QUESTIONNAIRE FOR M.SC NURSING STUDENTS

SECTION – I 
SOCIO-DEMOGRAPHIC DATA

  1. Age
a)      21 – 25 years                                                                           (           )
b)      26 – 30 years                                                                           (           )
c)      31 – 35 years                                                                           (           )
d)      36 -40 years and above                                                            (           )
  1. Religion
a)      Hindu                                                                                       (           )
b)      Muslim                                                                         (           )
c)      Christian                                                                                   (           )
d)      Others                                                                                      (           )
  1. Occupation
a)      Technical                                                                                  (           )
b)      Non Technical                                                              (           )
c)      Govt. Employee                                                                        (           )
d)      Daily Wages                                                                             (           )
  1. Educational Qualification
a)      Primary                                                                                    (           )
b)      Secondary                                                                                (           )
c)      Intermediate                                                                             (           )
d)      Degree                                                                                     (           )


  1. Family Type
a)      Nuclear Family                                                             (           )
b)      Extended Family                                                                       (           )
c)      Joint Family                                                                              (           )
d)      Others                                                                                      (           )
  1. Family Income / Month
a)      1000 – 2000/-                                                                          (           )
b)      2001 – 3000/-                                                                          (           )
c)      3001 – 4000/-                                                                          (           )
d)      4001 – 5000/- and above                                                         (           )
  1. Source of Knowledge
a)      Television                                                                                 (           )
b)      News paper                                                                             (           )
c)      Computer                                                                                 (           )
d)      Magazines                                                                                (           )



SECTION – II
QUESTIONNAIRE REGARDING KNOWLEDGE ON TOBACCO CHEWING

  1. What is Tobacco
a)      Tobacco is fresh moist leaf                                                        (           )
b)      Tobacco is dried leaf                                                                (           )
c)      Tobacco is ripen flavour leaf                                                     (           )
d)      Tobacco of perfumed leaf                                                         (           )
  1. Which chemical substance present in Tobacco?
a)      Alcohol                                                                                    (           )
b)      Nicotin                                                                                     (           )
c)      Caffiene                                                                                    (           )
d)      Nitrogen                                                                                   (           )
  1. What is the meaning of Tobacco chewing addiction?
a)      State of being depended on Tobacco chewing               (           )
b)      State of being depended on alcohol                                           (           )
c)      State of being depended on drugs                                             (           )
d)      State of being depended on injection                                         (           )
  1. How many types of Tobacco chewing you know?
a)      Smoking and Tobacco chewing                                     (           )
b)      Smokeless and Tobacco chewing                                              (           )
c)      Smokeless and chewing tobacco                                               (           )
d)      Consumption of alcohol                                                            (           )


  1. How many types of smokeless tobacco you know?
a)      Moist snuff, chewing tobacco                                        (           )
b)      Cigarattes and moist snuff                                                         (           )
c)      Beedies and moist snuff                                                 (           )
d)      Ripe cigar and moist snuff                                                         (           )
  1. Commonly where the tobacco is available?
a)      Medical shops                                                                          (           )
b)      General stores                                                                          (           )
c)      Fancy stores                                                                             (           )
d)      Kirana shop                                                                              (           )
  1. What are the ill effects of tobacco chewing?
a)      Increases health problems                                                         (           )
b)      Prevention of disease                                                                (           )
c)      Development of immunity                                                          (           )
d)      Promotes good health                                                               (           )
  1. What are the body parts mainly effect due to tobacco chewing?
a)      Eyes                                                                                         (           )
b)      Hair                                                                                          (           )
c)      Oral Cavity                                                                               (           )
d)      Nail                                                                                          (           )
  1. Which part effect commonly due to tobacco chewing?
a)      Skin Cancer                                                                             (           )
b)      Renal Cancer                                                                            (           )
c)      Breast Cancer                                                                          (           )
d)      Oral Cancer                                                                             (           )
  1. What is the commonest site of oral cancer?
a)      Mouth                                                                                      (           )
b)      Gums                                                                                       (           )
c)      Lips                                                                                          (           )
d)      Tongue                                                                         (           )
  1. What is the risk for oral cancer?
a)      Consumption of Tobacco chewing                                            (           )
b)      Alcohol consumption                                                                (           )
c)      Drug abuse                                                                               (           )
d)      Carticosteroids                                                                         (           )
  1. Which is the common effect of Tobacco chewing on heart?
a)      Prevent cardiac fortune                                                             (           )
b)      Maintain normal heart rate                                                         (           )
c)      Heart attack                                                                             (           )
d)      Improve circulation                                                                   (           )
  1. What is the effect of Tobacco chewing on blood vessels?
a)      Increase elasticity of blood vessels                                            (           )
b)      Altered structured of blood vessels                                            (           )
c)      Increase damage of blood vessels                                             (           )
d)      Increase thinness of blood vessels                                             (           )
  1. What is the effect of Tobacco chewing on GI system?
a)      Peptic ulcer                                                                              (           )
b)      Healthy peritoneal cavity                                                           (           )
c)      Improve digestion ability                                                           (           )
d)      Increase digestive enzymes                                                        (           )
  1. What is the withdrawal symptoms of Tobacco chewing?
a)      Altered speech                                                                         (           )
b)      Numbness of mouth                                                                  (           )
c)      Blurred speech                                                                         (           )
d)      Bleeding mouth                                                                         (           )
  1. When is withdrawal symptoms are appear?
a)      1-2 weeks after stoppage of chewing                                        (           )
b)      4-5 weeks after stoppage of chewing                                        (           )
c)      5-6 weeks after stoppage of chewing                                        (           )
d)      3-4 weeks after stoppage of chewing                                        (           )
  1. Which are the main symptoms of Tobacco chewing?
a)      Redness of oral cavity                                                               (           )
b)      Redness of nasal cavity                                                             (           )
c)      Redness of conjunctiva                                                 (           )
d)      Redness of the face                                                                   (           )
  1. What is the subjective symptoms of Tobacco chewing?
a)      Thickness of tongue                                                                  (           )
b)      Tasteless of substance                                                   (           )
c)      Twitching of oral cavity                                                             (           )
d)      Itching of oral cavity                                                                  (           )
  1. What are the clinical manifestations oral cancer?
a)      Soreness in oral cavity                                                  (           )
b)      Pain in oral cavity                                                                      (           )
c)      Un healthy mucous layer in oral cavity                           (           )
d)      Pain in the neck glands                                                  (           )
  1. How will you manage a case of Tobacco chewing?
a)      Taking a person to hospital                                                       (           )
b)      By taking history                                                                       (           )
c)      By giving health education on oral cancer                                   (           )
d)      By giving personal hygiene                                                        (           )
  1. Who develop more tobacco chewing?
a)      Teenagers                                                                                 (           )
b)      Young adult                                                                              (           )
c)      Elderly                                                                          (           )
d)      All age group                                                                            (           )
  1. In which age person will start tobacco chewing?
a)      Pre school                                                                                (           )
b)      School age                                                                               (           )
c)      Adolescent                                                                               (           )
d)      Old age                                                                                    (           )
  1. What is common cause for tobacco chewing?
a)      Easy availability                                                                        (           )
b)      Family pressure                                                                        (           )
c)      Friends pressure                                                                       (           )
d)      Time pass                                                                                 (           )
  1. What is the effect of tobacco chewing on teeth?
a)      Dental caries, peridental disease                                                (           )
b)      Healthy teeth                                                                            (           )
c)      Shiny teeth                                                                                (           )
d)      Cool teeth                                                                                (           )
  1. What are the types of smokeless tobacco?
a)      Pan                                                                                          (           )
b)      Gutka                                                                                      (           )
c)      Cigarettes & Beedies                                                                (           )
d)      Plug tobacco                                                                            (           )
  1. Who was discoloured tobacco?
a)      Madam Curey                                                                          (           )
b)      Grahambel                                                                                (           )
c)      Christopher Columbus                                                  (           )
d)      Robert Hook                                                                            (           )


SECTION – Iii
KNOWLEDGE QUESTIONNAIRE REGARDING PRACTICES OF TOBACCO CHEWING

  1. Which kind of practices is necessary to prevent tobacco chewing
a)      Healthy life style                                                                        (           )
b)      Unhealthy life style                                                                    (           )
c)      Mal practice                                                                             (           )
d)      All the above                                                                            (           )
  1. What are the preventive measures for tobacco chewing?
a)      Elderly males becoming addicted to tobacco chewing    (           )
b)      Protection from voluntary exposure to tobacco chewing             (           )
c)      Health education chewing cessation programmes                       (           )
d)      Encourage the tobacco chewing programme                              (           )
  1. Which is the best preventive practice of tobacco chewing?
a)      Forcing                                                                                     (           )
b)      Counselling and health education                                               (           )
c)      Encouraging                                                                              (           )
d)      Discouraging                                                                             (           )
  1. What kind of practice are you following while taking tobacco?
a)      Chewing in Pan                                                             (           )
b)      Chewing without Pan                                                                (           )
c)      Chewing with addition of other                                      (           )
d)      All the above                                                                            (           )


  1. When you taking tobacco did you?
a)      Swallow the content                                                                  (           )
b)      Spitting the content                                                                   (           )
c)      Keep for long time at check                                                      (           )
d)      Keep for long time below tongue                                               (           )
  1. When will you take more tobacco for chewing?
a)      During morning                                                                         (           )
b)      During afternoon                                                                       (           )
c)      During evening                                                              (           )
d)      Complete day                                                                           (           )
  1. Why will you take tobacco frequently?
a)      Time pass                                                                                 (           )
b)      For pleasure seeking                                                                 (           )
c)      To enjoy redness of mouth                                                        (           )
d)      All the above                                                                            (           )
  1. Where will you store tobacco?
a)      In Box                                                                                       (           )
b)      In Purse                                                                                    (           )
c)      In Bag at Hip                                                                            (           )
d)      In Pocket                                                                                 (           )
  1. Tobacco consumption will cause off?
a)      Increase health problem                                                            (           )
b)      Prevention of disease                                                                (           )
c)      Development immunity                                                               (           )

d)      Promote of good health                                                             (           )

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