Cigarette Project

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THE HEALTH EFFECTS CIGARETTE SMOKING HAS ON MALES BETWEEN THE

AGES OF 18 AND 55 IN MATHARE NORTH AREA 3 AND 4.

NAME:

ADM NO:

A PROJECT PROPOSAL SUBMITTED TO KIDS IN PARTIAL FULFILLMENT FOR A

DIPLOMA IN…………..

DATE OF SUBMISSION



CHAPTER ONE

INTRODUCTION

1.0 Introduction

Over the years, more and more people are engrossed in large amounts of pleasures

that the modern world has to offer and therefore, they encounter various dangers

connected with addictions while indulging themselves into those temptations. One of the

common problems that people face these days are perils of cigarette-smoking and

although people are highly aware of them they still continue to follow that bad habit

forgetting about disastrous effects it has not only on our health but also people

surrounding us when we smoke.

1.1 Background of the study

Concern about the health effects of tobacco has a long history. As early as 1604 James

I wrote A Counterblaste to Tobacco, in which he said that tobacco users were "harming

your selves both in persons and goods" and the Word of Wisdom of The Church of

Jesus Christ of Latter-day Saints, written in 1833, prohibits the ingestion of tobacco

thus: "…tobacco is not for the body, neither for the belly, and is not good for man, but is

an herb for bruises and all sick cattle, to be used with judgment and skill." (Doctrine and

Covenants 89:8).

The late-19th century invention of automated cigarette-making machinery in the

American South made possible mass production of cigarettes at low cost, and



cigarettes became elegant and fashionable among society men. In 1912, American Dr.

Isaac Adler was the first to strongly suggest that lung cancer is related to smoking. In

1929, Fritz Lickint of Dresden, Germany, published a formal statistical evidence of a

lung cancer-tobacco link, based on a study showing that lung cancer sufferers were

likely to be smokers. Lickint also argued that tobacco use was the best way to explain

the fact that lung cancer struck men four or five times more often than women (since

women smoked much less).

Prior to World War I, lung cancer was considered to be a rare disease, which most

physicians would never see during their career. With the postwar rise in popularity of

cigarette smoking, however, came an epidemic of lung cancer.

In 1950, Richard Doll published research in the British Medical Journal showing a close

link between smoking and lung cancer. Four years later, in 1954, the British Doctors

Study, a study of some 40,000 doctors over 20 years, confirmed the suggestion, based

on which the government issued advice that smoking and lung cancer rates were

related. The British Doctors Study lasted until 2001, with results published every ten

years and final results published in 2004 by Doll and Richard Peto. Much early research

was also done by Alton Ochsner. Reader's Digest magazine for many years published

frequent anti-smoking articles. In 1964, the United States Surgeon General's Report on

Smoking and Health, led millions of American smokers to quit, the banning of certain

advertising, and the requirement of warning labels on tobacco products.



1.2 Problem statement

The purpose of the study is to establish the health effects that a human adult male is

likely to face due to cigarette smoking both in the short term and in the long run and the

effects they are likely to face when they try to withdraw from the vice/addiction.

1.3 Objective of the study

1.3.1 General objective

The general objective of the study is to identify the numerous health effects men are

exposed to after being exposed to cigarette smoke either as active smokers or as

passive smokers in both the short run and in the long run.

1.3.2 Specific objective

From the statement of the problem above we can deduce the following specific

objectives

To determine the contents in a cigarette stick that causes addiction and harm to

the human body.

To identify and rank the various effects that are caused by cigarette smoking

according to their severity and the body organs affected.

1.4 Research questions

1. What are the effects of cigarette smoking?



2. Are there any harmful risks for non-smokers?

3. What harmful chemicals are found in cigarette smoke?

4. How does exposure to tobacco smoke affect the cigarette smoker?

5. How would smoking increase the risk of developing cancer and other diseases?

1.5 Significance of the study

The findings will be important in the following ways:

The findings can become a basis for other researchers and educators who would

wish to do more research on the topic.

The study will sensitize the public on the negative effects of cigarette smoking.

The study can be used by relevant government ministries as a source of

reference when formulating policies that are related to the topic under study.

1.6 Justification of the study

It is no longer in doubt that over the years; cigarette smoking has turned out to be a

social and health hazard that has affected many, both male and female and hence

requires urgent attention. However, appropriate response requires sound and basic

information. Currently, the information available is inadequate, mainly derived from

programs and to a large extent Kenyan-focused, thus the need for collection of

information with a more local perspective is needed.

Although the problem of cigarette smoking has been addressed over the years, results

are still yet to be seen as resent studies have shown an increase in cigarette smoking



especially in urban areas. This has been mainly due to the fact that efforts to redress it

was left to few NGOs with the government not until very recently, forming up NACADA

an organization tasked with the responsibility to control drug abuse within the country.

This then calls for more research into the area as it shows not enough has been done to

eradicate or control the vice.

1.7 Assumptions of the study

The following are the basic assumptions of the study.

i. That all respondents to be interviewed will provide the correct and reliable

information.

ii. That the weather conditions will be favorable and will allow easy collection

of data.

iii. That all the respondents are able to speak in Swahili or English as these

will be the mail languages used when collecting data.

1.8 Limitations of the study

One of the limitations anticipated to be encountered will be availability of information.

Not many people especially minors who smoke will be willing to admit let alone speak of

their cigarette smoking behaviors



Another limitation is availability of data. It will be hard to know of the various effects of

smoking on any single respondents as many of them do not attend frequent health

checkups hence have poor records on their health status.

The sample size may also be a hindrance. Too large sample may not be adequately

studied due to lack of availability of time and resources.

Inadequate finance may also be a limitation as it may affect the process of data

collection analysis and presentation.



CHAPTER TWO

LITERATURE REVIEW

2.0 LITERATURE REVIEW

The health effects of tobacco are the circumstances, mechanisms, and factors of

tobacco consumption on human health. Epidemiological research has been focused

primarily on cigarette tobacco smoking, which has been studied more extensively than

any other form of tobacco consumption.

Tobacco is the single greatest cause of preventable death globally. Tobacco use leads

most commonly to diseases affecting the heart and lungs, with smoking being a major

risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD)

(including emphysema and chronic bronchitis), and cancer (particularly lung cancer,

cancers of the larynx and mouth, and pancreatic cancer). It also causes peripheral

vascular disease and hypertension.

The effects depend on the number of years that a person smokes and on how much the

person smokes. Starting smoking earlier in life and smoking cigarettes higher in tar

increases the risk of these diseases. Also, environmental tobacco smoke, or

secondhand smoke, has been shown to cause adverse health effects in people of all

ages. Cigarettes sold in underdeveloped countries tend to have higher tar content, and

are less likely to be filtered, potentially increasing vulnerability to tobacco-related

disease in these regions.



The World Health Organization (WHO) estimates that tobacco caused 5.4 million deaths

in 2004 and 100 million deaths over the course of the 20th century.

2.1 Tobacco contents

There are over 4,000 known constituents in cigarette tobacco or its smoke (US

Department of Health and Human Services, 1989). Many of them are carcinogenic or

toxic. The toxicological and pharmacological characteristics of three of the most

important - nicotine, tar, and CO - are covered below.

2.1.1 Nicotine

Nicotine, a tertiary amine, is the major addictive substance in cigarette tobacco (US

Department of Health and Human Services, 1988). Nicotine is given off by burning

tobacco and carried into the respiratory tract on tar droplets and in the vapor phase. As

a weak base, nicotine may exist in an ionized or a non-ionized form. The relative

proportions of these two forms, determined by the pH of the smoke, affect where

nicotine is most readily absorbed into the body. At the acidic pH of most cigarette

smoke, absorption occurs predominantly in the lungs, but with the alkaline smoke

produced by cigars and pipe tobacco, nicotine, being predominantly non-ionized, is

absorbed mainly in the mouth.

Absorption into the blood stream is rapid, and concentrations of nicotine in the blood

rise rapidly during smoking. Nicotine is metabolized, mainly in the liver, and the two

major metabolites are cotinine and nicotine-N’-oxide. Nicotine is a powerful



psychoactive agent that has a variety of central and peripheral nervous system effects,

as well as effects on the cardiovascular, endocrine, gastrointestinal, and skeletal motor

systems. Self-administration of tobacco leads to physical nicotine dependence and

psychological dependence on smoking behavior, with withdrawal symptoms associated

with smoking cessation. The action of nicotine on the brain occurs rapidly after smoking,

and this is believed to provide optimal reinforcement for nicotine dependence.

Until recently, the tobacco industry had denied that nicotine in tobacco was addictive.

However, recent disclosed internal communications within the tobacco industry indicate

that, as long ago as the 1960s, the tobacco industry knew that nicotine was addictive,

and that the industry acknowledged internally they were in the business of initiating and

maintaining addiction. Excerpts from internal tobacco industry documents, cited in

Kessler (1994) include:

―Smoking is a habit of addiction‖ (1962) ―There is no doubt that nicotine plays a large

part in the action of smoking for many smokers. It may be useful, therefore, to look at

the tobacco industry as if for a large part its business is the administration of nicotine (in

the clinical sense).‖

―We are, then, in the business of selling nicotine, an addictive drug…‖ (1963)

The direct contribution of nicotine to tobacco-associated diseases is unclear, as it is

inhaled along with many other substances in tobacco smoke. The role of nicotine is to

maintain the addiction and other substances in tobacco smoke, particularly tar and

some of the gaseous components, are the main direct causes of disease. However, if

tobacco did not include nicotine few people would continue smoking - nicotine is a



necessary causal component for most of the health-related harm from tobacco smoking.

This assumption underlines much of the thinking in this report.

2.1.2 Tar

Tar is a composite term for the particulate matter that can be condensed from tobacco

smoke. Tar includes the majority of mutagenic and carcinogenic agents in tobacco

smoke (IARC, 1986). Tar probably contributes to the taste and aroma of cigarette

smoke and, as such, probably has some influence on smokers’ behavior. With nicotine,

tar is the substance which, historically, has been measured in tobacco smoke for a long

time. It is widely assumed to be the most health-damaging component of tobacco

smoke.

2.1.3 Carbon monoxide

Carbon monoxide (CO) is generated from incomplete combustion of carbon-containing

substances and, as such, the amount of CO generated in smoking a cigarette is

influenced by cigarette design and the puffing characteristics of the smoker (US

Department of Health and Human Services, 1989).

CO combines with the hemoglobin in the blood to form carboxyhaemoglobin. This

reduces the oxygen-carrying capacity of the blood. The precise nature of CO’s

contribution to tobacco-related disease is uncertain, but it is likely to make some

contribution.



2.2 Health effects of cigarette smoking

Many teenagers and adults think that there are no effects of smoking on their bodies

until they reach middle age. Smoking-caused lung cancer, other cancers, heart disease,

and stroke typically do not occur until years after a person's first cigarette. However,

there is much serious harm from smoking that occur much sooner. In fact, smoking has

numerous immediate health effects on the brain and on the respiratory, cardiovascular,

gastrointestinal, immune and metabolic systems. While these immediate effects do not

all produce noticeable symptoms, most begin to damage the body with the first cigarette

– sometimes irreversibly – and rapidly produce serious medical conditions and health

consequences.

Rapid Addiction from Early Smoking

Many teenagers inaccurately believe that experimenting with smoking or even casual

use will not lead to any serious dependency. In fact, the latest research shows that

serious symptoms of addiction such as having strong urges to smoke, feeling anxious or

irritable, or having unsuccessfully tried to not smoke can appear among youths within

weeks or only days after occasional smoking first begins.

The average smoker tries their first cigarette at age 12 and may be a regular smoker by

age 14.3 Everyday, more than 3,500 kids try their first cigarette and about 1,000 other

kids less than 18 years of age become new regular, daily smokers. Almost 90 percent of

youths that smoke regularly report seriously strong cravings and more than 70 percent

of adolescent smokers have already tried and failed to quit smoking. (Russell, 1990)



Diseases Caused By Active Smoking

2.2.1 Effects on the Brain

Part of the addictive power of nicotine comes from its direct effect on the brain. In

addition to the well understood chemical dependency, cigarette smokers also show

evidence of a higher rate of behavioral problems and suffer the following immediate

effects:

i. Increases Stress. Contrary to popular belief, smoking does not relieve stress.

Studies have shown that on average, smokers have higher levels of stress than

non-smokers. The feelings of relaxation that smokers experience while they are

smoking are actually a return to the normal unstressed state that non-smokers

experience all of the time Parrott (1999).

ii. Alters brain chemistry. When compared to non-smokers, smokers brain cells-

specifically brain cell receptors- have been shown to have fewer dopamine

receptors. Brain cell receptors are molecules that sit on the outside of the cell

interacting with the molecules that fit into the receptor, much like a lock and key.

Receptors (locks) are important because they guard and mediate the functions of

the cell. For instance when the right molecule (key) comes along it unlocks the

receptor, setting off a chain of events to perform a specific cell function. Specific

receptors mediate different cell activities. Smokers have fewer dopamine

receptors, a specific cell receptor found in the brain that is believed to play a role

in addiction Dagher (2001). Dopamine is normally released naturally while

engaging in certain behaviors like eating, drinking and copulation. The release of



dopamine is believed to give one a sense of reward. One of the leading

hypotheses regarding the mechanism of addiction theorizes that nicotine

exposure initially increases dopamine transmission, but subsequently decreases

dopamine receptor function and number. The initial increase in dopamine activity

from nicotine results initially in pleasant feelings for the smoker, but the

subsequent decrease in dopamine leaves the smoker craving more cigarettes

Gamberino & Gold (1999). New animal studies have shown that brain chemistry

and receptors may be altered early in the smoking process. Habitual smoking

may continue to change brain chemistry, including decreasing dopamine

receptors and thus yielding a more intense craving and risk of addiction. These

brain chemistry changes may be permanent. In addition, because the role played

by receptors in other cognitive functions, such as memory and intelligence, is

unknown, how cigarette smoking effects other brain functions by altering brain

chemistry is unknown Trauth (2000).

2.2.2 Effects on the Respiratory System

The respiratory system includes the passages from the nose and sinuses down into the

smallest airways of the lungs. Because all of these spaces are in direct communication

with one another, they can all be affected by tobacco smoke simultaneously.

i. Bronchospasm. This term refers to ―airway irritability‖ or the abnormal tightening

of the airways of the lungs. Bronchospasm makes airways smaller and leads to

wheezing similar to that experienced by someone with asthma during an asthma

attack Behrman (2000). While smokers may not have asthma, they are



susceptible to this type of reaction to tobacco smoke. An asthmatic that starts

smoking can severely worsen his condition. Bronchospasm makes breathing

more difficult, as the body tries to get more air into irritated lungs.

ii. Increases phlegm production. The lungs produce mucus to trap chemical and

toxic substances. Small ―finger like‖ hairs, called cilia, coat the lung's airways and

move rhythmically to clear this mucus from the lungs. Combined with coughing,

this is usually an effective method of clearing the lungs of harmful substances.

Tobacco smoke paralyzes these hairs, allowing mucus to collect in the lungs of

the smoker. Cigarette smoke also promotes goblet cell growth resulting in an

increase in mucus. More mucus is made with each breath of irritating tobacco

and the smoker cannot easily clear the increased mucus.

iii. Persistent cough. Coughing is the body’s natural response to clear irritants from

the lungs. Without the help of cilia (above), a smoker is faced with the difficult

task of clearing increased amounts of phlegm with cough alone. A persistent

cough, while irritating, is the smoker’s only defense against the harmful products

of tobacco smoke. A smoker will likely have a persistent, annoying cough from

the time they start smoking. A smoker who is not coughing is probably not doing

an effective job of clearing his/her lungs of the harmful irritants found in tobacco

smoke.

iv. Decreases physical performance. When the body is stressed or very active (for

example, running, swimming, playing competitive sports), it requires that more

oxygen be delivered to active muscles. The combination of bronchospasm and

increased phlegm production result in airway obstruction and decreased lung



function, leading to poor physical performance. Smoking not only limits one’s

current state of fitness, but can also restrict future physical potential.

v. Lung cancer . Lung cancer develops when cells become abnormal and grow out

of control. Over time they form a clump also known as a tumor. Lung cancer

usually develops in the tubes that carry air in and out of the lungs (the airways). It

can grow within the lung and spread outside the lung. Lung cancer often

develops slowly and the lungs do not feel pain. The result of this is that by the

time lung cancer is diagnosed, it has often spread outside the lung. If this

happens the cancer is not curable. Common symptoms are: a cough that won’t

go away, breathlessness, wheezing, coughing up blood, and weight loss.

Lung cancer is the most common cause of death from cancer in the world.

Anyone can develop lung cancer, but people who smoke are most at risk. Over

80% of lung cancers are caused by smoking. Smokers are up to 20 times more

likely to develop lung cancer than non-smokers IARC (2004). The risk increases

with the total number of cigarettes smoked. Stopping smoking prevents further

increase in the relative risk of lung cancer. Passive smoking can also cause lung

cancer.

vi. Cancer of the pharynx/ larynx / esophagus. This is a disease in which

malignant cells form in the tissue of the larynx / pharynx. The symptoms for

cancer of the larynx can be similar to the symptoms for other illnesses and

include: hoarseness or change of voice, difficulty of swallowing, coughing and

shortness of breath, weight loss, a feeling that there is a lump in the throat and

bad smelling breath. The treatment options include radiotherapy, surgery and



chemotherapy. If the larynx has to be removed the person is no longer able to

speak and breathe normally.

2.2.3 Effects on the Cardiovascular System

The cardiovascular system includes the heart and all of the blood vessels that carry

blood to and from the organs. Blood vessels include arteries, veins, and capillaries,

which are all connected and work in unison with the lungs to deliver oxygen to the brain,

heart, and other vital organs.

i. Adverse lipid profile. Lipids, a form of fat, are a source of energy for the body.

Most people use this fat in its good form, called high-density lipoproteins, or

HDLs. Some forms of fat, such as low density lipoproteins (LDLs, triglycerides

and cholesterol) can be harmful to the body. These harmful forms have their

greatest effects on blood vessels. If produced in excess or accumulated over

time, they can stick to blood vessel walls and cause narrowing. Such narrowing

can impair blood flow to the heart, brain and other organs, causing them to fail.

Most bodies have a balance of good and bad fats. However, that is not the case

for smokers. Nicotine increases the amount of bad fats (LDL, triglycerides,

cholesterol) circulating in the blood vessels and decreases the amount of good

fat (HDL) available. These silent effects begin immediately and greatly increase

the risk for heart disease and stroke. In fact, smoking 1-5 cigarettes per day

presents a significant risk for a heart attack.



ii. Atherosclerosis. Atherosclerosis is a process in which fat and cholesterol form

―plaques‖ and stick to the walls of an artery. These plaques reduce the bloods

flow through the artery. While this process starts at a very young age (Some

children younger than 1 year of age already show some of the changes that lead

to plaque formation), there are several factors that can accelerate

atherosclerosis. Nicotine and other toxic substances from tobacco smoke are

absorbed through the lungs into the blood stream and are circulated throughout

the body. These substances damage the blood vessel walls, which allow plaques

to form at a faster rate than they would in a non-smoker. In this way, smoking

increases the risk of heart disease by hastening atherosclerosis. In addition, a

recent study in Japan showed a measurable decrease in the elasticity of the

coronary arteries of nonsmokers after just 30 minutes of exposure to second

hand smoke Otsuka, (2001).

iii. Thrombosis. Thrombosis is a process that results in the formation of a clot

inside a blood vessel. Normally, clots form inside blood vessels to stop bleeding,

when vessels have been injured. However, components of tobacco smoke result

in dangerously increased rates of clot formation. Smokers have elevated levels of

thrombin, an enzyme that causes the blood to clot, after fasting, as well as a

spike immediately after smoking Hioki (2001). This process may result in

blockage of blood vessels, stopping blood flow to vital organs. In addition,

thrombosis especially occurs around sites of plaque formation (above). Because

of this abnormal tendency to clot, smokers with less severe heart disease, have

more heart attacks than nonsmokers. In addition, sudden death is four times



more likely to occur in young male cigarette smokers than in nonsmokers.

Mitchell (1999)

iv. Constricts blood vessels. It has been shown that smoking, even light smoking,

causes the body’s blood vessels to constrict (vasoconstriction). Smoking does

this by decreasing the nitric oxide (NO2), which dilates blood vessels, and

increasing the endothelin-1 (ET-1), which causes constriction of blood vessels.

The net effect is constriction of blood vessels right after smoking and transient

reduction in blood supply. Vasoconstriction may have immediate complications

for certain persons, particularly individuals whose blood vessels are already

narrowed by plaques (atherosclerosis), or partial blood clots, or individuals who

are in a hyper-coagulable state (i.e. have sickle cell disease). These individuals

will be at increased risk of stroke or heart attack. Barua, (2002)

v. Increases heart rate. Heart rate is a measure of how fast your heart is pumping

blood around your body. Young adult smokers have a resting heart rate of two to

three beats per minute faster than the resting heart rate of young adult

nonsmokers HHS (1994). Nicotine consumption increases a resting heart rate, as

soon as 30 minutes after puffing; and the higher the nicotine consumption

(through deep inhalation or increased number of cigarettes) the higher the heart

rate. Smokers’ hearts have to work harder than nonsmokers’ hearts. A heart that

is working harder is a heart that can tire-out faster and may result in an early

heart attack or stroke Rose (2001).

vi. Increases blood pressure. Blood pressure is a measure of tension upon the

walls of arteries by blood. It is reported as a fraction, systolic over diastolic



pressure. Systolic blood pressure is the highest arterial pressure reached during

contraction of the heart. Diastolic blood pressure is the lowest pressure, found

during the heart’s relaxation phase. Nicotine consumption increases blood

pressure Rose (2001). Older male smokers have been found to have higher

systolic blood pressure than nonsmoking men do. Higher blood pressure requires

that the heart pump harder in order to overcome the opposing pressure in the

arteries. This increased work, much like that related to increased heart rate, can

wear out a heart faster. The higher pressure can also cause organ damage

where blood is filtered, such as in the kidneys. Righetti, (2004)

2.2.4 Effects on the Gastrointestinal System

The gastrointestinal system is responsible for digesting food, absorbing nutrients, and

dispensing of waste products. It includes the mouth, esophagus, stomach, small and

large intestines, and the anus. These continuous parts are all easily affected by tobacco

smoke.

i. Gastro esophageal Reflux Disease. This disease includes symptoms of

heartburn and acid regurgitation from the stomach. Normally the body prevents

these occurrences by secreting a base to counteract digestive acids and by

keeping the pathway between the esophagus (the tube between the mouth and

stomach) and stomach tightly closed; except when the stomach is accepting food

from above. The base smokers’ bodies secrete is less neutralizing than

nonsmokers and thus allows digestive acids a longer period of time to irritate the

esophagus Fitzpatrick & Blair,( 2000). Smokers also have an intermittent

loosening of the muscle separating the esophagus and stomach, increasing the



chance of stomach acid rising up to damage the esophagus. These immediate

changes in base secretion and esophagus/stomach communication cause painful

heartburn and result in an increased risk of long-term inflammation and

dysfunction of the esophagus and stomach. Smoking also increases reflux of

stomach contents into the esophagus and pharynx. Occurring regularly over

time, this reflux may cause ulcerations of the lower esophagus, called Barrett’s

esophagus, to develop Falk, GW (2002). Barrett’s esophagus may develop into

esophageal cancer, which has a poor prognosis in most patients.

ii. Peptic Ulcer Disease. Peptic ulcers are self-digested holes extending into the

muscular layers of the esophagus, stomach, and a portion of the small intestine.

These ulcers form when excess acid is produced or when the protective inner

layer of these structures is injured. Mucus is produced in the stomach to provide

a protective barrier between stomach acid and cells of the stomach. Unlike in the

lungs where mucus production is stimulated by cigarette smoke, mucous

production in the stomach is inhibited. Peptic ulcers usually result from a failure

of wound-healing due to outside factors, including tobacco smoke Mitchell

(1999). Cigarette smoking increases acid exposure of the esophagus and

stomach, while limiting neutralizing base production (above). Smoking also

decreases blood flow to the inner layer of the esophagus, stomach and small

intestine. In these ways, cigarette smoking immediately hinders gastrointestinal

wound healing, which has been shown to result in peptic ulcer formation, when

not treated. Peptic ulcers are terribly painful and treatment involves the long-term



use of medications. Complications of peptic ulcers often require hospitalization

and may be fatal secondary to excessive blood loss. Mitchell (1999)

iii. Periodontal Diseases. These occur when groups of bacteria are able to form

colonies that cause infections and diseases of the mouth. Smoking quickly

changes the blood supply, immune response, and healing mechanisms of the

mouth, resulting in the rapid initiation and progression of infections. In this way,

smoking makes the mouth more vulnerable to infections and allows the infections

to become more severe. The bacterial plaques of smoking also cause gum

inflammation and tooth decay. In addition, smoking increases tooth and bone

loss and hastens deep gum pocket formation Johnson, GK & Slach, NA (2001).

iv. Halitosis. This is a fancy word for bad breath. Everybody knows that smoking

makes individuals and everything around them smell bad. Bad breath, smelly hair

and clothes, and yellow teeth are among the most immediate and unattractive

effects of smoking.

v. Cancer of the mouth. Mouth cancer can appear in different forms in the mouth.

Sometimes it appears as a white or red patch, but most often it appears as a

painless ulcer that doesn’t heal. After treatment, which may require surgery,

patients may have problems with breathing, swallowing, drinking and eating.

Speech may also be affected and occasionally lost forever. Facial disfigurement

can also occur.

vi. Pancreatic cancer. The cancer typically starts in the cells lining the ducts of the

pancreas. The symptoms can be quite vague and they vary depending on where

the cancer is in the pancreas – in the head, body or tail. Early symptoms can



include: loss of appetite, weight loss, pain in the stomach area and jaundice.

Pancreatic cancer is the 14th most common cancer worldwide and about 30% of

cases are attributable to smoking. The disease is uncommon in people under 40.

The main known risk factors are smoking, diets with very high levels of fat and

sugar and excess alcohol consumption. Smokers have up to 4 times more risk of

developing pancreatic cancer than non-smokers. The risk increases with the total

number of cigarettes smoked Couglinn (2003).

vii. Stomach cancer- There are different types of stomach cancer but most of them

arise from the glandular tissue lining of the stomach. The symptoms of stomach

cancer can be quite vague and may include: indigestions / acidity / burping,

feeling full, bleeding and feeling tired and breathless, blood clots, pain in the

upper abdomen. Stomach cancer is the fourth most common cancer in the

world. Anyone can develop stomach cancer. Age is a significant risk. 9 out of 10

cases are diagnosed in people over 55 years old. Other risks include a diet high

in salt and smoking and drinking. Smokers have up to 2 times more risk of

developing stomach cancer. The risk increases with the total number of

cigarettes smoked Stevens (2008).

2.2.5 Effects on the Immune System

The immune system is the body’s major defense against the outside world. It is a

complicated system that involves several different types of cells that attack and destroy

foreign substances. It begins in the parts of the body, which are in direct contact with

the environment, such as the skin, ears, nose, mouth, stomach, and lungs. When these



barriers become compromised, there are serious health consequences. Tobacco smoke

weakens the immune system in a number of ways.

i. Otitis Media. This is inflammation of the middle ear. The middle ear is the space

immediately behind the eardrum. It turns received vibrations into sound. The

middle ear is very vulnerable to infection. Children exposed to environmental

tobacco smoke (ETS) have more ear infections than those not exposed. Tobacco

smoke disrupts the normal clearing mechanism of the ear canal, facilitating

infectious organism entry into the body. The resulting middle ear infection can be

very painful, as pressure and fluid buildup in the ear. Continued exposure to

tobacco smoke may result in persistent middle ear infections and eventually,

hearing loss Agius (1995).

ii. Sinusitis. Sinusitis is sinus inflammation. Sinuses are spaces in the skull that are

in direct communication with the nose and mouth. They are important for

warming and moisturizing inhaled air. The lining of the sinuses consists of the

same finger-like hairs found in the lungs. These hairs clear mucus and foreign

substances and are therefore critical in preventing mucus buildup and

subsequent infection. Cigarette smoke slows or stops the movement of these

hairs, resulting in inflammation and infection. Sinusitis can cause headaches,

facial pain, tenderness, and swelling. It can also cause fever, cough, runny nose,

sore throat, bad breath, and a decreased sense of smell. Sinusitis is more

serious and requires a longer course of medical treatment than the common cold.

Long-term smoke exposure can result in more frequent episodes and chronic

cases of sinusitis; and the rate of sinusitis among smokers is high.



iii. Rhinitis. This is an inflammation of the inner lining of the nasal passages and

results in symptoms of sneezing, congestion, runny nose, and itchy eyes, ears,

and nose. Similar to symptoms of the common cold, rhinitis may begin

immediately in the regular smoker. Smoking causes rhinitis by damaging the

same clearing mechanism involved in sinusitis (above). Rhinitis can cause sleep

disturbances, activity limitations, irritability, moodiness, and decreased school

performance. Smoking causes immediate and long-lasting rhinitis.

iv. Pneumonia. Pneumonia is an inflammation of the lining of the lungs. This

inflammation causes fluid to accumulate deep in the lung, making it an ideal

region for bacterial growth. Pneumonia results in a persistent cough and difficulty

breathing. A serious case of pneumonia often requires hospitalization. Smoking

increases the body’s susceptibility to the most common bacterial causes of

pneumonia and is therefore a risk factor for pneumonia, regardless of age.

Pneumonia, if left untreated, can lead to pus pocket formation, lung collapse,

blood infection, and severe chest pain.

v. Premature aging of the skin. Each person’s skin has its own natural aging

process (intrinsic aging). How quickly the normal aging process unfolds is

controlled by genes someone inherits. However, there are also external factors

(extrinsic aging) such as environmental and life-style factors that influence the

aging process. The main symptoms are an unnatural acceleration of aging

process causing deep wrinkles and leathery skin. Research carried out in a

laboratory found that cells exposed to smoke produced far more enzyme

responsible for breaking down skin. The research also found that smoke caused



a drop in the production of fresh collagen by up to 40%. The combined affect is

what is causing premature skin aging in smoking Akimichi (2000).

vi. Kidney cancer . When kidney cancer first starts to develop, there are often no

obvious symptoms. Once the cancer begins to grow, the following are the main

symptoms: blood in the urine, a lump or a mass in the area of the kidneys. Other

more vague symptoms may include tiredness, loss of appetite, weight loss, a

pain in the side that won’t go away, high temperature and heavy sweating. The

main known risk factors are smoking and obesity. Smokers have up to 2 times

more risk of developing kidney cancer than non-smokers. The risk increases with

the total number of cigarettes smoked Wendy (2007).

2.2.6 Effects on the Metabolic System

Your metabolic system includes a complicated group of processes that break down

foods and medicines into their components. Proteins, called enzymes, are responsible

for this breakdown. The metabolic system involves many organs, especially those of the

gastrointestinal tract.

i. Scurvy and Other Micronutrient Disorders. Micronutrients are dietary

components necessary to maintain good health. These include vitamins,

minerals, enzymes (above) and other elements that are critical to normal

function. They must be consumed and absorbed in sufficient quantities to meet

the body’s needs. The daily requirement of these micronutrients changes

naturally with age and can also be affected by environmental factors, including

tobacco smoke. Smoking interferes with the absorption of a number of

micronutrients, especially vitamins C, E, and folic acid that can result in



deficiencies of these vitamins Goldman, Cecil (2000). A deficiency in Vitamin C

can lead to scurvy which is a disease characterized by weakness, depression,

inflamed gums, poor wound healing, and uncontrolled bleeding. Vitamin E

deficiency may cause blood breakdown, eye disease, and irreversible nerve

problems of the hands, feet, and spinal cord. Folic acid deficiency may result in

long-lasting anemia, diarrhea, and tongue swelling.

ii. Oxidative Damage. Oxidants are active particles that are byproducts of normal

chemical processes that are constantly underway inside the body. Their

formation is called oxidation. These particles are usually found and destroyed by

antioxidants, including vitamins A, C, and E. The balance of oxidation and anti-

oxidation is critical to health. When oxidation overwhelms anti-oxidation, harmful

consequences occur. Oxidants directly damage cells and change genetic

material, likely contributing to the development of cancer, heart disease, and

cataracts Goldman, Cecil (2000). Oxidants also speed up blood vessel damage

due to atherosclerosis (above) which is a known risk factor for heart disease.

Because smoking increases the number of circulating oxidants, it also increases

the consumption of existing antioxidants. This increase in antioxidant

consumption reduces the levels of antioxidants such as alpha-tocopherol, the

active form of vitamin E. Smoking immediately causes oxidant stress in blood

while the antioxidant potential is reduced because of this stress. This dangerous

imbalance cannot be neutralized and results in immediate cell, gene, and blood

vessel damage. In addition, a National Cancer Institute study found that beta-



carotene supplements, which contain precursors of vitamin A, modestly increase

the incidence of lung cancer and overall mortality in cigarette smokers.

2.2.7 Effects on Drug Interactions

Drug breakdown, or metabolism, is important to drug effectiveness and safety.

Medicines are naturally broken down into their components by enzymes. Factors that

affect drug metabolism effect drug function. Factors that speed up drug metabolism

decrease drug exposure time and reduce the circulating concentrations of the drug,

which compromises the effectiveness of the prescription Desai, HD, Seabolt, J, & Jann,

MW (2001). Conversely, factors that slow down drug metabolism increase the

circulating time and concentration of the drug, allowing the drug to be present at harmful

levels. Tobacco smoke interferes with many medications by both of these mechanisms.

For example, the components of tobacco smoke hasten the breakdown of some blood-

thinners, antidepressants, and anti-seizure medications; and tobacco smoke also

decreases the effectiveness of certain sedatives, painkillers, heart, ulcer, and asthma

medicines. Especially Vulnerable Populations

i. Asthmatics. Mainstream or Environmental Tobacco Smoke (ETS) exacerbates

asthma symptoms in known asthmatics. In addition, some studies have shown a

link between ETS in childhood and a higher prevalence of asthma in adulthood.

ii. Sickle Cell Patients. Patients with sickle cell anemia who smoke are known to

have increased incidence of Acute Chest Syndrome. Acute Chest syndrome is a

condition that presents with severe chest pain, and is a life-threatening

emergency.



While some of these effects are wholly or partially reversible upon quitting smoking,

research has shown that many are not. Quitting smoking provides enormous health

benefits, but some smoking-caused damage simply cannot be reversed. Moreover,

many of the effects outlined here can cause considerable harm to teenagers and others

soon after they begin smoking and well before they become long-term smokers.

The health effects of second hand cigarette smoke

Secondhand smoke is the combination of smoke from the burning end of a cigarette

and the smoke breathed out by smokers. Secondhand smoke contains more than 7000

chemicals. Hundreds are toxic and about 70 can cause cancer.

There is no risk-free level of exposure to secondhand smoke. Secondhand smoke

causes numerous health problems in infants and children, including severe asthma

attacks, respiratory infections, ear infections, and sudden infant death syndrome (SIDS).

Some of the health conditions caused by secondhand smoke in adults include heart

disease and lung cancer.

Effects of secondhand smoke on the cardiovascular system

Exposure to secondhand smoke has immediate adverse effects on the cardiovascular

system and can cause coronary heart disease. Nonsmokers who are exposed to

secondhand smoke at home or at work increase their risk of developing heart disease

by 25 –30%.

Breathing secondhand smoke can have immediate adverse effects on your blood and

blood vessels, increasing the risk of having a heart attack. Breathing secondhand



smoke interferes with the normal functioning of the heart, blood, and vascular systems

in ways that increase the risk of having a heart attack. Even brief secondhand smoke

exposure can damage the lining of blood vessels and cause your blood platelets to

become stickier. These changes can cause a deadly heart attack.

People who already have heart disease are at especially high risk of suffering adverse

effects from breathing secondhand smoke and should take special precautions to avoid

even brief exposures.

Effects of Secondhand Smoke on the respiratory system

Secondhand smoke causes lung cancer in adults who themselves have never smoked.

Nonsmokers who are exposed to secondhand smoke at home or at work increase their

risk of developing lung cancer by 20 –30%.

Nonsmokers who are exposed to secondhand smoke are inhaling many of the same

cancer-causing substances and poisons as smokers.

Secondhand smoke contains

about 70 cancer-causing chemicals. Even brief secondhand smoke exposure can

damage cells in ways that set the cancer process in motion. As with active smoking, the

longer the duration and the higher the level of exposure to secondhand smoke, the

greater the risk of developing different types of respiratory cancer.

Studies have shown that people who tend to breath in second hand smokers have high

chances of getting respiratory diseases such as pneumonia and bronchitis as compared

to those who don’t breathe second hand smoke Second hand smoke can cause

asthma attacks to people suffering from asthma. It also causes wheezing and coughing.



CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

In this chapter, details on how the research will be conducted are presented. The

chapter is divided into sections: the research design, target population, sample and

sampling techniques, research instruments, reliability and validity of instruments, data

collection procedures and methods of data analysis.

3.1 Research Design

The proposed study will adopt a descriptive survey design the design is considered

appropriate for the study because according to Kothari (1985) survey is concerned with

describing, recording, analyzing and reporting conditions that exist or existed. Gay

(1992) argues that survey method is widely used to obtain data useful in evaluating

present practices and in providing basis for decisions. In this study, the researcher will

collect data on the topic of research from various sources and describe the situation as

it is without manipulating variables; hence descriptive survey is most appropriate.

3.2 Study location.

The location of the study will be Kasarani Division of Nairobi Province, Kenya. The

selection of Kasarani District is prompted by the researcher’s professional interest to

conduct research in the district based on familiarity and ease of accessibility of the



points of data collection within the district by the researcher. Singleton(1993) observes

that the ideal setting for any study is one where the researcher has interest in, one that

is easily accessible and one that allows the researcher immediate rapport with the

respondents. Thus, the district is selected because of its accessibility and familiarity to

the researcher, and hence, data collection would not be hindered by the respondents

hostility. Gay (1992) point out that, sometimes being familiar with the research location

helps in gaining acceptance by the sampling population. Also no similar research has

been carried out in the district so far.

3.3 Target population

The target population for the study will be males of between the ages of 18 and 55 who

live and work within Kasarani District. According to statistics collected and compiled by

Kasarani Constituency Development Fund there are a total of 756,790 adult males

within Kasarani district. The study will target males between the ages of 18-55 within

this district.

3.4 Sampling and sampling techniques

A multi-stage sampling technique will be used to identify the sites from which data will

be gathered this means, the sample selection for cigarette smokers will be done in

stages. First the researcher will visit the study sites to map out sites which smokers

seem to frequent on a regular basis. Consequently, clusters are identified and listed.

From this listing two types of clusters emerge: One group with fewer smokers and the

other with a large number of smokers. The smaller clusters are eliminated, but all those

with larger populations are retained for the study. This procedure resulted in 10 clusters



within kasarani district. From this 10 individuals per cluster will be selected from the 10

clusters under the guidance of willingness to be interviewed and age of individual.

Therefore the study sample will comprise of 300 respondents from different

backgrounds and ages

3.5 Research instruments

The study will employ the use of questionnaires as the main instrument of data

collection. The survey questionnaire developed will be used to capture basic

demographic information on respondents and on various issues relating to cigarette

smoking and its effects. The questionnaire will sought to elicit information on the

existing interventions at the community level on the vice of cigarette smoking. However,

for the sake of consistency in understanding and interpretation of the questions, the

researcher will read out the questions and explain to the respondents how to fill them.

3.6 Reliability and validity

3.6.1 Reliability of the instruments

Mugenda and Mugenda (1999) define reliability as a measure of the degree to which a

research instrument yields consistent results or data after repeated trial. Before the

actual data collection, piloting of questionnaires and the interview schedule will be done

on one school and one health care institute within the area under study both of which

will not participate in the actual study. Piloting will enable the researcher to test the

reliability of the instruments.

There are three basic methods to test reliability: test-retest, equivalent form and internal

consistency. Most research uses some form of internal consistency. When there is a



scale of items all attempting to measure the same construct, then one would expect a

large degree of coherence in the way people answer those items. Various statistical

tests can measure the degree of coherence. Another way to test reliability is to ask the

same question with slightly different wording in different parts of the survey. The

correlation between the items is a measure of their reliability.

In this study, the researcher will use the pilot study to identify any items in the

questionnaires that are ambiguous or unclear to the respondents and change them

effectively. The pilot study will also enable the researcher to familiarize herself with

administration of the questionnaire.

3.6.2 Validity of the Instruments

Validity is defined as the accuracy and meaningfulness of inferences, which are based

on the research results Mugenda and Mugenda (1999). In other words, validity is the

degree to which results obtained from the analysis of the data actually represents the

phenomena under study. There are no statistical tests to measure validity. All

assessments of validity are subjective opinions based on the judgment of the

researcher. Nevertheless, there are three major types of validity: face validity, content

validity and construct validity.

Face validity refers to the likely hood that a question will be misunderstood or

misinterpreted. Pre-testing a survey is a good way to increase the likelihood of face

validity. The pilot study will be used to identify those items that could be misunderstood,

and such items will be modified accordingly, thus increasing face validity.



Content validity refers to whether an instrument provides adequate coverage of atopic.

Experts’ opinions, literature searches and pretesting of open-ended questions help to

establish content validity Wilkinson (1991). The researcher will prepare the instruments

in close consultation with her supervisors, whose expert judgment will help improve

content validity.

Construct validity refers to the theoretical foundations underlying theories or

measurement. It looks at the underlying theories or constructs that explain a

phenomenon. In other words, if one is using several survey items to measure a more

global construct e.g. a subscale of a survey, then one should describe why he/she

believes the items comprise a construct. If a construct has been identified by previous

researchers, then one should describe the criteria used to validate the construct. A

technique known as confirmatory factor analysis is often used to explore how individual

survey items contribute to an overall construct measurement (Chicago Manual, 2003).

However, in this study the researcher is not interested in measuring a certain construct.

The researcher will only collect information about the state of affairs in schools, and

thus construct validity is not applicable here.

Content validity refers to whether an instrument provides adequate coverage of a topic.

Expert opinions, literature searches, and pre testing of open-ended questions help to

establish content validity. The researcher will prepare the instruments in close

consultation with his supervisors, whose experts judgment will help improve content

validity.



Construct validity refers to the theoretical foundations underlying a particular scale or

measurement. It looks at the underlying theories or constructs that explain a

phenomenon. In other words, if one is using several survey items to measure a more

global construct (e.g. a subscale of a survey), then one should describe why he/she

believes the items comprise a construct. If a construct has been identified by previous

researchers, then one should describe the criteria used to validate the construct. A

technique known as confirmatory factor analysis is often used to explore how individual

survey items contribute to an overall construct measurement Chicago Manual (2003).

However, in this study the researcher is not interested in measuring a certain construct.

The researcher will only collect information about the state of affairs in schools, and

thus construct validity is not acceptable here.

3.7 Data collection procedure

The researcher will get an introduction letter from KIDS and research permit from the

ministry of education (MoE). Data for the study will then be collected through interviews

using both structured and unstructured questionnaires. Simple observations might also

be conducted in the 10 study sites. Secondary sources were also used to collect

information on policy, law and programs. The researcher will then visit each of the

cluster sites and administer the questionnaires herself. The respondents will be given

and assured of confidentiality after which they will be given enough time to fill in the

questionnaires, after which the researcher will collect the filled in questionnaires.



3.8 Data analysis procedure

Data collected from the field will be coded and entered into the computer for analysis

using the Statistical Package for Social Sciences (SPSS). Descriptive statistics

including percentages and frequency counts will be used to analyze the data obtained.

Bell (1993) maintains that when making the results known to a variety of readers, simple

descriptive statistics such as percentages have a considerable advantage over more

complex statistics, since they are easily understood. Borg and Gal (1983) also told that

the most widely used standard proportion is the percentage. The results of data analysis

will be presented in frequency tables, histograms and pie charts.



4.0 DATA ANALYSIS AND FINDINGS

4.1 Introduction

In this section an attempt is made to present and discuss the findings of the study on

the health effects of cigarette smoking, using descriptive statistics. Measures of central

tendency such as mean, mode and median are used to underscore the data into

manageable proportions. Simple tables and percentages are used at this stage mainly

to illustrate and to elaborate on what is being discussed. An in-depth study involving

300 male adults is also included.

The study population was obtained from five sub locations; Garden, Kahawa West,

Kariobangi North, Korogocho, and Mathare 4A all within Kasarani division, Nairobi

province. 300 respondents interviewed were distributed as follows: 55 (18.33%) from

Garden, 65 (21.67%) from Kahawa West, 70 (23.33%) from Kariobangi North, 50

(16.67%) from Korogocho, and 60 (20%) from Mathare 4A. The distribution of

respondents is summarized in Figure 1.

Figure 1 : Population distribution

Kahawa West,

21.67%

Mathare 4A,

20%Garden,

18.33%

Korogocho,

16.67%

Kariobangi North,

23.33%



4.2. Socio-demographic Characteristics

Sex and Age: The study population was almost evenly distributed. Their ages ranged

from 18 years to 55 years, with most of the respondents belonging to the 20-24 years

age range. However, the average age is 33 years—mean of 33 years. Overall, about

70% of the respondents were between aged 20 and 40 years.

Level of education: About a third (33.33%) of the respondents reported that they had

completed secondary level of education while one fifth (20%) reported that they had

completed primary level of education. The highest proportion of those reporting that

they had completed secondary level of education was found in Garden (41.6%). 10% of

the respondents reported post-secondary level of education.

Socio-

demographic

characteristics

Garden

(18.33%)

Kahawa West

(21.67%)

Kariobangi

North

(23.33%)

Korogocho

(16.67%)

Mathare 4A.

(20%)

Combined

Sex

Male 42.8 50.5 50.6 53.6 48.1

Age (years)

18 – 19 5.1 7.1 5.9 7.5 6.1

20 – 24 17.3 29.3 25.9 24.3 22.7

25 – 29 15.2 20.2 18.8 12.1 16.2

30 – 34 19.8 14.1 16.5 15.9 17.2

35 – 39 16.8 11.1 14.1 11.2 13.9

40 – 44 12.2 3.0 7.1 7.5 8.4

45 – 49 7.6 7.1 4.7 5.6 6.6

50 – 54 1.5 5.1 2.4 1.9 2.5

55+ 4.6 3.0 4.7 14.0 6.4

Total 100

Ethnicity



Kikuyu 8.5 23.8 71.4 64.5 34.8

Luo 9.5 9.9 8.0 2.7 7.3

Meru 2.0 2.0 4.8 1.8 2.4

Kalenjin 1.5 4.0 0 0 1.4

Kisii 15.6 16.8 1.2 2.7 10.5

Miji Kenda 0 0 0 0.9 0.2

Kamba 44.7 23.8 6.0 14.5 27.1

Luhyia 15.1 11.9 4.8 10.9 11.7

Other 2.5 7.9 7.1 1.8 4.3

No Response 0.5 0 0 0 0.2

Total 100

Highest level of education

None 3.0 1.0 2.4 5.5 3.0

Primary not

completed

19.9 13.9 10.6 22.7 17.7

Primary

completed

24.4 22.8 22.4 18.2 22.3

Secondary not

completed

17.9 9.9 22.4 15.5 16.5

Secondary

completed

27.9 41.6 28.2 25.5 30.2

Post-secondary 7.0 10.9 14.1 12.7 10.3

Total 100

Religious affiliation

Christian 92.5 97.0 96.5 93.6 94.4

Muslim 5.0 0 2.4 2.7 3.0

Hindu/Buddhist 0 0 0 0.9 0.2

None 1.5 3.0 1.2 1.8 1.8

Other 1.0 0 0 0.9 0.6

Total 100

Occupation

Student 1.0 5.0 9.4 4.5 4.0

Formal

employment

13.5 17.8 7.1 16.4 13.9



Self-

employment

50.5 35.6 43.5 33.6 42.5

Home maker 15.0 5.0 12.9 11.8 11.9

Work in family

business

0 3.0 0 0.9 0.8

Casual 11.5 12.9 16.5 18.2 14.1

None 8.5 19.8 10.6 14.5 12.5

Other 0 1.0 0 0 0.2

Total 100

Religious affiliation: As expected, the majority of those interviewed identified themselves

as Christians (94.4%), with the Muslims accounting for 3.0%. Other religious categories

reported include Hindu/Buddhist (0.2%) while 1.8% reported that they did not belong to

any religious group.

Occupation: Most of the respondents (42.5%) reported that they are self-employed

compared to those who are in formal employment (13.9%), casual labor market (14.1%)

or who reported themselves as home makers (11.9%). About one in ten (12.5%) of the

respondents did not report any occupation. The highest proportion of respondents

(16.4%) who reported that they had formal employment is found in Embakasi (17.8%)

perhaps as a result of its proximity to the Industrial area.

Population of smokers

Of the respondents interviewed in the research 65% of them were nonsmokers 10.4%

were smokers and 6% were ex-smokers. These findings are shown in figure 2 below.



Figure 2: Population of smokers, ex-smokers and nonsmokers

Availability and affordability of cigarettes

Availability, affordability and prevalence of selling points for cigarettes were assessed in

the five research sites. Cigarette sticks were categorized into four, namely: first

generation cigarettes (which include legal cigarettes. These are conventional and often

are high priced with a low tar content, such as Embassy lights, Dunhill lights and 555);

second generation cigarettes (which are brands that have been introduced lately into

the market. These are low priced and often have medium tar content such as

Sportsman, Safari, Pall Mall, Dunhill and Sweet-menthol); non filtered cigarettes such

as Rooster have very high contents of tar and other toxic elements as the tobacco

hardly undergoes any processing to reduce the high toxic contents such as tar.

65%

6%

10%

19%

Population of smokers

Nonsmokers

Ex smokers

Smokers

nonsmokers exposed to

second hand smoke



Type of cigarette

FirstgenerationbrandsN (%)

SecondgenerationbrandsN (%)

Non filteredcigarettesN (%)

Availability of Cigarettes

Easilyavailable

26.3 40.8

Moderatelyavailable

47.7 37.2

Not allavailable

13.9 8.1

Don’t know 12.1 13.9

Affordabilityof cigarettes

Easilyaffordable

10.7 32.5

Moderatelyaffordable

46.1 38.6

Not at all

affordable

21.8 7.5

Don’t know 21.4

Number of cigaretteselling points

Very many 23.1

Moderatelymany

21.1

A few 37

None 6.1

Don’t know 12.8Figure 3: Availability affordability and number of selling points of cigarettes

Overall, most respondents reported that non filtered cigarettes (65%) were more readily

available compared to the first (26.3%) and second (40.8%) generation brands. About

half of the respondents (47.7%) felt that first generation cigarettes were only moderately

available. Similar feelings were expressed in respect of affordability of these cigarettes

with most respondents reporting that non filtered cigarettes were more affordable while

most people were of the view that first and second generation cigarettes were regarded

as being moderately affordable. Unlike the pattern reported on availability and

affordability, for the number of selling points, only middle class cigarettes were reported

to have many points of sale.



Further analysis of the data shows an association between availability, affordability and

the number of outlets for cigarettes. First generation cigarettes have the largest

disparities in terms of availability, affordability and the number of outlets. While it is

viewed as generally available (74%), only about half of the respondents regard it as

affordable while fewer (24.2%) thought the outlets for the first generation cigarettes

were moderate to many. On the other hand, second generation cigarettes were thought

as being generally available (78%) and affordable (71.1%) with close to 62% saying that

there were many outlets. Non filtered cigarettes showed less variation in terms of

availability, affordability and the number of outlets available.

Visible Health Effects

70% of the smokers were observed to have had visible effects of smoking. The most

visible effects were stained and burnt fingers, stained teeth, bloodshot eyes, dried lips,

irritation after a short time without a smoke, the overwhelming smell of tobacco and

tobacco filled breath. The visible effects of cigarette smoking were as follows:

49.7% were recorded to have burnt and stained fingers

48.9% were recorded to have stained teeth

46% had blood shot eyes

70% had dried lips

41% were recorded as restless and irritable after short periods of time without

having a smoke

36%had an overwhelming body smell of tobacco

30% were recorded to have tobacco filled breath



Most of the respondents interviewed and were recorded as smokers were observed to

have a combination of two or more of the visible effects.

Respondents’ awareness of the harmful effects of tobacco including second handsmoke All respondents were aware of the health hazards, caused by smoking cigarettes

Knowledge of Specific Harmful Effects of Tobacco Use

Frequency % Valid Percent Cumulative Percent

YES 300 100.0 100.0 100.0

Recorded health effects

According to fig 4, 67% of the respondents recorded to have had frequent health

checkups over the last one year. The remaining respondents either never health

checkup or did attend less than one medical checkup in the last one year. Of the

respondents who recorded frequent health checkups, 35% of them were found to have

respiratory infections such as persistent coughs, stained teeth, high blood pressure etc.

60% recorded to have been advised to quit.

Of the respondents interviewed, 3% who were nonsmokers but had frequent health

checkups were found to be having respiratory diseases and infections. After evaluation

the respondents were found to be working in areas with numerous smokers such as

shops, canteens and bars. Hence the health effects were as a result of secondhand

smoke.



Respondents’ opinion of tobacco prevalence

Respondents were asked their opinion on the levels of worry on the current prevalence

of tobacco use in Kenya. 10.4% of the respondents did not find the current prevalence

of tobacco use in the country worrying, 70% found it worrying, 16.4% found it very

worrying while 3% did not know.

Opinion of current prevalence of cigarette smoking in Kenya

Frequency Percent

NOT WORRYING 10.4

WORRYING 70.1

VERY WORRYING 16.4

DONT KNOW 3.0

Total 300 100.0

Quitting

During the collection of data, 60% of the respondents replied to having had tried quitting

over the last one year. 2% of them were recorded to have been successful as shown in

figure---- below. 48% of them recorded only to have lasted only two days without a

smoke while 42% lasted for an average of two weeks. 8% recorded to have lasted more

than a month.



Figure 4: Rates of attempted cigarette smoking quitting

Respondents’ opinion of tobacco prevalence

Respondents were asked their opinion on the levels of worry on the current prevalence

of tobacco use in Kenya. 10.4% of the respondents did not find the current prevalence

of tobacco use in the country worrying, 70% found it worrying, 16.4% found it very

worrying while 3% did not know.


Frequency Percent

NOT WORRYING 10.4

WORRYING 70.1VERY WORRYING 16.4

DONT KNOW 3.1

Total 300 100.0

successful

2%

lasted less than a

week

48%

lasted less than a

month

42%

lasted more than a

month

8%

Rate of attempts to quit smoking



Discussion

The overriding concern of the study was to assess the health effects of cigarette

smoking on male adults that reside in Kasarani Division. Data was collected from a

sample of 300 male adults in Kasarani’s; Garden, Kahawa West, Kariobangi North,

Korogocho and Mathare North sub locations. The sampled men responded to questions

on cigarette use either as active smokers or as passive smokers.

This study established that cigarette smoking was harmful to one’s health as it affected

the body negatively. Close to half of these respondents recorded to have smoked a

cigarette even if it was just a puff, or were around active smokers which made them

passive smokers, a finding that is consistent with those from other studies in Kenya with

respect to cigarette smoking among adult men in Kenya.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Not Worrying Worrying Very

Worrying

Don’t Know


Opinion of current prevalence

of cigarette smoking in Kenya



Smoking harms nearly every major organ of the body. The risk of developing smoking-

related diseases, such as lung and other cancers, heart disease, stroke, and respiratory

illnesses, increases with total lifetime exposure to cigarette smoke. This includes the

number of cigarettes a person smokes each day, the intensity of smoking (i.e., the size

and frequency of puffs), the age at which smoking began, the number of years a person

has smoked, and a smoker’s secondhand smoke exposur e.

Consistent with the hypothesis that long term use of cigarettes causes adverse health

effects on the adult male body, this study found that the health effects of cigarette

smoking are as immediate as the first smoke, and increases with the intensity of the

smoking. All factors considered respondents who were around active smokers for long

periods of tome were 6.7 times more likely to have respiratory caused infections and

diseases as compared to those that were not around smokers. Similarly, respondents

who were active smokers were recorded to be 8 times more at risk to contract

respiratory diseases as compared to non-smokers.



5.0 Summary and conclusions

5.1 Conclusion

Recommendations



References

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5. Stevens J, Maastricht University, Belgium. Large cohort study links stomach

cancer to smoking (2008)

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