Knowledge and Practice towards Lung Cancer among University Students

Community Medicine Department, International Medical School, Management and Science University, Malaysia

Corresponding Author:

Redhwan Ahmed Al-Naggar
Community Medicine Department
International Medical School
Management and Science University, Malaysia
E-mail: radhwan888@yahoo.com

Received Date: March 07, 2012; Accepted Date: March 28, 2012; Published Date: March 30, 2012

Citation: Al-Naggar RA (2012) Knowledge and Practice towards Lung Cancer among University Students. J Community Med Health Edu 2:134. doi:10.4172/jcmhe.1000134

Copyright: © 2012 Al-Naggar RA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Community Medicine & Health Education

Abstract

Objective: The objective of this study was to determine the knowledge and practice towards lung cancer among university students.

Methodology: Cross-sectional study was conducted among Management and Science University students (MSU). Two hundred and thirteen students were selected randomly from all faculties. The data were collected from the lectures halls, library and university café. Data analysis was conducted using SPSS version 13, t-test was used for univariate analysis. Multiple linear regressions were used for multivariate analysis.

Results: A total number of 213 university students participated in this study. The majority of them females, 22 years old and younger, Malays, single, from non-medical schools and with family monthly income 3000 Ringgit Malaysia (RM) and less (57.3%, 65.3%, 78.4%, 97.2%, 55.9%, 59.6%, and 66.7%; respectively). The majority of the participants mentioned that they knew about lung cancer (93%). Regarding the knowledge about risk factors towards lung cancer, they knew that the risk factors of lung cancer are: smoking (100%), eating chili and deep fried food (68.5%), air pollution (89.2%), alcohol (75.6%), occupational hazard (75.6%), passive smoking (90.1%), exercise reduce the risk of lung cancer (83.1%) and lung cancer is inherited (51.6%). Regarding the practice towards lung cancer prevention, the majority of the participants mentioned that they are not smokers neither alcohol drinkers (90.1%, 94.8%; respectively). Regarding the factors associated with knowledge about lung cancer, marital status, type of faculty, and type of semester significantly influence the knowledge of university students (p=0.014, p=0.001, p=0.028; respectively) in univariate analysis. For multivariate analysis, only types of faculty significantly influence the knowledge of the university students towards lung cancer (p=0.001).

Conclusion: The university students had good knowledge about risk factors. Types of faculty significantly influence the knowledge of the university students towards lung cancer.

Keywords

Knowledge; Practice; Lung cancer; University students

Introduction

Lung cancer is the leading cancer worldwide in terms of incidence and mortality [1]. Although lung cancer remains the leading cause of cancer-related mortality in the United States, its incidence is decreasing [2]. It may due to better prevention, awareness and early detection.

Tobacco use is the main risk factor for lung cancer [3]. Radon, arsenic, asbestos, heavy metals-chromium VI, nickel, cadmiumcoke oven and coal gasification fumes and soot are well-known lung carcinogens [4-6]. Several studies reported that high fat consumption increases the risk of lung cancer [7,8]. Exposure to incense smoke and exposure to fry pan fumes were associated with a higher risk for lung cancer due to the presence of combustion-related carcinogens [9-13]. Another study showed that heavy pesticide usage was associated with increase of lung cancer [14]. Another study showed significant correlations between cancer risk and the use of insecticides, fungicides, herbicides, nematicides and all types of pesticides [15]. Potent insecticides, such as pyrethroids, which account for more than 30% of global use, are known to be carcinogenic [16]. Occupational exposures in industrial facilities have been held to account for a further 9% to 15% of cases [17].

Several studies have reported an association between risk of lung cancer and proximity to certain industries, such as iron and steel foundries or chemical, petrochemical and coke oven plants [18-21]. Another study reported increased lung cancer mortality in the proximity of a combustion installation located in Asturias [22]. Urban air pollution, particularly due to traffic and heating related emissions has also come to be viewed as a risk factor for developing lung cancer [23-25]. Several studies reported a link between several air pollution indicators and cancer risk among urban residents [26-28]. An Italian study showed that an increased risk for lung cancer among city residents living in the most polluted areas versus those living in less polluted areas [29].

There have been many studies investigating the relation between nutrition and lung cancer [30-36]. Studies suggested that increased vegetable and fruit intake is associated with a lower risk for lung cancer. For instance, Koo [30] reported that consumption of carrots, leafy green vegetables, fresh fruits, bean curd and fresh fish was associated with a lower risk for lung cancer.

There is no previous study which measured the knowledge and practice towards lung cancer among university students in Malaysia. Therefore, this study aimed to fill the gap among university students in Malaysia. The objective of this study was to determine the knowledge and practice towards lung cancer among university students.

Methodology

Cross-sectional study was conducted among Management and Science University (MSU) students. Students from all faculties namely: the International Medical School (IMS), the Faculty of Business and Management Professional (FBMP), Faculty of Health and Life Science (FHLS) and Faculty of Informative Science and Engineering (FISE) were selected randomly and included in this study from semester one through semester six. The protocol of this study was approved by the ethics committee of Management and Science University (MSU). The self- administered questionnaires were distributed randomly to all faculties’ students. The inclusion criteria were students who are able to speak English, 18 years old and above. However the exclusion criteria were students, not able to communicate in English and below 18 years of age. The scoring system was created based on the correct answer each correct answer was given one score and the wrong answer given zero score and then sum all the scores. Those who have scores below 5 have a poor knowledge and more than 5 score have a good knowledge. Data analysis was conducted by SPSS version 13, t-test. Multiple linear regressions were used for multivariate analysis.

Results

A total number of 213 university students were participated in this study. The majority of them were females, 22 years old and younger, Malays, single, from non-medical schools and with family monthly income 3000 Ringgit Malaysia and less (57.3%, 65.3%, 78.4%, 97.2%, 55.9%, 59.6%, 66.7%; respectively) (Table 1). Regarding the factors associated with knowledge about lung cancer, marital status, type of faculty and type of semester significantly influenced the knowledge of university students (p=0.014, p=0.001, p=0.028; respectively) (Table 1).

Table 1: Socio-demographic characteristics and associated factors of knowledge of university students towards lung cancer (n=213).

Regarding the knowledge about risk factors about lung cancer, the majority of the participants mentioned that they knew about lung cancer (93%) and they knew that the risk factors of lung cancer are: smoking (100%), eating chili and deep fried food (31.5%), air pollution (89.2%), alcohol (75.6%), occupational hazard (75.6%) passive smoking (90.1%), exercise reduce the risk of lung cancer (83.1%), and lung cancer is inherited (51.6%) (Table 2). Regarding the practice towards lung cancer prevention, the majority of the participants mentioned that they are not smokers neither alcohol drinkers (90.1%, 94.8%; respectively) (Table 2).

Table 2: knowledge and Practice toward lung cancer among university students (n=213).

For multivariate analysis, only type of faculty significantly influenced the knowledge of the university students towards lung cancer. Those from medical school had higher knowledge with 0.37 higher point than those from non medical schools (p=0.001) (Table 3).

Table 3: Prediction Model for factors associated with knowledge towards lung cancer among university students by Multiple Linear Regression.

Discussion

The participants in this study had a good knowledge in terms of lung cancer (93%) and the risk factors of lung cancer. This may due to the media attention to smoking and also to the anti-smoking program “Tak-nak” which is a very effective and with wider national spread. A Jordanian study reported that Knowledge of lung cancer was almost correct among university students [37]. Similar studies showed higher levels of knowledge related to smoking hazards among university students [38,39].

In this study, the majority of the participants (89.2%) mentioned that air pollution is one of the risk factors of lung cancer. Similar findings reported by Kofahi and Haddad [37] that 90.3% of the study participants were aware of the cancer risk from air pollution. Price and Everett [40] reported that the majority of the study participants were aware that air pollution is a lung cancer risk factor (79%).

In this study, about 31.5% of the study participants mentioned that eating chili and deep fried is the risk factor of lung cancer. Several studies reported that deep fried cooking and chili have been associated with an increased lung cancer risk [41-44].

Smoking is a well recognized risk factor in both men and women for lung cancer [45]. In this study, all the study participants knew that the risk factor of lung cancer is smoking (100%). Siahpush et al. [46] reported that smoking causes lung cancer. The effect of pipe and cigar use on the risk of lung cancer is similar to that of light cigarette smoking [47,48]. Similar study reported that the majority of the participants (82.1%) knew that smoking is a risk factor for lung cancer [49].

In this study, 90.1% of the study participants mentioned that second hand smoking is one of the risk factors of lung cancer. The causal association that has been established between secondhand tobacco smoking and lung cancer can explain 1.6% of lung cancers [50]. Results from a meta-analysis [51] and a comprehensive review [52] showed a relative risk between 1.14 to 5.20 in people who had never smoked but who lived with a smoker. A more recent study reported that passive smoking during childhood increased lung cancer risk in adulthood by 3.6 fold [53]. However, Kofahi and Haddad [37] reported that 58% of university students did not agree that secondhand smoke is a cancer risk.

In this study the majority of the study participants (75.6%) mentioned that alcohol is one of the risk factors of lung cancer. From a pooled analysis of 7 prospective studies with 399,767 participants and 3137 lung cancer cases, a slightly greater risk of lung cancer was indicated among people who consumed at least 30 g/d of alcohol than among those who abstained from alcohol [54].

In this study 75.6% of the study participants mentioned that occupational exposure is one of the risk factors of lung cancer. Many work settings could have exposed workers to carcinogens, leading to an increased risk of lung and other cancers. Crystalline silica and chrysotile asbestos are well known human carcinogens; as expected, workers exposed to silica dust and asbestos fiber are at a higher risk of developing lung cancer. Uranium miners and nuclear plant workers are also known to have an increased cancer risk because of exposure to radioactive particulate mass [55]. Similar findings reported from mainland China, Hong Kong and Singapore showed significant relationships between smoking habit and lung cancer [10,45,56]. At present, many occupations, industries, and specific chemical substances have been associated with a well established or suspected excess risk of lung cancer [57,58].

In this study 51.6% of the study participants mentioned that family history of lung cancer is one of the risk factors of risk factors. A reported family history of cancer or lung cancer increased the risk of lung cancer significantly in men and a similar trend in women. Most of the published literatures have shown a smoking-adjusted increased risk of lung cancer by about 2-4 fold associated with a family history of lung cancer [59-62]. The issue of genetic predisposition of lung cancer is being actively investigated by many researchers at present [63-65].

Majority of the students reported that exercise reduce the risk of lung cancer (83.1%). Regarding the practice towards lung cancer prevention, the majority of the participants mentioned that they are not smokers neither alcohol drinkers (90.1%, 94.8%; respectively).

Regarding the factors associated with knowledge about lung cancer, marital status, type of faculty, and type of semester significantly influence the knowledge of university students (p=0.014, p=0.001, p=0.028; respectively). For multivariate analysis, only types of faculty significantly influence the knowledge of the university students towards lung cancer (p=0.001). Medicine students had greater knowledge about lung cancer than did those in other specialties because of the emphasis of their curricula on health information, as was also noted by Abolfotouh et al. [66].

Finally, limitation of this study should be noted. Restricting the study to a single university limits generalizability to the total population of university students. Therefore, investigation of the perceptions of lung cancer and smoking with a larger sample representing all universities is worthwhile.

References

1. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74-108.
2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, et al. (2008) Cancer statistics, 2008. CA Cancer J Clin 58: 71-96.
3. Levi F (1999) Cancer prevention: epidemiology and perspectives. Eur J Cancer 35:1912-1924.
4. Catelinois O, Rogel A, Laurier D, Billon S, Hemon D, et al. (2006) Lung cancer attributable to indoor radon exposure in france: impact of the risk models and uncertainty analysis. Environ Health Perspect 114: 1361-1366.
5. Darby S, Hill D, Deo H, Auvinen A, Barros-Dios JM, et al. (2006) Residential radon and lung cancer--detailed results of a collaborative analysis of individual data on 7148 persons with lung cancer and 14,208 persons without lung cancer from 13 epidemiologic studies in Europe. Scand J Work Environ Health 32: 1-83.
6. Clapp RW, Howe GK, Jacobs MM (2005) Environmental and Occupational Causes of Cancer. A Review of Recent Scientific Literature. Lowell Center for Sustainable Production.
7. Alavanja MC, Brown CC, Swanson C, Brownson RC (1993) Saturated fat intake and lung cancer risk among nonsmoking women in Missouri. J Natl Cancer Inst 85: 1906-1916.
8. De Stefani E, Brennan P, Boffetta P, Mendilaharsu M, Deneo-Pellegrini H, et al. (2002) Diet and adenocarcinoma of the lung: a case-control study in Uruguay. Lung Cancer 35: 43-51.
9. Chiang TA, Wu PF, Ko YC (1999) Identification of carcinogens in cooking oil fumes. Environ Res 81: 18-22.
10. Gao YT, Blot WJ, Zheng W, Ersnow AG, Hsu CW, et al. (1987) Lung cancer among Chinese women. Int J Cancer 40: 604–609.
11. Koo LC, Matsushita H, Ho JHC, Wong MC, Shimizu H, et al. (1994) Carcinogens in the indoor air of Hong Kong homes: levels, sources, and ventilation effects on 7 polynuclear aromatic hydrocarbons. Environ Technol 15: 401-418.
12. Seow A, Poh WT, Teh M, Eng P, Wang YT, et al. (2000) Fumes from meat cooking and lung cancer risk in Chinese women. Cancer Epidemiol Biomarkers Prev 9: 1215-1221
13. Schoental R, Gibbard S (1967) Carcinogens in Chinese incense smoke. Nature 216: 612.
14. Wesseling C, Antich D, Hogstedt C, Rodríguez AC, Ahlbom A (1999) Geographical differences of cancer incidence in Costa Rica in relation to environmental and occupational pesticide exposure. Int J Epidemiol 28: 365-374.
15. Safi JM (2002) Association between chronic exposure to pesticides and recorded cases of human malignancy in Gaza Governorates (1990-1999). Sci Total Environ 284: 75-84.
16. Shukla Y, Yadav A, Arora A (2002) Carcinogenic and cocarcinogenic potential of cypermethrin on mouse skin. Cancer Lett 182: 33-41.
17. Spitz MR, Wu X, Wilkinson A, Wei Q (2006) Cancer of the lung. Cancer Epidemiology and Prevention. Oxford University Press: 638-658.
18. Belli S, Benedetti M, Comba P, Lagravinese D, Martucci V, et al. (2004) Case-control study on cancer risk associated to residence in the neighbourhood of a petrochemical plant. Eur J Epidemiol 19: 49-54.
19. Jedrychowski W, Becher H, Wahrendorf J, Basa-Cierpialek Z (1990) A case-control study of lung cancer with special reference to the effect of air pollution in Poland. J Epidemiol Community Health 44: 114-120.
20. Parodi S, Stagnaro E, Casella C, Puppo A, Daminelli E, et al. (2005) Lung cancer in an urban area in Northern Italy near a coke oven plant. Lung Cancer 47: 155-164.
21. Pless-Mulloli T, Phillimore P, Moffatt S, Bhopal R, Foy C, et al. (1998) Lung cancer, proximity to industry, and poverty in northeast England. Environ Health Perspect 106: 189-196.
22. García-Perez J, Pollán M, Boldo E, Pérez-Gómez B, Aragonés N, et al. (2009) Mortality due to lung, laryngeal and bladder cancer in towns lying in the vicinity of combustion installations. Sci Total Environ 407: 2593-2602.
23. Nyberg F, Gustavsson P, Järup L, Bellander T, Berglind N, et al. (2000) Urban air pollution and lung cancer in Stockholm. Epidemiology 11: 487-495.
24. Pershagen G, Simonato L (1990) Epidemiological evidence for the carcinogenity of air pollutants. Air pollutant and human cancer. In European School of Oncology monograph. Springer-Verlag.
25. Vena JE (1982) Air pollution as a risk factor in lung cancer. Am J Epidemiol 116: 42-56.
26. Beeson WL, Abbey DE, Knutsen SF (1998) Long-term concentrations of ambient air pollutants and incident lung cancer in California adults: results from the AHSMOG study.Adventist Health Study on Smog. Environ Health Perspect 106: 813-822.
27. Dockery DW, Pope CA 3rd, Xu X, Spengler JD, Ware JH, et al. (1993) An association between air pollution and mortality in six U.S. cities. N Engl J Med 329: 1753-1759.
28. Pope CA 3rd, Burnett RT, Thun MJ, Calle EE, Krewski D, et al. (2002) Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 287: 1132-1141.
29. Barbone F, Bovenzi M, Cavallieri F, Stanta G (1995) Air pollution and lung cancer in Trieste, Italy. Am J Epidemiol 141: 1161-1169.
30. Koo LC (1988) Dietary habits and lung cancer risk among Chinese females in Hong Kong who never smoked. Nutr Cancer 11: 155-172.
31. Koo LC, Ho JH (1996) Diet as a confounder of the association between air pollution and female lung cancer: Hong Kong studies on exposures to environmental tobacco smoke, incense, and cooking fumes as examples. Lung Cancer 14: S47-S61.
32. Wu-Williams AH, Dai XD, Blot W, Xu ZY, Sun XW, et al. (1990) Lung cancer among women in north-east china. Br J Cancer 62: 982-987.
33. Darby S, Whitley E, Doll R, Key T, Silcocks P (2001) Diet, smoking and lung cancer: a case-control study of 1000 cases and 1500 controls in south-west England. Br J Cancer 84: 728-735.
34. Feskanich D, Ziegler RG, Michaud DS, Giovannucci EL, Speizer FE, et al. (2000) Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Inst 92: 1812-1823.
35. Jansen MC, Bueno-de-Mesquita HB, Räsänen L, Fidanza F, Nissinen AM, et al. (2001) Cohort analysis of fruit and vegetable consumption and lung cancer mortality in European men. Int J Cancer 92: 913-918.
36. Voorrips LE, Goldbohm RA, Verhoeven DT, van Poppel GA, Sturmans F, et al. (2000) Vegetable and fruit consumption and lung cancer risk in the Netherlands Cohort study on diet and cancer. Cancer Causes Control 11: 101-115.
37. Kofahi MM, Haddad LG (2005) Perceptions of Lung Cancer and Smoking Among College Students in Jordan. J Transcult Nurs 16: 245-254.
38. Felimban FM (1993) The smoking practices and attitudes towards smoking of female university students in Riyadh. Saudi Med J 14: 220-224.
39. Melani AS, Verponziani W, Boccoli E, Trianni GL, Federici A, et al. (2000) Tobacco smoking habits, attitudes and beliefs among nurse and medical students in Tuscany. Eur J Epidemiol 16: 607-611
40. Price JH, Everett SA (1994) Perceptions of lung cancer and smoking in an economically disadvantaged population. J Community Health 19: 361-375
41. Krinsky NI, Johnson EJ (2005) Carotenoid actions and their relation to health and disease. Mol Aspects Med. 26: 459-516.
42. Ruano-Ravina A, Figueiras A, Freire-Garabal M, Barros-Dios JM (2006) Antioxidant vitamins and risk of lung cancer. Curr Pharm Des 12: 599-613.
43. Lam WK (2005) Lung cancer in Asian women-the environment and genes. Respirology 10: 408-417.
44. Siems W, Wiswedel I, Salerno C, Crifò C, Augustin W, et al. (2005) Beta-carotene breakdown products may impair mitochondrial functions--potential side effects of high-dose beta-carotene supplementation. J Nutr Biochem 16: 385-397.
45. Koo LC, Ho JH, Lee N (1985) An analysis of some risk factors for lung cancer in Hong Kong. Int J Cancer 35: 149–155.
46. Siahpush M, McNeill A, Hammond D, Fong GT (2006) Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: results from the 2002 International Tobacco Control (ITC) Four Country Survey. Tob Control 15: iii65–iii70.
47. Shaper AG, Wannamethee SG, Walker M (2003) Pipe and cigar smoking and major cardiovascular events, cancer incidence and all-cause mortality in middle-aged British men. Int J Epidemiol 32: 802-808.
48. Henley SJ, Thun MJ, Chao A, Calle EE (2004) Association between exclusive pipe smoking and mortality from cancer and other diseases. J Natl Cancer Inst 96: 853-861.
49. Kebede Y (2002) Cigarette smoking and khat chewing among college students in North West Ethiopia. Ethiop J Health Dev 16: 9-17.
50. Boffetta P (2006) Human cancer from environmental pollutants: the epidemiological evidence. Mutat Res 608: 157-162.
51. Hackshaw AK, Law MR, Wald NJ (1997) The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ 315: 980-988.
52. Whitrow MJ, Smith BJ, Pilotto LS, Pisaniello D, Nitschke M (2003) Environmental exposure to carcinogens causing lung cancer: epidemiological evidence from the medical literature. Respirology 8: 513-521.
53. Vineis P, Airoldi L, Veglia F, Olgiati L, Pastorelli R, et al. (2005) Environmental tobacco smoke and risk of respiratory cancer and chronic obstructive pulmonary disease in former smokers and never smokers in the EPIC prospective study. BMJ 330: 277.
54. Freudenheim JL, Ritz J, Smith-Warner SA, Albanes D, Bandera EV, et al. (2005) Alcohol consumption and risk of lung cancer: a pooled analysis of cohort studies. Am J Clin Nutr 82: 657-667.
55. Boffetta P (2004) Epidemiology of environmental and occupational cancer. Oncogene 23: 6392-6403.
56. MacLennan R, Da Costa J, Day NE, Law CH, Ng YK, et al. (1977) Risk factors for lung cancer in Singapore Chinese, a population with high female incidence rates. Int J Cancer 20: 854–860.
57. Dubrow R, Wegman DH (1983) Setting priorities for occupational cancer research and control: synthesis of the results of occupational disease surveillance studies. J Natl Cancer Inst 71: 1123-1142.
58. Steenland K, Loomis D, Shy C, Simonsen N (1996) Review of occupational lung carcinogens. Am J Ind Med 29: 474–490.
59. Tokuhata GK, Lilienfeld AM (1963) Familial aggregation of lung cancer in humans. J Natl Cancer Inst 30: 289-312.
60. Wu AH, Fontham ET, Reynolds P, Greenberg RS, Buffler P, et al. (1996) Family history of cancer and risk of lung cancer among lifetime nonsmoking women in the United States. Am J Epidemiol 143: 535-542.
61. Brownson RC, Alavanja MC, Caporaso N, Berger E, Chang JC (1997) Family history of cancer and risk of lung cancer in lifetime non-smokers and long-term ex-smokers. Int J Epidemiol 26: 256-263.
62. Liu ZY, He XZ, Chapman RS (1991) Smoking and other risk factors for lung cancer in Xuanwei, China. Int J Epidemiol 20: 26-31.
63. Bartsch H, Nair U, Risch A, Rojas M, Wikman H, et al. (2000) Genetic polymorphism of CYP genes, alone or in combination, as a risk modifier of tobacco-related cancers. Cancer Epidemiol Biomarkers Prev 9: 3-28.
64. Lan Q, He X, Costa DJ, Tian L, Rothman N, et al. (2000) Indoor coal combustion emissions, GSTM1 and GSTT1 genotypes, and lung cancer risk: a case-control study in Xuan Wei, China. Cancer Epidemiol Biomarkers Prev 9: 605 -608.
65. Bouchardy C, Benhamou S, Jourenkova N, Dayer P, Hirvonen A (2001) Metabolic genetic polymorphisms and susceptibility to lung cancer. Lung Cancer 32: 109-112.
66. Abolfotouh MA, Abdel Aziz M, Alakija W, Al-Safy A, Khattab MS, et al. (1998) Smoking habits of King Saud University students in Abha, Saudi Arabia. Ann Saudi Med 18: 212-216.