CHAPTER ONE: INTRODUCTION

1.1. Background of the Study:

Understanding regarding smoking is the present issue among people from all over the
world because, now people’s engagement with bad practice such as alcoholism, smoking
and other drug are the main problems. Tobacco is known to be the one commercially sold
product that if used as directed by the manufacturer will lead to certain disease and death.
Additionally, unlike a genetically caused disease, the health consequences of tobacco use
are directly tied to behavior and to the cultural and social structuring of people’s ideas,
actions, and relationships. For all of these reasons, tobacco use should be of primary
interest to medical sociology. In fact, however, as discussed below, there have been
relatively few focused sociological accounts of tobacco use in a cultural and social context.
This avoidance is noteworthy, reflecting both the fact that topics of study within medical
sociology (like other fields) accord greater or lesser social rewards for researchers as well
as the fact that in the West, where most medical anthropologists are found, tobacco use
lacks extensive symbolic or other cultural embellishment. However, from a strictly health
standpoint, tobacco use is of a far greater direct consequence than most topics regularly
studied by medical anthropologists (Singer, 2007). Smoking is a practice in which a
substance is burned and the resulting smoke is breathed in to be tasted and absorbed into
the bloodstream. The most commonly used substance is the dried leaves of the tobacco
plant which is rolled into a small square of rice paper to create a small, round cylinder
shape called “cigarette”. Perception surrounding smoking has varied from one place to
another over time; from holy to sinful, sophisticated and vulgar, a panacea and a deadly
health hazard. During the 21st century, smoking came to be viewed in a decidedly negative
light, especially in the Western countries. This is due to smoking tobacco being among the
leading causes of many diseases such as lung cancer, heart attack, Chronic Obstructive
Pulmonary diseases, erectile dysfunction and birth defects. The health hazards of smoking
have caused many countries to institute high taxes on tobacco products, run ads to
discourage use, limit ads that promote use, and provide help with quitting for those who do
smoke. 2 Some of the substances are classified as hard narcotics- like heroin, but the use of
these kinds of products is very limited because they are not usually commercially available.
Cigarettes are primarily industrially manufactured but it can also be handrolled from loose
tobacco and rolling paper.
Other smoking implements include pipes, cigars, bides, hookahs and bongs. Smoking is a
practice in which a substance is burned and the resulting smoke is breathed in to be tasted
and absorbed into the bloodstream. The most commonly used substance is the dried leaves
of the tobacco plant which is rolled into a small square of rice paper to create a small,
round cylinder shape called “cigarette”. Less common drug used for smoking includes
cannabis and opium. In the case of cigarette smoking, these substances are contained in a
mixture of aerosol particles and gases and include pharmacologically active alkaloid
nicotine; the vaporization creates heated aerosol and gas to form which in turn allows
inhalation and deep penetration into the lungs where absorption of the active substances
into the bloodstream occurs. Smoking is primarily practiced as a route of administration
for recreational drug use because the combustion of the dried plant leaves vaporizes and
delivers active substances into the lungs where they are rapidly absorbed into the
bloodstream and reach the bodily tissue. In some cultures, smoking is also carried out as a
part of various rituals, where participants use it to help induce trance-like states that they
believe, can lead them to spiritual enlightenment. Smoking is one of the most common
forms of recreational drug use. Tobacco smoking is the most popular form, being practiced
by over one billion people globally, and the majority of who are in developing countries.
Now various studies show that youth and teen age population are more victims of smoking.
1.2 Statement of the Problem
Smoke that is emerged out from a smoking device contains numerous toxicants known to
cause lung cancer, heart disease, and other diseases. The tobacco smoke delivers the
addictive drug nicotine and more frequent use is associated with the smokers being
addicted. Smoking also causes several diseases like asthma, oral cancer, stomach cancer,
hypertension, depression, blurred vision, indigestion, cough, etc. It has a peculiar nature of
accelerating ageing in rapid way. Aggregate health status of people living in the study area
seems very poor. Many people consult the local health post with various complaints of
cough, asthma and other similar smoking-related diseases. Indigenous Tharu and migrated
Brahmin, both the groups of people, living in the study area seem to have higher level of
smoking behavior. It was felt essential to study their smoking pattern with behavioral
comparison. This research aims to explore the comparative smoking behavior between the
above-mentioned two ethnic groups.
A man is made neither for a trade, nor for a hospital, nor for a poorhouse: such a prospect is
too terrible (Foucault, 1973). Healthy people are the future of nation. Healthy people are
the millstone of productivity. Smoking is one of the main challenges and a big concern in
public health in today’s time. Teenagers, especially students have been and are becoming
the victims of smoking culture. Most people are unaware that even the smallest level of
smoke use is dangerous, in part because this is not the case with other behavioral health
risk. Many smoking users cannot name specific diseases caused by smoking other than lung
cancer and do not know that smoking also causes heart diseases, stroke and many other
diseases including many types of cancer. "Health is Wealth” sounds good in proverb but
how our new generations are corrupting their health are main concerns in present
academic and non-academic discourse. The high prevalence of smoking among people aged
18-24 years indicates a need to focus tobacco use treatment interventions on this age
group. Intervention for young adult before they became addicted maybe critical in reducing
tobacco use among young adults. Now teen age and youth become main point of smoking
and alcoholism, that’s why this study tries to find the teen age perception on it. This study
tries to find out solutions of the following questions:
 What are the Knowledge, Attitude and Perception of cigarette smoking on health among
people from rural area?
 What are the major factors to understand the effects of smoking among rural people?
1.3 Objective of the Study
People and their health concerns about smoking were the general objectives and
knowledge regarding the consequences of cigarette smoking on health among the people
from rural area. The following were the specific objectives of the study:
 To study about peoples’ knowledge, attitude and perception of smoking.
 To analyze people’s level of knowledge, attitude and perception regarding cigarette
addiction and withdrawal effects/symptoms of smoking.
1.4 Significance of the Study
Healthy People are the indicators of the healthy future of the nation. Healthy people and
quality of life of the people is the backbone of the society. Modern capitalism has been
victimizing people as commodity through smoking and alcoholic culture. Effects of
globalization, mushrooming of different social media and new types of food fashion have
been bringing smoking as a fashion among students, especially among teenage students. So,
many researchers have attempted to explore the overall situation of students in many
educational organizations/institutions of the world. No research has been conducted about
the teenage students of the study area.
CHAPTER TWO: LITERATURE REVIEW
Smoking:
Smoking refers to the process of burning a substance (tobacco, drugs, etc.) and inhaling the
resultant smoke. Smoking is primarily practiced as a route of administration for
recreational drug use because the combustion of the dried plant leaves vaporizes. The
different forms or methods of smoking include cigar, cigarettes and pipes etc.(Mehta, 2015)
World Health Organization has estimated that about six million people worldwide each
year die due to tobacco use (smoking and smokeless). Tobacco use is associated with ill-
health, disability, and death from non-communicable chronic diseases, and tobacco
smoking is also associated with an increased risk of death from communicable diseases
(WHO, 2015). It is also estimated that the world's one billion smokers are women. Most
(75%) of these women live in low- and middle-income countries (WHO, 2010). Many more
girls than boys had misconceptions about smoking as they think it is an excellent way to
control weight. Research evidence shows that low self-esteem is associated with smoking,
and studies also showed that girls from developed countries have lower self-esteem than
boys. The findings from the research showed that women are more susceptible to smoking-
related morbidity and mortality (Allen, Oncken, & Hatsukami, 2014). In Nepal, about 16
billion NRs (Nepali Rupees) are spent annually on treating tobacco-induced diseases. In
Nepal, smoking-related problems are being tackled in various ways. Tobaccocontrol and -
regulation laws restrict people from smoking in public places or even in open spaces like
parks, schools, gyms, and bus stops. In 2014, Nepal introduced a law that states that 90
percent of a cigarette pack should be covered with pictures depicting the harmful effects of
smoking (Subedi, 2017).
Toxic chemicals that cause bad health for smokers and passive smokers include tar and
nicotine (The ASPECT Consortium, 2004). Tar has several components and contains more
than 40 cancer causing chemicals (American Academy of Family Physicians, 2007). Organs
affected by these poisons include not only mouth, vocal chords, throat, and lung, but also
kidney, bladder, uterus and ovaries. Nicotine is a poisonous, water-soluble alkaloid found
in tobacco leaves and used as an insecticide (American Academy of Family Physicians.
2007). One cigarette contains approximately 8 milligrams of nicotine. Nicotine increases
heart rate and blood pressure. Nicotine affects the body in only three-and-a-half seconds,
and the effect lasts approximately 90 minutes. Nicotine is an addictive drug and there is no
evidence that nicotine causes cancer. Nicotine replacement is also used as one kind of
smoking cessation medicine (Siahpush et al., 2006). It has been shown that combustion
aerosols from cigarettes contain common chemical components such as carbon dioxide and
carbon monoxide (Siahpush et al., 2006). Carbon monoxide is a major contributor to
cardiovascular diseases from smoking. It impairs oxygen transportation in the blood. It is
also strongly linked with the development of coronary heart disease. One gaseous
constituent in cigarette smoke is hydrogen cyanide. Cyanide released from a cigarette can
be 160 times greater than the level considered safe (Siahpush et al., 2006). It has a direct,
harmful effect on the cilia, a part of the natural lung clearing mechanism in humans,
thereby increasing the likelihood of developing disease. Risk from cyanide is significant
with just one cigarette per day. Another gaseous constituent in cigarette smoke is nitrogen
oxide, of which the primary form is nitric oxide (NO) (Tobacco-Related Disease Research
Program, 2007). Nitric oxide itself is not necessarily toxic for example, NO is produced in
the body bymany cell types as a physiological messenger molecule, and by inflammatory
cells as part of the defense mechanism against invading organisms. However, the relatively
high concentration of NO presented in tobacco smoke might render its toxicity. Certain
white blood cells were activated to produce a number of compounds, including reactive
nitrogen oxides that could cause specific modifications to cellular components for example,
proteins and their constituent amino acids. In many recent studies, a formation of 3-
nitrotyrosine has been associated with many diseases, including those associated with
inflammation in lung airways.
Factors causing people to Smoke:
According to Jones, and Rossiter, (2008), the rising trend of smoking among teenagers is
the act of smoking deemed to be normal in most of the social environment. It is no longer
forbidden or seems to be explicit in daily lives. Secondly, teenagers who are still at the
developing stage decided to choose between liking and disliking smoking to portray their
self-image. The third reason is vicarious learning. Teenagers as aficionados of actors or pop
stars tend to adopt and emulate the act of smoking. These reasons show how smoking had
make its mark among teenagers which affecting them directly and indirectly and as
consequences, they added these reasons to the rising number of smokers in the world.

According to Strong, and Eftychia, (2006), family plays an important factor in influencing
their children to smoke. It also stated that children were twice likely to become smokers if
both parents were smokers. Girls are relatively easier to be influenced compared to boys.
The author stated that children of single parent are easy to pick up smoking disregard
whether the other members of the family has such habit. Smoking creates a gateway for
them to escape from unhappiness faced in family problem and reduce their stress. This is
the main reason why people get hooked to smoking because most people spend a huge part
of their time with family.

One survey Enzler and Bower (2005), conducted by government-sponsored in the United
Kingdom, shows smokers tend to smoke because they are curious, influence and
encouragement from peers in school, social place or company. Half of the respondents in
the survey thought smoking is a part of growing up process and they feel like social reject if
the do not conform to this act. Smoking behavior has made its waves to become one of the
most important activities in social culture among young adults. If they do not follow the
trend, they will be dejected and alienated by their peers. Some even been ridiculed by their
peers and deemed to be debilitating the group’s reputation. In this case, it is easier to
follow the herd than to fight against it. Our surroundings tend to influence us
unintentionally, and mingling with the wrong group can affect one’s upbringing especially
smoking habit.

Tobacco advertisements are highly related with the burgeoning number of smokers,
especially among teenagers and children (Hastings and Aitken, 1995). Advertisement
portrays that smoking is fashionable and showing that smoking is something an adult will
do or should do. In the research held in Australia, the UK and the US have shown consistent
differences between under-age smokers and non-smokers of the same age in terms of a
variety of measures of the awareness about cigarette advertising. The result shows that
underage smokers have repetitive memory about tobacco advertisement. Influence from
advertisement somehow is not the main reason for people to start smoking unlike
influences from family, friends, or their favorite role models. This is because repetitive
advertisement and airtime tends to evoke our sub-conscious mind every now and then
making us to accept smoking is a part of our culture.

According to Wolburg (2008), he provided the scientific perspective on why do most

people incline to smoke on the first puff because nicotine, an ingredient in cigarette is
simply so addictive: second is that too many campaigns have failed the effective way to quit
smoke: thirdly bars are one of the place for people to be smoke addict. Nicotine produces
an elevated feeling and make people hooked into it on the first try. People will keep on
looking back for the same feeling as a residual effect of nicotine to get the same high and
unnoticing, it becomes a habit. When they realize it was a little bit too late as they plunged
down into this addiction. Other than that myriads of campaigns have been executed but
failed far behind of its objective to halt people from smoking. This is because campaigns
have failed to disseminate the right information and awareness to smokers. Without a
general idea how smoking can be an addiction, simple man will take this matter lightly and
might try out when his friends insisted he or she to try the first stick.

Empirical Review of the Study

P.N. Dhakal, held an investigation on ‘Smoking behavior of house-wives and its effect on
their health in Tarku VDC, Lamjung’ in 2008 AD. He has mentioned that majority of the
housewives learned smoking cigarettes from the age of 15 years to 25 year and continued
up to the present time. The number and frequency of cigarette smoking for majority of the
respondents ranged from 5 to 10 times per day and most of them spend five rupees per day
in buying cigarettes in average. The study found that majority of the respondents were
suffering from continuous cough, pain in throat and chest, stomach pain, headache, visual
imbalance and disturbances, loss of appetite, dry mouth cavity, etc. as the effects of
smoking behavior. Very few housewives wanted to quit their smoking behavior due to the
pressure of their family members as well as the harmful effects of smoking on their health.
(Sherchan, 2010).
The world’s leading health organization, WHO, published its health report in 2010 in its
yearly publication. According to this report, smoking-related total number of deaths is
about 4 million per year including about 11,000 deaths per day. Similarly, total male and
female smokers in the world were 47 percent and 17 percent of the total global population.
WHO has estimated that the total annual smoking-related number of deaths will be double
by 2020 AD. Out of total smoking-related deaths, more than 70% deaths occur in the
developing countries like ours. (WHO, 2010). In Nepal, a large portion of the adult
population smoke.
According to statistics, 60.145% of male adults and 19.969% of female adults are smokers
in Nepal. Similarly, 12.358% of youths under the age of 15 years smoke. Among the under-
15-year young children, 6.037% are females and remaining are males. (Source: United
Nations Population Division, World Population Prospects, 2000 revision)
 CHAPTER THREE: RESEARCH METHODOLOGY
3.1. Study Area: The study is going to be conducted among the population of.
3.2. Research Design: In this research, cross-sectional, exploratory and descriptive
research design will be adopted.
3.3. Study Population, Sample Size and Sampling Procedure: In this research, the study
population will be the the population of. Furthermore, each 50 people will be taken as
sample size for this study through convenience sampling technique or voluntary sampling
technique.
3.4. Nature and Sources of Data: Quantitative data will be collected for this research. For
the study, primary sources of data will be collected using structured and semi-structured
questionnaire with closed-ended question. Similarly, qualitative data will also be collected.
3.5. Methods of Data Collection: Primary data will be collected by using structured
questionnaire with close-ended questions. Qualitative data will be collected by using Key
Informant Interview (KII).
3.6. Method of Data Analysis: All the collected quantitative data will be edited, filtered
and endered in SPSS for the analysis. Descriptive statistic will be used for further anlaysis.
Output will be showed by using frequency, percentage, cross tabulation, pie-chat, mean,
minimum value and maximum value.
Limitations of the Study:
i. This study will be limited in only one place
ii. The sample size of this study is small as a result obtained result cannot be
generalized to whole population.
iii. The study will be conducted only one time
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