CONTENTS

TITLE 2

INTRODUCTION 2-3

RATIONALE 3-7

AIM 8

OBJECTIVES 8

LITERATURE REVIEW 8-10

ETHICAL CONSIDERATION 11

RESULTS 12-14

POLICIES 15

CONCLUSION 15

BIBLIOGRAPHY 16

APPENDICES

Questionnaires 17-18

Consent Forms 19-20

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TITLE

A Health Promotion Intervention To Promote The Awareness Of The Risks Of

Smoking Among Undergraduates at London Metropolitan University

INTRODUCTION

There are 5 different approaches to health promotion according to Naidoo and

Wills 2004. These 5 approaches are medical, educational, social, behavioral

change and empowerment models. According to Naidoo and Wills, the medical

approach is mainly branded as preventing ill health and premature death. The

educational approach gives knowledge and information to the public so they can

make informed choices about their health. The social change model

acknowledges the importance of the socio economic environment and attempts

to address this by using a top down approach while the empowerment approach

enables people to gain control over their own lives. The 5th approach is the

behavior change and this approach according to Naidoo and Wills encourages

individuals to adopt healthy behaviors.

World Health Organization (2005) (WHO) defines health promotion as ‘’the

process of enabling people to increase control over their health and its

determinants, and thereby improve their health. The WHO (2005) definition

aligns itself with the educational approach and this definition is generally

accepted as the primary goal of health promotion.

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Health education campaigns and health promotion measures have helped to

reduce the prevalence of cigarette smoking. In England, for instance, there has

been a substantial fall in the proportion of adults who smoke cigarettes, down

from 39% in 1980 to 21% in 2008. However, worrying levels of smoking persists

– especially among young people. Action on Smoking and Health (2013) (ASH).

Although there has been a decline in the number of young people who smoke

cigarettes there remains a significant minority who are regular smokers. Official

figures for England indicate that 12% of 15 year olds smoke at least once a week

(Fuller 2011). This is of particular concern because young people are the

smokers of the future. Young people are the most significant group of potential

recruits to the ranks of smokers and, as early starters, they are likely to suffer the

accumulated effects of smoking over a longer period of their lifetime.

According to medical dictionary smoking is the inhalation of the smoke of

burning tobacco encased in cigarettes, pipes, and cigars. Most people who smoke

do not really know how dangerous smoking really is to their health. Tobacco

contains nicotine, which is a very highly addictive substance, which makes it very

difficult for a smoker to quit. Tobacco use is included as one of the leading

causes of death and disability worldwide. Smoking is responsible for various

diseases such as Cancer, heart and lung diseases. Smoking also not only harms

the smoker but also those who inhale the smoke (known as the passive smoker).

I have chosen the topic smoking so that I can highlight the dangers of smoking

and also reduce the amount of smokers within the community.

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RATIONALE

After reading different articles, I have come to realize that smoking is one of the

killer diseases in the lives of students. Some are often affected at an early age

while others at a later stage of their lives. Cigarette smoking is the single most

preventable cause of premature death in the developed world (WHO 2006).

Throughout the world it is estimated that five million people die each year as a

result of smoking tobacco and that, on the basis of current trends, this figure is

set to rise to 10 million a year by 2030 (WHO 2006). Because of these reasons, I

came to a decision to use the educational approach to educate students on the

risks associated with smoking. Health education campaigns and health

promotion measures will help reduce the prevalence of cigarette smoking.

According to Naidoo & Willis, an education approach to health promotion will

provide information to help clients to make an informed choice about their

health behavior. This may be through provision of leaflets, visual displays or one

to one advice. It may also provide opportunities for the clients to share and

explore their attitudes to their own health. Naidoo, J and Wills, J. (2000).

According to Department of Health, Smoking causes more preventable deaths

than anything else- nearly 80,000 in England during 2011. There is also an

impact on smokers’ families. Each year, UK hospitals see around 9,500

admissions of children with illnesses caused by secondhand smoke. DH (2013).

About 1.3 billion people worldwide smoke and the number of smokers will

continue to rise. Among these numbers of smokers, 84% live in developing

countries. If the current pattern continues, it is estimated that death from

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tobacco consumption will rise to 100 million per year by the year 2020. Smokers

are at high risk of having cancer particularly lung cancer. DH (2010).

Smoking affects the heart, lungs and the central nervous system. While some

effects on the body are immediate such as increase in heart rate, which is due to

the stimulant nature of nicotine, which is found in the cigarette, some other

effects occur over a long period of time such as shortness of breath which is

caused by the gradual decrease in the lung function. Smokers find it difficult to

quit smoking because of the addictive nature of nicotine. Nicotine is a fast-acting

drug which when inhaled reaches the brain within 15 seconds. Coronary heart

disease and lung cancer are also other forms of smoking related diseases where

damage to the body tissues takes place over many years but the smoker remains

unaware of the severity of the damage until a major even such as myocardial

infarct occurs. Macleod Clark et al.

According to Macleod Clark et al, there has been no research, which shows that

there is any more significant cause of lung cancer than smoking. Lung cancer is a

disorder that has been specifically related to smoking. Macleod Clark et al also

went on to say that smoking produces two types of smoke. The first being the

mainstream smoke which is inhaled by the smoker while the second type of

smoke is the side stream smoke, which goes directly into the air from the

burning cigarette and is then inhaled by everyone around which includes both

the smoker and the non smoker. While the mainstream smoke is filtered which

modifies the amount of tar being inhaled by the smoker, the side stream smoke

remains unfiltered, which contains high level of harmful substances, which is

more harmful than the filtered mainstream smoke. Non-smokers also inhale

nicotine and studies have found that non-smokers do receive a small doze of

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nicotine, which is equivalent to smoking a small amount of cigarette through

inhaling. There is persuasive evidence that a non-smoker being exposed to

environmental tobacco smoke through passive smoking does increase their risk

of lung cancer. Macleod Clark et al (1987).

Smokers and non-smokers alike inhale secondhand smoking (SHS). Inhaling

tobacco smoke is an unavoidable consequence of being in a smoke filled

environment. (ASH 2013). SHS is a mixture of air-diluted ‘sidestream’ smoke

from the burning tip of a cigarette, and the exhaled ‘mainstream’ smoke exhaled

by the smoker. While the proportions of sidestream and exhaled mainstream

smoke differ, sidestream smoke is usually the larger constituent of SHS. (ASH

2013).

Several studies have been carried out over the years to develop effective

methods on how to stop smoking. The various methods are outlined below.

Most of all research literature on smoking cessation identifies a high level of

motivation as the pre-requisite for a successful cessation.

The NHS Stop Smoking Services was established in 2000. According to ASH facts,

the number of people using the services grew year on year rising to over 800,000

in 2011. A review of the stop smoking services found out that over the first ten

years of operation, they helped an estimated 20,000 people to achieve long-term

abstinence. (ASH 2014).

Nicotine Replacement Therapy (NRT) is available in patches, chewing gum,

lozenges, mouth spray and nasal spray and is usually taken for 8 to 12 weeks.

Electronic Cigarettes (also known as vaporizers) are increasing in popularity as

an alternative to smoking tobacco products and there is growing evidence that

they may effective in helping smokers to quit. (ASH 2014)

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Health benefits after stopping smoking

Some of the health benefits from stopping smoking can occur quite quickly as the
table below shows.

Time since quitting Health Benefits to quitting

20 minutes Pulse return to normal

8 hours Nicotine is reduced by 90% and carbon monoxide levels

in blood reduce by 75%. Circulation improves.

24 hours Carbon monoxide and nicotine almost eliminated from

the body. Lungs start to clear out smoking debris.

48 hours All traces of nicotine are removed from the body. The

ability to taste and smell improves.

72 hours Breathing is easier. Bronchial tubes begin to relax and

energy levels increase.

2-12 weeks Circulation improves

3-9 months Coughing and wheezing declines

1 year Excess risk of a heart attack reduces by half

10 years Risk of lung cancer falls to about half that of a

continuing smoker

15 years Risk of a heart attack falls to the same as someone who

has never smoked.

Source: Smokefree NHS.

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AIM

The aim is to promote the awareness of the risk associated with smoking among

London Metropolitan Students.

OBJECTIVES

By the end of this intervention, I will identify 5 places in the community where

useful information on how to stop smoking can be sought.

State 5 health benefits associated with quitting smoking.

LITERATURE REVIEWS

A total number of 8 literature reviews were identified using the relevant search

method. Where the topics covered in the review were similar, the most recent

one was used hence 6 reviews are included here.

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AUTHORS TITLE METHODOLOG OUTCOMES/ SUMMARY
Y RESULTS
ASH 2014 Stopping A quantitative The number To assist
http://www.ash.o smoking. data was used of people every smoker
rg.uk/files/docu The to measure the using stop to quit
ments/ASH_116.p benefits & prevalence of smoking smoking
df aids to risks of services grew
Accessed quitting smoking. to over
15/02/2015 800,000 in
2012
https://www.gov.Local stop An informative In 2010/11, A system
data was used 787,527 could be set
uk/government/u smoking
to inform treated up to re-
ploads/system/u services – people smoker engage with
episodes were unsuccessful
ploads/attachme Monitoring
recorded by quitters,
nt_data/file/2169 and local stop- attracting
smoking them back to
27/9193-TSO- guidance
services, the service at
2900254-NHS- update resulting in a later date or
offering an
Stop- 2012/13 383,548 self-
alternative
reported
Smoking_Accessib treatment.
quitters at four
le.pdf weeks
Accessed
15/02/2015
http://www.hscic Statistics on A quantitative 73 per cent of This report
NHS Stop report which successful includes
.gov.uk/searchcat
Smoking includes quitters at the information on
alogue?productid Services, information on 4 week follow- the number of
=12896&topics=1 England - the number of up had their people setting
April 2013 people setting a results a quit date and
%2fPublic+health quit date and confirmed by the number
%2fHealth+prom the number Carbon who
who successfully Monoxide (CO) successfully
otion&sort=Relev quit at the 4 verification quit at the 4
ance&size=10&pa week follow-up week follow-
up
ge=1#top

9
Accessed
15/02/2015
NICE 2010 A qualitative Integrate To produce
School- data was used information public health
http://www.nice.
based about the guidance on
org.uk/guidance/ health effects school-based
interventio of tobacco
ph23/chapter/2- interventions
ns to use, as well as to prevent the
public-health- the legal, uptake of
prevent economic and
need-and-practice smoking
smoking social aspects among
Accessed of smoking, children and
into the
15/02/2015 young people.
curriculum.

Department of Healthy A quantitative People Smoking

Health (2011) Lives, approach was diagnosed prevalence
Healthy Lives, Healthy used to with cancer is has fallen
Healthy People: A People: A measure the predicted to little since
tobacco control Tobacco prevalence and 2007 so new
rise more than
plan for England. Control risk of smoking action needs
3% a year
https://www.gov. Plan for to be taken to
uk/government/u England drive smoking
ploads/system/u rates down
ploads/attachme further.
nt_data/file/2137
57/dh_124960.pd
f
NHS 1999, Effective A qualitative The Effective
University of York, Health data was used programmes healthcare
UK. Care to present their included summaries
http://www.york.a preventing findings training to the research
c.uk/inst/crd/EHC/ the uptake recognise the evidence on
ehc55.pdf of smoking pressures to approaches to
Accessed in young smoke or not preventing the
15/02/2015 people to smoke and uptake of
some form of smoking in
education young people.

10
Ethical Consideration

This promotion intervention involves primary data collection from individuals

and therefore becomes important to consider the relationships with others in

the society. Autonomy is defined as ‘respect for the individual to make his or

her own decisions according to their beliefs and values and empowering them to

make their own decision’ (Charles, Gafni and Whelan, 1997). It is derived from

the Greek word autonomous meaning self-rule. Ethical considerations must be

considered when examining the issues of the right to smoke. One must always

remember that the smoker has a right to smoke and therefore their legal right to

make a choice. As the health promoter, it is my responsibility to interact with the

students and provide them with all the information about the risks associated

with smoking and then allow them makes their own choices/decisions, which is

consistent with their personal values and beliefs. If the student decides to stop

smoking it then means they decided to do so with a sense of choice and personal

support.

Beneficence is the next step in maintaining the autonomy of the student, but it is

also the primary responsibility of the health promoter to provide the best option

in the interest of the student..

Students will be treated equally avoiding any form of discrimination. This will be

done by providing same questions throughout the questionaire without regard

were 10 participants (5 male and 5 female) and each were given same

questionaire which covered the risk associated with smoking, the health benefits

derived when quitting smoking and useful places in the community where help

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to quit smoking can be sought. The anonymity of the students were emphasized

and confidentiality was stirctly maintained on all questionaires.

The questions were developed from the relevant literature and there were also

leaflets which were distributed. The leaflets was a channce to get the message

delivered to them persuasively.

The post-questionnaire will be distributed after the presentation to evaluate the

intervention.

RESULT

Table one is the result of individual questions given to 10 students which is to

state 5 risks associated with smoking, identify 3 places in the community where

help and information on risks associated with smoking can be sought and to

state 5 health benefits for quitting smoking.

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PRE-INTERVENTION QUESTIONNAIRE

Table 1

QUESTIONNAIRE NUMBER OF PERCENTAGE

STUDENTS %

State 5 risks associated with 4 40

smoking

Identify 3 places in the community 3 30

where help and information on
risks associated with smoking can
be sought
State 5 health benefits for quitting 3 30
smoking

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POST-INTERVENTION QUESTIONNAIRE

Table 2

The post-intervention questionnaire had exactly the same questions as in the

pre-intervention questionnaire. Same questions were posted in the same

sequence and a few minutes after the pre-intervention and talking sessions.

QUESTIONNAIRE NUMBER OF PERCENTAGE

STUDENTS %

State 5 risks associated with 7 70

smoking

Identify 3 places in the community 4 40

where help and information on
risks associated with smoking can
be sought
State 5 health benefits for quitting 8 80
smoking

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POLICIES

The London Metropolitan University does not have a coherent policy on smoking

on the campus. It is only in classrooms and the library that smoking is

disallowed. Students who smoke sometime share a cigarette during their breaks.

According to DH (2013), the Government wants to reduce smoking rates to

18.5% or less for adults (compared to 21.2% for April 2009-March 2010) –

meaning around 210,000 fewer smokers per year, 12% or less for 15 year olds

(compared to 15% in 2009) and 11% or less for pregnant women, measured at

the time given birth (compared to 14% over 2009 to 2010).

The Government has also banned TV and press advertising of tobacco but

cigarettes are still on display on shelves in smaller shops. The government plans

to ban eye-catching display of cigarettes in all shops from April 2015. They are

already banned in supermarkets.

The government will also continue to set tax rates high enough to discourage

people from smoking.

CONCLUSION

This health intervention has shown the rate of smoking not only among

undergraduates of London Metropolitan University but in other UK Universities.

Tobacco still remains one of the leading causes of death worldwide annually. It

is therefore important to come up with a prevention programme to help reduce

the incidence of cigarette smoking.

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BIBLIOGRAPHY
ASH (2014) Smoking Statisrics, London: Action on Smoking and Health. Available at
http:/ http://www.ash.org.uk/information/facts-and-stats/fact-sheets, accessed 15
February 2015.

Charles, C., Gafni, A. and Whelan, T. (1997). Shared decision-making in the medical
encounter: what does it mean? (or it takes two to tango). Social Science and Medicine,
44(5), pp.681-692.

DH, (2010) Tobacco

http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthi
mprovement/Tobacco/index.htm, accessed 15 February 2015

Fuller, E (ed). (2011) Smoking, Drinking and Drug Use Among Young People in England
in 2010. London: NHS Information Centre

Macleod, C and Haverty, S. (1992). Smoking cessation the health professional’s role.
http://www.google.co.uk/#hl=en&tbo=d&sclient=psy-
ab&q=2.3.3+Smoker%27s+cLINICS&oq=2.3.3+Smoker%27s+cLINICS&gs_l=serp.3...2081
8.42011.0.42417.28.25.3.0.0.0.219.3064.4j20j1.25.0.les%3B..0.0...1c.1.3.psy-
ab.gtqPdICKfYI&pbx=1&bav=on.2,or.r_gc.r_pw.r_qf.&fp=351d3163f681acd7&biw=1024&
bih=563, accessed 15 February 2015

Naidoo, J. and Wills, J (2004) Health Promotion foundations for practice. Balliere Tindall and
Royal College of Nursing, London.

NHS 1999, University of York, UK.

http://www.york.ac.uk/inst/crd/EHC/ehc55.pdf accessed 15/02/2015

https://www.gov.uk/government/policies/reducing-smoking accessed 15 February

2015

http://www.ash.org.uk/files/documents/ASH_597.pdf accessed 15 February 2015

http://www.ash.org.uk/files/documents/ASH_116.pdf Accessed 15 February 2015

http://www.nice.org.uk/guidance/ph23/chapter/2-public-health-need-and-practice
Accessed 15/02/2015

http://www.hscic.gov.uk/searchcatalogue?productid=12896&topics=1%2fPublic+healt
h%2fHealth+promotion&sort=Relevance&size=10&page=1#top

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216
927/9193-TSO-2900254-NHS-Stop-Smoking_Accessible.pdf
Accessed 15/02/2015

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Pre-Intervention Questionnaire

A health promotion intervention to promote the awareness of the risks of

smoking among undergraduates at London Metropolitan University

State 5 risks associated with smoking

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Identify 3 places in the community where information on how to quit smoking can
be sort?

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State 5 health benefits for quitting smoking

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Post-Intervention Questionnaire

A health promotion intervention to promote the awareness of the risks of

smoking among undergraduates at London Metropolitan University

State 5 risks associated with smoking

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Identify 3 places in the community where information on how to quit smoking can
be sort?

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State 5 health benefits for quitting smoking

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 CONSENT FORM

PROJECT TITLE:

A Health Promotion Intervention To Promote The Awareness Of The Risks Of Smoking Among
Undergraduates at London Metropolitan University

PROJECT SUMMARY: An intervention to promote the Awareness of the risks of smoking and the
effects it has on the health of undergraduates at London Metropolitan University.

By signing below, you are agreeing that: (1) you have read and understood the
Participant Information Sheet, (2) questions about your participation in this study
have been answered satisfactorily, (3) you are aware of the potential risks (if any),
and (4) you are taking part in this research study voluntarily (without coercion).

_________________________________
Participant’s Name (Printed)*

_________________________________ _________________________________
Participant’s signature* Date

_______________________________ _________________________________
Name of person obtaining consent (Printed) Signature of person obtaining
consent

*Participants wishing to preserve some degree of anonymity may use their initials (from the
British Psychological Society Guidelines for Minimal Standards of Ethical Approval in
Psychological Research)

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 PARTICIPANT INFORMATION SHEET

Dear Students,

You are invited to take part in an intervention to promote the Awareness of the risks of smoking
and the effects it has on the health of undergraduates at London Metropolitan University.

.it will take place in STUDIO ROOM 6 AT THE UNIVERSITY TOWER BUILDING AT 12.30PM
TO 13.30PM.

(You will be asked to take part in a questionnaire, please note that consent forms will be
presented on the day for participants to fill out)

By Olubunmi Odeseye

Id No: 12058198

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