Knowledge and Attitude towards Smoking among University Students in Lahore

Abstract Background: Smoking is the major health problem all over the world and now it’s become trend in university students to have smoking behavior because they believed that due to smoking they will be more acceptable in friends group. The most prevalence of smoking among university students is due to the attitude of students that it could enhance their personal attributes and make a positive change in their personality. The most provoking factor in the students to start smoking was the lack of knowledge regarding the harmful effect of smoking and also the students believed that smoking can reduce stress. Objective: To assess knowledge and attitude of university students towards smoking. Methodology: A cross sectional descriptive study design was used to assess the knowledge and attitude of university students towards smoking. Sample size of 222 students were taken from three departments of The University of Lahore, in which 80 students were from Nursing, 82 from Biotechnology(IMBB) and 60 physiotherapy students were included in this study. Results: Out of 222 students 32% were current smokers while 68% were nonsmokers, 70% students believed that Nicotine in Cigarette is not addictive to human, 83% of the respondents believed that smoking is a disgusting behavior and 85% of the respondents believed that smoking should be banned in Universities significant amount of students. Conclusion: there is strong link between the students’ attitude and smoking behavior and it is important for parents and teachers to supervise their student’s behavior.


Introduction
Smoking is one of the most treatable health hazards for the smokers and for passive smokers also which can be preventable .smokingbehavior is developing day by day in young generation and the attitude of students towards smoking is changed, most of the students believed that smoking may add a positive attributes in their personality instead of having enough knowledge that smoking cause serious diseases (Oort, 2006).
According to Rozi (2005) university students play a vital role in the development of any nations if they utilize their energy on positive activities instead of involving in a bad activities and companies which destroy their lives According to Akram et al.(2014) smoking can be defined as burning of tobacco substance via cigarette and then the smoke of tobacco is inhaled, tested and taking puff through mouth.Cigarette smoking will be accountable for many of the heart, brain and lungs related disease due to which multiple morbidity and mortality of the smokers occurs.
According to Sharif, 2012 smoking is the leading health hazards and causes of deaths in all over the world which can be preventable if sufficient steps were taken for the prevention and ban smoking in universities and colleges.Smoking is the single most preventable reason for death worldwide, tobacco utilization result in the death of millions of people every year.And if current patterns continue, the deaths from tobacco will be increase to more than 8 Million if current situation continue by the 2030 with the majority of the tobacco-related morbidity and mortality happening disproportionately in low and middle income countries.
According to Gajalakshmi et al. (2004), the World Health Organization (WHO) (2009) has estimated that that 5 million of death happen annually due to tobacco use and this number of deaths is expected to reach more than 8 Million by the year 2030.

Research Article
M. Ali et al. (2017) Int. J. Soc. Sc. Manage. Vol. 4, Full text of this paper can be downloaded online at www.ijssm.org/&http://nepjol.info/index.php/IJSSM/issue/archiveAccording to WHO (2011) in Pakistan the prevalence rate of smoking is very high which is almost exist thirty two percent in males while a little portion of female smokers are also exist who are practice smoking in daily life which cause very serious and injurious health problems like lung cancer is the top number of cancers among Pakistani men and it is portrayed from various studies that there is a strong link between lung cancer and smoking According to Maula et al.(2012) there are several factors which were associated with the greatest frequency and acceptance of cigarette smoking behavior in Pakistan, in which the most leading factors were smokers friend and the pressure of friends and stress which enhance the prevalence of cigarette smoking behavior in Pakistan.
According to El Ansari, (2002) is a major health concern for the smokers but it also can cause very serious threat for the passive smokers also and can affect children and women's especially pregnant women's.Smoking has also environmental influence and can hurt passive smokers According to Abu-Baker (2010) when exposure of the pregnant women's towards smoking remains for long time then it cause a serious threat for her baby.The impact of smoking is not limited on the smokers, but it can spread to affect the non-smokers as well.Second hand smoking has an impact on both outcomes represented in low birth weight According to Hsieh (1996) various studies shows that there is strong link between smoking behavior and knowledge regarding smoking effects.Knowledge towards smoking play a vital and significant role to start smoking or cease smoking.
According to Ashley et al, (2000) this is portrayed from various studies that knowledge and attitude have a significant relation with smoking behavior and suggesting that sufficient amount of knowledge can minimize the chances for a person to become addicted towards smoking According to Ajzen (1991) attitude is the learned predisposition and act towards anything while in the context of smoking any mental and psychological force which push the person to start smoke, attitudes are reflected to be Important precursors of behavior, Attitude is directly link with smoking because many of the students start smoking while they think that smoking play a vital role to fit in group and can add a positive attributes in their personality

Purpose of the Study
Cigarette smoking is major health hazard in various educational and non-educational institutes in Pakistan which can cause various health problems and influence the universities environment.The aim of this cross sectional study was exploring the university student's knowledge and attitude toward smoking among university students in Lahore.

Significance
This study was very significant from all points of view the first significance was for those participants from whom the data were collected, many of fresh students suffered from the bad company of their friends and start smoking as they think that smoking could bring a positive change in their personality so by reading and understanding the questionnaire they were aware from the negative effects of smoking and the participants who are already smoking have the possibilities to minimize practice of smoking as much as possible.This study was also very important in research point of view because it will play a vital role for the development of rules against cigarette smoking in universities.This study was also very significant for me because knowledge is the ultimate product of the study and the understanding of various factors form which students start smoking will be learned Smoking is a major health hazards in many of university and this study will also play a vital role for banning smoking in university areas and make the university environment smoke free.

Objectives
1. To assess the knowledge of university students regarding cigarette smoking 2. To assess the attitude of university students regarding cigarette smoking

Research Questions
1. What is the knowledge of university students towards cigarette smoking? 2. What is the attitude of university students towards cigarette smoking?

Dependent variable
Dependent variable for the study was Smoking habit

Independent variable
Independent variable of this study was Knowledge and attitude

Literature Review
According to Abu-Baker (2010) when viewing the health concerns of the public health then Smoking are considered is the major one in all over the world, while if this problem arise from the educational institutions then it became a great concern for the country and the community as well and will required enough steps to be taken by the stake holders.
According to Brown et al. (2003) tobacco is the reason of massive amount of deaths in all over the world, it is reveled from various studies that three millions of people are suffered from deaths each year worldwide and these deaths is going up day by day.The estimation of world Health Organization shows that if the current pattern of smoking is persist then these deaths will be reached to an amplified amount by the year 2030.
According to (Oort, 2006) who investigate the knowledge of students regarding smoking stated that Smoking shows its ultimate results and exceed the number of deaths which occur by the disease and accidents due to smoking behavior round about thousands of people died each year in which one in six death occur in the USA, looking to existing figure of deaths which occur due to smoking proving that smoking is more dangerous and fetal then AIDS, car accidents, killings, suicides, drug overeats and fires combined.
According to Akram et al. (2014) conducting a study on students attitude it is portrayed from his study that if smokers were aware of the dangerous effects of smoking then they will refrain from smoking habit, The main reason for practicing cigarette smoking behavior among students in Pakistan is the exam stress and friends pressure which pursue students to get addicted of smoking.
According to Akram et al. (2014) who conducting a study on knowledge of students regarding cigarette smoking find that there is no big difference between male and female students in their knowledge and attitude but a large difference in their practices exist.A massive amount of students believed that smoking is not good while very few students claimed that it is not bad, many of the students got idea to start smoking from their parents significant amount of students get idea of smoking from their teachers and environment of the educational institutions According to Jajja (2013) who conducted a study in Bahria University and Ziaudin Medical University stated that medical students have more awareness regarding the negative effects of smoking behavior while non-medical students have no such a knowledge.The study portrayed that peer pressure and media play an important role via enhancing the cigarette smoking behavior in young adults.
According to Sharif (2013) who conducted study in Irbid, Jordan find out that Most of the university students, regardless of their smoking status, have sufficient knowledge about the negative effects of smoking, however, students had a lesser extent of that knowledge than non-smoking students.Some smokers thought that smoking helps they fit in with their peers; this was more pronounced among females.This may be because they feel that they are more accepted as smokers within their friends who are in most cases smokers as well.About half the smokers believe that smoking helps them concentrate while studying.
According to Sharif (2013) student's grades and passing university examinations are some of the most important factors in building their future careers at this stage of a student's life.In other words, the core of the student's focus is to succeed and obtain high grades.They may take the risk of smoking for the sake of concentrating while studying.This negative attitude might be the most important factor to be considered in any smoking control program for university students.The number of cigarettes smoked per day was associated with the time the student first started smoking.The students who start to smoke before enrollment in a university usually smoke more cigarettes than those who start after being enrolled.This can be explained by the fact that smokers are becoming more addicted to nicotine According to Lecacheux et al. (2009) knowledge and attitude play an important role while starting smoking several studies shows that lack of knowledge and negative attitude might be the most important factor to be considered in any smoking control program for university students.This wrong attitude and belief is contrary to the scientific fact that some of the substances included in cigarettes cause confusion and cognitive modifications

Methodology
A descriptive cross sectional cross sectional study was carried out in the University of Lahore to assess the knowledge and attitude of the students towards smoking from March 2016 To April 2016.The 222 participants was selected through simple random sampling method from three departments Nursing, IMBB and DPT from different semesters.The students outside from university of Lahore and above mentioned departments were excluded from this study.A self-administered and modified version of questionnaire which was adopted from the article "influence of Knowledge and Attitudes on Smoking Habits Among Young Military Conscripts in Taiwan" written by (Lin, Wu, Lai, Shi, and Chu 2010) which is developed by the writer himself, was used to collect data from the participants.
Questionnaire were consist of three sections, (Section A) composed of demographic data which include Name (optional) Age, Gender, institute, department, semester and smoker or nonsmoker information about the participant.(Section B) composed of the questions regarding the assessment of knowledge which include 10 questions, the participants can answer these questions through likert scale from strongly agree to strongly disagree.And the last (section C) include 10 questions regarding the assessment of attitude and the participants were answered to these questions according to 5 likert scale.After floating Questionnaire among the participants the data was analyzed through SPSS version 21 for Descriptive statistics and finding mean, frequencies, validity and reliability.Consent was taken from all the participants and free hand were given to the participants to take part in the study or refused to participate, the privacy of the participants were also considered and the choice were given to the participants to mentioned name or not.

Data Analysis
This chapter includes 3 portions of analysis.First analysis was demographic analysis.It gives us details of 4 demographic questions which is gender, Age, Department and Smoking Habit Descriptive analysis was used for assessment of knowledge and attitude of the students towards smoking which include 10 questions of knowledge and 10 questions of attitude Reliability of the scale was measured through Cronbach's alpha value while the validity is measured through KMO value.4.2

Demographic analysis
Gender Fig. 1 shows that Data was collected from both genders.Statistics shows that 81.53% responses were taken from the male students and 18.47% of respondents were female.

Descriptive and Normality Statistics
Normality Tests At first data was analyzed for missing values and other typing errors were also analyzed so that errors could rectify.Value of the data was assessed by analyzing normality.Normality was examined through skewness, kurtosis and histograms (Munro, 2005).Scores of knowledge and attitude were normally distributed and were well in range +1 to -1 hence findings indicated normality of the data (Table 3).Descriptive Analysis Independent Variable Knowledge Summed scores were used to calculate means range, median and standard deviation with the purpose of conducting descriptive analysis of knowledge.Sample of 222 students was used for analysis purpose range of score was 32 as our mean and standard deviation are (M = 28, SD = 5.66) (Table 4).

Attitude
Table 4 shows summed scores which were used to calculate means range, median and standard deviation with the purpose of conducting descriptive analysis of Attitude.Sample of 222 students was used for analysis purpose range of score was 29 as our mean and standard deviation are (M =25, SD =5.09).Cronbach alpha above 0.70 is considered to be the acceptable indicator of internal consistency reliability (Santos, 1999;Bryman& Cramer, 2005;Pallant, 2007;Hair et al., 2006).
The alpha values of Knowledge is 0.73 which is above from 0.70 indicate that the scale which is used are reliable.However alpha value for Attitude was well which was 0.69 which is just a point below from 0.7 which are acceptable according to ( Nunnally, 1978).

Convergent Validity
Convergent was established by applying factor analysis.
Factor analysis was performed by using principle component analysis with varimax rotation.Each of the dimensions was analyzed by performing factor analysis.
At start complete instrument was consisted on total 2 items.Instrument was consisting of 2 independent variables.After applying factor analysis no items were dropped and the number of items was remaining 33.Criteria for factor loading were .50 and items below that set criteria were dropped from analysis.More over all assumption of factor analysis was fulfilled .assumptionsimply that KMO value must be above .60and Bartlett's test must be significant so whole set criteria was fulfilled (Table 6).

Findings of the Study
The participants of the study were asked about different questions to assess knowledge and attitude of the participants towards smoking, the participants answered to these questions from strongly agree to strongly disagree, the result of the participants response are given in Table 7 to 26. .

Research Question 1:
Does nicotine in cigarettes not addictive to humans?Table 7 shows that for the first question n= 92(41.4%) of the participant were strongly agree, n=64 (28.8%) were agree, n=27 (12.2%) were Neutral, n=27(12.2%)were disagree and n=12 (5.4%) were strongly disagree to this statement.Are smokers more prone to lung cancer than nonsmokers?
Table 8 shows the response of the participants toward second questions which was about the likeliness of the smokers towards lungs cancer n=125(56.3%) of the respondents were strongly agree, n=68(30.6%)were agree, Full text of this paper can be downloaded online at n=17(7.7%) were Not Sure, n=6(2.7%)were Disagre while n=6(2.7%)were strongly disagree to this statement.The participants were also asked about the statement that Smoking in pregnancy only harms maternal health, but has no effect on the fetus.For which the response of n=82(36.9%)were strongly agree, n=52(23.4%)were agree, n=43(19.4%)were Not sure, n=18(12 disagree and n=27(12.2%)were strongly disagree to this statement (Table 9).fourth question that the participants that does health of secondhand smokers is affected are not from the smoking of other person?For this statement n=92(41.4%)respondents were strongly agree, n=39(17.6%)were agree, n=24(10.8%) were Disagree and n=365(15.8%)were strongly disagree to this statement.Research Question 5: Can smoking relieve stress and lower blood Participants of the study were also assessed about the knowledge that can smoking relieve stress and lower blood pressure?For which n=79 (35.6%) were strongly Agree, n= 64(28.8%)were Agree, n=37(16.7%)were Not sure, n=34(15.3%)were Disagree and n=8 (3.6%) were strongly disagree to this statement (Table 11).moking make you feel fatigued easily?The Sixth question asked to participants in the study that can smoking make you feel fatigued easily?For which n=110 (49.5%) were strongly agree, n=42 (18.9%) were Agree, n=32(14.54%)were Not Sure.n=21(9.5%)were Disagree and n=17 (7.7%) were strongly disagree to this statement.The details are given in Fig. 3.

Can smoking make you feel fatigued easily?
Research Question 7: Does nicotine stimulates first the human nervous system, and then inhibits it?The participants' knowledge was assessed about the statement that does nicotine first stimulates the human nervous system, and then inhibits it?The response of the participants shows that n=89 (40.1%) were strongly disagree, n=47(21.2%)were agree, n=64 (28.8%) were Not sure, n=17 (7.7%) were disagree and n=5 (2.3%) were strongly disagree to this statement.The data is given in Table 12.The participants were also asked to answered the question which was about the knowledge that "Does smoking increases the air exchange capacity of the lungs?" for which n=79 (35.6%) of the respondents were strongly agree, n=48 (21.6%) were agree, n=53 (23.9%) were Not sure, n=15 (6.8%) were agree and n=27 (12.2%) of the respondents stated that they are strongly disagree to this statement (Fig 4).Research Question 9: Do you know that long-term smoking causes respiratory mucosa cilia to atrophy?Table 13 shows the answer of the ninth question which were asked form the participants that " Do you know that long-term smoking causes respiratory mucosa cilia to atrophy?" for which n=86 (38.7%) of the participants were strongly agree, n=84 (37.8%) were agree, n=39 (17.6%) were Not sure, n=7 (3.2%) were disagree and n=6 (2.7%) were strongly disagree to this statement.Does carbon monoxide in cigarettes decrease the binding ability between hemoglobin and oxygen in red blood cells?
Table 14 shows the last question about the knowledge asked to participants, "Does carbon monoxide in cigarettes decreases the binding ability between hemoglobin and oxygen in red blood cells?"where n=125 (56.3%) of the respondents were strongly agree, n= 54 (24.3%) were agree, n=31 (14%) were Not sure, n=5 (2.3%) were disagree and n=7 (3.2%) of the participants were strongly disagree to this statement.Does smoking signify that one is a grown-up?
The attitude of the study participants were also determined through a self-administered questionnaire the first question which was asked from the participants about their attitude towards smoking was "Smoking signifies that one is a grown-up" for which n=98(44.1%) of the respondents were strongly agree, n=72 (32.4%) were agree, n=29(13.1%)were Not sure, n=16 (7.2%) were disagree and n=7 (3.2%) were strongly disagree to this statement.
The details are given in Table 15.The second question which was asked to the participants was "Does smoking relax body and reduces stress?" for which n= 76(34.2%) of the participants were strongly agree, n= 90(40.5%)were agree, n=36 (16.2%) were not sure, n=10(4.5%)were disagree while n=10 (4.5%) of the participants were strongly disagree to this statement.The details are given in Table 16.The participants were also given a chance to answer the question that "Does smoking cause disgusting behavior?"for which n=105 (47.3%) of the participants were strongly agree, n=80 (36%) were agree, n-=13 (5.9%) were Not sure, n=13 (5.9%) were disagree and n=11 (5%) were strongly disagree to this statement (Table 17).Is Smoking hazardous to the health of others?Answer of fourth question received by respondents is shown in Table 18.Where, n=81 (36.5%) were strongly agree, n=90 (40.5%) were agree, n=26 (11.7%) were neutral, n=13 (5.9%) were disagree and n=12 (5.4%) were strongly disagree to this statement.Participants attitudes were also determined by asking this question "Does smoking help thinking?".The result showed n=135 (60.8%) of the participants were strongly agree, n=42 (18.9%) were agree, n= 31 (14%) were neutral, n=9 (4.1%) were disagree and n= 5 (2.3%) were strongly disagree to this statement (Table 19).The sixth question which were asked from the participants was "Does accepting a friend's offered cigarette give more acceptance among the friends?" which showed n=120 (54.1%) of the respondents were strongly agree, n=64 (28.8%) were agree, n=18 (8.1%) were not sure, n= 10 (4.5%) were disagree and n=10 (4.5%) were strongly disagree to this statement.The data is given in the Table 20.The seventh question for the assessing the attitude of the participants was "Does smoking should be strictly prohibited in universities for better public health?"for which, Table 21 shows that n=122 (55%) were strongly agree, n= 77 (34.7%) were agree, n= 10 (4.5%) were neutral, n=5 (2.3%) were disagree and n=8 (3.6%) were strongly disagree to this statement.Attitude of the participants were also assessed by asking this question that "Does smoking is a personal freedom and others have no right to interfere?" for which n=102 (45.9%) of participants were strongly agree, n=79 (35.6%) were agree, n=11 (5%) were neutral response, n=20 (9%) were disagree and n=10 (4.5%) were strongly disagree to this statement.Details are shown in Table 22.The ninth question which was asked from the participants to determine the attitude was "Do you prefer being with friends who do not smoke?"where, n=87 (39.2%) were strongly agree, n=89 (40.1%) were agree, n=37 (16.7%) were neutral, n=1 (0.5%) were disagree and n=8 (3.6%) were strongly disagree to this statement (Table 23).The last question for determining the attitude of the participants toward smoking was "Do you hope that your children will not smoke?"for which n=140 (63.1%) of the participants were strongly agree, n= 67 (30.2%) were agree, n=7 (3.2%0 were neutral, n=3 (1.4%) were disagree and n=5 (2.3%) were strongly agree to this statement.Details are tabulated in Table 24.

Discussion
This cross-sectional research design was used to assess the knowledge and attitude of university students towards smoking in Lahore for which total of 222 participants were studied, the overall knowledge of the students were good and they were aware about the dangerous effect of smoking but instead of this knowledge 32% of the respondents were involved in smoking habit which was a great concern for the stake holders of the university.
According to Khader (2008) who conduct a study in Ibrid Jordan it is portrayed from his study that 29.3% of the students were involved in smoking in University of Jordan.The World Health Organization WHO {2009) has estimated that 5.4 millions of deaths happen annually due to tobacco use and this number of deaths is expected to reach more than 10 million by the year 2030 (Gajalakshmi et al.2004)It was evident from this study that 87% of the respondents believed that Smoking was the major cause of lungs cancer and smokers are more likely to get lungs cancer.
According to WHO (2011) smoking in daily life which cause very serious and injurious health problems like lung cancer is the top number of cancers among Pakistani men and it is portrayed from various studies that there is a strong link between lung cancer and smoking.
It was also portrayed from this study that 59% of the respondents believed that smoking has no effect on second hand smoker or passive smoker which was a flaws in the knowledge of students because smoking can also effect passive smokers.According to El-Ansari (2002) Smoking is a major health concern for the smokers but it also can cause very serious threat for the passive smokers also.
The other significant point in assessing knowledge of the students was 65% of the respondents believed that smoking could relieve stress and lower blood pressure According to Jajja, N (2013) there is no link between smoking and lowering blood pressure.Despite of enough knowledge regarding the harmful effect of smoking the prevalence of smoking were also high in university students.
It was evident from this study that 68% of the students believed in the attitude that smoking signifies that one is grown up According to Rozi (2005) it is evident from his study that many of the university students adopt smoking behavior because of their attitude towards smoking that it can add a positive attribute in their life.This was also evident from the study that 85% of the students were agreed that smoking should be banned in universities, this can play a vital role for developing rules and laws about prohibition of smoking in educational institutions.
According to Lin, Wu, (2010) smoking should be strictly prohibited in universities and college premises to promote proper educational environment and minimize hazardous environment for students.

Conclusion
This study indicate that there was a growing number of smokers in university because of their thinking that smoking could add a positive attribute in their life and students were also suffered from the bad company of their friend.Many of students believed that they would be more acceptable in a group of friends when they smoke.
Students have enough knowledge regarding the harmful effect of smoking but behavior modification is very hard in this innovative world.The findings of this study is not more different from the study conducted abroad.

Limitations
The present study design was cross sectional and just give a snapshot about situation the sample size was small which cannot be generalized for all the Universities of Pakistan.
Recommendations 1) Smoking should be strictly prohibited in Universities 2) Workshop should be arrange for the students regarding the harmful effects of smoking 3) Application of existing rules should be carried out to minimize the prevalence of smoking in universities 4) Students should be fine when they were found to smoking in University premises 5) Parents should keep deep focus on their child attitude 6) Smoking is a major health hazards which should be highlighted by the print and electronic media

Fig 4 :
Fig 4: Does smoking increase the air exchange capacity of the lungs?

Table 1 :
DepartmentThe participants of the study were randomly selected from different department of University of Lahore which are (n=80, 36%) student belong to Nursing department, (n= 82, 36.9%)studentsbelong to IMBB department and (n=60, 27%) of the students were selected from DPT department of UOL.More details are given in Table1.Departments of respondents AgeFig.2shows that 41.89% of respondents belong to 18-23 age group.50% of respondents belong to 23-27 age group.5.41% of respondents belong to 28 to 32 age group and 2.7% of respondents belongs to 33-37 age groupFig.2:Age of respondentSmoking HabitTable2shows that among 222 students (n=71, 31.9%) of students were smokers while (n= 151, 68%) of the students were Non Smokers.

Table 2 :
Smoking habit of respondents

Table 3 :
Summary of skewness and kurtosis results

Table 4 :
Summary of Descriptive Analysis Validity and Reliability AssessmentTable5presents Cronbach's alpha for two scales used in the study.Cronbach alpha is the most commonly used measure of scale reliability(Cortina, 1993).

Table 5 :
Summary of Reliability analysis

Table 6 :
Summary of KMO Bartlett's assumptions

Table 7 :
Does nicotine in cigarettes not addictive to humans?

Table 8 :
Are smokers more prone to lung cancer than non smokers?

Table 9 :
Does smoking in pregnancy harms only maternal health, not on the fetus?

Table 10 :
Does health of second affected?

Table 11 :
Does smoking relieve stress and lower blood pressure?
Can smoking make you feel fatiguedThe Sixth question asked to participants in the study that can smoking make you feel fatigued easily?For which n=110 (49.5%) were strongly agree, n=42 (18.9%) were Agree, n=32(14.54%)were Not Sure.n=21(9.5%)were Disagree and n=17 (7.7%) were strongly d statement.The details are given in Fig 3: Can smoking make you feel fatigued easily?http://nepjol.info/index.php/IJSSM/issue/archive

Table 12 :
Does nicotine stimulates first the human nervous system, and then inhibits it?
Does smoking increase the air exchange capacity of the lungs?

Table 13 :
Do you know that long-term smoking causes respiratory mucosa cilia to atrophy?

Table 14 :
Does carbon monoxide in cigarettes decrease the binding ability between hemoglobin and oxygen in red blood cells?

Table 15 :
Does smoking signify that one is a grown-up?

Table 16 :
Does smoking relax body and reduces stress?

Table 17 :
Does smoking cause disgusting behavior?

Table 18 :
Is Smoking hazardous to the health of others?

Table 19 :
Does smoking help thinking?

Table 20 :
Does accepting a friend's offered cigarette give more acceptance among the friends?

Table 21 :
Does smoking should be strictly prohibited in universities for better public health?

Table 22 :
Does smoking is a personal freedom and others have no right to interfere?

Table 23 :
Do you prefer being with friends who do not smoke?

Table 24 :
Do you hope that your children will not smoke?
AcknowledgmentFirst of all I thank Almighty ALLAH and MUHAMMAD PBUH for giving me the courage and determination in conducting this research I feel deepest gratitude to my supervisor Miss Firdous Hameed who gave me the freedom to explore on my own and at the same time the guidance to recover when my step faltered.I feel great delighted to express my deep sense of obligations to Sir Ali Waqas and my HOD Dr Muhammad Afzal.Words are lacking to express my humble obligation to my affectionate Father, Mother, Elder brothers, Sisters and Friends for their love good wishes, inspiration and uncasing prayers for me, without which the present destination would have been a mere dream.DedicationI humbly dedicate this piece of work to my family members; particularly, my parents who offered me unconditional love and support me throughout my life.