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Olowookere et al. Tobacco Induced Diseases 2014, 12:6 http://www.tobaccoinduceddiseases.com/content/12/1/6

RESEARCH Open Access

Awareness and attitude to the law banning smoking in public places in Osun State, Nigeria Samuel Anu Olowookere1*, Ebenezer Gbenga Adepoju2 and Olalere Omoyosola Gbolahan3

Abstract

Objective: This study determined the awareness and attitude towards the Osun state prohibition of smoking in public places law.

Method: Descriptive cross-sectional study design. 520 consenting respondents recruited using a convenience sampling method were interviewed using a semi-structured questionnaire covering their smoking pattern, awareness and attitude towards the law of prohibition of smoking in public places in Osun State. Data analyzed using descriptive and chi-square statistics.

Results: Only 38% were aware of the law while none had seen the document. Fifty six percent felt cigarette smoking is a problem that required the law to be implemented, while only 20% agreed that the law will stop tobacco use. The radio (58%), bill boards (45%) and newspapers (44%) were the major sources of awareness of the law. The perception of risk posed to the public and family health by cigarette smoking was poor among the participants.

Conclusion: There is poor awareness and attitude to the law of prohibition of smoking in public places in Osun State. It is necessary to increase sensitization of the general public and enforcement of the law.

Keywords: Law on cigarette smoking prohibition, Public places, Osun state, Nigeria

Introduction There are about 1.3 billion smokers in the world and ap- proximately 80% of them live in the developing countries [1]. Previous studies on the burden of tobacco use in Nigeria had reported a prevalence of current smoking as high as 31.9% in some urban areas and as low as 17.6% in the rural areas [2,3]. A recent study in Osogbo, Osun state reported that 8.7% of their study participants were current smokers [4]. Various studies in Nigeria and be- yond have also suggested a high level of passive smoking in the general population [2-5]. For example, Desalu et al. in 2011 reported 38.8% of their study population having regular exposure to second hand smoke with 24.4% from public places [3]. In Nigeria most states do not have a law in place to con-

trol smoking in public places [6], and in states where a law exists, such as in Osun state there had been no studies, to our knowledge, that assessed public awareness and

* Correspondence: [email protected] 1Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria Full list of author information is available at the end of the article

© 2014 Olowookere et al.; licensee BioMed Ce Creative Commons Attribution License (http:/ distribution, and reproduction in any medium Domain Dedication waiver (http://creativecom article, unless otherwise stated.

attitudes to the law, hence the objective of this study was to determine population awareness and attitudes to the law prohibiting cigarette smoking in public places in Osun state, Nigeria.

Methods Study setting Osun state was created out of old Oyo state by the Nigerian Federal Government on August 27, 1991. It is located in the heartland of Yoruba people in the South west geo-political zone of Nigeria. It shares the distinctive high urbanization attributes of most parts of Yorubaland. It is bounded in the north by Kwara state, in the east partly by Ekiti state and partly by Ondo state and in the west by Oyo state. According to the 2006 population cen- sus, Osun state has a population of 3,416,959. The study site is Osogbo, the capital of Osun state. The population of Osogbo by 2006 census is 288,455. The bill regulating smoking in public places in Osun state was sponsored by the Osun State House of Assembly which was eventually

ntral Ltd. This is an Open Access article distributed under the terms of the /creativecommons.org/licenses/by/2.0), which permits unrestricted use, , provided the original work is properly credited. The Creative Commons Public mons.org/publicdomain/zero/1.0/) applies to the data made available in this

Table 1 Sociodemographic characteristics of the respondents

Characteristics Frequency (n = 520) N (%)

Age group

19-29 34 (6.6)

30-39 134 (25.8)

40-49 152 (29.2)

50 and above 200 (38.4)

Sex

Male 239 (46)

Female 281 (54)

Marital status

Single 150 (28.8)

Married 350 (67.4)

Divorced 20 (3.8)

Highest education level

None 64 (12.4)

Primary 92 (17.6)

Secondary 188 (36.2)

Tertiary 176 (33.8)

Occupation

Civil servant 111 (21.4)

Traders 138 (26.5)

Artisan 87 (16.7)

Transporters 129 (24.8)

Unemployed 55 (10.6)

Ethnicity

Yoruba 466 (89.6)

Igbo 23 (4.4)

Others 31 (6.0)

Religion

Christianity 294 (56.5)

Islam 210 (40.4)

Traditional religion 16 (3.1)

Smoking pattern

Current smokers 42 (8.1)

Former smokers 57 (10.9)

Never smokers 421 (81.0)

Olowookere et al. Tobacco Induced Diseases 2014, 12:6 Page 2 of 4 http://www.tobaccoinduceddiseases.com/content/12/1/6

signed into law by the Executive Governor on 14th

December, 2009.

Sample This is a descriptive cross-sectional study. The required sample size of 384 was calculated using an appropriate statistical formula for estimating the minimum sample size in descriptive health studies [n = Z2pq/d2] and esti- mated prevalence of cigarette smoking taken as 50% since it is not exactly known. The minimum sample size was increased by 10% to take care of incomplete/non re- sponse and refusals. A total of 520 consenting respon- dents were interviewed out of 640 Osogbo residents (response rate 81.3%) approached to participate in this study. Convenience sampling method was used to enroll these participants during the month of March, 2011. Permission to conduct the study was granted by the Osun State Hospital Ethics and Research Committee. In- formed consent was taken from the respondents while they were reassured of the confidentiality of the infor- mation obtained. The respondents included 239 males (46%) and 281 fe-

males (54%). Their mean age (SD) was 42.2 (12.4) years ranging from 15 to 68 years. Most of the study participants were civil servants (21.4%) and Transporters (24.8%). They were interviewed with a pretested semi-structured ques- tionnaire that included questions on their sociodemo- graphic information, smoking patterns, awareness and attitude to the law prohibiting cigarette smoking in public places in Osun State, source of awareness of this law and their opinion about cigarette smoking. The re- spondents’ cigarette smoking status was categorized into ‘ever smokers’ and ‘never smokers’. ‘Ever smokers include former and current smokers. ‘Current smokers’ were respondents who smoked at least a cigarette in the one month prior to the study. ‘Former smokers’ were reported as those who had smoked for six months but had not smoked for at least one month prior to the study. Those who ‘Never smoked’ had never smoked a cigarette [4].

Statistical analysis Data was entered into and analysed with SPSS version 16. Frequencies and proportions were used to summarise cat- egorical variables, while quantitative data were presented as means and standard deviations. Chi-square statistics were used to determine the strength of association of dif- ferent factors with their cigarette smoking status. p values < 0.05 was considered statistically significant.

Results A total of 520 respondents were interviewed: 239 males (47%), 281 females (53%), and age range 15 – 68 years (mean 42.2 ± 12.4 years). Majority of the respondents were

civil servants (21.4%), Traders (26.5%) and Transporters (24.8%). Most had secondary school education and above (70%) and married (67.4%). Nineteen percent had ever smoked a cigarette with 8.1% current smokers (Table 1). Table 2 reported the respondents’ awareness and atti-

tude to the Osun state prohibition of smoking in public places. Only 38% were aware of the law prohibiting to- bacco smoking in public places in Osun State while none of the respondents had seen the document. Over

Table 2 Respondents’ awareness and attitude towards the Osun state prohibition of smoking in public places

Variable Cigarette smoking status Total (n = 520)

*p value

Ever (%) Never (%)

n = 99 n = 421

Awareness of the no smoking law

Yes 28 (28.3) 170 (40.4) 198 (38) 0.026

No 71 (71.7) 251 (59.6) 322 (62)

Seen the no smoking law document

Yes 0 (0) 0 (0) 0 (0)

No 99 (19) 421 (81) 520 (100)

The law is needed to control smoking

Yes 15 (15.2) 276 (65.6) 291 (56) 0.001

No 84 (84.8) 145 (34.4) 229 (44)

Smoking affects public health

Yes 16 (16.2) 278 (66) 294 (56.5) 0.001

No 83 (83.8) 143 (34) 226 (43.5)

Law will stop cigarette smoking

Yes 12 (12) 92 (22) 104 (20) 0.001

No 23 (23) 211(50) 234 (45)

Don’t know 64 (65) 118 (28) 182 (35)

Smokers deserve right to smoke

Yes 59 (59.6) 50 (11.9) 109 (21) 0.001

No 40 (41.4) 371 (88.1) 411 (79)

*chi-square statistic.

Table 3 Respondents’ opinion on cigarette smoking

Variable Cigarette smoking status Total (%) *p value

Ever (%) Never (%) N = 520

n1 = 99 n2 = 421

Smoking is harmful to health

Agree 15 (15.2) 271 (64.1) 286 (55) 78.452; 0.001

Disagree 84 (84.8) 150 (35.9) 234 (45)

Number of cigarette stick safe

None 53 (53.5) 295 (70.1) 348 (67) 9.901; 0.002

≥1 46 (46.5) 126 (29.9) 172 (33)

Smoke free environment is necessary

Agree 26 (26.3) 80 (19) 106 (20.4) 2.603; 0.107

Disagree 73(73.7) 341 (81) 414 (79.6)

Smokers should not smoke at home

Agree 32 (32.3) 89 (21.1) 121 (23.2) 5.614; 0.018

Disagree 67 (67.7) 332 (78.9) 399 (76.8)

*chi-square statistic.

Table 4 Sources of awareness of the Osun state prohibition of smoking in public places

*Sources of awareness Frequency (n = 198) N (%)

Radio 115 (58)

Bill board/poster/leaflet 89 (45)

Newspapers 87 (44)

Health workers 73 (37)

Television 69 (35)

Friends 45 (23)

School 26 (13)

Internet 8 (4)

No response 6 (3)

*Multiple responses.

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28% of ever smokers compared with 40.4% of never smokers were aware of the law (p = 0.026). Also, 15.2% of ever smokers compared with 65.6% of never smokers believe the law is needed to control cigarette smoking (p = 0.001). Fifty six percent felt cigarette smoking is a problem that required the law whereas 20% felt that the law will curb cigarette smoking eventually. The major- ity (59.6%) of ever smokers compared with 11.9% of never smokers believe smokers deserve right to smoke (p = 0.001). Although 21% felt cigarette smokers have the right to smoke, such right should not infringe on other people’s right to healthy environment. Table 3 reported the respondents’ opinion towards

cigarette smoking. Over 15% of ever smokers compared with 64.1% of never smokers agree that smoking is dan- gerous to health (p = 0.001). 46.5% of ever smokers com- pared with 29.9% of never smokers stated that smoking at least one cigarette per day is safe (p = 0.002). Also, 32.3% of ever smokers compared with 21.1% of never smokers agree that smokers should not smoke at home (p = 0.018). The majority (56.5%) agreed that smoking af- fects family health; 33% felt smoking 1 cigarette sticks or more per day is safe. Only 20.4% agreed there should be smoke free areas in public places whereas 23% felt smokers should not smoke at home.

Table 4 reported the respondents sources of awareness of the Osun state prohibition of smoking in public places. The radio (58%), bill boards (45%) and newspa- pers (44%) were the commonest sources of information about the law in Osun state.

Discussion This population based study assessed the awareness and attitude of the respondents to the Osun state prohibition of smoking in public places. It reported low awareness among respondents with the radio as the main source of awareness. It should however been noted that the radio remains the commonest source of general awareness among this population making it a very important route of communication with the populace. Hence policy makers need to make use of such medium to inform, educate and communicate to the general public about this law.

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Studies had showed that smoking is the most import- ant avoidable cause of premature morbidity and mortal- ity in the world [1,5]. This study reported about one- fifth of respondents were ever smokers. Several studies in Nigeria had reported similar finding [6]. Over three fifth of the respondents were not aware of

the law prohibiting smoking in public places while none of the study participant had read the actual document. This situation can make it difficult for the legislation in public places to be effective therefore, it is essential that there is more sensitization of the general public or else the chances of failure remain high. It is therefore im- portant to disseminate information about the law in order to eliminate smoking in public places. Its proper implementation and enforcement will further reduce to- bacco induced diseases in this study environment [5,7]. While the majority felt that the law prohibiting

cigarette smoking in public places in Osun State is ne- cessary, fewer smokers saw the necessity of this law in protecting both their and public health. In fact, some smokers felt that the law cannot stop smoking in public places and that smokers deserve the right to smoke wherever they like at anytime. These views expressed by the smoking population contradict the general opinion of non smokers. This further showed the need to en- hance awareness and support enforcement of the law. Previous studies had reported that few states in the country have adopted the law, therefore its successful implementation lies on both the government and the cit- izens; the power to implement and enforce the law lies with the government while the will power to embrace and obey the law lies with the citizens [5]. Some of the smokers in our study believed that cigarette

smoking is not dangerous to their health. This view needs consideration as it implies that these smokers are either unknowingly or carelessly endangering their life but that of their close family members, co-workers and neighbours. Also, only a few smokers felt a smoke free environment is necessary. This calls for urgent attention in order to re- duce the effects of tobacco exposure among this popula- tion. There is urgent need for more public education in Osun state and beyond on the danger of cigarette use in both the smoking and non smoking population. To the best of our knowledge, this is the first study

performed to assess the awareness and attitude of Osogbo residents to the Osun state prohibition of smok- ing in public places law. We were also unable to identify other studies done to assess such law in operation in other states in Nigeria. A limitation is the use of the convenience sampling technique to select the study population, which limits its generalizability to the popu- lation of the State or Nigeria in general. This was done to ensure a proportionate increase in the smoking popu- lation among the selected respondents.

In conclusion, the present level of awareness of the law prohibiting cigarette smoking in public places in Osun state was poor. It is recommended that strategies to increase the present level of public awareness on dan- gers of cigarette smoking and enforcement of the law of prohibition of smoking in public places should be put in place. These strategies will include awareness creation activities in public places, bill boards, jingles on the radio and other mass media venues.

Competing interest The authors disclose no potential conflicts of interest.

Authors’ contributions AEG and OSA made substantial contributions to conception and design of the study while all the authors were involved in data collection, analysis and interpretation. All authors were involved in writing the manuscript and approved the final copy.

Acknowledgement The authors thank the entire staff of Department of Preventive Medicine, State Specialist Hospital, Osogbo for their support and cooperation during the study period.

Short report There is poor awareness and attitude to the law banning cigarette smoking in public places in Osun state, Nigeria. Also, the perception of risk posed to the public and family health by cigarette smoking was poor. Sensitization of the general public and enforcement of the law is essential.

Author details 1Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. 2Department of Preventive Medicine, State Specialist Hospital, Asubiaro, Osogbo, Osun-State, Nigeria. 3Department of Oral and Maxillofacial Surgery, University of Ibadan, Ibadan, Nigeria.

Received: 27 December 2013 Accepted: 21 March 2014 Published: 27 March 2014

References 1. The Global Tobacco Surveillance System. The GTSS. http://www.cdc.gov/

tobacco/global/gtss/tobacco_atlas/pdfs/tobacco_atlas.pdf. 2. Ayankogbe OO, Inem OA, Bamgbala OA, Robert OA: Attitudes and

determinant of cigarette smoking among rural dwellers South West. Nigeria Niger Med Pract 2003, 44:70–74.

3. Desalu OO, Onyedum CC, Adewole OO, Fawibe AE, Salami AK: Secondhand smoke exposure among nonsmoking adults in two Nigerian cities. Ann Afr Med 2011, 10:103–111.

4. Adepoju EG, Olowookere SA, Afolabi OT, Olajide FO, Aluko OO: A population based study on the prevalence of cigarette smoking and smokers’ characteristics at Osogbo, Nigeria. Tobacco Use Insights 2013, 6:1–5. doi:10.4137/TUI.S10763.

5. Callinan JE, Clarke A, Doherty K, Kelleher C: Legislative smoking bans for reducing second hand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2010, 4(Art. No): CD005992. doi:10.1002/14651858.CD005992.pub2.

6. Agaku I, Akinyele A, Oluwafemi A: Tobacco control in Nigeria- policy recommendations. Tob Induced Dis 2012, 10:8.

7. Adejuwon GA: Tobacco use and second hand smoke as risk factors for diseases in Nigeria: implications for collaborative research and multilevel tobacco control strategies. Afr J Med Med Sci 2009, 38(Suppl 2):21–29.

doi:10.1186/1617-9625-12-6 Cite this article as: Olowookere et al.: Awareness and attitude to the law banning smoking in public places in Osun State, Nigeria. Tobacco Induced Diseases 2014 12:6.