NURSING RESEARCH 1

GROUP 1:

Malao, Ryan Clyde B.

Pablo, Cecil C.
Macli-ing, Jhoy A.

Instructor: Sir Hoover Agyao

OBSTACLES TO SMOKING CESSATION: Struggles, Barriers, and the role of the health care
providers in encouraging smoking cessation.

INTRODUCTION

HISTORY

In 6000 B.C. in Central America tracked the origin of the tobacco plant. But by 1
B.C., the plant had spread all over America and used by the Indigenous People in any
ways for various purposes. The natives were the one who found out that the leaves
could chew, smoke in the pipes, and also use tobacco enemas. It was done for religious,
ceremonial and also medicinal purposes.

Christopher Columbus discovered and landed in the New World (America),

where they were able to witness the native people smoking tobacco and tried and enjoyed
the experience and took tobacco with them in Europe. However, most of the Europeans
do not appreciate the taste of tobacco until mid-16th century, when adventurers and
diplomats like France’s Jean Nicot, named nicotine and began to be known for its use.
Then, tobacco was introduced to other country like France, Portugal, and Spain and
England. By 1700s, smoking had continually more expanded and tobacco industry was
more developed.

In the late 1800s, cigarette making machines were developed. It can make about
200 cigarettes per minute.During the Civil War, the cigarette machine helped create
cigarettes and boost production. So, in 1913, the modern cigarette was introduced to
society. Until around early 1930s and late 1970s, the number of users increased including
women. In the early 20th century, the widespread of cigarette smoking continued to grow
because of the development of new forms of tobacco promotion and the ability of the
tobacco industry through its power and wealth to influence the policies of political party.
However, later in the 20th century, smoking became less depressed due to the knowledge
of the individual about the negative effects to health from both the user and non-user of
cigarette.
 After the Spaniards found out about the people were already planting tobacco,
they experimented on the tilling of tobacco to the places they colonized. Upon invading
the Philippines, they planted tobacco because they saw the potential of becoming affluent
while gaining big income for Spain and could give a good income to the Spanish
government in the Philippines. The Filipinos in Ilocos Region and in Cagayan Valley was
forced, abused and maltreated to plant tobacco. However until now, the habit of smoking
and chewing tobacco and the knowledge and skills to grow the plant stayed with the
Filipino people.

Place where tobacco plantation is in active here in the Philippines

According to the Cross Statistics of the Philippines from 2013-2017, the abaca
production has increased in an average annual rate of 1.5 percent. Bicol region, Eastern
Visayas, Davao Region, Caraga and Autonomous Region of Muslim Mindanao are the
places where they plant tobacco.

Philippine Government data show that the substantial part of tobacco production
in the country takes place in the northern provinces of Luzon, with CAR, Region 1 and
Region 2 collectively accounting for 90% of both total land area and quantity produced
(PSA 2013).
n= population size

Region Province Municipality n

LUZON

Cordillera Administrative Region (CAR) Abra Pilar 15

Badoc 14
Batac 16
Pasuquin 4
Ilocos Norte
Pinili 19
Vintar 3
Cabugao 16
Candon 22
Narvacan 13
San Emilio 12
Ilocos Sur Santa Cruz 14
Santiago 16
Region 1: Ilocos Region Sinait 16
Sta. Maria 4
Balaoan 17
Bauang 15
 La Union Sto. Tomas 3
Alcala 9
Pangasinan San Fabian 11
Villasis 7
Alcala 6
Cagayan Amulung 17
Tuao 13
Aurora 11
Region 2: Cagayan Valley
Isabela Cabagan 11
Quirino 14
Roxas 22
Region 4B: MIMAROPA Mindoro San Jose 15
VISAYAS

Region 6: Western Visayas Iloilo Pototan 5

Region 7: Central Visayas Negros Oriental Guihulngan 11
MINDANAO

Region 10: Northern Mindanao Alubijid 13

Misamis Oriental Gitagum 15
Laguindingan 22

TOTAL 421
Source: The economics of tobacco farming in the Philippines

BACKGROUND

Cigarettes are small cylinders filled with tobacco leaves that is finely cut and
wrapped in thin paper. It contains nicotine and many cancer-causing chemicals that are
harmful to both smokers and nonsmokers, according to National Cancer Institute. What
does this mean? Not only those who are users or smokers can develop and acquire
diseases that caused by the content of the tobacco, but also those who are not users or
non-smokers, which can be deadly to both sides. Smoking gives disease and disable and
harms closely every organ of the body.Cigarettes are addictive. Why? Nicotine causes the
smokers to become addicted and chemical substance itself is deadly even in a small
doses. When the tobacco smoke is being inspired into our body, the nicotine passes
directly to every organ.

According to WHO, tobacco took lives of more than 8 million people each year,
where more than 7 million passed away are the result of direct tobacco use and around
1.2 million are the result of non-smokers who are being endangered to second-hand
smoke. Why? Smoking cigarettes which may lead to nicotine addiction and can cause
many types of cancer, including cancers of the lung, larynx, mouth esophagus, throat,
kidney, bladder, pancreas, stomach, and cervix, and acute myeloid leukemia. Also, it
causes other health problems, including heart disease, stroke, and lung diseases, such as
emphysema and chronic bronchitis (National Cancer Institute). Not only that, but also
diabetes and also increases risk for tuberculosis, certain eye diseases and problems of the
immune system, including rheumatoid arthritis, according to Centers for Disease Control
and Prevention. Approximately 12 percent of all heart disease deaths due to tobacco use
and exposure to secondhand smoke from the data shown by the WHO.

How about those who are not smoking but exposed to smoke or what we call
second-hand smoke? Second-hand smoke is the smoke which we can inhale from
restaurants, public areas and even offices especially those closed spaces. No one is safe
and excused who is with someone smoking tobacco. It can cause serious cardiovascular
and respiratory diseases like coronary heart disease and lung cancer, especially in adults
because they have low and compromised immune system. Also with pregnant women
which it may cause their pregnancy complications and low birth weight. In infants, it may
increase the risk and prone of sudden infant death syndrome. Additionally, it causes of
more than 1.2 million of premature infants deaths per year and 65 000 children die each
year from illnesses related to second-hand smoke.

According to Department of Health (DOH), Philippines is one of 15 countries

worldwide with a heavy responsibility of tobacco-related ill health, which is 87, 600
Filipinos die annually from tobacco-related diseases. Top cause of death related to
cigarette is the ischemic heart diseases or the “hardening of arteries” results of more than
74,000 cases recorded from 2016. Additionally, the Philippine Statistics Authority noted
five other non-communicable diseases related to smoking as the top reasons of mortality
and morbidity among Filipinos namely, cancers, stroke, hypertension, diabetes mellitus
and other heart diseases, which are known as the strong connection to the risk factors is
the tobacco use.

Despite of the negative effects of the tobacco to one’s health, the production of
tobacco is still active. Also, even if how much the government warned the users by
increasing the taxes and attaching pictures that may destroy their health and making laws
to control the use of tobacco, still individuals are smoking.However, according from the
records of the Philippine Statistics Authority and DOH disclosed that 14.7 percent of the
country’s 108 million population or 15 million Filipino smokers have sustained their
habit despite the campaign against smoking.

Though, it is very difficult to break the habit, smoking is really one’s choice. It is
the individual itself will decide on whether or not to smoke. This article provides
 information about the risks related to smoking, an overview of nicotine addiction,
including why it is difficult to stop, and an outline of the advantages and disadvantages of
quitting smoking. When you have decided to quit, you will gain the information in this
research about the physiological, psychological and behavioral aspects of nicotine
addiction, the other methods available to help you quit, and the steps you can do to make
the process easier. Having an idea about and understanding the numerous facets of the
smoking habit can put you on the proper track to successful smoking cessation.

STATEMENT OF THE PROBLEM

With the given background of smoking, it is very essential for the smokers to be aware of
the health hazards brought by smoking. Furthermore, health care providers are the front liners in
convincing the individuals and give them motivations to stop smoking that’s why they should
understand:

1. What causes a person to smoke?

2. What are their barriers to smoking cessation?
3. What are the advantages and disadvantages of quitting?
4. What are the role of health care providers in promoting and supporting smoking
cessation?
5. What are the treatments available to help the smokers in overcoming their addictions?

Research Methodology

This chapter presents the research design, instruments used in data gathering, data
gathering process, data analysis, population and locale of the study and the treatment of data.

Research Design

Qualitative research was used in this study; which aims an in-depth analysis and research.
It mainly focused on gaining insights, reasoning, and motivations. We conducted qualitative
focus group which was done in a group discussion setting and face – face interview with
continuing smokers.

Instruments Used in Data Gathering

Participants were screened in order to verify motivation level to quit smoking using the validated
Readiness to Quit Ladder [Biener L, Abrams DB: Contemplation Ladder: validation of a
measure of readiness to consider smoking cessation]; a scale of items 1-10 (‘I have quit
smoking’ to ‘I have decided not to quit smoking for the rest of my life, I have no interest in
quitting’). It was decided to classify those with a score of below 6 as having low motivation to
quit, and those with a score of 6 and above as having high motivation to quit. Participants also
completed a short baseline questionnaire designed to gather more data needed in our research.

We also used face to face interview, in order to develop and explore the variety of factors
in assisting and identifying the characteristics and attitudes of both smokers with high and low
motivation to quit and details of plans to continue or quit smoking and evaluate their beliefs
about smoking, and some other factors intended to understand why smokers continue to smoke,
and methods which may give them motivations to quit  (talked about the influence of the policy
such as taxation of cigarettes and the impact of this on motivation to quit). The discussions that
are included are; reasons for smoking, attitudes towards smoking and quitting, motives for
quitting, advantages and disadvantages of smoking, and barriers to quitting.

Data Gathering Process

We gathered 50 students who are smokers from CCDC, aged 18 - 21 who were not
currently engaged in quit attempts, but had varying levels of motivation to quit in the future
and other 50 respondents were recruited from the residents of CentalPobllacionBuyaganaged
30 and above who are long term smokers.

We conducted an initial visit to our respective targets prior to arranging date and time for
the focus group in order to complete baseline questionnaire and for them to be screened
according to their motivation score which was categorized whether low motivation smoker or
high motivation smoker. Some participants may not be confident in speaking with the group so
therefore; we included face-to-face interviews with both groups of smokers, to let participants
speak freely about their experiences in a more confidential manner. Focus groups and individual
interviews were indeed useful to address the research question. Both focus groups and interviews
took place at publically accessible locations for participants including community center
(Buyagan Elem. School and CCDC).

Focus group lasted for about 50 minutes, and interviews for approximately 15-30
minutes, and were recorded using a mobile phone. We followed the interview schedule to cover
pre-defined topic for discussion, and allowed for other ideas to emerge freely in both focus
groups and interviews.

DATA ANALYSIS

Focus group and interview data were analyzed based from the thematic Framework
Analysis [Ritchie J, Lewis J. Qualitative research practice. London: SAGE Publications Ltd;
2003,Qualitative research in health care. Analyzing qualitative data, Pope C, Ziebland S, Mays
N, BMJ. 2000 Jan 8; 320(7227):114-6] to allow for themes to come out from the data, together
with analyzing pre-existing concepts (such as differences in motivation level).We considered
separating analysis of focus groups and interviews; though, in view of the identical research
question and pre-defined themes explored, this came out to yield little more than formal value,at
the same time as maintaining awareness of this context, data were thus analyzed together, using
an overarching framework. Analysis involved transcribing each interview by familiarizing with
the data and by readingthe transcripts multiple times. The themes that were define earlier and
emerging key points were developed into a thematic framework table, where each main point
was divided into sub-points which were then coded in the transcripts. Analysis was undertaken
manually, and in order to classify within which group of participants each point occurred, the
synthesized and charted transcript data into the table with each key point containedinformation
of each participants’ response to it. Interpretative analysis [Ritchie J, Lewis J. Qualitative
research practice. London: SAGE Publications Ltd; 2003] involved grouping together same key
points to seerepeated themes which revealed attitudes towards smoking and quitting in both
groups, and any differences which occurred between the two groups.

LOCALE AND POPULATION

Poblacion is situated in the Central part of the Municipality of La Trinidad. It is bounded

in the South by Barangay Betag, in the East by Barangay Cruz, in the West and North by the
Barangay Wangal and by the Barangay Puguis in the Southwest. The Barangay has an estimated
land area of 104.6614 hectares, which comprises 1.29% of the municipality of La Trinidad’s
total land area. It is the eleventh largest Barangay or the 6th smallest one, whichever one prefers
to describe. Its land use has been categorized into residential, agricultural, institutional, water or
rivers abdcreeks, commercial and forest land. Being the second most densely populated
Barangay, most of the land in the area is used for residential. The propped land use is distributed
equally based on the needs of the population. It allotted more area for residential to compensate
the increase in population but agricultural land use assumed to be constant.