Smoking causes various morbidity and mortality chronic bronchitis, cerebral stroke, ischemic heart disease, laryngeal cancer, low birth rate, lung cancer, and so on (Suzuki et al., 2005). According to the tobacco control state highlights, 2010, smoking is one of the most preventable causes of death and diseases in the US. In Singapore, the prevalence of daily smokers, aged 18 to 69 years, was 21.8% in males and 3.5% in females as reported by National Health Survey, 2004. Therefore, encouraging anti-smoking campaign would promote the healthy lives of people. On the other hand, studies suggested that nurses smoke as the same rate as other people of similar age and socio-economic status. (Hughes & Rissel, 1999; Rowe & Macleod Clark, 2000). Nurses are the health-care providers who are mostly in contact with the people and patients and thus they have to be the role model. When nurses are smoking, they will not be able to dissuade the patients from smoking. This will in turn affect the commencement of smoking cessation programs, health promotion program against smoking and so on. As such, it is important to know the beliefs and attitudes of the youth to create effective preventive smoking programs. Upon the results and findings, prevention of smoking and smoking related health problems will be modified and launched properly in the community.
The purpose of this literature review is to determine the students' attitude and beliefs towards smoking, to know the correlation between the knowledge about smoking related diseases and smoking behaviors.
Beliefs and attitude towards smoking
The study of youth's beliefs and behaviours in Malaysia and Thailand suggested that to predict the smoking behaviours among the youth, it is important to know the youth's beliefs about smoking. Parent's behaviour such as approval or disapproval of children's smoking is shown as a good predictor of youth's behaviours.
According to Parkison. et al., 2009, there is another belief called "aesthetic belief" which are like the believe smoking make them look sexy, matured, or cool. This study showed that among males and females youth, males were more likely to think that smoking make them attractive and modern than female were. To sum up, males have higher positive aesthetic beliefs than female both in Malaysia and Thailand.
In addition, the studied also did review on the antismoking media and beliefs about smoking among the youth of Malaysia and Thailand. They suggested that antismoking media will play an important role to change the beliefs about smoking among the youth. The more the exposure to the information on the harmful effect of smoking, the less positive beliefs towards smoking will be (Parkison et al., 2009)
According to the study done by Clark, et al., 2004, the persons who smoke are less likely to show strong attitude towards supporting the rights of non-smokers than those who do not smoke. Some of the studies reviewed by Pericas et al., 2009 also showed that non-smokers supported the tobacco restriction laws than the smokers did (Clark et al., 2004 & Rigotti et al., 2003).
When there is a lesser degree of positive attitude towards smoking, the attitude towards smoking can be changed as well. This is one of the factors that we can look into in order to dissuade youths from smoking or persuade smoking cessation.
Knowledge about smoking related risks
It is always important to find out the correlation between the knowledge about harmful effect of smoking and smokers' behaviors. A study done by Clark. et al., 2001 in an Australian university, has shown that the level of specialized knowledge about smoking related diseases were high in those who quitted smoking than those who were the current smokers and non-smokers.
There was minimal association between levels of knowledge and attitudes about being sensitive to smoking-related health risks. It is stated after some articles and studies are reviewed and resulted as there is no significant difference in knowledge about consequences of smoking between smokers and non-smokers. Knowledge about the effects of smoking is not related to attitudes about the habit in nursing students (Clark. et al., 2004). It is also said that knowledge of a smoker on health risk was not helpful in quitting (Morrell et al., 2008).
In the nationwide survey study done in Japan about smoking, it was concluded knowing the consequence of smoking did not stop the smokers from smoking (Suzuki. et al., 2005).
If a person has knowledge about the consequences of doing something, he or she tends not to do that. However, the above findings showed that there is not significant relation between knowledge and the students' smoking habits or the smokers have more knowledge about smoking related diseases. These findings are explained by Festinger's theory of cognitive dissonance in the study done by Clark et al., 2004 and the study done by Pericas et al., 2009.
According to Festinger's theory 1957, an individual needs to have coherence in their beliefs. If there is an incongruent belief within oneself, he or she will try to maintain coherence or consonance. Cognitive dissonance occurs when there is a psychological stress caused by the incoherence of beliefs within oneself. For instance, it happens when knowing that smoking is harmful to the people around as well as oneself believing that smoking is harmful and at the same time feeling that smoking helps him or her relax. Cognitive dissonance results in making a person to ignore or think less about the harmful effect of smoking. In the future, anti-smoking programs can be modified based on this finding especially cognitive dissonance.
It has been shown that patient are less likely to take advice to quit smoking from health care professionals who smoke and more likely to take advice from those who do not smoke.
Those who smoke are less likely to advocate the smoking cessation; and thus awareness on smoking should be targeted or greatly emphasize on the primary healthcare providers (Pericas, 2009).
To conclude, there is a need for nursing students so as to encourage effective anti-smoking behaviors since before they go out to the work place. The more we put effort towards anti-smoking, the lower the prevalence will be and hence will promote the professional standard to create a healthier and better community.
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