Tobacco consumption behavior of nursing students (n = 432)

Attitudes and Beliefs toward Tobacco Control

[Table 2] summarizes the findings regarding the students' attitudes toward tobacco control by their smoking status. Fifty-seven (13.2%) of the students reported that there was no policy that forbids smoking in school buildings and clinics and 151 (35.0%) stated that the policy was not enforced. Compared with non-smokers, a higher proportion of smokers believed that the policy existed and was enforced in the campus, but these differences were statistically not significant. With regard to their beliefs toward tobacco control policies, non-smokers were more positive toward banning smoking in restaurants [333 (84.5%) vs. 26 (68.4%), p <0 class="i" xss=removed>p <0 class="i" xss=removed>p <0>

Nursing students' demographic characteristics and attitudes toward tobacco control by their current smoking status

Educational Training on Smoking and Smoking Cessation

[Table 3] depicts nursing students' educational training on tobacco control by their smoking status. The differences in responses to questions like “were you taught about dangers of smoking,” “did you discuss the reasons why people smoke,” and “have you heard of using antidepressants in tobacco cessation” between smokers and nonsmokers were statistically significant whereas no statistically significant differences were identified in the responses for other questions indicating similar levels of training and understanding.

Nursing students' educational training on tobacco control by their current smoking status (positive responses)

Factors Associated with Current Smoking Status

[Table 4] presents the multivariate logistic regression model showing the possible factors associated with the current smoking status of nursing students. After adjustment of confounders, variables like male gender (adjusted OR: 6.53, 95%-CI: 2.61–16.36), not supporting a smoking ban in discos/bars/pubs (adjusted OR: 2.82, 95%-CI: 1.13–7.05), lack of knowledge about dangers of smoking (adjusted OR: 2.48, 95%-CI: 1.10–5.60), and not discussing the reasons of smoking (adjusted OR: 2.49, 95%-CI: 1.05–5.93) had shown significant associations with the current smoking status of nursing students.

Multivariate logistic regression analysis showing factors associated with current smoking status of nursing students

Discussion

The present study shows a prevalence of current smokers of 8.8%, higher than the country figure of 3.4%-reported in a study conducted in 2007.[15] and this may be attributed to stress, peer influence, and curiosity. Given the rise of prevalence of smoking among Indian nursing students and the key role of these health professional students as future behavioral models and counselors, more attention should be focused on smoking cessation training of nursing students. More than 80%-of the respondents had tried their first tobacco use before reaching the age of 20 years, indicating the importance of initiating interventional measures during adolescence. Nearly 70%-of the students currently using tobacco reported that they want to quit, which is comparable with the national figure.[15] Thus, it can be inferred that with timely intervention, many students can be saved from falling prey to tobacco. Our study revealed that more than half of the respondents were exposed to secondhand smoke in living places and public places, which is higher than the national figures.[15] This indicates ineffective implementation of the smoking ban in the region. Also, nearly 75%-of the students were of the view that policy banning smoking was not enforced on school premises, again indicating complacency in implementation despite the policy existed. In our study, concerning attitudes and beliefs, nonsmokers appeared to be more active than smokers in smoking cessation counseling. This is consistent with the results of previous literature.[16] [17] [18]

Compared with the results reported in earlier studies,[15] [19] [20] our study showed that a higher proportion of nursing students had received any formal training in smoking cessation approaches. In this study, we observed that 91%-of students thought that health professionals should get specific training on cessation techniques. Similar findings have been reported in other GHPSS studies.[15] [20] [21] As nurses are the largest group of health care professionals and spend more time with the patients, they can adequately contribute to health promotional activities. They can effectively counsel their patients about smoking cessation techniques and persuade them to stop tobacco use.[13] Thus, it is imperative to put more emphasis on smoking cessation techniques in the nursing curriculum and there should be sincere efforts to train 100%-of nurses on tobacco cessation approaches. There is evidence that nurses who had received training were more likely to perform tobacco control interventions than untrained nurses.[22] Also, nursing students' knowledge of intervention methods for tobacco cessation such as nicotine replacement therapies and the use of antidepressants could be further improved by improving the content of the current nursing curriculum on tobacco cessation. Sarna et al reported in their study that nurses in Asian countries may not be adequately trained to help tobacco users to quit as the curriculum does not offer appropriate training related to tobacco cessation interventions.[6]

In agreement with our findings, males were more likely to smoke than females in previous studies.[16] [23] [24] Our study revealed that compared with nonsmokers, smokers were more unlikely to support the fact “smoking should be banned in discos/bars/pubs.” This is consistent with the result reported in an earlier study.[20] Similarly, Brar et al in their study conducted on medical students observed that more nonsmokers were supportive of banning smoking in discos/bars/pubs.[24] In our study, students who were taught about the dangers of smoking appeared to have a lower probability to be a smoker. Also, those who discussed the reasons why people smoke were less likely to be smokers. This is supported by the findings of a previous study.[20] This indicates that knowledge about smoking and its dangers might prevent nursing students from being a smoker.

In interpreting our results, the main limitations of the study should be addressed. First, the design of our study was cross-sectional and thus causality of association cannot be established. Second, there is a risk of underreporting and recall bias due to self-reported data. Also, the population split in the study was leaning more toward female students than males and this might lead to bias in the findings of the study. However, the study provides relevant information regarding tobacco consumption behavior, attitudes, and educational training of nursing students. The multicentric nature of the study increases the generalizability of the findings of our study. Furthermore, as the survey was anonymous and completely voluntary, it can be assumed that smoking status was reliably captured. Further research in diverse geographical settings is needed to establish the findings of our study.

Conclusion

The prevalence of current smoking among nursing students studying in nursing colleges of Bhubaneswar is 8.8%. The study findings indicate that smoking prevalence among the nursing students might be reduced by helping students develop a positive attitude toward smoking ban in discos/bars/pubs, teaching them about the dangers of smoking, and discussing the reasons of smoking during their school training.

Conflict of Interest

None declared.

Source(s) of Support in the Form of Grants, Equipment, Drugs, or all of These

None.

Authorship Statement

The manuscript has been read and approved by all the authors, that the requirements for authorship have been met, and that each author believes that the manuscript represents honest work.

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Publication History

Article published online:
18 April 2022

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