Cigarette Smoking and Its Effects On Asthmatic Persons

Cigarette smoking and its effects on asthmatic persons
Research Topic:
Cigarette smoking and its effects on Asthmatic persons

TABLE OF CONTENTS
Content
Pages
1.0 CHAPTER I Introduction
1.1
Background
1.2
Purpose of the Study
1.3
Statement of the Problem
1.4
Research Questions
1.6
Key Definition
2.0
CHAPTER II - Literature Review
2.1
Introduction
2.2
What are the health effects of smoking on asthmatic persons?
2. 3
To what extent are asthmatics making visit to the hospital due to an asthma attack?
2.4
The Treatment and Control of Asthma when Triggered by Second Hand Smoking
2.5
What is the socialization of asthmatics that smoke and the psychology behind the act?
2.6
Conclusion
3.0
CHAPTER III - Methodology
3.2
Study Design
3.3
Research protocol
3.3.1
Research Activities
19
3.3.2. Budget
3.4
Study setting
3.5
Study variables
2

3.6
Study Participants
3.7
Target Population
3.8
Sampling Procedures
3.8.1
Sample Frame
3.8.2 Sample selection

3.8.3
Sample Size
3.9
Concerns of Ethics
3.10
Procedure for data collection
3.11
Instruments
3.11.1 Questionnaires
3.11.2 Pre-testing
3.11.3 Interviews
3.12
Data Analysis
3.12.1 Interpretation of data

3.13
Presenting Results
3.14
Time
3.15
Inclusion Criteria
3.16
Exclusion Criteria
3.17
Scope and Limitations
4.0 References
30
Appendix A
34
Appendix B
35

1.0
CHAPTER I - Introduction
1.1
Background
Asthma is a chronic disease in which sufferers have repeated attacks of difficulty in
breathing and coughing. There seems to be an increase in the amount of asthma all over the
world, especially in children.
Tobacco smoke is dangerous to your health, whether you inhale from your own cigarette
or breathe in second-hand smoke. When you have asthma, it can be even worse (Coverage
forTobacco Use Cessation Treatments, 2000).
According to the Jamaica Gleaner the number of asthma patients showing up at the
island's public health facilities continues to spiral (Hunter, 2011). Some 19,647 cases of asthma
were seen in primary health-care facilities in 2008. In addition to that figure there were 55,572
visits to accident and emergency departments for asthma in that year compared with 41,858 in
2007. This represents an overall increase of 32.8 per cent (Hunter, 2011). The
total hospital discharges for asthma in 2008 were 2,185 cases and a total of 1,418 cases of asthma
were seen in public outpatient departments, where 100 clinics were held.
1.2
Purpose of the Study

The purpose of this study is to determine the effects of cigarette smoking on the
development of asthmatic persons. This information would be ascertained through a series of

questionnaires and interviews. Statistical data will be gathered from places such as the Ministry
of Health and Environment and other relevant authorities. It serves to provide needed attention to
4

areas that need improvement or commendation in the process of facilitating easy and affordable
means of complying with the stipulated laws.
1.3
Statement of the Problem
What is the effect of cigarette smoking on asthmatic persons?
1.4
Research Questions
In order to aid in the data collection process, subsequent questions were formulated from the
predominant topic:
1. What are the health effects of cigarette smoking on asthmatic persons?
2. To what extent are asthmatics making visit to the hospital due to an asthma attack?
3. What is the socialization of asthmatics that smoke and the psychology behind the act?
4. The Treatment and Control of Asthma when Triggered by Second Hand Smoking?
1.5
Significance of the Study

This study serves to create awareness about the adverse effects of cigarette smoking and
significantly how it affects asthmatic persons.

It also aims to enhance the financial resources for asthma research and anti-smoking
activities in Jamaica. With the knowledge Corporate Jamaica will gain from this research paper
they will be more than willing to contribute funding to better the care provided to asthmatics
especially our Jamaican citizens.
1.6
Key Definition
Asthma: Asthma has been defined as a chronic inflammatory disorder of the airways that is
associated with recruitment of inflammatory cells and the clinical development of wheezing,
shortness of breath, chest tightness, and cough (Barrios, Kheradmand, Batts, & Corry, 2006).
Passive smoking: Passive smoking is the inhalation of smoke, called second-hand smoke (SHS),
or environmental tobacco smoke (ETS), by persons other than the intended "active" smoker.
Mainstream smoke: Mainstream smoke is the smoke that is inhale and exhale by the smoker.
Side stream smoke: Side stream smoke is the smoke emitted from a smoldering cigarette
between puffs.
Secondhand Smoke: The combination of smoke from the burning end of the cigarette and from
exhaled smoke. Secondhand smoke has been established as a risk factor for developing lung
cancer, as well as other illnesses, such as asthma (Lung Cancer Analysis, 2010).
Outpatient: A patient who receives treatment at a hospital, but does not spend the night there
(http://www.merriam-webster.com/dictionary/outpatient).
2.0
2.1
CHAPTER II - Literature Review
Introduction
Cigarette tobacco smoke is a short term respiratory irritant that is associated with an increased
risk of respiratory tract infections, chronic airway diseases and cardiovascular diseases.
Cigarette smoking has been induced by a number of social and psychological factors ranging
from peer pressure and psychological conditioning through parents. Cigarette smoke has proven
to be especially detrimental to asthmatic persons as it causes severe coughing and wheezing
which temporary worsens breathing. One would believe that an asthmatic person would choose
to avoid smoking, but a number of studies and reports have proven the opposite. Hospitalization
due to asthma has increased significantly and has ceased the attention of health officials
worldwide. Most of this attention is however focused on children as they are more vulnerable to
this common illness. Asthma is said to be a long-term condition with no cure and hence the focus
of asthma treatment is to minimize the effects/ symptoms associated with asthma This literature
review was done to outline the complications that are associated with asthmatics when they are

exposed to smoke and just how important it is to ensure that these persons are protected from
these harmful effects. The review will further outline the health effects of smoking on asthmatic
persons and the extent with which asthmatics are making visit to the hospital due to an asthma
attack.
The review will also outline The Treatment and Control of Asthma when Triggered by Second
Hand Smoking and the socialization of asthmatics that smoke and the psychology behind the
act.
2.2 What are the health effects of smoking on asthmatic persons?

Cigarette smoke contains thousands of different chemicals, or smoke constituents, also referred
to as smoke emissions. The Asthma Partners Association implies that there is little good that can
be said about cigarette smoking. It is pleasurable for some people, helps to curb appetite, and
relieves the addictive need for another cigarette. On the negative side, the list of harmful effects
is long. Cigarette smoking can be especially harmful to asthmatic patients as they have very
sensitive airways. According to the Centres for Disease Control and Prevention, 2013 Asthma is
a chronic disease that affects the airways of the lungs. During an asthma attack, airways (tubes
that carry air to your lungs) become swollen, making it hard to breathe. As the walls of the
airways swell, they narrow, and less air gets in and out of the lungs. This review is aimed at
gaining an understanding of how cigarette smoking affects asthmatic patients. It also sought to
identify the health effects of smoking on asthmatic patients.
Active cigarette smoking and the health effects on asthmatic patients

Cigarette smoking is associated with an increased risk of respiratory tract infections, chronic
airway disease and cardiovascular disease. Given the irritating effects of tobacco smoke and the
association of cigarette smoke with respiratory illness, patients with asthma would seem to be a
group that would avoid smoking entirely. However, it is our experience that many patients
presenting to the emergency department (ED) with acute asthma actively smoke cigarettes
(Silverman, Boudreaux, Woodruff, Clark & Camargo, 2003). This idea is also expressed by
Thompson, Chaudhurri & Livington, 2004. They pointed out that for adolescents with asthma,
prevention of smoking onset is even more important than for healthy adolescents, as the health
risks of smoking are more pronounced in people with asthma. According to the Australian
Institute of Health and Welfare, 2005, 26 % of people with current asthma smoke: 27% of males
(compared with 28% of males without asthma) and 25% of females (compared with 21% of
females without asthma). Smoking in people with asthma may have both an immediate impact
by triggering asthma, as well as long-term effects such as increased asthma severity and an
increased frequency of attacks (Siroux, Pin, Oryszczyn, Le Moual, & Kauffmann, 2000).
Partners Asthma Centre, 2010 implied that cigarette smoking has special meaning for persons
with asthma. In asthma, allergic inflammation of the bronchial tubes causes mucus production,
leading to cough and phlegm. In long-term cigarette smokers, chronic inhalation of smoke from
burning tobacco leaves also stimulates the mucous glands in the bronchial tubes to make excess
mucus, giving rise to daily cough with phlegm. In asthma, spasm of the muscles surrounding the
bronchial tubes along with swelling of those tubes makes breathing difficult. Some cigarette
smokers may develop an irreversible narrowing of their bronchial tubes which is caused from
inflammation and scarring and as a result causes permanent breathing problems. Asthmatic
individuals who smoke cigarettes are in "double jeopardy": they risk episodes of breathing

difficulty due to asthma on top of everyday shortness of breath from the cigarette smoke-induced
lung diseases, emphysema and chronic bronchitis. Smoking worsens asthma and counteracts
asthma medication by worsening the inflammation of the airways that the medicine tries to ease.
(Macnair, 2013)
People with asthma who smoke experience more respiratory symptoms, worse asthma control,
more airway inflammation, an inferior short-term response to inhaled corticosteroid treatment,
and an accelerated decline in lung function than those who do not smoke. Smoking increases the
risk of chronic obstructive pulmonary disease (COPD). In people with asthma, this can result in
overlapping of COPD symptoms with those of asthma, which can delay the diagnosis of COPD
and complicate management (Piipari, Jaakkola, Jaakkola & Jaakkola , 2004).
Individuals with asthma who smoke and continue to smoke have worse symptoms and
experience more rapid decline in pulmonary function than those who have asthma but do not
smoke. Those people with asthma and who smoke are more prone to chest infections because the
body is unable to clean the lungs properly.
Boulet , Lemire , Archambault , Carrier , Descary , Deschesnes, 2006 study showed that
compared with those with asthma but non-smokers, smokers had more respiratory symptoms and
had features similar to those found in the early stages of chronic obstructive pulmonary disease
(COPD).
Second hand smoke and the heath effect on asthmatic patients
Second hand smoke is a mixture of the smoke given off by the burning end of a cigarette, pipe,
or cigar, and the smoke exhaled by smokers. Second hand smoke is also called environmental
tobacco smoke (ETS) and exposure to second hand smoke is sometimes called involuntary or
10

passive smoking. (United States Environmental Protection Agency, 2011). Such an exposure on
asthmatic patients has been associated with aggravation and occurrence of increased prevalence
of respiratory symptoms, acute respiratory infections, bronchial hyper-responsiveness and
asthma, especially in children (Jindal & Gupta, 2004). The Partners Asthma Centre, 2010
implied that breathing the smoke from other persons' cigarettes can be troublesome if you have
asthma. It can cause cough and wheeze and temporary worsening of your breathing. Having
asthma means having air passageways in your lungs that are extra-sensitive to irritants in the air
that you breathe, including second-hand smoke.
The American Lung Association, 2013 research states that Second hand smoke is linked to other
health problems, including lung cancer, ear infections and other chronic respiratory illnesses,
such as bronchitis and pneumonia.
2.3 To what extent are asthmatics making visit to the hospital due to an asthma attack?
Asthma is one of the main causes of morbidity and hospitalization in young children
(Brbck L, Bjr O, Nordahl G., 2003). The World Health Organization (WHO) describes
Asthma as a chronic disease characterized by recurrent attacks of breathlessness and wheezing,
which vary in severity and frequency from person to person (WHO 2011). It is a very prevalent
chronic respiratory condition in Jamaica and all over the world which affects both children and
adults alike. The relative risk of asthma hospitalization adjusted for daily weather conditions but
mostly from small particles and gaseous emissions (Jones, 1998). In 1981 it was very prevalent
among our islands high school children affecting 21% of the children population and in 1995;
exercise-induced asthma was identified in 20.8% of children in Kingston, St Andrew and St
11

Catherine (Rose, Gilbert, Thame, & Bailey, 2009) and in 1996, there were 2,260 in-patients with
asthma, but increase of 2,806 cases in 1999 (CM, 2000).
According to the statistical data gathered from the Pan American Health
Organization(PAHO) in 1999 Respiratory tract infections accounted for 12% of all visit to
accident and emergency departments of hospitals, with asthma accounting for 49% of these visits
(PAHO).
Although there is no gender difference in the prevalence of asthma, females have a considerable
higher risk than men of being admitted to hospital for asthma attacks (Prescott, E., Lange, P. and
Vestbo, J, 1997). Staff Reporter for the Jamaica Gleaner Nadisha Hunter reported in 2011 that
there was an increase in the number of asthma patients showing up at the island's public health
facilities (Hunter, 2011). Some 19,647 cases of asthma were seen in primary health-care facilities
in 2008 and in addition to that figure 55,572 visits were made to accident and emergency
departments for asthma in that year compared to a significantly lower number of 41,858 in 2007.
This represents an overall increase of 32.8 per cent (Hunter, 2011). Hunter also made mention of
the fact that a total of 1,418 cases of asthma were seen in public outpatient departments, where
100 clinics were held and that for the year 2008 2,185 asthmatics were discharged from the
hospitals.
Health Minister Rudyard Spencer recently said in an article that much needed donations
are welcomed as this will improve the care given to asthmatics especially the nations children as
asthma is one of the common illnesses that affect both the adult and child population in Jamaica,
and is the leading cause of hospitalization among children under five years old (Hunter, 2011).
Though asthma remains a concern in all countries regardless of their level of development, 80
per cent of deaths occur in low and middle-income countries like Jamaica.
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2.4The Treatment and Control of Asthma when Triggered by Second Hand Smoking
Second-Hand Smoking (SHS) is the term used to describe the inhalation of tobacco smoke by a
person other than the active smoker (the person who is smoking). Asthma is a respiratory
condition characterized by the presence of various degrees of airflow obstruction in breathing
due to airway wall inflammation and bronchial smooth muscle constriction (DiPiro, et al. 2008).
It is usually caused by allergic reactions and other forms of hypersensitivity. They go on to
explain that asthma symptoms often include wheezing, breathlessness, chest tightening and
coughing. Additionally, Asthma is one of the most common chronic diseases in childhood (Jim,
2010). According to Bilan, Sharifi, Valizadeh, & Zarei (2013), asthma may be triggered by
external factors known as Environmental Triggers. In other words, SHS may cause an individual
with asthma to have an asthma attack. These triggers cause the symptoms of asthma to become
more severe (an asthma attack). The most commonly known environmental triggers are tobacco
smoking, strong odours, fumes, viral infections, stress and allergies (Harver & Kotses, 2010).
The Centers for Disease Control and Prevention, National Institute of Occupational
Safety and Health, (1991) notes that The more SHS you breathe, the higher the level of these
harmful chemicals in your body. They explain that the smoke contains nicotine and toxic
chemicals, and when these chemicals are inhaled by a non-smoker they will have the same effect
as they do on the active smoker. Zeise & Dunn (2000), agree with this statement as they explain
that whenever an asthmatic individual is exposed to SHS, he/she is likely to experience asthma
symptoms. Stapleton, Howard-Thompson, George, Hoover, & Self (2011) express their
agreement with this as they explain that SHS from parents who smoke is associated with
increased prevalence of asthma and respiratory symptoms among school children, along with
more severe disease among those children with established asthma.
13

Jindal, Gupta, Kumar, & Singh (1994) examined and compared the severity of asthma
between two groups of adult asthmatics, one group was exposed to SHS while the other was not.
The study revieled a number of statistically significant reductions in the SHS exposed group of
asthmatics. These figures included FEV1i values of 68.7% and 80.8% for SHS exposed and SHS
non-exposed rspectively. Although these findings were made there was some level of
inconsistency in the patients who were used in the study. The average age SHS exposed group
was 39.5 as opposed to that of the non-exposed group which was 33.8. The genders of the
individuals were undescribed. These inconsistencies may have led to inaccurate recordings.
Asthma is a long term condition with no known cure. Therefore, the focus of asthma
treatment is to control the disease and allow the patient to live a normal life (National Heart,
Lung, and Blood Institute, 2012). Treatment varies depending on the severity of the asthma
symptoms. According to Stapleton, et al. (2011) SHS exposure is associated with asthma,
respiratory tract infections, and other body system damage. The symptoms experienced when
asthma is triggered by SHS hardly differ from those experienced due to other (more direct)
triggers. Evidently, as stated by Barnes, Rodger, & Thomson (1998), treatment methods for SHS
induced asthma is similar to those methods used for asthma induced by allergies and viruses.
Stapleton, et al. (2011) suggests that an effective method of reducing and in turn controlling the
cases of asthma due to SHS would be for health care providers to discuss primary smoking in
addition to SHS with all their patients. This suggestion is indeed a valid one, however, it would
serve as a reactive and individuals would have been unaware of these conditions until they find
themselves with the disease. Another potential problem is the fact that most smokers are addicted
to this habit and find it extremely difficult to just stop smoking because they were told to do so.
14
2.5 What is the socialization of asthmatics that smoke and what is the psychology behind
the act?
According to the Asthma and Allergy Foundation of America (AAFA), the cause of asthma is
still yet unknown but there is evidence that asthma and allergy are in part determined by heredity
(AAFA, 2005). In addition to genetics, there are various environmental factors that typically can
result in the onset of asthma with smoke being this researches stimulant of focus.
Some cigarette smokers develop irreversible narrowing of their bronchial tubes from
inflammation and scarring, causing permanent breathing problems. Active cigarette smoking has
been associated with the development of asthma in some studies (Rasmussen FSHC,
Lambrechtsen J, Hansen HS, Hansen NC. 2000). Persons with asthma who smoke cigarettes are
at twice the risk, where they risk episodes of breathing difficulty due to asthma on top of
everyday shortness of breath from the potential cigarette smoke-induced lung diseases,
emphysema or chronic bronchitis. Contrary to what would be expected, smoking habits of
asthmatics do not differ from those of the general population: approximately 30% of asthmatic
patients smoke cigarettes.(Michelle D. Althuis, Mary Sexton and Dimitri Prybylski, 1999).
Even with health campaigns, cigarette taxes, and no smoking policies having major impact in
reducing the number of current cigarette smokers in the United States, approximately 25% of the
adult population continue to be active smokers (down from 40% in the 1960s) (Partners Asthma
Center, 2010). With a quarter of Americas population still being active smokers, it can be
difficult for asthmatics to avoid exposure to second-hand cigarette smoke (also called passive
15

smoking or environmental tobacco smoke exposure). "Logistic regression analyses showed that,
compared with nonasthmatic adolescents, asthmatic adolescents were more likely to have
smoking parents." (Zbikowski SM, Klesges RC, Robinson LA, Alfano CM, 2002) In home
second-hand smoke exposure is one of the common causes of children developing asthma. And
therefore children of parents who smoke cigarettes are more likely to develop asthma than
children of parents who do not smoke. In addition, parental smoking leads to worse asthma
control in their asthmatic children. In a recently reported scientific study of asthmatic children,
asthmatic symptoms lessened dramatically in the group of children whose cigarette-smoking
parents agreed not to smoke in the home compared to those whose parents continued their
pattern of cigarette smoking without change (Partners Asthma Center, 2010). To understand the
addiction, how it starts and how people become addicted, we must understand further the social
and physical aspects of the addiction. Smoking is used as a tool, particularly by young people as
a means of bending rules and finding excitement. It is also used as a means of breaking down
social barriers making one feel as if apart of a group, as they relate to other smokers (Dichter,
2007). While there are certainly other influences that can lead a smoker into the habit, peer
pressure is one of the biggest.(Cunnigham, 2013) These social pressures during the time when
people are most susceptible to outside influences (the teenage years) and where they rely on peer
companionship is when asthmatics will tend to ignore their special health conditions in
preference to a sense of normalcy. The main reason people are addicted to smoking to do with
the interaction with the cigarette and its chemicals. That interaction of the nicotine in cigarettes
and dopamine in our bodies. What is dopamine? We cannot truly gain an understanding of
nicotine addiction, or any form of drug addiction for that matter, without a basic understanding
of the brain's primary motivation neurotransmitter, dopamine. The brain's dopamine pathways
16

serve as a built-in teacher. It uses a desire, yearning or wanting sensation to get our attention
when it wants to pound home a survival lesson necessary to keep us humans alive and thriving
(Polito, 2013). Dopamine overtime and as the body becomes less receptive to the effects of
nicotine, creates a craving similar to that of hunger where the urges only become stronger the
more the body becomes desensitized to the stimulant, in this case nicotine. Once the stimulant is
received it gives the addict a sense of relaxation and relief as they have satisfied their craving. It
is this momentary high that the addicts come to depend on. That same tool that can be used for
breaking down social barriers or giving a sense of relief can become a crutch for asthmatics.
Chronically ill patients tend to exhibit significant elevated scores on depression and/or other
psychiatric disorder scales. Smoking employees, who reported having asthma, chronic
bronchitis or emphysema were more likely to report suffering from depressed mood compared to
smokers with no long-lasting disease (Wagena EJ, Kant I, Huibers MJ, van Amelsvoort LG,
Swaen GM, Wouters EF, van Schayck CP, 2004), as these illnesses are sometimes accompanied
by such psychological effects, it is natural that this high would be something difficult to give
up once experimented with. There is also the cases of adult onset asthma where,it is possible to
first develop asthma at age 50, 60 or even later in life (AAFA, 2005). Of interest, most adults
who experience the new onset of asthma after age 50 have a past history of cigarette smoking
(Partners Asthma Center, 2010). In such cases the asthmatic will have a difficult time with
nicotine cessation in a case where they have been addicts for most of their lives.
The power of the addiction to smoking shouldnt be underestimated. Its physical and emotional
grip is enormous, comparable, the Surgeon General has said, to heroin addiction. (Partners
Asthma Center, 2010)
17
2.6 Conclusion
Conclusion
It has been established that cigarette smoking is hazardous particularly to the health of
asthmatics as most studies indicate that smoking affects asthma adversely at all ages. Exposure to
environmental tobacco smoke, in children, is likely to be a significant risk factor for
development of asthma. Environmental tobacco exposure in patients with established asthma is
associated with severe symptoms, increased health care utilization for asthma, including hospital
admissions as well. People with asthma have even more reasons than those without asthma to
avoid smoking. Although active smoking is not the biggest risk factor for inception of asthma, it
is associated with worse outcome with regard to asthma related health care mortality. Greater and
more consistent effort must therefore be given to encourage patients with asthma not to smoke.
In addition to the known adverse health effects of smoking in the general society, the fact that
cigarette smoking worsens asthma and reduces the effectiveness of medication warrants serious
efforts by health professionals and patients to eradicate smoking. Furthermore, patients with
asthma should be given full support in their right to a smoke-free environment, both at home and
at work.
Some of the limitations of this review was that there was no assessment of whether self reported
respiratory symptoms were infact due to asthma, these same symptoms could reflect other
diagnoses.
18
CHAPTER III - Methodology
3.1Overview
This section presents an overview of the methods to be used in the study.
3.2 Study Design

To ascertain answers to the research questions both qualitative and quantitative study methods
will be employed. The research will employ correlation research techniques as this approach will
either prove or disprove whether the problems posed in the research are causal or merely
correlated with the variables in the research. Statistical evidence will be collected from the
quantitative data collection and presented as percentages. The qualitative collection data will
enable inductive analysis.
3.3 Research protocol

The research proposal will be completed in a step - wise manner where each part of the research
will benefit or affect the following part to make it flow chronologically and logically. A time line
will be devised to help ensure the completion of the proposal. A title that is of relevance in the
society was decided upon by the researchers. The title will introduce the Cigarette smoking and
its effects on asthmatic persons and background information will be gathered from secondary
sources. From the title, four (4) research questions were developed to prompt a deeper
19

investigation to the problem in order to arrive at feasible conclusions. If there are any key terms
that need to be defined for clarity throughout the research, they will be identified and defined at
this point. The literature review was centered on the research questions that were previously
drawn from the titles problem. A list of activities will be outlined that correlate with the timeline
devised.
A feasible and representative study setting will be selected and the population to which
the study is aimed to affect or the target population will be identified. The instruments to be used
will be decided upon and the ethical issues that relate to the instruments will be made known.
The data will be collected from hospitals, medical doctors, nurses and other health care
professionals within the sample size as well as parents who have children suffering from this
condition. The instruments to be employed are questionnaires and interviews that will provide
quantitative and qualitative data. The participants will be briefed about the purpose of the
research and they will be thanked for their participation. However, the validity of the
questionnaire will be pre-tested prior to the distribution of the questionnaires to the participant.
The data collected will be analyzed and discussed. A conclusion linking the data collected and
discussions to the need to conduct a full research in the area being proposed will be constructed.
20
3.3.1 Research Activities

These research activities will be conducted in the time allotted below to enable the completion of
the research in the year 2013.
Research Activities for Proposal
Deadline
September
October
November
December
Formulate Title, Purpose of Research,

Research Questions and Significance of
Study
State Key Terms and Determine Study
Area
Collect secondary information for
literature review
Determine sample frame and sample size
Develop Questionnaire and Interview
questions
Print and Distribute Questionnaires and
conduct interviews
Collect Data from Instruments
Analyze data collected
Complete first draft
Final report submission
3.3.2 Timeline Budget
Table 2
List of items to be used in proposal and estimated cost
ITEM
QUANTITY
UNIT COST (JA$)
Typing Sheets
1 pack
$600
Stationery / Printing
1
$2000
Telephone Bill
4 months
$1000
Travel
4 months, 4 researchers
$16,000/month
Food
4 months, 4 researchers
$20,000/month
TOTAL (JA$)
$600
$2000
$4000
$64,000
$80,000
21

Ink (Black)
Internet Cost
SPSS Licensing fee
Total
1
4 months, 4researchers
1
$2000
$3000/month
$15,000
$2000
$12000
$15,000
$178,650
NB. SPSS - Statistical Package for the Social Sciences
3.4 Study setting

The study concerns a population of Health care professionals and their clientele. The
sample frame will be drawn from the South East Health Region (i.e. Kingston and St. Andrew).
3.5 Study variables

The main study variables are the effects of cigarette smoking on asthmatic person.
The dependent variables are the asthmatic patients while the independent variable is effects of
smoking.
3.6 Study Participants

The study participants will be the nurses at the Bustamante Hospital for Children and the
University Hospital of the West Indies (UHWI) and their clientele within the South East region.
Fifteen (15) nurses will be interviewed and fifteen (15) will be respondents to questionnaire,
while thirty (30) clientele will respond via questionnaire.
3.7 Target Population
22

The target population will include persons that are known asthmatics between the ages 565 years old. The population will include two groups. A group that resides with family members
who are smokers and who smoke within the home, or live in areas where smoke is always
present in the environment from factories and other industrial areas, and those who live in smoke
free homes.
3.8 Sampling Procedures

3.8.1 Sample Frame
According to the Ministry of Health Regional Health Authorities Kingston and St. Andrew
fall in South East region. The Regional Health Authorities provides us with the listing of the
number as well as the names of hospitals within this region. This database was used to select the
hospitals that would be used to ascertain the necessary information.
3.8.2 Sample selection
The hospitals that will be included in the study will be selected by simple random
selection. This will be done by placing the names of all the hospitals within the predetermined
boundary in a bag and randomly selecting two (2) hospitals in order to make a comparison. A
non-probability sampling technique specifically convenient to our sampling will be done to
solicit members of the population who are clientele at the previously selected hospital. Persons
who do not meet the inclusion criteria will not be considered.
Table showing the sample list that will be used to collect information for the study
23

Hospital Selected
Bustamante Hospital
for Children
University Hospital of
the West
Indies(UHWI)
TOTAL 2
Number of
Nurses
Nurses
Customer
87
Interview
5
Questionnaire
10
Questionnaire
15
100
10
15
187
15
15
30
3.8.3 Sample Size

Nine (9) hospitals are within the South East Region according to the Ministry of Health
Regional Health Authorities and from that amount two were selected using the most convenient
sampling method. The table above shows how the number of nurses and customers at the
hospitals were selected as well as how the fifteen (15) interviews and forty-five (45)
questionnaires will be distributed.
3.9 Concerns of Ethics

A consent form will be issued to the likely participants before the research begins. The
consent form will be entailed with the nature and the true purpose of the study, what would occur
during the research sessions, the risks that would be involved, and assured them all data collected
would be coded to protect their identity and privacy.
Firstly the research project will be a complete anonymity of participants. Secondly the
research project will be planned so that the chance of misleading results is minimized. Third, the
research will be planned so that it meets ethical acceptability. Any doubts we the researcher may
have regarding questionable ethical procedures or methods will be resolved through peer review
or through consultation with the conflicting parties and *Sir*. Fourthly, steps will be taken to
24

protect and ensure the dignity and welfare of all participants, as well as those who may be
affected by the results of the research.
3.10 Procedure for data collection

Data will be collected in the form of questionnaires and interviews. The questionnaires
will be collected soon after they are distributed and completed. Questionnaires save time in the
collection of data and allows for open-ended and close-ended questions. Close-ended
questionnaires will provide easy manipulation of data and aid statistical presentations while
open-ended questions will provide the research with feedback and give an insight on the effects
that smoke and smokers have on asthmatic children. This will enable effective data analysis as
the researcher can compare the findings to that in the previous literatures. The information
gathered for the previous literature review, was sourced from the internet which provided
numerous researches done by other individuals as well as journals that relate to the research
problem. Many reputable and official databases were accessed also. The library at the University
of Technology, Jamaica (UTECH) was used as it houses many of the local secondary sources
such as newspaper articles and local journals. These were easily accessible and benefited the
overall compilation of the review. Usually, the information found in these publications are sound
and are sworn to truthful information as they serve to inform the wider public. Following this
procedure will aid a comprehensive data analysis and interpretation of data.
3.11 Instruments
Two methods of data collection will be employed for this study, namely, Questionnaires
and Interviews.
25

3.11.1 Questionnaires
Printed questionnaires will be used to determine the publics awareness of the effects of
smoke on asthmatic patients as well as their awareness of possible complications as a result of
the same problem. The questionnaires will be distributed by hand at the selected hospitals and
the clients present in the hospital at that time will be asked to complete the simple questionnaire.
A total of forty-five (45) questionnaires will be prepared and delivered and sixteen (15) nurses
will be respondents to questionnaire, while thirty (30) clients will respond via questionnaire.
Respondents will be given a brief introduction to the purpose of the study, the number of
questions on the questionnaires, the amount of time that will be required to complete the
questions and will be told to place a tick/circle the most suitable answer. However, for openended questions they will be told to please keep all responses short and within the context of the
research. In addition, the anonymity of the participants will be made clear that is, no use of
identification will be attached to the questionnaires.
3.11.2 Pre-testing
Ten (10) individuals will be selected to review the questionnaire in terms of contents,
audience appropriateness and format. The individuals will have similar characteristics to those in
the study sample as well as they must have some affiliation with the hospitals. Three (3)
university nurses and seven (7) students will be selected. This will enable the researcher to get
feedback on the relevance, clarity, reliability, and validity of the questionnaires. After the
individuals who participated in the pre-testing review the instrument, the comments and
suggestions relating to the instrument will be noted and used to revise the questionnaires.
26

3.11.3 Interviews
Ten (10) interview questions will be formulated and directed to fifteen (15) nurses. They
will be structured in a similar way to the questionnaires. This will be necessary as they may be
too busy to complete a questionnaire and their responses may improve the qualitative data
collected. The interview responses will be used to answer the first and second research
problems. That is, to determine the complications associated with asthma when asthmatics are
exposed to smoke and how often children between this age group are hospitalized or have to
make a visit to the hospital due to an asthma attack and to correlate the findings to the methods
that are being implemented.
3.12 Data Analysis

Since the instruments used were qualitative and quantitative, the data analysis will follow
suit. The quantitative data will provide numerical data that will be obtained from the close-ended
questions. The open-ended questions and interview questions will provide data that can be
analyzed to give an insight on the feelings or comments of the participants. These will aid the
interpretation of the data that will be presented in tables and other pertinent forms. A chi square
test will be considered to enhance the analysis as well as frequency distribution curves.
3.12.1Interpretation of data
The data that was collected will be interpreted to determine the meaning of the results of
the study. The possible explanations for the outcome of the results will be ascertained. Based on
the results gathered it will be possible to decide if further investigation needs to be conducted
27

and if all the questions have been answered satisfactorily. The aim of the interpretation of data is
to scrutinize the raw data and identify patterns and relationships that can formulate a conclusion
that can benefit the target population.
3.13 Presenting Results

The results of the analysis will be presented in the format deemed most appropriate for
each group of results upon completion of the study. Tables, graphs and charts will be considered.
3.14 Time
The study will occur during the course of a semester, which is four months long. That is,
the proposal is expected to be completed and then having received approval, the research will be
conducted in the following months.
3.15 Inclusion Criteria

Hospitals that fall within the Kingston and St. Andrew region will be included in the
study. Members of the public at these selected hospitals at the time of the research visits will be
included in the study.
3.16 Exclusion Criteria

Not all the hospitals within the South East Health Region of Kingston and St. Andrew
could have been selected. Registered Nurses working at the selected hospitals are many in
28

number and all could not be included in the study. Members of the public who are not present in
the hospital at the time of the researchers/interviewers visit will not be included in the study.
3.17 Methodological and other limitations

The most convenient sampling will be used in the quantitative phase of the study.
Therefore, the research cannot say with confidence that the sample will be representative of the
population (Creswell, 2002).
The results of discriminant analysis have limited generalizability. Usually they generalize
only to those populations from which the sample was obtained (Tabachnick & Fidell, 2000).
Due to the nature of qualitative research, the data obtained in the second phase of the
study may be subject to different interpretations by different readers.
Because of the interpretative nature of the qualitative research, the investigator may introduce
her bias into the analysis of the findings.
29

4.0 References
Australian Institute of Health and Welfare. Australian Centre for Asthma Monitoring. Asthma in
Australia 2005. AIHW Asthma Series 2. AIHW cat. no. ACM 6. Canberra: AIHW, 2005.
Barnes, P. J., Rodger, I. W., & Thomson, N. C. (1998). Asthma: Basic Mechanisms and Clinical
Management (3 ed.). Academic Press.
Brbck L, Bjr O, Nordahl G. (2003). Early determinants of rst hospital admissions for asthma
and acute bronchitis among Swedish children. Acta Pdiatr 2003; 92: 27-33.
Bilan, N., Sharifi, A., Valizadeh, L., & Zarei, S. (2013). Effect of Education and Controlling
Asthma Triggers on Quality of Life among Adolescents with Asthma. Journal Of
Mazandaran University Of Medical Sciences (JMUMS)(98), 48-57.
Centers for Disease Control and Prevention, National Institute of Occupational Safety and
Health. (1991). Environmental Tobacco Smoke in the Workplace Lung Cancer and
Other Health Effects. Current Intelligence Bulletin 54(91-108).
Chronic Respiratory Diseases:Asthma. (2011). Retrieved from World Health Organization:
http://www.who.int/respiratory/asthma/en/.
C.M (2000). Respiratory illnesses on the rise in Jamaica. Retrieved from: The Jamaica Gleaner.
http://jamaica-gleaner.com/gleaner/20001203/lead/lead1.html
Creswell, J. W., & Maitta, R. (2002). Qualitative research. In N. Salkind (Ed.),
Handbook of research design and social measurement, pp. 143-184. Thousand
Oaks,
CA: Sage Publications.
30

DiPiro, J. T., Talbert, R. L., Yee, G. C., Matzke, G. R., Wells, B. G., & Posey, L. M. (2008).
Pharmacotherapy: A Pathophysiologic Approach (8th ed.). United States: McGraw-Hill.
Hunter, N. (2011). Asthma Cases on the Rise. Retrieved from: The Jamaica Gleaner.
http://jamaica-gleaner.com/gleaner/20110504/lead/lead8.html
Harver, A., & Kotses, H. (2010). Asthma, Health and Society: A Public Health Perspective.
Springer.
Jim, N. (2010). Chronic Disease Management. Springer.

Jindal, S. K., Gupta, D., Kumar, L., & Singh, A. (1994). Indices of morbidity and control of
asthma in adult Jones, A.P (1998). Asthma and domestic air quality; Social Science &
Medicine, Volume 47, Issue 6, Pages 755-764.
Kahan,S, McCue D, J, Perkins, J.2006. In a page inpatient medicine. Retrieved on November 1
2011 from: http://books.google.com.jm/books?
id=KOJABYhOwfgC&pg=PA18&dq=severe+complications+associated+with+asthma+
when+asthmatic+children+are+exposed+to+smoke&hl=en&ei=mm6zToiHNufq0gGEgq
WgBA&sa=X&oi=book_result&ct=result&resnum=10&ved=0CFwQ6AEwCTgK#v=on
epage&q&f=false
Macnair, P. (2013). Smoking health risks. Retreived from

http://www.netdoctor.co.uk/health_advice/facts/smokehealth.htm#ixzz2iUQhn9Ih
National Heart, Lung, and Blood Institute. (2012, June 15). How Is Asthma Treated and
Controlled? Retrieved October 20, 2013, from nhlbi.nih.gov:
http://www.nhlbi.nih.gov/health/health- Prescott, E., Lange, P. and Vestbo, J (1997).
Effect of gender on hospital admission for asthma and prevalence of self-report asthma: a
31

prospective study based on a sample of the general population. Copenhagen City Heart
Study Group. Thorax 1997; 52: 287-289
Partners Asthma Centre. (2010). Cigarette Smoking and Asthma. Breath of Fresh Air. (chapter
30). Retrieved from
http://www.asthma.partners.org/newfiles/BoFAChapter30.html
Piipari R, Jaakkola JJ, Jaakkola N, Jaakkola MS.( 2004). Smoking and asthma in adults
[Abstract]. Eur Respir J 24:734-739. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/15516665
Rose, G., Gilbert, T., Thame, M., & Bailey, K. (2009). Asthma clinic attendance improves
quality of life of Jamaican asthmatic children and their parents. Annals of Tropical
Paediatrics (2009) 29, 203208 , 1-2.
Silverman, R. A., Boudreaux, E.D., Prescott G. Woodruff, Clark, Camargo, C.A. Jr. (2003)
Cigarette Smoking Among Asthmatic Adults Presenting to 64 Emergency Departments.
The American College of Chest Physicians, Vol 123, No. 5. Retreived from
http://journal.publications.chestnet.org/article.aspx?
volume=123&issueno=5&page=1472&etoc
Siroux , V., Pin, I., Oryszczyn, M.P., Le Moual, N.,& Kauffmann, F. (2000). Relationships Of
Active Smoking to Asthma And Asthma Severity in The EGEA Study. Epidemiological
Study on The Genetics And Environment Of Asthma [Abstract]. European Respiratory
Journal, 15(3), 470477.
Stapleton, M., Howard-Thompson, A., George, C., Hoover, R. M., & Self, T. H. (2011).
Smoking and Sloan, F. 2004. The price of smoking. MIT Press. Retrieved on November
2, 2011 From: http://books.google.com.jm/books?
id=FJVWY9HS_Y8C&pg=PT307&dq=severe+complications+associated+with+asthma+
when+asthmatic+children+are+exposed+to+smoke&hl=en&ei=6jOzTq7PF8GqgwfInbS
32

nBA&sa=X&oi=book_result&ct=result&resnum=1&sqi=2&ved=0CCoQ6AEwAA#v=o
nepage&q&f=false
Suppli Ulrik C., Lange P., (2001). Cigarette smoking and asthma. Monaldi Arch Chest Dis
2001; 56: 4, 349353.
Tabachnick, B. G., &Fidell, L. S. (2000).Using multivariate statistics.NewYork, NY:
Allyn& Bacon
The Health Task Force.(2009).Vision 2030 Jamaica National Development Plan Draft: Health
Sector Plan.Table E below shows the distribution of health centres and hospitals within
the regional .p 26.
Thomson, N.C., Chaudhuri, R., Livington, E. (2004). Asthma and cigarette smoking.
European Respiratory Journal 2004 Vol. 24 pp. 822-833. Retreived from
http://ash.org.uk/files/documents/ASH_595.pdf
United States Environmental Protection Agency. ( 2011). Health Effects of Exposure to
Secondhand Smoke. Washington,DC 20460 ,USA: U.S. EPA/Office of Radiation and
Indoor Air.
Zeise, L., & Dunn, A. J. (2000). Health Effects of Exposure to Environmental Tobacco Smoke:
The Report of the California Environmental Protection Agency. DIANE Publishing.
Appendix A
33
Source: Ministry of Health

Table Showing
NETWORK OF SERVICES DELIVERY FACILITIES, 2006
Regional
Health
Authorities
Parishes
Facilities
Population
Served
Admissions
Per 1000
Population
Discharges
Per 1000
Population
1 233 076
69.8
69.3
363 215
65.8
65.5
385 560
84.6
84.5
577 975
55.7
56.1
22
2 559 826
Hospitals
South East
Region
North East
Region
Western
Region
Southern
Region
TOTAL
Kingston, St.
Andrew, St.
Thomas, St.
Catherine
Portland, St.
Mary, St.
Ann
Trelawny, St.
James,
Hanover,
Westmoreland
St. Elizabeth
Manchester
Clarendon
Appendix B
34
Cover Letter
Date _/_/_
Asthma is a disorder that causes the airways of the lungs to swell and narrow, leading to
wheezing, shortness of breath, chest tightness, and coughing. When an asthma attack occurs, the
muscles surrounding the airways become tight and the lining of the air passages swells. This
reduces the amount of air that can pass by. Smoke and smoking contributes significantly to
asthmatic attacks especially in our children between the ages of 1-14 years and it is far more
dangerous to their health.
This questionnaire is being administered by third year students at the University of
Technology, Jamaica. This study is to determine the effects of smoking on the development of
asthma in the 1-14 age groups in Jamaica.Your cooperation is requested to enable the
completion of this research. The information you will provide will be confidential and you are
not requested to place your name or address on the paper. The information will only be used for
the purpose of this study.
Thank you.
Interview
35
1. What is your occupation?

2. What do you believe are the three (3) major complications associated with an asthma
attack?
3. What treatment methods are preferred by the asthma sufferers parents/ guardians and
what do you think is the reason for this?
4. Do you believe asthma attacks can be fatal, if yes, are infants more susceptible?
5. Describe one of the ways in which asthma sufferers are treated when they have an
attack.
6. Describe one of the ways in which asthma sufferers are treated when they have an
7.
attack.
Do you think the population is adequately aware of the effects cigarette smoking can
have on asthma sufferer?

8. What measures can be implemented to further educate the population about the
harmful effects of cigarette smoking and asthma?
Questionnaire
There are two (2) pages to this questionnaire. Please complete all questions as applicable. Tick or
circle the answer that you find most suited to you or, where indicated, write your answer on the
lines provided and keep as short and concise as possible. Only fill out the sections that apply to
36

you. There is no need to write your name on this questionnaire. Thank you for your cooperation.
It should only take ten (10) minutes.
1. Sex:
Male [ ]
Female [ ]
2. Occupation: ____________________________________________________
3. Do you or anyone you know suffer from frequent asthmatic attacks?
Yes [ ]
No [ ]
4. If yes, how often are these attacks triggered?
Once per week [ ]
Twice per week [ ]
Three or more times per week [ ]
5. What do you believe are the three (3) major complications associated with an asthma
attack?
a. ____________________________________________________________
b. ____________________________________________________________
c. ____________________________________________________________
6. What treatment methods are preferred by the asthma sufferers parents/ guardians
Herbal [ ]
Medical [ ]
7a. Are asthma attacks fatal or could be fatal?

Yes [ ]
No [ ]
b. Explain your answer: ____________________________________________________

_____________________________________________________________________
_____________________________________________________________________
7. According to your records what percentage of children between the ages of 114 are hospitalized due to secondhand smoking?
1-10% [ ]
11-20% [ ]
21-35% [ ]
37

36-50% [ ]
8. Asthma attacks may range for mild to severe and can cause irreparable damage to the
brain or lungs.
Strongly agree [ ]
Agree [ ]
Strongly disagree [ ]
disagree [ ]
9. Describe one of the ways in which asthma sufferers are treated when they have an attack.
___________________________________________________________________
___________________________________________________________________
10.
Describe one of the ways in which asthma sufferers are treated when
they have an attack.
____________________________________________________________________
____________________________________________________________________
11.
Do you think thepopulation is adequately aware of the implications of
cigarette smoking and asthma?
Yes [ ]
No [ ]
If no, what can be done to further educate the population about such a serious illness?
_________________________________________________________________
_________________________________________________________________
38
i FEV1 this is reduced due to an obstruction of air escaping from the lungs, a lower value is worse.
Normal values are approximately 80%.

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