INTRODUCTION:

“Health is wealth and let our school children enjoy good health with good education, better health with better education and best health with best education”

Oral cancer or mouth cancer is one of the leading cancers in the world. It is a cancer that occurs in any part of the mouth; on the tongue's surface, in the lips, inside the cheeks, in the gums, in the roof and floor of the mouth, in the tonsils, and also in the salivary glands. Most persons have no detectable symptoms during the early stages of oral cancer. When signs and symptoms do appear, they typically include: Patches on the lining of the mouth or tongue, usually red or red and white in colour, mouth ulcers that do not go away, a sore that does not heal, pain when swallowing, jaw pain, jaw stiffness etc.

As per World Health Organization report 2013 oral cancer accounts for approximately 3, 00, 00000 deaths annually worldwide including 1, 30,000 cases of oral cancer are being found only in India.² There is evidence that this cancer is more common in the developing countries in contrast to the developed ones, with the highest oral cavity cancer rates being found in Malaysia, South-Central Asia, and Central and Eastern Europe and the lowest in Africa, Central America, and Eastern Asia for both males and females.

India is the second largest producer of tobacco and most of the tobacco produced is consumed within the country only, with approximately 274.9 million tobacco users according to recent data (Global Adult Tobacco Survey-GATS, 2010). As per this report more than one-third (35%) of adults in India use tobacco in some form or the other, 163.7 million are users of only smokeless tobacco, 68.9 million do smoking, and 42.3 million users are of both smoking and smokeless tobacco.

Oral cancer is a serious public health problem with over 3, 00, 00000 new cases are reported annually worldwide, two- third of which occurs in developing countries. The overall mortality rate for intra- oral cancer remains high at approximately 50 % even with modern medical services, probably due to the advanced stage of the disease. This outlines recent advances in the understanding of the roles and interactions of major risk factors for oral- cancer worldwide, notably tobacco, alcohol and betel quid and the genetic polymorphisms determining their metabolism that may predispose patients to oral carcinoma.

A WHO international Agency conducted a study in 2008 for research on cancer concluded that smokeless tobacco users have an 80% higher risk of developing oral cancer and 60% higher risk of developing pancreatic and oesophageal cancer. Chewing tobacco has been linked to dental caries. A study by the “National Institute of Health” and the “Centres for Disease Control and Prevention” found chewing tobacco users were four times more likely than non-users to have decayed dental root surfaces.

Biswas AK, Sarkar J. J Pak Association 2010 conducted study on tobacco use among urban school boys of Paschim Midnapore, west Bengal India out of 454 students, 201(44.3%) were ever users of tobacco whereas 135(29.7%) were current users. Majority of the current users utilized both form of tobacco. Initiation of tobacco before 10 years were more in smokeless (11.4%) form than smoking (4.5%), but smokers showed steep rise (49.3%) at 14-15 years. Proportion of current users significantly (p < 0.001) increased along with increase in pocket money. Compared to non-users current users had more exposure to tobacco in the family and friends. Both current users and nonusers showed positive attitude towards tobacco use. Though knowledge of harmful effects of tobacco was well perceived but significantly more (p < 0.005) non-users had shown interest to prohibit smoking in public places. More non-users (75%) than ever users (26.4%) had shown favourable opinion regarding future tobacco use.

Ali NS., Khuwaja AK., Ali T., Hameed R, (2009) conducted study on smokeless tobacco use among children who visited family practice clinics in Karachi, Pakistan. The objective of study was to estimate proportion of use and the knowledge about smokeless tobacco in relation to cancer. This study concludes that over half of the children were using smokeless tobacco and had poor knowledge about its hazards and the study suggests that there was a need for socially and culturally acceptable educational and behavioural interventions for control of smokeless tobacco usage.

Institute of cytology and preventive oncology, 2005 conducted on knowledge, attitude and practice of tobacco use among school students in Noida UP. Two schools covering 299 students were included in this study. The frequency of ever smoking was 9.0% and that of chewing was 6.0%. The Current smokers and chewers were 3.3% and 4.7% respectively. Out of 299 students the numbers of girls included in the sample were 55. The frequency of current or ever smoking and chewing among girls was 3.6% and 1.8% respectively.

OBJECTIVES:

1. To assess the knowledge regarding Prevention of Oral Cancer among the students of higher secondary before structured teaching programme.

2. To assess the attitude regarding Prevention of Oral Cancer among the students of higher secondary before structured teaching programme.

3. To assess the knowledge regarding Prevention of Oral Cancer among the students of higher secondary after structured teaching programme.

4. To assess the attitude regarding Prevention of Oral Cancer among the students of higher secondary after structured teaching programme.

5. To assess the effect of structured teaching programme on knowledge regarding Prevention of Oral Cancer among students of higher secondary.

6. To assess the effect of structured teaching programme on attitude regarding Prevention of Oral Cancer among students of higher secondary

7. To determine the association between the knowledge regarding Prevention of Oral Cancer among the students of higher secondary with selected socio-demographic variables.

8. To determine the association between the attitude regarding Prevention of Oral Cancer among the students of higher secondary with selected socio-demographic variables.

HYPOTHESIS:

H₁: The post test mean knowledge and attitude score regarding prevention of oral cancer is significantly higher than post test mean knowledge and attitude score (p <0.05 level of significance).

H₀: The post test mean knowledge and attitude score regarding prevention of oral cancer is not significantly higher than post test mean knowledge and attitude score.

MATERIALS AND METHODS:

Research approach-Quantitative research approach was used for the study.

Research design-The term research design refers to the plan or organization of a scientific investigation.

Research setting

The study was conducted in the selected Schools of Jalandhar in the month of April, 2015 on higher secondary school students from PAP Government senior secondary school, Victor Model School, Government senior secondary school Ladhewali and Saint Soldier School, Jalandhar, Punjab.

Total population:

It consists of students of higher secondary in selected schools of Jalandhar Punjab.

Target population:

The target population include the students of higher secondary schools PAP Government school, Victor Model school, Government senior secondary school Ladhewali, Saint Soldier School Jalandhar, Punjab.

Sample size and sampling technique:

Total 160 students of higher Secondary schools were selected. Stratified random sampling technique was employed collect sample. age, gender and class were set as strata.

Criteria for sample selection:

Inclusion criteria

1. The Students who were willing to participate in the study.

2. The Students from selected schools of Jalandhar.

Exclusion criteria:

1. Students who were above 18years of age.

Research variables:

Independent variable:

The independent variable is Structured Teaching Programme on prevention of oral cancer among students of higher secondary schools.

Dependent variable:

The Dependent variable is knowledge and attitude regarding prevention of oral cancer.

Socio – demographic variables of the study:

The socio demographic variable of the study were Age (in years), Gender, Class, Type of school, Type of family, Residence, Education of mother, Education of father, Father’s occupation, Mother’s occupation and Family income (in rupees).

Selection and development of tool:

As study is on effect of structured teaching programme on knowledge and attitude regarding prevention of oral cancer among students of higher secondary in selected schools of Jalandhar, Punjab, therefore a tool is prepared in the form of self structured knowledge and attitude questionnaire to assess the knowledge and attitude score of the selected sample. Preliminary drafting of tool is prepared after extensive review of literature and consulting with subject experts.

The tool was divided into four parts:

Part 1- Socio-demographic variables:

It consisted of socio- demographic variables. age (in years), gender, class, type of school, type of family, residence, education of mother, education of father, father’s occupation, mother’s occupation and family income (in rupees).

Part 2: It consisted of structured teaching programme regarding prevention of oral cancer.

Part 3: A Self Structured Knowledge and attitude Questionnaire consisted of 24 multiple choice questions regarding prevention of oral cancer. Each correct answer was awarded 1 mark and incorrect answer was awarded 0 marks.

Level of Knowledge	Score	%
Excellent	20 – 24	83.33-100
Good	14 - 19	58.33-79.17
Average	08 - 13	33.33 - 54.17

Maximum score= 24

Minimum score = 00

Part 4: It consisted of 5 point rated Attitude scale regarding the prevention of oral Cancer which consist of 10 questions.

Level of attitude	Score	%
Strongly positive	41-50	85.00-100
Positive	31-40	63.33-83.33
Neutral	21-30	41.67- 61.67
Negative	Nov-20	21.67- 40.00
Strongly Negative	00-10	00.00-20.00

Maximum Score = 50

Minimum Score = 00

Validity of tool and content:

The content validity of the tool was determined by the expert’s opinion on the relevance of items. These experts were from the specialty of Community Health Nursing, Child Health Nursing. The suggestions were incorporated after consultation with the research supervisor. The self structured knowledge and attitude questionnaire is used which comprise of 24 questions in knowledge and 10 questions in attitude scale for assessment of knowledge and attitude regarding prevention of oral cancer among students of higher secondary schools. The self structured knowledge and attitude questioner was translated into Punjabi by language experts for the purpose of data collection.

Pilot study:

The pilot study was conducted in the month of Feburary, 2015, to determine the reliability of the tool and feasibility of the study. The study was conducted in Mata Ganga Public school Rama Mandi Jalandhar Cantt. Pilot Study was conducted on 16 students of higher secondary, to identify the reliability of the tool and feasibility of the study. Pilot study was started on 22-02-15 and completed on 1-03-15.Written informed consent was taken from each parents and students and prior instructions were given to the students. Pre test knowledge and attitude was assessed by self structured knowledge and attitude questioner. Structured Teaching Programme was given for 45 minutes only to group. After seven days, post test knowledge and attitude of group was assessed with the help of same self structured knowledge and attitude questionnaire.

Reliability of tool:

It is the degree of consistency or accuracy with which an instrument measures the attribute it is designed to measure. Reliability was obtained by test retest method and was calculated by Karl’s Pearson co-efficient of co-relation formula. The reliability of tool was 0.75, which indicated the tool was reliable.

Data collection procedure:

The data collection procedure of the study was carried out in the month of April 2015 from PAP School, Victor Model School, Government School, Saint Soldier Divine Public schools of Jalandhar, Punjab. Before collecting the data, investigator obtained permission from selected schools of jalandhar. Data was collected from students of higher secondary and the sample size was 160. The investigator had taken written informed consent from the students and their parents for participation in the study. Participants were assured that their responses would be kept confidential and used only for research purpose. Pre test knowledge of group was assessed by self structured knowledge and attitude questionnaire. A structured teaching programme regarding prevention of oral cancer was given to the group. Post test knowledge of group was assessed after seven days.

Ethical considerations:

1. Ethical permission was taken from the Principal of S.G.L nursing college Semi, Jalandhar, Punjab.

2. Written permission was obtained from the research ethical clearance committee of S.G.L Nursing College Semi, Jalandhar, Punjab.

3. Written permission was obtained from Principals of selected schools of Jalandhar, Punjab.

4. Informed written consent was obtained from the samples and parents.

5. Confidentiality and anonymity of study subjects was maintained throughout the study.

Plan of data analysis:

Data analysis and interpretation of data was done according to the objectives of the study. Analysis was done by using descriptive and inferential statistic. Descriptive statistic used was Frequency, Percentages, Mean and S.D. Inferential statistics used were chi square test and ANOVA test.

MAJOR FINDINGS:

· According to age (in years), majority of students were in age group of 97(60.6%) 17-18years, followed by 63(39.4%) were in 15-16years.

· In gender, majority were females 90(56.2%) whereas males were70 (43.8%).

· As per class 75(46.9%) were 10+1 and 85(53.1%) were 10+2 qualified.

· According to type of school, majority of students were from private school 97(60.6%) where as 63(39.4%) were from government school.

· In accordance with residence, majority of students 149(93.1) were from urban areas, 11(6.9%) were from rural area.

· As per type of family majority of students belongs to nuclear family 93(58.1%) and 67(41.9%) were from joint family.

· According to educational status of mother, majority of mothers were having secondary education 85(53.1%), followed by 40(25%) graduation or above, 23(14.4%) were primary and only 12(7.5%) were illiterate.

· According to educational status of father, majority of fathers were having secondary education 70(43.8%), followed by 59(36.8%) were graduated or above, 20(12.5%) were primary and only 11(6.9%) were illiterate.

· As per fathers occupation, majority of fathers were skilled 130(81.2%), 30(18.8%) were unskilled.

· As per mother’s occupation, mother’s had same results in skilled and unskilled 80(50.0%).

· In accordance with family income, majority of students had monthly family income 71(44.3%) of Rs 10,000rs, 51(33.9%) had in between Rs 10,000-20,000, and 38(23.8%) were having above Rs20, 000.

ACKNOWLEDGEMENT:

My study is purely dedicated to my guruji and beloved parents.

REFERENCES:

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2. World health organization report on the global tobacco epidemic 2009. Available from:https://www.google.co.in.search ?q=who+report+on+global+tobacco+epidemic.

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4. Narayan Raj, Asthana Samita, Satyanarayana L. Assessment of prevalence of tobacco use and impact of health education among school students.. Annual report 2003-2005.

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6. C Das Bhudev, C. Bharti Alok, Hedai Suresh, Institute of cytology and Preventive oncology, Annual report 2003- 2005.

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9. Data of Punjab regarding the cases of oral cancer.http://www.timesofindia.indiatimes.com.

10. Jemal A, Brey F, Center M, et al (2011).Global Cancer Statistics. CA: Cancer J Clin/article/61; 69-90.

Received on 22.09.2015 Modified on 19.10.2015

Int. J. Adv. Nur. Management 4(1): Jan. - Mar. 2016; Page 11-15

DOI: 10.5958/2454-2652.2016.00003.2