), in a cross sectional studies, assessed students knowledge and determine the relationship between this knowledge and some of the demographic characteristics of those students. The study reported that the prevalence of smoking was 21.1% among the students, more than half of students smoked higher than female. Higher percentage of smoke students have smoked less than 20 cigarettes per day peer and parents were the main reason given by students for stating smoking. All the students have a good knowledge about smoking related diseases and its complications. The study recommended the urgent need for health awareness about the health damage caused by cigarette smoking among meddle school students and high school alike as well as the need to reduce smoking and make students busy with other school activities. Anna and Egbe (2015) in other study in another study investigated the knowledge of youths about the negative health effects of cigarette smoking. Most of the young smokers recounted some health hazards associated with smoking but expressed a sense of invincibility to the hazards of smoking. Some resorted to reducing their dai/consumption of cigarette or taking cancer protective foods to avoid the health consequences of their smoking habit. Over half of the participants (56.1% n=305) had a high knowledge level of the negative health among non smokers females, students respondents had never smoked. They suggested need to reuse more awareness in the population on the dangers of smoking.

Similarly, Ebirim, Agwu, Owutoma and Gabriel (2014) in a study determined the prevalence knowledge of cigarette smoking among in school adolescents in Nigerian population and to assess their level of knowledge on the health effect of cigarette smoking. 944 students were randomly selected in school male adolescents in Owerri. The research reported a prevalence of 15.3% for ever smoked adolescents and 11.2% for current smokers at mean average age of 14 years. 63% had good knowledge of health problem 36.1% indicated peer group as their initiator. Their major reason for smoking were friends and role model and out of curiosity. They concluded that poor knowledge of the health problems associated with smoking is the major reason for smoking and recommended awareness creation on health problems associated with cigarette smoking

Passive smoking has a negative impact on those around they also went further to compare the knowledge of smokers to that of non-smokers, the non-smokers has higher percentage which is 91.5% as compared to 86.7% of smokers. Passive smoking is as harmful as active smoking.

Howbeit, another factor affecting secondary school student smoking is reinforcing factors. The serve as reinforces to student whose parents and or siblings smoke. According to (Lee and Tak, 2005) smokers are more likely to have parents and close friends who smoke. Having family members who smoke provides young people easier access to cigarettes, there is also great   psychological impact and attachment between the smoking parent and the school child; this creates a mental image that smoking is an acceptable norm. In another study conducted on Korean secondary school students, it was found that 69.4% had smoking parents and they recommended that prevention effort among secondary school children should focus on their smoking parents. (Scragg and Glover 2007)

Moreover, there are enabling factors that are also associated with cigarette smoking among secondary school students and they to do with the smoking related environment. In Nigeria there is no strict ban on selling cigarette to under 18 years children therefore; parents and grown up adults prefer send children to buy cigarettes for them. The young smokers “good” use of this opportunity to buy theirs there buy have access to cigarette.

Although in Korean Society were there are bans on children below 18 years to purchase cigarette, report said that more than 90% of the young smokers were able to buy cigarettes despite the ban on selling tobacco to children under 18 (upi.Com, 2008).

Tobacco smoking has actually been found to be harmful to nearly every bodily organ and orange system in the body and diminishes a person’s overall health.

Smoking is the leading cause of cancer and death from cancer, the more the exposure the more the risk of developing various forms of cancer which includes cancer of the lung, mouth, nose, larynx marrow (myeloid leukemia) kidney, cervix, ovary, urethra liver, bladder, bowel and stomach. Lung disease such as bronchitis and chronic obstructive pulmonary diseases (U.S Department of Health and Human service 2010 and 2014).  (  U.S Department of Health and Human Services (2014) reported that, smokers are more likely than non-smokers to develop heart diseases with increased risk for stroke and coronary heart diseases by two to 4 times, lung cancer by 25 times.

In the respiratory tract, smoking also triggers asthma attack and smoker are more liable to die from congestive obstructive pulmonary diseases than non smokers.

On the reproductive organ, smoking can result to infertility and have intrauterine effect on babies causing preterm deliveries, still birth, low birth weight sudden infant death syndrome (crib death), ectopic pregnancies, or facial clefts in infants with women  having lower density of bone than non smoking women . US Department of Health and Human Services (2006 and 2010), also reported that, smoking affects sperm count and it’s viability, thereby  reducing fertility and increased risk for birth defects and miscarriages.

Smoking also affects the health of teeth by discoloring them and gums and can cause tooth loss, there is also increased risk for cataracts and age related macular degeneration.

Moreover, there is increased risk of developing diabetes, 30-40% higher for active smokers than nonsmokers. On the immune system, cigarette smoking depresses immune function, increasing susceptibility to infections such as pneumonia and influenza, more severe and longer lasting illness. It also the lower levels of protective antioxidants such as vitamin C in the blood resulting to increased levels of free radicals in the system and impaired wound healing. On musculoskeletal system it tightens the muscles and reduces bone density.

Outside the health consequences of smoking, smoking also affect neurocognitive functions. Sucobsen, Krystal, Westerveld, Frost and Pugh (2005) reported that young adult’s smokers were inferior to non smokers on measure of sustained attention and impulse control, processing speed and general intelligence. In across sectional study to compare middle aged non-smokers was reported for auditory verbal learning and/or memory working, executive function general intellectual abilities, visual search speed, processing speed and cognitive flexibility (Casper, Arndt, tissues, Mckiogam, P Spinks 2010).

Stewart, Deary, Fowkes, Price (2006) in across-sectional population-based study with community dwelling older adults, smoking status was used as prospective, retrospective predictor, current smoking and any history of smoking were associated with poorer performance on measures of global cognition function. Previous smoking history was associated with poorer cognitive flexibility and impaired general cognitive function or decreased risk of global cognitive impairment. A longitudinal research with non demented, population based samples found that current cigarette smokers demonstrated an abnormal rate of decline on indices of reasoning and auditory-verbal memory in middle aged adult and an abnormal decline on measures of global cognitive function and auditory-verbal memory in older adults, (Sabia, Marnot, Dufouil, Manoux, 2008). However, Heffernan, ling, Parott , Buchanan, Scholey Rodgers (2005) reported that, the level and toxicity of smoking as reflected in the no of cigarette smoked per day, duration  of smoking over life time and/or dose-duration were inversely related to various domains of neurocognitive functions in adults across a wide range. In the study, chronic smoking was associated with increased risk for various forms of dementia in particular Alzheimer disease and vascular dementia.

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