Chapter 1

Introduction

1.1 Background of the Study

Smoking is one of the most important preventable health problems in the world. It causes
disease, disability, and early death, but it can be reduced through proper knowledge and
timely health education. Studies from different settings show that young adults often
begin smoking because of curiosity, peer influence, stress, family smoking, easy
availability of tobacco products, and the belief that smoking is a sign of maturity or
relaxation (Fente et al., 2023; Patel, 2022; Anam et al., 2022). This makes smoking a
significant public health concern at the global level.
At the global level, research has shown that many young adults have only partial
knowledge about the harmful effects of smoking. For example, Fente et al. (2023)
reported that most young adults in Nigeria were aware that smoking is harmful, but some
still had incomplete knowledge about its wider health consequences. Kumar et al. (2024)
also found that although many students in India had awareness of smoking hazards, gaps
still remained in their understanding of tobacco-related risks. Likewise, Oke et al. (2024)
reported that even young public health advocates had limited understanding of tobacco
harm reduction and smoking cessation communication. These findings show that
awareness about smoking is not always complete, even among educated young people.
At the national level, Bangladesh continues to face a substantial tobacco burden. Anam et
al. (2022) found that current tobacco smoking was present among undergraduate
students, with a higher prevalence among males, and that non-smokers had better
knowledge than smokers about the harmful effects of smoking. Islam et al. (2025) also
reported that university students in Bangladesh had only moderate knowledge regarding
smoking-related exposure and health risks. Rahman and Gietel-Basten (2024) found that
among rural youth in Bangladesh, satisfactory knowledge was associated with a lower
likelihood of smoking. These findings indicate that knowledge about smoking remains
uneven and that many young adults in Bangladesh still need more effective health
education.
At the local level, young adulthood is a critical stage for health decision-making. During
this period, many individuals become more independent, enter college or work, and face
new social pressures. Some young adults start smoking due to curiosity, stress, peer
influence, family smoking, or misinformation about tobacco use. Once nicotine
dependence develops, quitting becomes more difficult. Therefore, knowledge regarding
smoking is important because it can help young adults understand the harmful effects of
smoking, the diseases caused by smoking, the addictive nature of nicotine, and the
benefits of quitting (Patel, 2022; Kumar et al., 2024; Rahman & Gietel-Basten, 2024).
The present research focuses on the influence of knowledge regarding smoking among
young adults. The study is important because it can show whether better knowledge is
linked with safer smoking-related behavior. If young adults understand the harmful
effects of smoking clearly, they may be less likely to start smoking, may avoid tobacco-
related risk, and may make more informed health choices. Nurses and other health
workers also have an important role in providing health education, counselling, group
discussion, role play, and community awareness programs for young adults (Patel, 2022;
Oke et al., 2024).
1.2 Statement of the Problem
Smoking among young adults is a serious and preventable health risk. Many young adults
know that smoking is harmful, but some of them do not know the full range of diseases
caused by smoking or the strong addictive nature of nicotine. Some young adults may
also have wrong ideas, such as smoking reducing stress, occasional smoking being
harmless, or tobacco use being socially acceptable.
There is a need to assess how knowledge regarding smoking influences young adults.
Without knowing their level of knowledge and the factors linked with smoking behavior,
it is difficult to plan proper health education. The findings of the study can help nurses,
teachers, families, and community health workers to design better awareness programs.
Therefore, the problem of the present study can be stated as: “A study to assess the
influence of knowledge regarding smoking among young adults in selected area.”
1.3 Objectives of the Study
The objectives of the study are divided into general objective and specific objectives.
General objective:
To assess the influence of knowledge regarding smoking among young adults.
Specific objectives:
• To assess the level of knowledge regarding smoking and its harmful effects among
young adults.
• To identify the influence of knowledge on smoking-related behavior among young
adults.
• To find the association between knowledge regarding smoking and selected socio-
demographic variables such as age, gender, education, family history of smoking, and
peer influence.
• To suggest suitable health education measures for improving knowledge and preventing
smoking among young adults.
1.4 Hypothesis
The following hypotheses may be used for the study:
• H1: There is a significant influence of knowledge regarding smoking on smoking-
related behavior among young adults.
• H2: There is a significant association between knowledge regarding smoking and
selected socio-demographic variables of young adults.
• H0: There is no significant influence of knowledge regarding smoking on smoking-
related behavior among young adults.
1.5 Scope and Delimitations of the Study
The scope of the study is related to young adults and their knowledge regarding smoking.
The study can be useful in college, community, hostel, and urban or rural settings where
young adults are found. It covers knowledge about the harmful effects of smoking,
nicotine addiction, quitting benefits, and the role of health education. The study can also
help to understand whether knowledge is linked with smoking-related behavior.
The study has value for community health nursing because nurses often work with young
people, families, and communities. The findings can support health education programs,
campus awareness sessions, and counselling services. It can also provide a base for future
studies on smoking prevention, tobacco control, and behavior change among young
adults.
The study is delimited to young adults who are included in the selected area at the time of
data collection. It may use a structured questionnaire to collect information. The study
may not include detailed clinical testing, biochemical testing, or long-term follow-up.
The answers may depend on self-report, so some respondents may underreport smoking
because of fear or social shame. The findings may not be generalized to all young adults
because the study is limited to the selected sample and setting.
1.6 Significance of the Study
The study is significant because smoking is a preventable cause of many serious diseases.
If young adults receive correct knowledge at the right time, they may avoid starting
smoking or may decide to quit early. Early prevention is better than treatment because
tobacco-related diseases can lead to long-term suffering and high cost for the family and
the health system.
For young adults, the study can help to show the importance of knowledge in making
healthy choices. It may help them understand that smoking is not a sign of confidence or
maturity. It is a harmful habit that can reduce health, money, physical fitness, and quality
of life.
For nursing practice, the study can guide nurses in planning health education. Nurses can
use the findings to prepare teaching materials, posters, leaflets, group teaching, peer
education, and counselling sessions. They can focus on areas where young adults have
low knowledge, such as addiction, quitting methods, and newer nicotine products.
For nursing education, the study can help students understand how knowledge and
behavior are connected. Nursing students can learn to assess community needs and plan
simple interventions. For nursing research, the study can provide a base for further
studies on tobacco prevention, effectiveness of educational programs, and smoking
cessation support among young adults.
For families and communities, the study is useful because smoking does not affect only
one person. Family members and friends can support young adults to avoid smoking and
to quit. Teachers, community leaders, and health workers can also help to create smoke-
free homes, colleges, and public places. Thus, the study has value for health promotion,
disease prevention, and social awareness.
1.7 Operational Definitions of Key Terms
Knowledge regarding smoking: refers to the information and understanding that young
adults have about smoking, its harmful effects, nicotine addiction, quitting benefits, and
prevention measures.
Smoking: refers to the act of inhaling and exhaling smoke from tobacco products such as
cigarettes, bidis, cigars, or similar products.
Young adults: refers to individuals in the young adult age group selected for the study,
usually between 18 and 30 years, according to the study criteria.
Influence: refers to the effect or relationship of knowledge regarding smoking on
smoking-related behavior among young adults.
Smoking-related behavior: refers to actions such as smoking, trying to smoke, avoiding
smoking, willingness to quit, or avoiding tobacco-related risk.
Health education: refers to planned teaching activities used to increase knowledge and
encourage healthy behavior related to smoking prevention and cessation.
1.8 Organization of the Thesis
The thesis is organized in a systematic way so that the research problem can be
understood clearly. Chapter 1 presents the introduction of the study. It includes the
background of the study, statement of the problem, objectives, hypothesis, scope and
delimitations, significance, operational definitions, and organization of the thesis.
Chapter 2 presents the review of literature. It discusses previous studies related to
knowledge regarding smoking and the influence of knowledge on smoking behavior
among young adults. Chapter 3 presents the research methodology, including research
approach, design, setting, sample, sampling technique, tool, data collection method, and
plan for data analysis.
Chapter 4 will present the analysis and interpretation of data. Chapter 5 will present
discussion, summary, conclusion, nursing implications, limitations, and
recommendations. In this way, the thesis moves from introduction to evidence, method,
result, and final conclusion.
References
Anam, M. R., Shamsi, T., Al Amin, A., Ahmed, N., Hasan, M. T., & Sen Gupta, P. K.
(2022). Knowledge, attitudes and practices relating to tobacco smoking in undergraduate
students in a selected university of Bangladesh. International Journal of Community
Medicine and Public Health, 9(4), 1637-1642. [Link]
6040.ijcmph20220832
Fente, A. E., Aduema, W., Buno, M. E., Erho, A. S., & Racheal, B. E. (2023).
Knowledge and attitude of the health implication of smoking in young adult (18-30
years) in Bumoundi Community, Bayelsa State. Greener Journal of Medical Sciences,
13(2), 112-119.
Islam, M. M., Al-Mamun, F., ALmerab, M. M., Moonajilin, M. S., & Mamun, M. A.
(2025). Factors influencing knowledge and attitudes towards second-hand smoking
exposure among university students: An exploratory study. INQUIRY: The Journal of
Health Care Organization, Provision, and Financing, 62, 1-10.
[Link]
Kumar, B. T., Rajesh, N., Ramakrishna, B. B., Vaddeswarapu, R. M., Lokesh, K. V.,
Lavanya, B., & Alla, R. K. (2024). Knowledge, attitude, and awareness on smoking
habits among the student population: A questionnaire-based study. Studies in Science of
Science, 42(12), 277-290.
Oke, G. I., Ademola, P. S., Utaka, E. N., John, E., Adam, M. F., Okereke, B., Onyia, I.
M.-A., & Adebisi, Y. A. (2024). Knowledge, perception, and willingness of emerging
public health advocates to effectively communicate about smoking cessation and
Tobacco Harm Reduction in Africa. Discover Psychology, 4, Article 6.
[Link]
Patel, R. (2022). A study to assess the knowledge regarding harmful effect of smoking on
health among young adult at Jodhpur urban area of Ahmedabad city, Gujarat. IOSR
Journal of Nursing and Health Science, 11(5, Ser. III), 50-62.
[Link]
Rahman, K. M. M., & Gietel-Basten, S. (2024). Influence of knowledge and attitudes on
youth smoking in rural areas of the Mymensigh Districts of Bangladesh: A cross-
sectional study. SAGE Open, 14(2), 1-8. [Link]
I can update your Chapter 1 by removing mentions of “attitude” and “second-hand
smoking” in section 1.1, and integrate relevant references from your literature review.
Here’s a revised version of Chapter 1, section 1.1 with the requested edits and citations
added appropriately:

1.1 Background of the Study (Revised)

Smoking is one of the most important preventable health problems in the world. It causes
disease, disability, and early death, but it can also be prevented through proper
knowledge. The World Health Organization (WHO) states that tobacco kills more than 7
million people each year (WHO, 2025). This shows that smoking is not only a personal
habit, but also a public health problem. Therefore, young adults need correct information
about smoking before the habit becomes established and harder to stop.
Young adulthood is a time of many changes. During this stage, a person may enter
college or work, become more independent, make new friends, and face new social
pressures. Many young adults start to make their own choices about health habits.
Smoking can begin because of curiosity, peer pressure, stress, family smoking, easy
access to cigarettes, or the wrong belief that smoking makes a person look mature or
relaxed. Once nicotine dependence develops, quitting becomes more difficult. For this
reason, young adults are an important group for smoking prevention.
Knowledge regarding smoking refers to understanding the harmful effects of smoking,
diseases caused by smoking, the addictive nature of nicotine, and the benefits of quitting.
A young adult with good knowledge may understand that smoking can cause lung cancer,
chronic respiratory disease, heart disease, stroke, reduced physical fitness, poor oral
health, and early death. Good knowledge may also help a young adult avoid smoking and
support a smoke-free home or campus (Fente et al., 2023; Patel, 2022; Kumar et al.,
2024; Oke et al., 2024).
At the same time, knowledge alone may not always change behavior. A person may
know that smoking is harmful but may still smoke because friends smoke, tobacco
products are easy to buy, or smoking is socially accepted. Stress, sadness, low self-
confidence, and addiction can also contribute to continued smoking (Rahman & Gietel-
Basten, 2024; Anam et al., 2022). Therefore, the present research focuses on the
influence of knowledge regarding smoking among young adults. The study is important
because it can show whether better knowledge is linked with safer behavior.
The problem is also significant in Bangladesh and other developing countries. Around
80% of the world's tobacco users live in low- and middle-income countries, where the
health and economic burden is high (WHO, 2025). The Global Adult Tobacco Survey in
Bangladesh collects data on tobacco smoking, cessation, media exposure, and knowledge
about health effects (Bangladesh Bureau of Statistics & National Tobacco Control Cell,
2017). This shows that knowledge is an important part of tobacco control. However,
many young adults may still have incomplete knowledge, especially about nicotine
addiction, newer tobacco products, and quitting support (Islam et al., 2025; Oke et al.,
2024).
Newer nicotine and tobacco products also make this issue more complex. E-cigarettes,
heated tobacco products, and other nicotine products are sometimes seen by young
people as safe or modern. However, nicotine is highly addictive, and it can harm the
developing brain up to about age 25 (CDC, 2025). Young adults may not fully understand
these risks. If their knowledge is incomplete, they may move from one tobacco or
nicotine product to another. For this reason, research on knowledge regarding smoking
should include traditional cigarettes, nicotine addiction, and new forms of tobacco use.
Nurses and other health workers have an important role in preventing smoking among
young adults. They can provide health education, counselling, short advice, posters,
group discussion, role play, and community awareness programs. In colleges and
communities, nurses can help young adults understand the harmful effects of smoking
and the benefits of quitting. The present study will help in identifying knowledge gaps
and planning simple, need-based health education for young adults (Patel, 2022; Kumar
et al., 2024; Oke et al., 2024).

If you want, I can go through the entire Chapter 1 next, remove all “attitude” and
“second-hand smoking” references wherever they appear, and update the references
section so it fully matches your revised citations. This will make the chapter ready for
submission.
Do you want me to do that?