Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTION

1.

Name of the candidate and address

Mrs. MAHALAKSHMI.B,

1ST YEAR M.Sc. NURSING,

ROYAL COLLEGE OF NURSING,

7TH MAIN ROAD, 1ST BLOCK,

UTTARAHALLI, BANGALORE-560061.

2.

Name of the institution

Royal College of Nursing,

3.

Course of study and subject

1st Year M.Sc. Nursing,

Obstetrics and Gynecological Nursing.

4.

Date of admission to course

01.06.2009.

5.

Title of the topic

“A Descriptive Study to Assess the Knowledge and Attitude regarding Ill Effects of Alcoholism and Smoking on Antenatal mothers among Women who are visiting selected Pubs in Mahatma Gandhi road, Bangalore city with a view to develop an Information Booklet.”

6.

Brief resume of the intended work: 6.1 Need for study 6.2 Review of Literature 6.3 Objectives of the Study 6.4 Operational definitions 6.5 Hypothesis of the Study 6.6 Assumptions 6.7 Delimitations of the Study 6.8 Pilot Study 6.9 Variables

Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed

7.

Materials and Methods:

7.1 Source of data: Data will be collected from the Women who are visiting selected

Pubs in Mahatma Gandhi road, Bangalore.

7.2 Methods of collection of data: Structured questionnaire and an attitude scale. 7.3 Does the study require any investigation or interventions to be conducted on

Patients or other humans or animals? – No. 7.4 Has ethical clearance been obtained from your institutions?

Yes, ethical committee’s report is here with enclosed.

8.

List of References

Enclosed

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTION

1.

Name of the candidate and address

Mrs. MAHALAKSHMI.B,

1ST YEAR M.Sc. NURSING,

ROYAL COLLEGE OF NURSING,

7TH MAIN ROAD, 1ST BLOCK,

UTTARAHALLI, BANGALORE-560061.

2.

Name of the institution

Royal College of Nursing,

3.

Course of study and subject

1st Year M.Sc. Nursing,

Obstetrics and Gynecological Nursing.

4.

Date of admission to course

01.06.2009.

5.

Title of the topic:

“A Descriptive Study to Assess the Knowledge and Attitude regarding Ill Effects of Alcoholism and Smoking on Antenatal mothers among Women who are visiting selected Pubs in Mahatma Gandhi road, Bangalore city with a view to develop an Information Booklet.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

“I have taken more out of alcohol and alcohol has taken out of me.”

-Winston Churchill.

India is a diverse country, with marked regional variation in lifestyles. India is a powerhouse catering to rich country with great culture and traditions. Indian women were tradition and cultured and they look so graceful and glorious. The status of women in India has been subject to many great changes over the past few millennia. As women become more educated,westernized more economically independent, changing attitudes and high-income groups have contributed to Alcoholism and smoking among women.

The word "alcohol" is derived from the Arabic word al kuhul, meaning 'essence'. The English word alcohol, derived through Medieval Latin from Arabic, is first recorded in 1543 in this sense.1

Alcohol has been consumed in India at least since the Vedic period of 2000–800 BC. However, Buddhism, Jainism, and Islam did not allow their followers to drink. Alcohol became more freely available in the Indian subcontinent under British rule. Mahatma Gandhi campaigned against liquor production and sales on the grounds that it was injurious to health.

According to new statistics, India is one of the largest producers of alcohol in the world and there has been a steady increase in its production over the last 15 years in South-East Asia. Women tend to drink more in Assam, Arunachal Pradesh, Sikkim, and the northeast, Madhya Pradesh, Chhattisgarh, Orissa and Andhra Pradesh than their counterparts in the rest of the country. 2

A study in 1997 in Bangalore city found that one-fifth of young people who frequently went to pubs on weekends were girls aged 13 to 19 years. In addition, the traditional model of excessive binges in women's drinking may carry over to India's new drinking culture, cautions the WHO report .As women's roles change to allow them the freedom--and hazards--of drinking.3

Those who are alcoholic are found to be smoking as quoted by Gerard Way Cigarettes and coffee: an alcoholic's best friend.

Tobacco smoking is the practice where tobacco is burned and the vapors either tasted or inhaled. The practice began as early as 5000–3000 BC. Many civilizations burnt incense during religious rituals, which was later adopted for pleasure or as a social tool. 4

Smoking among females it is crucial to also take into account the fact that smoking, and tobacco use in general, is a global issue that is not confined to the borders of the Western world. The World Health Organization (WHO) notes the stark difference between women in various geographic locations as it states that about 22 percent of women in developed countries and 9 percent of women in developing countries smoke tobacco.” However, numerically the number of women could be more in developing countries. 5

31 May is World No Tobacco Day. The WHO theme for the year 2010 is "Gender and tobacco with an emphasis on marketing to women". It is estimated that more than 8 percent of girls between 13 and 15, or around 4.7 million girls, are using tobacco products in the Asia-Pacific region, said the WHO

March 20th, 2010 New Delhi - Over two million pregnant women in India consume tobacco products, a shocking figure revealed by the Indian health ministry. "It is shocking that over 8.5 percent of the ante-natal mothers in India are tobacco users," said Jagdish Kaur, in-charge of the tobacco control programme in the health ministry.6

Smoking and drinking, however, can be very difficult behaviors to change. Many people need help-support from friends and family, medical assistance, counseling, etc-to get through the process. Most importantly, the person must want to change her behavior-it cannot be forced.

6.1 NEED FOR THE STUDY:

“First the man takes a drink; then the drink takes a drink; then the drink takes the man.”

-Edward Rolland Still.

Alcohol consumption and Tobacco smoking is increasing in developing countries including India. This increase has an impact on the society, especially among the poor and the high income group.

WHO estimates that there are about 2 billion people worldwide who consume alcoholic beverages. Globally, alcohol causes 3.2% of all deaths (1.8 million deaths) and 4% of Disability-Adjusted Life Years (58.3 million DALYs). This proportion is much higher in males (5.6% deaths and 6.5% of DALYs) than females (0.6% deaths and 1.3% DALYs). (WHO 2002).

India's National Newspaper, the Hindu May 2008 has stated that, in India the alcohol consumption is 2 litres per person a year. The statistics show an extreme gender difference in consumption patterns. Prevalence among women has consistently been estimated at less than 5 per cent but is much higher in the northeastern States. Significantly higher use has been recorded among tribal, rural and lower socio-economic urban sections.

A study in the southern Indian state of Karnataka reported that there was no major difference between the amounts of alcohol drunk by men and women on any typical drinking occasions. Kumar (1997) reported that “of the 500 youth (Interviewed) going to pubs in Bangalore city during the weekends about 100 are girls (13 to 19 years). Notions of virtue and a negative image of the person, who consumes alcohol, seem to be key reasons for under-reporting and also low consumption, but not exactly abstention. On the other hand, there is seen to be an increasing trend in alcohol consumption among young women, especially in urban areas. Among the high income group, economic independence, changing roles in society (entry of women into traditionally male dominated areas), the number of women, boys and girls who have taken to drinking alcohol is also quite high. Two divergent patterns of drinking are noticed among women. These are the traditional pattern and an emerging pattern.7

Tobacco use among women is prevalent in all regions of India and among all sections of society —overall, 2.4% of women smoke and 12% chew tobacco. An available study on pregnant women suggests that tobacco use prevalence among them is not different from that of women in the general population. Over two million pregnant women in India consume tobacco and over 8.5 percent of the ante-natal mothers in India are tobacco users," This is a cause for concern, as it indicates no specific tobacco use prevention efforts during antenatal care. In a report from a large teaching maternity hospital in Mumbai, 33.4% of women in the reproductive age group were smokeless tobacco users. Women in many rural areas believe that tobacco has many magical and medicinal properties; keeping the mouth clean, getting rid of a foul smell, curing toothache, controlling morning sickness, during labour pains etc.

A prospective cohort study was conducted, on Smokeless tobacco use, birth weight, and gestational age: population based of 1217 women who were three to seven months pregnant in Mumbai India. The Objective was to study the effect of using smokeless tobacco during pregnancy on babies' birth weight and gestational age at birth. 1167 women (96%) were followed up and the study was conducted in eight primary health post areas in the city of Mumbai. Results shows that smokeless tobacco use was associated with an average reduction of 105 g in birth weight (95% confidence interval 30 g to 181 g) and a reduction in gestational age of 6.2 (3.0 to 9.4) days. The odds ratio for low birth weight was 1.6 (1.1 to 2.4), adjusted by logistic regression for maternal age, education, socioeconomic status, weight, anaemia, antenatal care, and gestational age. The adjusted odds ratio for preterm delivery (< 37 weeks) was 1.4 (1.0 to 2.1); for delivery before 32 weeks it was 4.9 (2.1 to 11.8) and before 28 weeks it was 8.0 (2.6 to 27.2). Thus the study was concluded as Consumption of smokeless tobacco during pregnancy decreases gestational age at birth and birth weight independent of gestational age. It should receive specific attention as a part of routine prenatal care.8

The Ill effects of Drinking alcohol and Smoking by pregnant women is associated with low birth weight and premature birth, as well as higher rates of illness (colds, bronchitis, ear infections, etc.), breathing problems, and sudden infant death syndrome (SIDS) in their babies and Fetal Alcohol Syndrome (FAS) is a collection of defects that may include any combination of reduced growth (before or after birth), facial deformities, a small head (likely related to reduction of brain size), and abnormal behavioral development.9

When the investigator was working as a staff nurse in one of the Maternity hospital in Bangalore, came across many young healthy mothers with preterm labour, low birth weight babies and babies with congenital anomalies, which was a shocking fact. After reviewing the data from the women’s in detail, it revealed that those women’s had the habit of smoking and alcoholism from teenage. Apart from this, the investigator witnessed that most of the girls among teenagers regularly visiting pubs every weekend. Being a female, that was a heartfelt scene for the researcher and thought of taking up the task of assessing the “knowledge and attitude regarding Ill Effects of Alcoholism and Smoking on Antenatal Mothers” among women of 18-35 years because as this is the peak of reproductive age and educating them. So that complications during pregnancy can be avoided and complications of neonates or congenital malformations can be prevented.

6.2 REVIEW OF LITERATURE:

Review of literature is a summary of theoretical and empirical sources to generate a picture of what is known and not known about a particular problem.10

A Study conducted to assess the, Anemia in Pregnant Women who use Smokeless Tobacco. It was examined whether smokeless tobacco use during pregnancy influenced hemoglobin levels in a population-based cohort of 918 pregnant women in Mumbai, India. Mean hemoglobin levels (Hb) were significantly lower in users (10.00 g/dl) compared with nonusers (10.46 g/dl), p<.000. Anemia (Hb<10 g/dl) was significantly associated with smokeless tobacco in the univariate analysis (OR=1.7, 95% CI 1.2–2.5). The results suggest that smokeless tobacco use during pregnancy is associated with lower hemoglobin levels, as has often been observed with cigarette smoking. Smokeless tobacco use is widely prevalent among women in Southeast Asia and is gaining popularity across the world as a safe alternative to smoking. Further exploration and clarification of this association is therefore of considerable importance to public health. 11

The Collaborative Study was conducted by ICMR Task Force National on Identification of High Risk Families, Mothers and Outcome of their Off-springs with particular reference to the problem. The objectives was to assess the determinants of and rates of abortion, stillbirth, and infant mortality for a cohort of pregnant women from slums in New Delhi, Calcutta, and Madras, India and rural slums in Hyderabad, Varanasi, and Chandigarh, India in 1981. The results showed variation both between and within urban and rural areas. Rural pregnancy outcome showed fewer LBWs and perinatal and neonatal mortality. There was a demonstrated need for prenatal care and referral due to the 10-12% with a poor obstetric history and the significant number with anemia, bleeding, hypertension, toxemia, and urinary tract infections during this pregnancy. Many women were malnourished (body weight 40 kg, height 145 cm, and mid arm circumference of 22.5 cm. These women can be identified as high risk. Other risk factors identified were women with disadvantageous personal habits: smoking, alcohol use, tobacco chewing, and working.12

A Study was conducted on, Sister Chromatid exchanges in betel and tobacco chewers. The incidence of sister-chromatid exchange (SCE) was investigated in the lymphocyte chromosomes of betel and tobacco chewers. Betel chewers and betel-with-tobacco chewers showed higher yields of SCE than normal controls. Higher frequencies of SCE were also observed in individuals who chewed more than 10 betel leaves, or betel leaves-with-tobacco, per day, compared to people who chewed less than 10 betel leaves, or betel leaves-with-tobacco, per day, respectively. Subjects who had chewed betel leaves and betel leaves + tobacco for more than 10 years showed an elevated frequency of SCE.13

A Study was conducted, to assess the effect of tobacco chewing in pregnancy. The effects of tobacco chewing by pregnant women were investigated. The findings suggest that when compared with those who did not do so, tobacco-chewing mothers had a greatly increased stillbirth rate, a low male: female infant sex ratio and a major reduction in birth weight which was due in large part to early delivery.14

A prospective cohort study to investigate Smokeless Tobacco Use and Risk of Stillbirth in Mumbai was conducted on 1217 women who were between 3 and 7 months' gestation. Of these, 96% were contacted after delivery to determine the pregnancy outcome. The findings suggest that Overall occurrence of stillbirth among singleton deliveries in this population was 4.1%. Smokeless tobacco use was reported by 17% of women; 8.9% of smokeless tobacco users had a stillbirth compared with 3.1% among nonusers (life-table adjusted hazard ratio = 3.1; 95% confidence interval = 1.7-5.6). Thus it was concluded that Smokeless tobacco use during pregnancy increases stillbirth risk, with a risk at least as great as that associated with maternal cigarette smoking.15

The article describes a study among all 2,477 pregnant women, who gave birth in Rabin Medical Center during November 1999–April 2000. Its purposes were to identify the scope of alcohol use during pregnancy, and check children prenatally exposed to alcohol (daily drinking/binge drinking) for possible alcohol effects. Relatively high rates of amniocenteses (26.52%), maternal-serum alpha-Feto protein examination (72.22%), screening ultrasound (98.34%) and targeted ultrasound (27.77%) were found, and 8.8% reported smoking. The results of self-report maternal alcohol use studies in various countries, and the fact that half of the Israeli women 18–40-year-old drink alcohol, the article tries to explain the reasons for the results obtained in the current study: abstinence among pregnant women (1.13% reported alcohol drinking during pregnancy) and nonexistence of alcohol drinking in the family (0.84% reported drinking by a family member), and suggests recommendations for future research.16

A Study, Smoking on the rise among women in Andhra Pradesh states that Loosening inhibitions, changing attitudes and much more have contributed to the rise of cigarette smoking among women from high income groups in Hyderabad. Recent studies say not only are more women smoking than ever before but most of them are young girls, who start well before the age of 18. Twenty-three-year old girl admits she started smoking when she was in class 12, like many of her friends. “A lot more girls smoke in private parties because they know everyone there,” Not only are coffee shops and night clubs less public but are restricted to a certain age group and social class. Girls smoke here because there are not as many eyes judging them. Also, alcohol makes people less self-conscious. “Many girls smoke only after drinking because they feel less inhibited,” Stress also plays a role because many of them work late hours.17

The cross-sectional study was conducted on Harmful Alcohol Use in Goa, India, And Its Associations with Violence. The Aim of the study was, to determine (i) the prevalence and characteristics of harmful alcohol consumption in general practice attendees; (ii) social and psychological associations with harmful drinking and (iii) recognition of harmful drinking by GPs. A total of 1567 general practice attendees were recruited. Results suggest that a total of 338 men (41%) and 597 women (81%) reported that they never consumed alcohol. One hundred and twenty-eight people or 8.2% scored 8 on the AUDIT [123 (15%) men and five (0.7%) women] and were classified as harmful or dependent drinkers.. Thus it was Concluded that, these data provide the first evidence in India on (i) the role of the GP in identification of harmful alcohol use and (ii) the contribution of harmful drinking to the perpetration of physical violence from the perspective of the alcohol user.18

The Study was conducted by Centers for Disease Control and Prevention (CDC) Alcohol Consumption among Women Who Are Pregnant or Who Might Become Pregnant in United States, 2002. CDC analyzed data for women aged 18-44 years from the 2002 Behavioral Risk Factor Surveillance System (BRFSS) survey. The results of that analysis indicated that approximately 10% of pregnant women used alcohol, and approximately 2% engaged in binge drinking or frequent use of alcohol. The results further indicated that more than half of women who did not use birth control (and therefore might become pregnant) reported alcohol use and 12.4% reported binge drinking. Women who are pregnant or who might become pregnant should abstain from alcohol use that adversely affects the mother and fetus. 19

The Study was conducted to assess the association between maternal alcohol consumption during pregnancy and childhood leukemia. Analyses were conducted by type of leukemia, children's age at diagnosis, and type of alcoholic beverage and trimester of pregnancy at alcohol use. Alcohol intake during pregnancy (yes versus no) was statistically significantly associated with childhood acute myeloid leukemia (AML) [odds ratio (OR), 1.56; 95% confidence interval (CI), 1.13-2.15] but not with acute lymphoblastic leukemia (OR, 1.10; 95% CI, 0.93-1.29). The OR of AML for an increase of a drink per week was 1.24 (95% CI, 0.94-1.64). The association of alcohol intake during pregnancy with AML was observed for cancers diagnosed at age 0 to 4 years (OR, 2.68; 95% CI, 1.85-3.89) in five studies without heterogeneity (I2 ≤ 0.1%). The results of case-control studies indicate that maternal alcohol consumption during pregnancy is associated with a significantly increased risk of AML in young children. 20

The study was conducted on Social support and prenatal alcohol use in Brigham and Women's Hospital, Boston. The purpose of this study is to evaluate the degree, predictors, and consequences of social support in a cohort of 200 pregnant women who scored 2 or more on the T-ACE, a 4-item screening questionnaire for prenatal drinking. The pregnant women completed the Maternal Social Support Index (MSSI).The results suggest that Social support was not predictive of either subsequent prenatal alcohol use or newborn birth weight. Thus the study was concluded that Regardless of social support, previous, pre pregnancy, and early pregnancy drinking were the most predictive factors for subsequent prenatal alcohol consumption in this sample, underscoring the importance of screening pregnant women for drinking.21

The Article describes smoking and drinking patterns during pregnancy amongst a cohort of 2266 women who enrolled at a London antenatal clinic 1982-1983. The study reveals that only 12% of mothers were non-drinkers before pregnancy, but 44% abstained in the first trimester, 38% in the second and 50% in the third. Before pregnancy 20% of mothers were drinking more than the recommended 10 units of alcohol per week. This dropped to 6% during pregnancy. Consumption levels fell amongst those who continued smoking. The heaviest pre-pregnancy smokers were the most likely to reduce but the least likely to stop. Smoking was positively associated with the level of both pre-pregnancy and pregnancy drinking. The most commonly cited reasons for changes in drinking and smoking habits in pregnancy were concern for the child, concern for self or concern for both. Mothers who drank more than 10 units of alcohol per week during pregnancy were more likely to be older, of higher social status and primiparous. In contrast those who smoked in pregnancy were more likely to be younger, of lower social status and multiparous. This has important implications for planning antenatal health education.22

The aim of the prospective cohort study was to evaluate the impact of tobacco smoke exposure, measured by maternal serum concentration of cotinine, on fetal mid gestation biometric parameters and umbilical artery (UA) qualitative blood flow indices. The study population consisted of 114 healthy women in 20 to 24 weeks gestation who were recruited from the patients of two antenatal care units in Lodz, Poland. Significant negative correlation was found between fetal biparietal diameter (BPD) and serum cotinine concentration. Serum cotinine positively correlated with all blood flow indices under study (systolic/diastolic index [S/D], resistance index, and pulsality index) after controlling for gestational age, gender, and femur length. The midgestation UA S/D ratio > 3 was found to be a significant risk factor for decreased birth weight. Thus it was concluded that tobacco smoke exposure is a significant factor inducing increased resistance of umbilical blood flow as measured in 20 to 24 weeks gestation. 23

The study was conducted to assess the prevalence of low birth weight and its association with maternal factors in a 1994 study of 201 pregnant women from an urban area in Nagpur, India. 61 women (30.3%) delivered a low-birth-weight infant. Multivariate analysis identified the following maternal risk factors for a low-birth-weight delivery: anemia (odds ratio [OR], 4.81), low socioeconomic status (OR, 3.96), short birth interval (OR, 3.84), tobacco exposure (OR, 3.14), height (OR, 2.78), maternal age (OR, 2.68), body mass index (OR, 2.02), and primiparity (OR, 1.58). These findings suggest that a greater emphasis should be placed on encouraging adequate birth intervals, weight gain during pregnancy, avoidance of tobacco chewing and exposure to passive smoke, and prevention of adolescent pregnancy.24

A longitudinal prospective study was conducted to examine the relative importance of prenatal exposure to cigarettes and alcohol and familial/genetic susceptibility for alcohol dependence in the etiology of childhood psychopathology in Pennsylvania USA. Mothers were interviewed concerning their prenatal use of substances, and information was gathered concerning their personal and familial loading for psychiatric disorders. The result shows that internalizing and externalizing disorders were found to be associated with familial loading for alcoholism and prenatal exposure to cigarettes and alcohol. Results of these analyses revealed that the only childhood disorder that was elevated was ADHD, and that this was the result of the familial risk variable only. Thus it was concluded Familial loading for alcohol dependence is an important risk factor for the development of childhood psychopathology and may account for the previously reported associations between prenatal exposure to nicotine and alcohol. substance abuse/dependence etiology and childhood psychopathology need to include consideration of both prenatal exposures and familial loading for alcohol dependence and other psychiatric disorders.25

The Explorative study was conducted to assess pregnant women's attitudes towards drinking alcohol in pregnancy and their attitudes towards sources of information about drinking in pregnancy. The sample was 20 pregnant women recruited from community organizations in UK. The finding suggest that most women found information and advice about safe levels of drinking in pregnancy confusing and lacking in evidence and detail. Thus it was concluded as pregnant women wished to take responsibility for their own health and make choices based on informed advice. In order to do so, they require clear and consistent advice about safe levels of drinking from policy makers and health professionals.26

6.3 OBJECTIVES OF THE STUDY:

1. To assess knowledge of women regarding the ill effects of alcoholism and smoking on Antenatal Mothers.

2. To assess the Attitude of women regarding the ill effects of alcoholism and smoking on Antenatal Mothers.

3. To find out the association between the knowledge and selected demographic variables of Women.

4. To find out the association between the Attitude and selected demographic variables of Women.

5. To find out the Correlation between the knowledge and Attitude of Women regarding the ill effects of alcoholism and smoking on Antenatal Mothers.

6. To prepare an information booklet based on the knowledge of women regarding Ill effects of Alcoholism and Smoking on antenatal Mothers.

6.4 OPERATIONAL DEFINITIONS:

1. Assess : - Assess refers to the process of critical analysis and valuation or judgment of the status or quality of a particular condition or situation.

2. Knowledge: - It is the women’s intellectual ability to answer correctly for the questions related to ill effects of alcoholism and smoking on Antenatal Mothers.

3. Attitude: - Refers to opinion or way of thinking of women regarding ill effects of alcoholism and smoking on Antenatal Mothers.

4. Ill effects: - Harmful effects that occur due to alcoholism and smoking.

5. Alcoholism: - Drinking of alcoholic beverages like beer, whisky, arrack, wine and rum etc.

6. Smoking: - The practice of inhaling the fumes from burning tobacco leaves by using cigarette, cigar or pipes.

7. Antenatal mother: - is a woman who is carrying viable products of conception in the womb from first week till the time of delivery.

8. Women: - An Adult human females between the age group of 18-35 years.

9. Pubs: - A place of business where alcoholic beverages are sold and drunk.

10. Information Booklet:- A small thin book with the inclusion of facts told or discovered about ill effects of alcoholism and smoking on antenatal mothers and its prevention.

6.5 ASSUMPTIONS:

1. Women may possess some knowledge regarding the ill effects of alcoholism and smoking on Antenatal Mothers.

2. Knowledge of Women can be assessed with the help of a structured questionnaire.

3. Attitude of women can be measured by using an attitude scale.

4. The increase knowledge of women may show positive attitude towards prevention of Alcoholism and Smoking.

6.6 DELIMITATIONS OF THE STUDY:

1. The study will be limited to selected Pubs in Mahatma Gandhi road, Bangalore.

2. The study is limited to Women of 18-35 years of age only.

6.7 PILOT STUDY:

The study will be conducted with 6 samples. The purpose to conduct the pilot study is to find out the feasibility for conducting the study and design on plan of statistical analysis.

6.8 VARIABLES:

Variables are qualities, properties, or characteristic of persons, things, or situations that change or vary and are manipulated or measured in research.

· Dependent variable:

Knowledge and Attitude of women regarding Ill effects of Alcoholism and Smoking on Antenatal Mothers.

· Independent variable:

The demographic variables of women like age, marital status, educational status, occupation, monthly income, place of stay, number of pegs per day and number of cigarettes per day.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

The data will be collected from the women who are visiting selected Pubs in Mahatma Gandhi road, Bangalore.

7.1.1 RESEARCH DESIGN:

Descriptive Research Design.

7.1.2 RESEARCH APPROACH:

Descriptive Survey Approach.

7.1.3 SETTINGS OF THE STUDY:

The study will be conducted at selected Pubs in Mahatma Gandhi road, Bangalore.

7.1.4 POPULATION:

All women who meet the inclusion criteria in selected Pubs in Mahatma Gandhi road, Bangalore.

7.2 METHODS OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE)

The data collection procedure will be carried out for a period of one month. The study will be conducted after obtaining permission from concerned authorities. The investigator will collect data from women by using structured questionnaire to assess knowledge and an attitude scale to assess the attitude regarding the Ill effects of Alcoholism and Smoking on Antenatal Mothers.

Data collection instruments consist of the following sections:

Section ‘A’: Demographic data

Section ‘B’: Questions related to assess the knowledge of women regarding Ill effects of Alcoholism and Smoking on Antenatal Mothers.

Section ‘C’: Attitude scale to assess the attitude of women regarding Ill effects of Alcoholism and Smoking on Antenatal Mothers.

7.2.1 SAMPLING TECHNIQUE:

Sampling technique adopted for the selection of sample is non-probability convenience sampling.

7.2.2 SAMPLE SIZE:

The sample consists of, 60 women of selected Pubs in Mahatma Gandhi road, Bangalore.

SAMPLING CRITERIA:

7.2.3 INCLUSION CRITERIA:

1. Women who are between the age group of 18 -35 years.

2. Women who visit pubs in Mahatma Gandhi road, Bangalore.

3. Women who know to read and write Kannada or English.

4. Women who are willing to participate in the study.

5. Women who are present during the time of study.

7.2.4 EXCLUSIVE CRITERIA:

1. Women who are above 35 years.

2. Women who does not visit pubs in Mahatma Gandhi road, Bangalore.

3. Women who does not know to read and write Kannada or English.

4. Women who are not willing to participate in the study.

5. Women who are not present during the time of study.

6. Women who are selected for pilot study.

7.2.5 TOOL FOR DATA COLLECTION:

Structured questionnaire and an attitude scale are used to collect data from Women.

7.2.6 DATA ANALYSIS METHOD:

The data collected will be analyzed by using descriptive and inferential statistics.

· DESCRIPTIVE STATISTICS:

Frequency and percentage for analysis of demographic data and mean, mean percentage and standard deviation will be used for assessing the level of knowledge and attitude.

· INFERENTIAL STATISTICS:

Chi-square test will be used to find out the association between knowledge and attitude of women regarding Ill effects of Alcoholism and Smoking on Antenatal Mothers and selected demographic variables. Product Moment Correlation Coefficient (r) will be used to find out the correlation between the knowledge and attitude.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?

Since the study is Descriptive in nature, investigation or interventions are not required.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION?

The main study will be conducted after the approval of research committee of the college. Permission will be obtained from the Head of the Institution. The purpose and details of the study will be explained to the study subjects and assurance will be given regarding the confidentiality of the data collected.

8. LIST OF THE REFERENCE (VANCOUVER STYLE FOLLOWED):

1. West's Encyclopedia of American Law, from ...Simple alcohols - Nomenclature - Physical and chemical properties. Available from: www.answers.com

2. The Hindu : Front Page : Alcohol in India at a new high, 2008/05/03. Available from: www.thehindu.com

3. Lisa Raffensperger. India: Alcohol in a Changing Women's Culture | Earth Trends 2008-04-29 16:27. Available from:earthtrends.wri.org

4. Wikipedia, the free encyclopedia History - Consumption - Psychology - Impact Available from: en.wikipedia.org

5. Wikipedia, the free encyclopedia. The future: women, smoking, and globalization. Available from: en.wikipedia.org/wiki/Women_and_smoking

6. Michael Perry. World No Tobacco Day targets women, girls May 31, 2010. Available from URL: www.reuters.com/article/id

7. Alcohol Usage: Impact and Consequences. Available from: http//:www.searo.who.int/.../ Alcohol_and_Substance_abuse_5BangaloreSt

8. Prakash C Gupta, project coordinator and S Sreevidya, senior research scientist. Smokeless tobacco use, birth weight, and gestational age: population based prospective cohort study of 1217 women in Mumbai, India. April 1, 2004. Available from URL: www.google.com

9. Pregnancy Symptoms, Pregnancy, Signs Of Pregnancy, Pregnant Women ... Available from URL: www.health.indiamart.com

10. Nancy Burns, Susan. K. Groove. Understanding Nursing Research, 4th ed. Missouri: Saunders Company, 2007.

11. Sreevidya Subramoney, M.D. and Prakash C. Gupta, D.Ph. Anemia in Pregnant Women Who Use Smokeless Tobacco, Available from URL: www.google.com

12. Bhargava SK, Singh KK, Saxena BN. ICMR Task Force National Collaborative Study on Identification of High Risk Families, Mothers and Outcome of their Off-springs with particular reference to the problem of maternal nutrition, low birth weight, perinatal and infant morbidity and mortality in rural and urban slum communities, Indian Pediatr. 1991 Dec; 28(12):1473-80. Available from: URL: http//:www.pubmed .com

13. Ghosh R, Ghosh PK. Sister chromatid exchanges in betel and tobacco chewers, Mutat Res. 1984 Feb; 139(2):79-81. Available from: URL: http//:www.pubmed .com

14. Krishna K. Tobacco chewing in pregnancy, Br J Obstet Gynaecol. 1978 Oct; 85(10):726-8. Available from: URL: http//:www.pubmed .com

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26. Neil Raymond, Charlotte Beer, Cristine Glazebrook and Kapil Sayal. Pregnant women's attitudes towards alcohol consumption, BMC Public Health 2009, 9:175doi:10.1186/1471-2458-9-175. Available from: URL: http://www.biomedcentral.com

9.

Signature of the candidate

10.

Remarks of the guide

11.

Names and designation of

11.1 Guide

11.2 Signature

11.3 Co- guide

11.4 Signature

11.5 Head of the department

11.6 Signature

12.

12.1 Remarks of the chairman and principal

12.2 Signature

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