KNOWLEDGE AND ATTITUDE REGARDING HIGH RISK BEHAVIOR AMONG ADOLESCENT BOYS AT SELECTED SCHOOLS, THIRUVALLUR DISTRICT,
CHENNAI, 2011.
DISSERTATION SUBMITTED TO
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2012
KNOWLEDGE AND ATTITUDE REGARDING HIGH RISK BEHAVIOR AMONG ADOLESCENT BOYS AT SELECTED SCHOOLS, THIRUVALLUR DISTRICT, CHENNAI, 2011.
Certified that this is the bonafide work of
Ms. BHUVANESWARI.S
OMAYAL ACHI COLLEGE OF NURSING,
#45, AMBATTUR ROAD, PUZHAL, CHENNAI – 600 066.
COLLEGE SEAL
SIGNATURE: ________________
Dr.(Mrs).S.KANCHANA
B.Sc.(N)., R.N., R.M., M.Sc.(N)., Ph.D., Principal & Research Director,
Omayal Achi College of Nursing,
Puzhal, Chennai – 600 066, Tamil Nadu.
Dissertation Submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY
CHENNAI
In partial fulfilment of requirement for the degree of
MASTER OF SCIENCE IN NURSING
APRIL 2012
KNOWLEDGE AND ATTITUDE REGARDING HIGH RISK BEHAVIOR AMONG ADOLESCENT BOYS AT SELECTED
SCHOOLS, THIRUVALLUR DISTRICT, CHENNAI, 2011.
Approved by Research Committee in December 2010.
PROFESSOR IN NURSING RESEARCH
Dr.(Mrs).S.KANCHANA __________________________
B.Sc.(N)., R.N., R.M., M.Sc.(N)., Ph.D., Principal & Research Director,
Omayal Achi College of Nursing,
Puzhal, Chennai – 600 066, Tamil Nadu.
CLINICAL SPECIALITY HOD
Dr.(Mrs).S.KANCHANA __________________________
B.Sc.(N)., R.N., R.M., M.Sc.(N)., Ph.D., Principal & Research Director,
Omayal Achi College of Nursing,
Puzhal, Chennai – 600 066, Tamil Nadu.
CLINICAL SPECIALITY RESEARCH GUIDE
Mr.V.CHITHRAVEL, M.Sc.(N)., __________________________
Lecturer, Community Health Nursing, Omayal Achi College of Nursing,
Puzhal, Chennai – 600 066, Tamil Nadu.
MEDICAL EXPERT
Dr.K.R. RAJANARAYANAN __________________________
B.Sc. M.B.B.S., FRSH (London),
Honorary Professor in Community Medicine, Omayal Achi College of Nursing,
Puzhal, Chennai – 600 066, Tamil Nadu.
Dissertation Submitted to
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY
CHENNAI
In partial fulfilment of requirement for the degree of
MASTER OF SCIENCE IN NURSING
APRIL 2012
I thank God Almighty for the abundant blessings throughout my career and sustaining me in the course of my endeavor.
At the outset, I the investigator of the study would like to extend my heartful thanks and gratitude to the Managing Trustee, Omayal Achi College of Nursing who have given me an opportunity to do post graduate education in nursing.
I express my sincere thanks to Dr.Rajanarayanan, B.Sc., M.B.B.S., FRSH [London], Research Coordinator ICCR, Honorary Professor in Community Medicine for the valuable suggestions and guidance throughout the study.
I express my deep sense of indebtness to Dr.(Mrs).S.Kanchana, Principal and Research Director ICCR, Omayal Achi College of Nursing for her constant source of inspiration and encouragement throughout the study.
I express my humble gratitude to Prof.(Mrs).Celina.D, Vice Principal, Omayal Achi College of Nursing, for her valuable guidance and support during the study.
I owe my profound gratitude and exclusive thanks to my Clinical Specialty Research Guide Mr.V.Chithravel, Lecturer, Omayal Achi College of Nursing for timely corrections, support and guidance throughout the study.
I am greatly indebted to express my heartfelt thanks to ICCR Executive Committee Members, Omayal Achi College of Nursing, for their suggestions and guidance for the study.
for their encouragement, suggestions and guidance throughout the study.
I am thankful to all the experts in the field who have given their valuable guidance and suggestions in validating the tool for the study.
I am immensely thankful to the Head Master, Government Higher Secondary School, Pandeswaram for granting me the permission to conduct the study.
I thank the peer educators and samples who had given their full support and co-operation throughout the study.
I acknowledge my sincere gratitude to Mr.Venkatesh, Biostatistician for his help in statistical analysis of the study.
I extend my thanks to the Librarians of Omayal Achi College of Nursing and The Tamil Nadu Dr.M.G.R.Medical University, for their co-operation in collecting the related literature for this study.
I express my sincere gratitude to Ms.Santhi, M.A., B.Ed., for editing this manuscript and tool in English.
I express my sincere gratitude to Ms. Meenal, M.A., B.Ed., for editing this manuscript and tool in Tamil.
A special bouquet of thanks to all my classmates and specialty student colleagues who have helped me a lot to complete the study.
I extend my warmest thanks to my peer evaluator Mrs.Suprabha.V.R., for doing the peer evaluation of the research report.
Mrs.S.Poongothai, my brother Mr.Dhinakaren and my sister Ms.S.Leelavathi for encouragement, constant support and sincere prayers to make my study a success.
I extend my thanks and gratitude to Mr.Suresh Babu, for typing and technical support.
I extend my sincere gratitude to Mr.G.K.Venkataraman, Elite Computers for typing the manuscript.
CHAPTER CONTENTS PAGE NO.
I
` II
III
ABSTRACT INTRODUCTION Background of the study Need for the study Statement of the problem Objectives
Operational Definitions Assumption
Null hypotheses Delimitation
Conceptual framework Outline of the study report REVIEW OF LITERATURE Review of related literature
RESEARCH METHODOLOGY Research approach
Research design Variables
Setting of the study Population
Sample
Criteria for sample selection Sample size
Sampling technique
1 7 10 10 10 11 11 12 12 15
16
26 26 27 27 28 28 28 28 29
IV
V VI
Development and description of the tool Content validity
Pilot study
Reliability of the tool
Procedure for data collection Plan for data analysis
DATA ANALYSIS AND INTERPRETATION Organization of data
Presentation of data DISCUSSION
SUMMARY, CONCLUSION, IMPLICATIONS, RECOMMENDATIONS AND LIMITATIONS BIBLIOGRAPHY
APPENDICES
29 32 33 35 35 37
38 39 52 56
64 i - xlviii
TABLE NO. TITLE PAGE NO.
1(a) Frequency and percentage distribution of demographic variables with respect to age, religion, type of family, educational status of the father and educational status of the mother.
39
1(b) Frequency and percentage distribution of demographic variables with respect occupation of the father, occupation of the mother, family monthly income and type of T.V. program.
40
1(c) Frequency and percentage distribution of demographic variables with respect to personal habit of smoking, personal habit of alcoholism, family history of smoking and family history of alcoholism.
41
1(d) Frequency and percentage distribution of demographic variables with respect to incidence of road traffic accidents, occurrence of violent activities and occurrence of self infliction behavior.
42
2 Frequency and percentage distribution of pretest and post test level of knowledge regarding various aspects of high risk behavior among adolescent boys.
43
3 Comparison of pre and post test level of mean differed knowledge and attitude regarding high risk behavior among adolescent boys.
46
4 Association of mean improved knowledge score with selected demographic variables like type of family, educational status of the father and family history of smoking.
48
5 Association of mean improved attitude score with selected demographic variables like age in years, educational status of the father and family history of smoking.
50
FIGURE NO. TITLE PAGE NO.
1 Conceptual framework 14
2 Percentage distribution of overall pre and post test level of knowledge regarding high risk behavior among adolescent boys.
44
3 Percentage distribution of overall pre and post test level of attitude regarding high risk behavior among adolescent boys.
45
4 Correlation between mean improved knowledge score with attitude score regarding high risk behavior among adolescent boys.
47
APPENDIX TITLE PAGE NO
A Ethical Clearance Certificate i
B Letter seeking and granting permission for
conducting the study ii
C
Content validity
i. Letter seeking experts opinion for content validity
ii. List of experts for content validity iii. Certificates for Content validity
iii
iv v
D Certificate of English editing ix
E Certificate of Tamil editing x
F
Informed Consent
- Informed consent requisition form – English - Informed written consent form – English - Informed consent requisition form – Tamil - Informed written consent form – Tamil
xi xii xiii xiv
G
Copy of the tool for data collection - English
- Tamil
- Scoring key for knowledge and attitude
xv xxix
xlii
H Plagiarism Report xliii
I Coding for the demographic variables xliv
J Blue print of the tool xlvii
K
Intervention tool - English - Tamil
xlviii
Flash cards, Pamphlets and Posters
A pre experimental study to assess the effectiveness of peer education on knowledge and attitude regarding high risk behavior among adolescent boys at selected schools, Thiruvallur district, Chennai.
INTRODUCTION
“Adolescent is like a river, too much freedom can destroy self and others, too much control can affect the development of self and others, optimum freedom with optimum responsibility is just right”.
The adolescents tryout many new roles during this time as part of the important developmental task of identity formation. The peer group is of almost importance as adolescent with new roles outside the confines of the family unit.
Adolescents are interested in peer group and may try to stay away from parents. Too much restrictions, rigid rules and philosophy of parents, improper parent adolescent relationship lead to adolescent to risk taking behavior with the advancement and spread of mass media like television, films, internet, magazines and books adolescents try to identify defense mechanisms which are identification of themselves with the heroes and heroines. This may lead to risk taking behavior like smoking, alcoholism, drug addiction, unprotected sexual activity, violence and attempt suicide.
Objective
1. To assess the pre and post test level of knowledge and attitude regarding high risk behavior among adolescent boys.
2. To assess the effectiveness of peer education on knowledge and attitude regarding high risk behavior among adolescent boys.
high risk behavior among adolescent boys.
4. To associate the mean differed knowledge and attitude score with selected demographic variables.
METHODOLOGY Research Design
Pre experimental one group pre test - post test design.
Setting
The study was conducted at Government Higher Secondary School, Pandeswaram, Thiruvalllur District, Chennai.
Sample
100 adolescent boys in the age group of 14- 19 years studying at Government Higher Secondary School, Pandeswaram, Thiruvalllur District, Chennai.
Intervention
A peer education on high risk behavior was administered to the adolescent boys through peer education training module. The module consists of A.V.Aids like flash cards for smoking, pamphlets for violence, self infliction behavior and unsafe sex, posters for alcoholism.
Measurement and tool
The level of knowledge was assessed by self structured knowledge questionnaire and attitude was assessed by modified 4 point Likert scale. Both descriptive and inferential statistics were used for data analysis.
The present study aimed to assess the effectiveness of peer education on knowledge and attitude regarding high risk behavior among adolescent boys. The overall mean improved score for knowledge was 14 with the ‘t’ value of 33.33 and the overall mean improved score for attitude was 15.58 with the ‘t’ value of 27.59 which were highly significant at p<0.001 level.
DISCUSSION
The present study concluded that there was a significant improvement of knowledge and attitude of adolescent boys in posttest after administration of peer education. Thus peer education was an effective tool to improve knowledge and attitude regarding high risk behavior among adolescent boys.
Implication in Nursing Practice
The community health nurse can incorporate effectiveness of peer education in various settings like school, community and hospital, on various topics and to train the adolescent boys to perform the role of peer educators and to prevent them to engage in high risk behavior.
CHAPTER – I
INTRODUCTION
BACKGROUND OF THE STUDY
Adolescence is the phase, usually between 10 to 20 years in which children undergo rapid changes in body size, physiology and psychological and social functioning.
Adolescence begins with the onset of puberty, defined by the UNICEF as
“the sequence of events by which the individual is transformed into a young adult by a series of biological changes”. According to the WHO adolescence is the period of life that extends from 10 to 19 years (Wongs, 2009)40.
Arbitrarily adolescence is divided into three phases: Early, middle and late adolescence. Early adolescence refers to age 10 to 13 years, middle adolescence is 14 to 16 years and late adolescence is 17 to 20 years.
In 2009, there were 1.2 billion adolescents aged 10–19 years in the world forming 18% of world population. Adolescent numbers have more than doubled since 1950 (world population prospects, 2010)105.
At the global level, adolescents share of the total population peaked in the 1980s at just over 20%. About 88% of the world's youth living in developing countries. Asia alone is home to 70% of the developing world's young people. The least developed countries are home to roughly 1 in every 6 adolescents. More than half of the world’s adolescents live in either the South Asia or the East Asia and Pacific region, each of which contains roughly 330 million adolescents (UNFPA, 2003)104.
India has the largest national population of adolescents (243 million), followed by China (207 million), United States (44 million), Indonesia and Pakistan (both 41 million) (world population prospects, 2010)105.
As per the 2001 Census of India, population age between 15-24 years accounts for 195 million of the 1,029 million of India’s population. In other words, every fifth person in India belongs to the age group of 15-24 years. By 2011, this age group is expected to grow to 240 million and account for a slightly higher proportion of the total population than in 2001. There is an unfavorable sex ratio of 927 females to 1,000 males except in the states of Kerala and Goa.
Adolescents population (10–19 years) by region, 2009.
¾ East Asia and Pacific - 329 million
¾ South Asia - 335 million
¾ Middle East and North Africa - 84 million
¾ West and Central Africa - 94 million
¾ Eastern and Southern Africa- 91 million
¾ Industrialized countries - 118 million
¾ Latin America and Caribbean - 108 million
Adolescent boys outnumber girls in all regions with data available including the industrialized countries. Parity is closest in Africa, with 995 girls aged 10–19 for every 1,000 boys in Eastern and Southern Africa and 982 girls per 1,000 boys in West and Central Africa, while the gender gap is greatest in both Asian regions (world population prospects, 2010)105.
Estimated adolescent Population (15–24 years)
2000 2005 2010 2015 2020
Males 98,958 107,192 112,930 115,209 110,077 Females 91,295 99,430 105,342 108,111 104,212
One trend that will continue to intensify in the coming decades is that ever more adolescents will live in urban areas. In 2009, around 50% of the world’s adolescents lived in urban areas. By 2050, this share will rise to almost 70% with the strongest increases occurring in developing countries (world population prospects, 2010)105.
There is a lack of knowledge and awareness among adolescents about health issues and problems. An Indian Council of Medical Research (ICMR) study showed that knowledge and awareness about puberty, menstruation, physical changes in the body, reproduction, contraception, pregnancy, childbearing, reproductive tract infections, sexually transmitted infections (STIs) and HIV was low among boys and girls especially in younger adolescents (ages 10–14). The study reported that older adolescents (ages 15–19) had better knowledge than young adolescents.
Adolescence is also a stage when young people extend relationships beyond their parents and family. It is a time of intense influence of peers, and the outside world in the society. A desire to experiment and explore can manifest in a range of behaviors-exploring sexual relationships, alcohol, tobacco and other substances abuse. The anxiety and stress associated with achievement failure, lack of confidence etc are likely to lead to depression, anger, violence and other mental health problems.
Projections indicate that by year 2050, the Nation's racial ethnic minority groups (Black, Hispanic, American Indian and Asian) will constitute approximately 56% of the adolescent population. While the health status of adolescents differs according to age, gender, race, and ethnic origin, there is ample documentation suggesting that adolescents regardless of background may engage in high-risk behavior.
In United States the Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among adolescents and young adults:
1) Behaviors that contribute to unintentional injuries and violence.
2) Tobacco use.
3) Alcohol and other drug use.
4) Sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs) including human immunodeficiency virus (HIV) infection.
5) Unhealthy dietary behaviors and 6) Physical inactivity.
YRBSS includes a National school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and local school-based YRBSS conducted by state and local education and health agencies. This report summarizes results from the 2009 national survey, 42 state surveys, and 20 local surveys conducted among students in the age group of 12-19 years.
Results from the 2009 national YRBSS indicated that many high school students are engaged in behaviors that increase their likelihood for the leading causes of death among persons aged 10–24 years in the United States. Among high school students nationwide 9.7% rarely or never wore a seat belt when riding in a car driven by someone else, 28.3% of high school students rode in a car or other vehicle driven by someone who had been drinking alcohol, 17.5% had carried a weapon, 41.8% had drunk alcohol, 20.8% had used marijuana, 31.5% of high school students had been in a physical fight and 6.3% had attempted suicide.
In the United States, 74% of all deaths among youth and young adults aged 10–24 years result from four causes: motor-vehicle crashes (30%), other unintentional injuries (16%), homicide (16%) and suicide (12%), 9.1 million cases of sexually transmitted diseases (STDs) among persons aged 15–24 years and the
estimated 6,610 cases of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among persons aged 15–24 years that occur annually.
Illicit drug use is both a health and public concern. The effects of illicit drug use include risky driving, engagement in high-risk sexual behaviors and violence.
Recent estimates suggest that 22% of teens use marijuana and that 10% of teens used marijuana before the age of 13. Approximately 3% use cocaine (Center for health statistics, 2011)100.
Engagement in sexual behavior is considered to be another group of high- risk behaviors for youth because of the potential physical and socio emotional risks they present.
A more powerful and cost-effective approach may be to employ strategies designed to address factors associated with multiple risky behaviors. This Research Brief brings together findings from developmental science and from rigorous program evaluations to identify seven actionable, feasible strategies and relevant programs that have been found to affect two or more risky behaviors.
These strategies are to
1. Support and strengthen family functioning
2. Increase connections between students and their schools 3. Make communities safe and supportive for children and youth 4. Promote involvement in high quality out-of-school-time programs 5. Promote the development of sustained relationships with caring adults 6. Provide children and youth opportunities to build social and emotional
competence and
7. Provide children and youth with high quality education during early and middle childhood.
International academy of education suggested the following strategies,
¾ Start prevention early.
¾ Provide positive consequences to increase desirable behaviors.
¾ Clear, immediate, mild negative consequences can reduce problem behaviors.
¾ Create opportunities for children to observe and practice interpersonal as well as academic skills.
¾ Know where children and adolescents are, what they are doing and with whom and provide appropriate supervision.
¾ Reduce youths’ access to the situations in which problem behavior is particularly likely to occur.
¾ Reduce children’s exposure to negative conditions that cause stress.
According to the Wagner (1982)106, the history of peer education can be traced back as far as Aristotle. There have been many peer education initiatives throughout history working in a variety of contexts. Worthy of the “monitorial system” setup by Joseph Lancaster in London in the early 1800s by which teachers taught monitors who then passed on what they had learned to other children.
Currently peer education seems to be gaining popularity in relation to HIV prevention and sexual health promotion. In 1991, WHO recommended a global review of peer education HIV prevention initiatives.
Peer education can support young people in developing positive group norms and in making healthy decision about sex. The main role of the peer educator is to help the group members define their concerns and seek solutions through the mutual sharing of information and experiences. There is a great variety in the support provided to peer educators. Sometimes they are unpaid volunteers, sometimes they are given a small honorarium, and sometimes they receive a reasonable salary. The peer educators may be supported by regular meetings and training, or expected to continue their work without formal supports.
NEED FOR THE STUDY
During the transition from childhood to adulthood, adolescents establish patterns of behavior and make lifestyle choices that affect both their current and future health. Taking risks is fairly common in adolescence. Yet, risky behaviors can be associated with serious, long-term and in some cases life-threatening consequences. Serious health and safety issues such as smoking, alcoholism, violence, self infliction behaviors and risky sexual behaviors (unsafe sex) can adversely affect adolescent and young adults.
However, prevention efforts traditionally have taken a targeted approach, seeking to prevent a risky behavior among adolescent boys. Some adolescents also struggle to adapt behaviors that could decrease their risk of developing chronic diseases in adulthood. Environmental factors such as family, peer group, school and community characteristics also contribute to adolescents health and risk behaviors.
Information on prevalence of tobacco use in India is available from surveys carried out in general community. As per various surveys carried out during 2002, the prevalence of tobacco use among men above 15 years of age varied between 46% and 63% in urban areas and between 32% and 74% in rural areas.
Substance use is another group of behaviors that contribute to immediate as well as long-term damage. Drinking and drug use have been linked to motor vehicle accidents, fighting/violence, problematic relationships and social interactions, and various diseases. Drinking and cigarette smoking are most common in this group of behaviors.
Rehm and colleagues (2003)103 conducted an international comparison of average alcohol consumption in people aged 15years and older around the world using the WHO data. These analyses found the following:
Average alcohol consumption was highest in Europe, the Americas, and established market economies such as Australia, Japan, and New Zealand, although there were exceptions (e.g., Muslim countries of the former Soviet Union and Yugoslavia and the least developed countries in South and Central America) and generally it was lower in Africa and Asia.
In many other established market economies such as Canada and the United States a smaller but still significant decrease in total alcohol consumption has occurred over the same period. In most countries of the America and Africa and in the eastern Mediterranean countries, alcohol consumption has been constant or slightly decreasing during recent decades.
Alcohol consumption appears to have increased the most in Asian countries and in some developed countries (e.g., Denmark, Finland, Ireland, and Japan) have countered the trend toward decreasing alcohol consumption.
Among teens, many of the most self-injurious behaviors are related to driving. Many injuries are exacerbated (and deaths are caused) by the failure to wear seatbelts. Approximately 30% of youth Nationwide report that they rarely or never wear seatbelts. The combination of alcohol use and driving also contributes to deaths among teens from car crashes. About 10% of teens report driving after drinking, and 36% admit riding in a car where the driver had been drinking.
Fighting and aggression comprise another group of self-injurious behaviors.
It is second to vehicular accidents as the leading cause of death among those 15-34 years of age.
Finally, suicide is one of the highest risk behaviors among youth today.
Close to 17% (almost one out of every five) of youth report having considered suicide within the past year and 13% actually planned it (national and state numbers are similar). Among teens 8.4% attempt suicide every year. Suicide now
is the third leading cause of death among those ages 15-24 with 86% of those deaths from males and 14% from females.
UNICEF supported HIV/ AIDS/ STI project (1996 to 2000) for national assessments of HIV/ AIDS/ STI prevention education in call of the countries of the Mekong, sub regions. UNICEF has subsequently supported development of new life skills based HIV/ AIDS preventing and healthy living education programs in primary and lower secondary schools in each of the countries and gives ongoing technical assistance in teacher training, curriculum development and implementation.
UNICEF supports a range of peer education programs on HIV/ AIDS/ STI across a variety of target groups, young women, street children and young people with AIDS, young drug / substance users, young factory workers and others.
The experience of investigator in community health nursing practice, has given focus in the following two facts,
¾ Change in behavior, attitude and life style of the people is very difficult.
¾ Dissemination of information when given to adolescents takes place very quickly.
The Investigator also believed that the adolescent boys may engage in high risk behavior which may affect the health status and future. Training of the peer educators in the community may enhance the healthy lifestyle practices among adolescent boys and if they send to community with bits of information regarding prevention of disease and promotion of health in all aspects will serve as a great asset to the health.
STATEMENT OF THE PROBLEM
A pre experimental study to assess the effectiveness of peer education on knowledge and attitude regarding high risk behavior among adolescent boys at selected schools, Thiruvallur district, Chennai.
OBJECTIVES
1. To assess the pre and post test level of knowledge and attitude regarding high risk behavior among adolescent boys.
2. To assess the effectiveness of peer education on knowledge and attitude regarding high risk behavior among adolescent boys.
3. To correlate mean differed knowledge score with attitude score regarding high risk behavior among adolescent boys.
4. To associate the mean differed knowledge and attitude score with selected demographic variables.
OPERATIONAL DEFINITIONS Effectiveness
The term effectiveness refers to the outcome or results of the peer education on high risk behavior to adolescent boys elicited through self administered knowledge questionnaire and attitude scale.
Peer education
It refers to the education given on high risk behavior by trained peer educators using high risk behavior module.
High risk behavior
It refers to the behavior which may be unhealthy and the adolescent boys may prone to engage and in this study it includes, smoking, alcoholism, violence, self infliction behavior and unsafe sex among adolescent boys.
Knowledge on high risk behavior
It is the existing and gained information regarding high risk behavior among adolescent boys as measured by structured knowledge questionnaire.
Attitude on high risk behavior
It refers to the ideas and beliefs regarding high risk behavior among adolescent boys as measured by 4 point Likert scale.
Adolescent boys
It refers to the boys between the age group of 14 to 19 years studying at selected schools and living in a rural community.
ASSUMPTIONS
1. Adolescent boys may engage in high risk behavior.
2. Peer education may enhance the knowledge and attitude and thereby prevent adolescent boys from engaging in high risk behavior.
3. Formal training may be required for adolescent boys to undertake the role of peer educator.
NULL HYPOTHESES
NH1-There is no significant difference between pre and post test level of knowledge and attitude regarding high risk behavior among adolescent boys at p<0.05.
NH2- There is no significant correlation between mean differed knowledge score with attitude score regarding high risk behavior among adolescent boys at p<0.05.
NH3- There is no significant association between mean differed knowledge and attitude score with selected demographic variables at p<0.05.
DELIMITATION
The study was delimited to a period of 4 weeks of data collection.
CONCEPTUAL FRAMEWORK
Conceptual framework or model refers to concepts that structure or offers a framework of proposition for conducting research. The conceptual framework comprises of interrelated concepts linked together, which explains the phenomenon of interest of the investigator, this explains the nature of relationship between the concepts and guides the investigator to propose the study and work on it systematically.
The investigator adopted the integrated Kurt Lewins change theory and Von Bertalannfy’s general system model which is primarily focusing on change in the behavior. This change in adolescent boys occurs in three stages. The theorist explains that the change occurs in three sequential steps.
I. Input II. Throughput III. Output I.INPUT
The investigator assumes the restraining factors and enhancing factors are the input. The restraining factors are peer pressure, family influences, cultural factors, social factors and enhancing factors are health education, health care services, peer approach, positive reinforcement, guidance and counseling services.
II.THROUGHPUT
The throughput has three factors. They are
Unfreezing
Freezing
Refreezing
a) Unfreezing
When desire for change develops the people are motivated to change either internally or externally by some external force, which causes disequilibrium in the system, so the system is more vulnerable to change. Here the peer educator as a change agent and the investigator who is an external force assess the existing level of knowledge and attitude regarding high risk behavior among adolescent boys.
b) Freezing
Freezing occurs when the people examine, accept and try the innovation.
During this stage people experiences series of knowledge transformation, ranging from acceptance commitment to accomplishing change. The investigator has planned to administer the peer education training by peer educators regarding high risk behavior through flash cards, pamphlets and posters.
c) Refreezing
Refreezing occurs when people is established as an accepted and permanent part of the system. This involves integrating or internalizing the change and then maintaining the investigator will assess the new change by assessing the post test level of and attitude regarding high risk behavior among adolescent boys.
III.OUTPUT
If the adolescent boys have gained adequate knowledge it may reveal that the adolescent boys internalized the change and in turn promote the practice to improve quality life. This has to be enhanced.
If the adolescent boys have still inadequate knowledge and negative attitude regarding high risk behavior it reveals that there is no behavior change in the adolescent boys. So they have to be motivated for change.
OUTLINE OF THE REPORT
Chapter I : This chapter dealt with the background of the study, need for the study, statement of the problem, objectives, operational definitions, assumptions, null hypotheses, delimitation of the study and conceptual framework.
Chapter II : This chapter deals with the review of literature.
Chapter III : This chapter deals with the research methodology.
Chapter IV : This chapter deals with the data analysis and interpretation.
Chapter V : This chapter contains the discussion of the findings.
Chapter VI : This chapter consists of the summary, conclusion, implications, recommendations and limitations of the study.
The report ends with the Bibliography and Appendices.
CHAPTER – II
REVIEW OF LITERATURE
Review of literature is a systematic search of a published work to gain information about a research topic (Polit and Hungler, 2011)27. Conducting a review of literature is challenging and an enlightening experience.
The review of literature was based on extensive survey of books, journals, and international nursing indicates. A review of literature relevant to the study was undertaken which helped the investigator to develop deep insight into the problem and gain information on what has been done in the past.
An extensive review of literature was done by the investigator to lay a broad foundation for the study.
For the purpose of logical sequence the chapter was divided into two parts.
Section A: Review related to high risk behavior among adolescent boys.
Section B: Review related to effectiveness of peer education on high risk behavior.
Section A: Reviews related to causes of high risk behavior among adolescent boys.
Clark H.K., et al., (2011)49 conducted a randomized control trial to identify the ‘project success’ effects of substance use-related attitudes and behaviors among 7 adolescent boys both in study and control group in alternative high schools. After a prevention program on substance-use related attitude researcher found the project success significantly increased in study group than control group. The study concluded that media, peer influence, and second hand smoke exposure were the most important factors influencing smoking initiation and were common to all racial/ethnic groups in this study.
Sychareun.V, et al., (2011)82 conducted a cross-sectional study to assess the concurrent multiple health risk behaviors among 1360 adolescents between 14 to 19 years in Luangnamtha province. The study finding reported that majority had two or fewer risk behaviors and multiple risk behaviors increased with age for both sexes. Researcher concluded that risk reduction messages should take into account of diverse multiple health risk behaviors within the specific socio-cultural and gender specific context and target vulnerable adolescents.
Voorhees. C.C, et al., (2011)85 conducted Cross-sectional, multistage, probability sample survey a to assess the effects of peers, tobacco advertising, and second hand smoke exposure influences smoking initiation among 308 adolescent boys aged between 12 to 17 years age, in USA. After the health information researcher concluded that media, peer influence, and second hand smoke exposure were the most important factors influencing smoking initiation and were common to all racial/ethnic groups in this study.
Walton. M.A, et al., (2011)86 conducted a descriptive study to find out the sexual risk behaviors among teens in relationship with violent behaviors and substance use among 1576 samples aged between 14-18 years. The study findings reported that 12% had four or more partners, of those 45.3% reported using condom all the time and 14.7% reported using substances before sex. The researcher concluded that the participants who were reported violence are more likely had sex and less likely used condoms.
Bidstrup. P.E, et al., (2011)43 examined the five social-cognitive factors in the attitude, social influence, self-efficacy (ASS) model for smoking initiation among 12 adolescent boys through semi-structured interviews and observations.
The researcher concluded that applying theoretical models in health research should be a continuous process and discussed the theoretical assumptions of the model when applied to a specific sample.
Lopez Larrosa. S., (2010)93 conducted a study to detect the risk and protective factors for drug use in the community, family, school and peers/individual among 2440 adolescents. The researcher found that older adolescents have more risks and less protection than the youngest. The study concluded that the risk factors are more closely related to drug use and are due to availability of drugs in the community, family attitudes, favorable to drug use, family history of antisocial behavior, early start and use of drugs by friends, perceived risk and attitudes favorable to drug use. In the protective factors, the role played by social skills for alcohol use is important.
Perez Milena, A., (2010)96 conducted a qualitative study to find out the motivation (attitudes, beliefs and experiences) behind adolescent alcohol consumption among 6-8 adolescent boys aged between 12-18 years for 50mintues and it was recorded by videotape during the school year 2008-09. The study reported that alcohol consumption among adolescents is related to social and leisure activities from early family experiences and due to increased peer relationships.
Brenner, et al., (2009)45 conducted a study to find out the risk factors for alcohol use by using socio ecological model among 711, 18 years old adolescent boys at urban high school youth in USA. They found that peer alcohol use and peer support were associated with more alcohol use and the maternal support was negatively associated with alcohol use. Despite significant variation at the neighborhood level, neighborhood disadvantage was not directly associated with adolescent drinking.
Lin. P.L., (2008)71 investigated the factors related to adolescent tobacco use among 4,500 adolescents in southern Taiwan. This study found that having friends who offered cigarettes, academic achievement, father's educational level, perceived peer smoking behavior to be primary influences on smoking, attitude, and self- efficacy and significant predicators of adolescents current smoking behaviors. This
study suggests further experimental studies are necessary to test the effectiveness of tobacco control programs designed in reference to the findings of this study.
Fletcher.A, et al., (2008)56 conducted experimental and school-level and individual-level observational study to examine the institutional factors influencing adolescents use of drugs at London. Experimental studies suggested that changes to the school social environment that increases student consumption of drugs.
School-level and individual-level observational studies consistently reported that disengagement and poor teacher-student relationships were associated with drug use and other risky health behaviors. The researcher concluded that the interventions that promote a positive school ethos and reduce student disaffection may be an effective complement to drug prevention interventions addressing individual knowledge, skills and peer norms.
Fritz. D.J, et al., (2008)58 identified the program strategies for adolescent smoking cessation by describing adolescents perceptions towards smoking. The study results suggested that the adolescent smokers fail to consider their future health and continue to be unaware of the harmful effects of smoking and the addictive nature of tobacco. They concluded that with these strategies, school nurses can provide leadership in the design and implementation of school based smoking cessation programs.
Bart Smet., (2004)41 conducted a study to find out the determinants of smoking behavior among 6276 adolescents in the age group of 11, 13, 15 and 17 year old in Semarang, Indonesia. The researcher found that smoking increased dramatically between the ages of 11 and 17 years from 8.2% to 38.7%. Researcher concluded that the effective smoking prevention programs should take into account the dominant influence of peers in the onset and maintenance of smoking behavior.
In general, school related items had a less important role in predicting smoking behavior than expected.
Gramer.E, et al., (2004)62 conducted a descriptive study among 1487 students to find out healthy lifestyles choices for adolescents at Cambridge, Massachusetts. The strict and broad assessments of healthy behaviors were defined for students: use of alcohol, tobacco, and illegal drugs, sexual behavior, and attempted suicide. In both, peers approval negatively influenced adolescents lifestyles. These results reinforce the importance of school, peer and parent support of positive behaviors.
Valois.R.F, et al., (2004)84 conducted a study to explore risk factors and behaviors associated with aggressive and violent behaviors are discussed via 6 major factor categories (individual, family, school/academic, peer-related, community and neighborhood and situational) among adolescents in Columbia. The researcher concluded that the adolescent aggression and violence develops and manifests within a complex constellation of factors and the prevention intervention efforts should be theory based, multi component, and multisystem and it should begin in middle school and continue into high school with a comprehensive evaluation design.
Danne.D.M.,(2003)52 stated the incidence of violent victimization against children and violence-related behavior in today's youth. Researcher found that the exposure to violence in the home, school, community or video games and other entertainment significantly influences aggressive behaviors among children and adolescents. Other childhood violence predictors include alcohol and drug use, gender and low self-esteem. The researcher suggested that the nurses who recognize dangerous and potentially dangerous behavior in children and adolescents are better able to provide violence prevention and intervention services and referrals to children at risk or in danger.
Geckova. A, et al., (2003)59 stated the determinants of adolescents smoking behavior. These determinants were divided into individual factors, social factors and societal factors. Individual factors include knowledge, intentions, attitudes,
health-related behavior, personality characteristics and school-related variables.
Social factors include smoking behavior of parents, siblings, peers and significant adults but also family characteristics, social support and socio-economic status.
Societal factors include restrictions on smoking, tobacco advertisement, and smoking behavior of adolescent role model.
Kobus.K., (2003)70 reviewed a theoretical frameworks and empirical findings which inform the current state of knowledge regarding peer influences on teenage smoking at Chicago. Specifically, social learning theory, primary socialization theory, social identity theory and social network theory were discussed. Review of this work reveals the contribution that peers have in adolescents use of tobacco, in some cases promoting use and in other cases deterring it. This review also suggests that peer influences on smoking are more subtle than commonly thought and need to be examined more carefully, including consideration of larger social contexts e.g. the family, neighborhood and media.
Kersti Piirna., (2003)67 conducted a study to find out the prevalence and patterns of passive smoking among 2170 adolescents within the age groups of 13- 14, 15-16 and 17-18years in Estonia. Nearly half (48%) of the respondents had no daily exposure to cigarette smoke and one third (31%) was exposed daily for less than 1 hour, 15% for 1-5 hours and 6% for over 5 hours a day. Researcher concluded that environment gives considerable impact to the development of smoking habits and passive smoking as an inducing factor associated with higher prevalence of smoking among the adolescents.
Section B: Review related to peer education.
Inmann. D.D, et al., (2011)65 stated the healthy People 2020 includes an objective to increase the proportion of elementary, middle and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury, violence, suicide, tobacco use and addiction, alcohol or other drug use, unintended pregnancy, HIV/AIDS, and
sexually transmitted infections (STI), unhealthy dietary patterns and inadequate physical activity. A comprehensive literature review was undertaken to identify evidence-based, peer-reviewed programs, strategies, and resources. The results of this review are presented organized as sexual health, mental and emotional health, injury prevention, tobacco and substance abuse and exercise and healthy eating.
Mason-jones. A.J, et al., (2011)73 conducted a quasi-experimental study to evaluate the effectiveness of government-led peer education program to promote sexual and reproductive health among 3934 adolescents at 30 public high schools (15 intervention, 15 comparison). In the intervention schools, peer educators were recruited and trained to provide information and support to their fellow students.
The findings suggest that the peer education program was effective in reducing the age of sexual debut or condom use.
Nanche. C, et al., (2010)94 conducted semi-structured interviews to evaluate the impact of a peer education on smoking prevention program among students through stakeholders in London, United Kingdom. The researcher found that the positive changes in student relationship to smoking and their ability to contribute as peers to its prevention, as well as unexpected changes generated by the program in terms of the professional practices of stakeholder.
Zhang. H.B., (2009)97 conducted a study to determine feasibility and effectiveness of the peer education intervention on HIV/AIDS among men having sex with men (MSM). Intervention included were distributing the educational materials, condom promotion and promoting HIV-test and STIs clinic referral by 40 MSM as popular opinion leaders who received the knowledge and intervention skill training. Meanwhile, popular opinion leader intervention was implemented in MSM peer network to advocate safe sex. Researcher concluded that the intervention based on MSM peer network is feasible and can increase knowledge related to HIV/STDs and self-efficacy and as well as condom use and HIV testing.
Medley. A, et al., (2009)74 conducted a study to find out the effectiveness of peer education interventions for HIV prevention in developing countries through meta-analysis. The finding indicates that peer education programs in developing countries are moderately effective at improving behavioral outcomes. Researcher suggests that further research is needed to determine factors that maximize the likelihood of program success.
Cimini. M.D, et al., (2009)48 conducted a randomized control trial to assess the effectiveness of peer-facilitated interventions addressing high-risk drinking among 695 college students at USA. The exploratory analyses indicated that decreases in perceived norms and increases in use of protective behavioral strategies were associated with reductions in alcohol use and alcohol-related problems at follow-up. Researcher concluded use of protective behaviors within brief cognitive-behavioral intervention protocols delivered by trained peer facilitators warrants further study using randomized clinical trials.
Stephenson. J., (2008)79 assessed the effectiveness of school-based peer-led sex education among 9,000 pupils aged 13-14 years at England. Schools were randomized to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). Peer educators, aged 16-17 years, were trained to deliver three 1-hour classroom sessions of sex education to 13- to 14 years old pupils from the same schools. The study findings concluded that compared with conventional school sex education at age 13-14 years, this form of peer-led sex education was associated with change in teenage STDs, it merits consideration within broader teenage STDs prevention strategies.
Borgia. P, et al., (2005)44 evaluated the effectiveness of peer education when compared to teacher-led curricula in AIDS prevention programs conducted among 1295 students in Rome, Italy. Eighteen high schools were randomly assigned to one of two prevention programs: one led by teachers and the other by peer leaders. The researcher found that peer-led group had greater improvement in
knowledge, compared to the teacher-led group. Researcher concluded that peer-led intervention, compared to that led by teachers was a greater improvement in knowledge of HIV.
Cho. H.et al., (2005)47 examined the effectiveness of reconnecting youth, a prevention program for 1,218 and 15 years aged students at-risk high school youth at North Carolina USA. They tested whether positive efficacy trial effects could be replicated and whether any negative behavioral effects occur when clustering high- risk youth. These effects included less optimal scores on measures of anger, school connectedness, conventional peer bonding and peer high-risk behaviors. Further, this study provides evidence that clustering high-risk youth in preventive interventions has the potential for iatrogenic effects.
Fennel. R., (2004)55 reviewed the evaluation of peer education program a brief literature on process and outcome evaluations and offers suggestions to encourage evaluations that will yield more accurate and useful information. Such information is particularly important at a time when many universities face budgetary constraints that put these programs and those who administer them at risk when programs and services are curtailed.
Hlongwa, L., (2004)63 conducted a study to assess the effectiveness of peer education model for influencing positive behavior change among adolescent boys.
Three different peer education models were evaluated. Self administered questionnaires and focus group discussions were conducted reaching 194 peer educators. Interviews were conducted with 525 youth participants, 62 key community informants and 31 parents of peer educators. The researcher found that 77% of youth participants reported positive behavior change because of their involvement in the peer education program.
Wiist, W.H., (2004)88 conducted a study to find out the effectiveness of peer education in prevention of adolescent smoking among 347 adolescents. The
method of selection of student teachers was by either a popular vote of students or the adult teachers and principals have chosen the student teachers. The peer leaders were identified by a computerized algorithm and by friendship questionnaire. The intervention was focused on social skills to prevent smoking and consisted of 8 weeks of education. The researcher concluded that the prevention rate of smoking is positive through peer education.
CHAPTER – III
RESEARCH METHODOLOGY
This chapter describes the methodology followed to assess the effectiveness of peer education on knowledge and attitude regarding high risk behavior among adolescent boys at selected schools, Thiruvallur district, Chennai.
This phase of the study included selecting a research design, variables, setting, population, sample, inclusive and exclusive criteria for sample selection, sample size, sampling technique, development and description of the tool, content validity, ethical consideration, pilot study, reliability and procedure for data collection and plan for data analysis.
RESEARCH APPROACH
The research approach used in this study was quantitative research approach.
RESEARCH DESIGN
A pre experimental one group pre test post test design was undertaken for the present study.
The investigator selected pre-experimental study, as because control in the same setting was not possible.
Based on Polit and Hungler (2011)27 schematic representation of pre experimental study, the study framework was
GROUP PRE TEST (O1)
INTERVENTION (X)
POST TEST (O2) Adolescent
Boys (14-19
years)
Assessment of existing level of knowledge and attitude regarding high risk behavior among adolescent boys.
Peer education through peer training module on high risk behavior among adolescent boys.
Assessment of post test level of knowledge and attitude regarding high risk behavior among adolescent boys.
VARIABLES
Independent variable
Peer education.
Dependent variable
The level of knowledge and attitude regarding high risk behavior among adolescent boys.
Extraneous variables
The demographic variables comprised of age, religion, type of family, educational status of the father, educational status of the mother, occupation of the father, occupation of the mother, family monthly income, type of T.V program, personal habit of smoking, personal habit of alcoholism, family history of smoking, family history of alcoholism, incidence of road traffic accidents, occurrence of violence activities and occurrence of self infliction behavior.
SETTING OF THE STUDY
The study was conducted in Government Higher Secondary School at Pandeswaram, Thiruvallur district. This school has students from 6th to 12th standards both boys and girls.
The total number of students – 1094 The total number of boys - 607
The total number of girls - 487
The total number of students from 14-19years – 387
Annual general health checkup to all students done by staff of Omayal Achi Community Health Centre.
POPULATION
The target population for the study includes all adolescent boys between 14 to 19 years and the accessible population was 607 adolescent boys who were willing to get information from their peers at Government Higher Secondary School, Pandeswaram.
SAMPLE
The study sample comprised of adolescent boys in a selected school who fulfilled the inclusive criteria of the study.
CRITERIA FOR SAMPLE SELECTION Inclusive Criteria
1. Adolescent boys between the age group of 14 to 19 years.
2. Adolescent boys who were able to read or write Tamil or English.
Exclusive Criteria
1. Adolescent boys who have already attended an education or awareness program on high risk behavior.
2. Adolescent boys who were not willing to receive education from their peers.
SAMPLE SIZE
A total of 100 adolescent boys studying at Pandeswaram, Government higher secondary school were selected as samples.
SAMPLING TECHNIQUE
The non probability purposive sampling technique was used to select the samples for the study.
DEVELOPMENT AND DESCRIPTION OF THE TOOL
After an extensive review of literature and discussion with experts in the field of Community Health Nursing, a self structured knowledge questionnaire and attitude scale was constructed as a tool for collecting data on knowledge and attitude regarding high risk behavior among adolescent boys.
The data collection tools used for the study included 3 sections.
Section A: Demographic Variables
The Demographic variables comprised of age, religion, type of family, educational status of the father, educational status of the mother, occupation of the father, occupation of the mother, family monthly income, type of T.V program, personal habits of smoking, personal habit of alcoholism, family history of smoking, family history of alcoholism, incidence of road traffic accidents, occurrence of violent activities and occurrence of self infliction behavior.
Section –B
This section consisted of description about knowledge and attitude questionnaire.
Part I:
Structured knowledge questionnaire which consisted of 35 multiple choice questions with 4 options, each question had one correct answer and the boys were instructed to select one answer to elicit the knowledge level of adolescent boys regarding high risk behaviors.
The questions were formulated under the separate sub headings
S.NO CONTENT NO OF QUESTIONS
1 2 3 4 5 6 7
Meaning of high risk behavior Causes
Risk factors
Withdrawal symptoms Adverse effects
Prevention Treatment
9 5 2 2 10
5 2 TOTAL 35 SCORING KEY:
The correct answer was given ‘1’ mark and wrong answer was given ‘0’ mark to interpret the level of knowledge.
The level of knowledge was categorized as <50 % - Inadequate knowledge
51-74% - Moderately adequate knowledge >75% - Adequate knowledge
Part II:
A modified 4 point Likert scale consisting of 20 statements was used to assess the attitude regarding high risk behavior among adolescent boys. Out of the 20 statements, 10 statements were positively worded statements and 10 statements were negatively worded statements. The samples were required to read the statements and put “ ” mark against their opinion.
Each statement had 4 responses to select.
Scoring key:
S.NO Questions Strongly agree Agree Disagree Strongly disagree
1 Positive 4 3 2 1
2 Negative 1 2 3 4
Maximum score: 80
Level of Attitude:
<50% - Unfavorable attitude
51-74% - Moderately favorable attitude >75% - Favorable attitude
SECTION C: INTERVENTION TOOL
The intervention tool had training of peer educators by the investigator by using structured peer education training package.
PREPARATION OF PEER EDUCATORS FOR PEER EDUCATION Training of peer educator was done through FIVE phases
PHASE I
It included the selection of peer educator based on the following criteria 1. Willing &committed for peer welfare
2. Having a good communication skill 3. Popular among peer group
4. Able to grasp, retain and transform the received information from the investigator into knowledge and favorable attitude for their peer groups.
PHASE II
The investigator conducted pretest to assess the knowledge and attitude regarding high risk behavior among peer educators by using structured knowledge questionnaire and 4 point Likert scale.
PHASE III
The investigator had given training to the peer educators using peer education training module by using flashcards, pamphlets and posters and lecture and chalkboard.
PHASE IV
The post test evaluation of knowledge and attitude was done for the peer educators by using same knowledge questionnaire and attitude scale by the investigator.
PHASE V
The investigator empowered adolescent boys with appropriate A.V.Aids in Tamil to undertake the role of peer educators and handed over the flashcards, pamphlets and posters to them in following topics.
9 Flash card – Smoking
9 Pamphlets – Violence, Unsafe sex, Self infliction behavior.
9 Posters - Alcoholism
CONTENT VALIDITY
The validity of the tool was obtained from 1 Community Medicine Expert and 3 Nursing Experts in the field of Community Health Nursing.
Suggestions given by the experts are,
• Exclude drug abuse- Done in main study and the questions related to drug abuse was also removed in knowledge and attitude questionnaire.
• Use only smoking as a training module – which was not done as because the investigator thought that the other 4 high risk behaviors also are more common among adolescent boys.
Modification was done in the tool as suggested by the experts and it was incorporated in the main study and tool was finalized.
ETHICAL CONSIDERATION
The ethical principle followed in the study were, 1. Beneficiary
i. Freedom from harm and discomfort
The study participants were not subjected to unnecessary risks for harm during the study period.
ii. Protection from exploitation
The participants were assured that their participation or information they provided would not be used to harm them in any way.
2. Respect for human dignity
The participants were given full rights to ask question, refuse to give information and also to withdraw from the study.
As the participants were less than 18 years written consent form was obtained from their parents and the oral consent was obtained from the participants initially for the willingness to participate in the study.
3. Justice
The selection of study participants was completely based on research requirements. A full privacy was maintained throughout the process of data collection.
PILOT STUDY
Pilot study is a trial run for major study to test the reliability, practicability and feasibility of the study and the tool. The pilot study was conducted in the month of June at Murugappa polytechnic college, Avadi, Chennai. It was conducted after receiving a formal permission letter from the Principal, Omayal Achi College of Nursing. The permission for conducting the study in Murugappa polytechnic was obtained from the Principal, Murugappa polytechnic College. The investigator selected 12 samples who fulfilled inclusive criteria as samples by using non probability purposive sampling method.
On first day, a brief information about self and the purpose of the study was explained to the adolescent boys, privacy was provided and confidentiality regarding the data was assured to the boys so as to get their co-operation in the
procedure of data collection. After getting the written consent from their parents, data collection was carried out.
On second day the HOD of electrical department gave permission to conduct the study in D.M.E I year classroom. The classroom was well ventilated with natural and artificial ventilation, with comfortable seating arrangement for the participants.
Then the investigator initially collected demographic variables which were about 18 questions and followed by pre test was conducted to assess the level of knowledge and attitude by using structured knowledge questionnaire and 4 point Likert scale for 12 samples. The knowledge questionnaire consisting of 45 questions in 6 components (Smoking, Alcoholism, Drug abuse, Violence, Self infliction behavior, and Unsafe sex) with 4 options were given to the participants and were requested to select the answer from the 4 options. 20 attitude questions were given to put (9) mark which they thought appropriate to that question. It took 15 to 20minutes for them to finish the questionnaire and rating scale.
After the pre test the investigator had given training to the peer trainers for 3 days for 30 to 45minutes each day. The intervention was given through peer educator training module by means of lecture and chalkboard method.
On 5th day the investigator conducted posttest to the peer educators by using same knowledge and attitude questionnaire. In that 2 peer educators had adequate knowledge (>75%) and favorable attitude (>75%) about high risk behavior. Then the peer educators were empowered with the training module to undertake the role of peer educators.
On 6th day, the peer trainers introduced themselves to the peer trainees about their teaching, purpose of the study and requested them to co-operate for the each session. Each peer educator gave training to 5 peer trainees for 4 days and
