Tobacco use among medical students in Europe: Results of a multicentre study using the Global Health Professions Student Survey

Mindful Eating, Nutrition Knowledge, and Weight Status among Medical Students: Implications for Health and Counseling Practices

Academic stress and transitioning to young adulthood can lead medical students to develop inadequate eating habits, affecting both their physical and mental well-being and potentially compromising their ability to offer effective preventive counseling to future patients. The primary objective of this study is to analyze the levels of mindful eating and nutrition knowledge in Romanian medical students and their associations with various sociodemographic variables. Additionally, we explore the relationship between mindful eating and nutrition knowledge while accounting for sociodemographic factors and examine the impact of these factors on excess weight. Significant predictors of excess weight include high weight gain in the past year (OR = 15.8), the mindful eating questionnaire (MEQ) score (OR = 0.131), male gender (OR = 2.5), and being in the clinical years of medical school (OR = 2.2). While nutrition knowledge levels do not directly impact weight status, they share a 4% common variance with mindfulness in multivariate analysis. Notably, high weight gain is independent of the levels of mindful eating, but univariate testing links it to disinhibition and emotional response, components of mindfulness. Mindful eating stands out as independently associated with both nutrition knowledge and excess weight among medical students. Thus, interventions to address obesity should consider incorporating mindfulness training to enhance food intake awareness and improve weight management outcomes in Romanian medical students.

Sleep Quality and Nicotine Dependence Among Lebanese University Residents and Fellows: A Cross-Sectional Study

Background and objectives Sleep quality and nicotine addiction are important public health issues with significant negative impacts on individual well-being and the performance of healthcare professionals. This study aims to determine the prevalence and association of nicotine dependence and poor sleep quality among residents and fellows enrolled in the Lebanese University. Methods A cross-sectional study using the snowball-sampling technique was conducted in Lebanon between January and March 2023. Data were collected through an online survey that included information on socio-demographic characteristics, nicotine dependence, and sleep quality. A total of 350 residents and fellows were included in the study. Bivariate analysis and multivariable logistic regression were carried out to identify the factors associated with sleep quality. Adjusted odds ratio and 95% confidence intervals were reported. Results One quarter (25.1%) of the residents and fellows were smokers; among them, 44.3% smoked I Quit Ordinary Smoking (IQOS), 14.8% smoked cigarettes, 10.2% smoked waterpipe (WP), 12.5% smoked cigarettes and WP, and 18.2% smoked IQOS and WP. According to the Pittsburgh Sleep Quality Index (PSQI), 34.3% of participants had poor sleep quality. Smokers had 12.5 times higher odds of experiencing poor sleep quality compared to non-smokers (adjusted odds ratio ORadj = 12.58 with 95% confidence interval [CI] of 7.07-22.36; p-value <0.001). In addition, smoking a combination of two types of tobacco products (cigarettes with WP or IQOS with WP) posed the highest risk of poor sleep quality, with an adjusted odds ratio of 31.54 (95% CI of 9.15-45.74, p-value <0.001). Elevated Fagerström Test for Nicotine Dependence (FTND) and Lebanon Waterpipe Dependence Scale (LWDS-11) scores indicated an increased risk of poor sleep quality (adjusted odds ratio ORadj = 4.69 with 95% CI of 2.179-10.10; p-value <0.001; and adjusted odds ratio ORadj =1.27 with 95% CI of 1.04-1.55; p-value 0.019, respectively). Conclusion Our study found a significant association between nicotine dependence and poor sleep quality among medical residents and fellows, with smokers being more susceptible to sleep disturbances. The high prevalence of IQOS smoking among medical residents and fellows in Lebanon highlights the urgent need for comprehensive research investigating the effects of heated tobacco products. Furthermore, our study reveals a critical insight into the potential additive effects of nicotine, suggesting that the concurrent use of multiple tobacco products may further elevate the risk of poor sleep quality. Recognizing the implications of our findings, it is imperative to develop targeted interventions and educational programs that promote healthier sleep habits and facilitate smoking cessation among medical residents and fellows.

Nursing students' attitudes, behaviour, and knowledge toward smoking cessation: Results from a descriptive survey at a regional university

BACKGROUND

Smoking is the largest single cause of lifestyle-related preventable morbidity and mortality. Nurses form the largest cohort of health professionals and are strategically placed to implement smoking cessation interventions. However their capacity is underutilised, particularly in rural and remote areas in countries such as Australia where the incidence of smoking in is higher than average and access to healthcare is limited. One strategy to address the underutilisation of nurses in smoking cessation interventions is to include training in the university/college nursing curriculum. To effectively implement this training, it is vital to have an in-depth knowledge of student nurses' attitudes towards smoking including the role of healthcare professionals in smoking cessation, their smoking behaviour and that of their peers, and knowledge regarding smoking cessation techniques and resources.

OBJECTIVES

Investigate nursing students' attitudes, behaviour, and knowledge towards smoking cessation, determine the impact of demographics and educational experienced on these, and develop recommendations for future research and educational practice.

DESIGN

Descriptive survey.

PARTICIPANTS

Non-probability sample of undergraduate nursing students (n = 247) from a regional Australian university.

RESULTS

Significantly more participants had tried smoking cigarettes than had not (p = 0.026). There were no significant relationships between gender and smoking (p = 0.169) or e-cigarette use (p = 0.200), but a significant relationship was found between age and smoking status where older participants (48-57 years) were more likely to smoke (p < 0.001). Most participants (70 %) were supportive of public health measures to reduce cigarette smoking but felt that they lacked specific knowledge to assist their patients to cease smoking.

CONCLUSIONS

Within education there needs to be an emphasis on the central role that nurses play in smoking cessation with a greater focus on training nursing students about smoking cessation strategies and resources. There is also a need to ensure that students know it falls within their duty of care to address smoking cessation with patients.

Public support for car smoking bans in Poland: a 2022 national cross-sectional survey

OBJECTIVE

The objectives of this study were to assess the prevalence of self-reported secondhand smoke exposure in cars among adults in Poland and to characterise public attitudes towards the implementation of the ban on smoking in cars with children.

DESIGN

Cross-sectional survey was carried out between 4 March 2022 and 7 March 2022 on a national sample of 1090 adult Polish residents. The questionnaire included 12 closed questions on smoking behaviours, secondhand smoke exposure as well as attitudes towards different smoke-free laws.

PARTICIPANTS

Data were obtained from 1090 individuals, aged 18-84 years, 52.6% were females.

RESULTS

Almost every fifth respondent (17.7%) declared secondhand smoke exposure in cars in the past 30 days (31.8% of smokers and 12.0% of non-smokers; p<0.001). Lack of the implementation of smoke-free home rules (aOR 2.92, 95% CI 1.99 to 4.29; p<0.001), age 18-29 years (aOR 2.06; 95% CI 1.16 to 3.67; p=0.01), current smoking (aOR 1.99, 95% CI 1.37 to 2.90; p<0.001) as well as bad financial situation (aOR 1.60, 95% CI 1.02 to 2.48; p=0.04) were significantly associated with the higher risk of secondhand smoke exposure in cars. Out of all respondents, 84.2% supported the implementation of the ban on smoking in cars with children. Out of 12 different sociodemographic factors, only the female gender (aOR 1.94, 95% CI 1.37 to 2.74) and being non-smokers (aOR 1.70. 95% CI 1.20 to 2.41; p=0.003) were significantly associated with the higher odds of supporting the implementation of the ban on smoking in cars with children.

CONCLUSIONS

This study showed high public support for the implementation of the ban on smoking in cars with children. Social support for smoke-free environments in Poland should be used by public health specialists and policy-makers to strengthen the national tobacco control act.

Assessing Smoking Habits, Attitudes, Knowledge, and Needs among University Students at the University of Milan, Italy

BACKGROUND

College campuses and universities are valuable settings for smoking prevention programs targeting young adults.

AIM

To investigate smoking habits, electronic cigarette (e-cig) and heated tobacco product (HTP) use, exposure to passive smoke, compliance with smoking bans on campus, attitudes toward the anti-smoking policies, and educational needs among students at the University of Milan, Italy.

METHODS

A validated questionnaire was web-submitted to 64,801 students in the period May-July 2021. For each item, the frequency was calculated and χ² test with Bonferroni correction was used to compare differences among the 10 faculties of the University.

RESULTS

7162 students participated in the survey, while 6605 questionnaires were included in this report (62% female, 84% aged 18-25 years). Sixty-four percent of participants were never smokers, 19% were smokers, 2.8% were e-cig or HTP users, 3.7% were dual smokers, 10% were former smokers, and 66% reported routinely spending free time with smokers. Almost all students were aware of the dangers of active and passive smoking of cigarettes, while about 20% did not have an opinion on the dangers of e-cigs/HTPs. Only 49% were aware of the smoking ban in the outdoor areas of the university. Students from the faculties of Law and Political, Economic, and Social Sciences smoked more frequently and were more frequently exposed to passive smoke than other students. Medicine students were the most aware of the dangers of passive smoking and using e-cigs/HTPs.

CONCLUSIONS

This is the first study in Italy involving the entire student population of a university and highlighting differences among faculties in terms of active and passive smoking and opinions. The results suggest that prevention campaigns addressed to students should consider their specific study curricula and give information tailored to the different educational needs to efficiently support health promotion.

Actions Speak Louder Than Words: Health Behaviours and the Literacy of Future Healthcare Professionals

Our everyday behaviours in life can positively and negatively impact our health, thus cumulatively shaping our lifestyles as more or less healthy. These behaviours are often determined by our knowledge, literacy, motivations and socioeconomic backgrounds. The authors aimed to assess health behaviours and explore variables that may affect persons studying to become future healthcare professionals in Poland. This study was conducted with a group of 275 undergraduate students attending the Poznan University of Medical Sciences representing six different majors of study. We used self-reported, cross-sectional survey conducted through the use of a questionnaire that consisted of one standardised scale (Juczyński’s Health Behaviour Inventory) as well as a self-developed health literacy measure. The students showed average to high levels of health-promoting behaviours (mean HBI = 82.04 ± 11.26). Medium to strong associations were found between these behaviours and high scores on the health literacy scale (p = 0.001, r = 0.45 between total scores of the two scales). Dietetics students and female respondents scored significantly better on both scales, which suggests that their self-reported behaviours and health literacy were higher than those of other participants. Exhibiting health-protective behaviours and high health literacy is likely to result in the better individual health of our respondents, but, more importantly, will also influence their future professions. As members of the healthcare workforce they will be responsible for the health of the population and it is crucial for them not only to provide care, education, and guidance, but also to act as role-models for their patients and society.

Actions Speak Louder Than Words: Health Behaviours and the Literacy of Future Healthcare Professionals

Our everyday behaviours in life can positively and negatively impact our health, thus cumulatively shaping our lifestyles as more or less healthy. These behaviours are often determined by our knowledge, literacy, motivations and socioeconomic backgrounds. The authors aimed to assess health behaviours and explore variables that may affect persons studying to become future healthcare professionals in Poland. This study was conducted with a group of 275 undergraduate students attending the Poznan University of Medical Sciences representing six different majors of study. We used self-reported, cross-sectional survey conducted through the use of a questionnaire that consisted of one standardised scale (Juczyński’s Health Behaviour Inventory) as well as a self-developed health literacy measure. The students showed average to high levels of health-promoting behaviours (mean HBI = 82.04 ± 11.26). Medium to strong associations were found between these behaviours and high scores on the health literacy scale (p = 0.001, r = 0.45 between total scores of the two scales). Dietetics students and female respondents scored significantly better on both scales, which suggests that their self-reported behaviours and health literacy were higher than those of other participants. Exhibiting health-protective behaviours and high health literacy is likely to result in the better individual health of our respondents, but, more importantly, will also influence their future professions. As members of the healthcare workforce they will be responsible for the health of the population and it is crucial for them not only to provide care, education, and guidance, but also to act as role-models for their patients and society.

Smoking Habits and Workplace Health Promotion among University Students in Southern Italy: A Cross-Sectional Pilot Investigation

The study aimed to investigate the tobacco smoking prevalence, habits and awareness among a cohort of healthcare students from a university hospital in southern Italy and the associations with socio-demographic determinants. A secondary outcome was to estimate the educational needs to receive information on smoking-related risk factors. Five hundred and forty-nine students completed a self-administered questionnaire (180 male and 369 female, average age 25 yo, ±5.9 SD), enrolled from October 2018 to November 2019 at the University of Naples 'Luigi Vanvitelli', and the collected data were analysed by descriptive and inferential statistical analysis. The sample's prevalence of current smokers was 25.3%, without a significant sex difference. The multiple logistic regression model showed the link between smoking habits and alcoholic beverage consumption (p < 0.001) and living with smokers (p = 0.003). The enrolled cohort does not seem to need more information about the risks of cigarette smoking (p = 0.028). The data analysis and the comparison with the current literature allowed the authors to hypothesise a training model to be adopted within a workplace health promotion programme managed by an occupational physician. This model included targeted training for smoking dissuasion, focusing on sex and gender, cohabitant's influence, and combined addiction management. Further research will focus on the effectiveness of these proposed models.

Analysis of the Lifestyle of Spanish Undergraduate Nursing Students and Comparison with Students of Other Degrees

Background: Nursing students are exposed to concepts of healthy lifestyles while they are attending university. Objective: The aim of this study was to analyze whether nursing students have a healthier lifestyle than non-nursing students and to determine whether their behaviour is consistent with their beliefs. Methods: A cross-sectional study, with 293 university students was performed by using a validated questionnaire to measure beliefs and behaviour regarding health. Results: The lifestyle pattern of the nursing students evaluated was characterised by a high percentage of nurses with low levels of physical activity, poor balanced diet and smoking habits. The comparative analysis showed no significant differences between nursing students and students from other degrees. Conclusions: Students have a positive attitude and knowledge about healthy lifestyle, but do not transfer it to their own lives. Nurses’ lifestyle can unintentionally affect the behaviour of other people through their own behaviour and beliefs because they serve as a model for a healthy lifestyle. These findings support that nurse educators have an active role as promoter of health by using lessons to modify the behaviour of their students.

Erciyes Üniversitesi Öğrencilerinde Sigara İçme Durumunun 1985 – 2019 Yılları Arasındaki Değişimi

Amaç: Bu çalışmada Erciyes Üniversitesi öğrencileri arasında sigara kullanım durumu ile nikotin bağımlığı düzeyini saptamak ve elde edilen verilerin ilgili bölüm ve araştırmacılar tarafından 1985 ve 2005 yıllarında yapılan önceki çalışmalarla karşılaştırarak, tütün kullanma durumundaki değişimi değerlendirmek amaçlanmıştır. Yöntem: Bu kesitsel Araştırma 2018-2019 eğitim döneminde, Erciyes Üniversitesi Tıp, Mühendislik ve İlahiyat fakültelerinde okuyan öğrenciler üzerinde yapıldı. Örneklem büyüklüğü 1500 kişi olarak hesaplandı. Veri toplama aracı olarak, araştırmacılar tarafından hazırlanan ve 48 sorudan oluşan anket formu ve altı sorudan oluşan Fagerström Nikotin Bağımlılık Testi (FNBT) kullanıldı. Bulgular: Çalışma 1348 öğrenci ile tamamlandı. Sigara kullanım oranı kadınlarda %6.3 ve erkeklerde %28.0 ve toplamda %16.1 olarak bulundu. Bölümlere göre en yüksek sigara içme oranı %25.9 ile mühendislik fakültesinde görüldü. Tıp fakültesi ve ilahiyat fakültelerinde sigara içme oranları sırasıyla %13.9 ve %5.0 olarak bulundu. Erkeklerde nikotin bağımlılık düzeyi yüksek ve çok yüksek olanların oranı %17.6 ile kadınların %6.4’lük oranından anlamlı olarak daha yüksekti (p=0,027). Toplam FNBT puan ortalaması 3.06±2.32 idi. Genel anlamda sigara kullanım sıklığı değerlendirildiğinde; 1985 yılında % 29.8 (E: 33.90, K: 12.20) ve 2005 yılında % 16.7 (E: 25.60, K:5.10) iken, 2019 yılına gelindiğinde % 16.1 (E: 28.0, K:6.3) olmuştur. Sonuç: Erciyes Üniversitesi öğrencilerinde sigara kullanım oranı öğrenci profilinin değişimine bağlı olarak etkilenmektedir. Her ne kadar alınan önlemler ile bir dönem sigara kullanımı düşmüş olsa da 2019 yılında, cinsiyet bazında; hem kadın, hem de erkeklerde sigara içme oranında bir yükselme olduğu söylenebilirken genel kullanım oranında ise düşüş görülmektedir.

Oral Health Knowledge, Attitudes, and Behaviors (KAB) of German Dental Students: Descriptive Cross-Sectional Study

Germany's 2030-oral health agenda incorporates behavioral targets such as twice-daily toothbrushing and routine dental check-ups. Given the professional and social roles of dentists in oral health promotion, the oral health-related knowledge, attitudes, and behaviors (KAB) of dentists and dental students became worth investigation. The present study was designed as a descriptive cross-sectional study that aimed to evaluate oral health KAB of German dental students using the Hiroshima University - Dental Behavioral Inventory (HU-DBI). A total of 508 dental students filled in the questionnaire, out of which 74.2% were females, 38.8% were clinical students, 11.4% reported tobacco smoking at least once week, 26.6% reported drinking alcohol at least once a week, and 82.9% reported suffering from problematic internet use. The overall HU-DBI score was high (7.67 ± 1.32), and it was slightly higher among females (7.70 ± 1.33) than males (7.59 ± 1.29), and gender-diverse students (7.33 ± 1.37). Clinical students (7.88 ± 1.26) had a significantly higher HU-DBI score, especially in the domain of oral health behaviors, compared with preclinical students (7.53 ± 1.34). A significant improvement in oral health behaviors and HU-DBI score was found between the third- vs. the fourth year, which corresponds to the period when prophylaxis, hygiene, and periodontology courses are delivered. Tobacco smoking was significantly associated with poor oral health knowledge, behaviors, and overall HU-DBI score. Problematic internet use and alcohol drinking had slightly lower HU-DBI scores. The findings of the present study call for early implementation of preventive dentistry elements in German curricula and addressing oral health needs of gender minorities in Germany by future epidemiologic studies.

Oral Health Knowledge, Attitudes, and Behaviors (KAB) of German Dental Students: Descriptive Cross-Sectional Study

Germany's 2030–oral health agenda incorporates behavioral targets such as twice-daily toothbrushing and routine dental check-ups. Given the professional and social roles of dentists in oral health promotion, the oral health-related knowledge, attitudes, and behaviors (KAB) of dentists and dental students became worth investigation. The present study was designed as a descriptive cross-sectional study that aimed to evaluate oral health KAB of German dental students using the Hiroshima University – Dental Behavioral Inventory (HU-DBI). A total of 508 dental students filled in the questionnaire, out of which 74.2% were females, 38.8% were clinical students, 11.4% reported tobacco smoking at least once week, 26.6% reported drinking alcohol at least once a week, and 82.9% reported suffering from problematic internet use. The overall HU-DBI score was high (7.67 ± 1.32), and it was slightly higher among females (7.70 ± 1.33) than males (7.59 ± 1.29), and gender-diverse students (7.33 ± 1.37). Clinical students (7.88 ± 1.26) had a significantly higher HU-DBI score, especially in the domain of oral health behaviors, compared with preclinical students (7.53 ± 1.34). A significant improvement in oral health behaviors and HU-DBI score was found between the third- vs. the fourth year, which corresponds to the period when prophylaxis, hygiene, and periodontology courses are delivered. Tobacco smoking was significantly associated with poor oral health knowledge, behaviors, and overall HU-DBI score. Problematic internet use and alcohol drinking had slightly lower HU-DBI scores. The findings of the present study call for early implementation of preventive dentistry elements in German curricula and addressing oral health needs of gender minorities in Germany by future epidemiologic studies.

Validation of a Questionnaire to Assess Smoking Habits, Attitudes, Knowledge, and Needs among University Students: A Pilot Study among Obstetrics Students

In Italy, smoking is still widespread among a relatively high percentage of young people. This study aimed to develop and validate a questionnaire to assess smoking habits, passive smoke exposure, electronic cigarette (e-cig) and heated tobacco product (HTP) use, attitudes, knowledge, and needs among undergraduates. A questionnaire consisting of 84 items was developed starting from a literature review and existing questionnaires. A two-round validation was performed by a team of 10 experts. The item-level content validity index (I-CVI), the scale-level content validity index (S-CVI), and the kappa statistics k, taking into account chance agreement, were calculated from the experts' rating. The questionnaire was emailed to 114 students from the Obstetrics Degree of the University of Milan (Italy) to be pilot tested. After the second round of validation, all indexes were above the respective acceptability criteria: the I-CVI was 1.00 for all but three items, k was >0.74 ("excellent") for all items, and the S-CVI was 0.964. Eighty-nine students participated in the survey: 17 classified themselves as smokers, eight as new product users, and four as former smokers, 72% students declared to routinely spend free time with smokers, while almost all students believed that healthcare professionals play a pivotal role in preventing smoking towards their patients and society. This questionnaire will be used in a survey among students from the University of Milan as a first step for future campaigns targeting health promotion.

Exploring Trends and Differences in Health Behaviours of Health Sciences University Students from Germany and England: Findings from the "SuSy" Project

Objectives: This research aimed to explore the health behaviours of health sciences students over time and across different settings. Methods: A health behaviour surveillance system has been implemented in Hamburg and Manchester among under- and postgraduate health sciences students. Trends among the Hamburg sample were described. In a cross-sectional assessment, health behaviours across both universities were examined using multivariate regression analysis. Results: Between 2014 and 2018, increasing trends in physical activity and cannabis and alcohol consumption were observed in Hamburg (n = 1,366). While fruit and vegetable intake was constantly low, tobacco smoking decreased. No clear trend was observed for stress perception. The comparison (n = 474) revealed that Manchester students had higher odds of smoking, excessive alcohol consumption, and fruit and vegetable consumption; and lower odds of being physically active, and consuming cannabis. No difference in stress perception was observed. Conclusions: Varying trends and potential areas of intervention were identified for health behaviours in Hamburg. The comparison with Manchester students revealed differences in behaviours, which could be further explored to help inform health promotion strategies in both settings.

Mental Health Disturbances and Related Problems in Italian University Medical Students from 2000 to 2020: An Integrative Review of Qualitative and Quantitative Studies

Background and objectives: The presence of mental health problems in the population of medical students in Italy has been evaluated in several cross-sectional studies, which have used different methodologies and study designs. However, a global overview of the prevalence of mental health problems in Italian medical students is not available, although this would be essential for promoting preventive strategies and supportive treatments. Materials and Methods: An integrative review aiming to describe the prevalence of mental health problems in Italian medical students has been performed. Results: The most relevant findings are the high prevalence of substance use, in particular alcohol and nicotine, and of depressive and anxiety disorders in Italian medical students. In particular, substance use ranges from 13 to 86%, which is higher compared to Italian students coming from other faculties. Italian medical students show a high rate of smoking and of depressive symptoms of about 20%. Conclusions: Our findings highlight the need to develop appropriate supportive interventions for the medical student population, which are rarely provided and implemented among the routine activities of Italian medical universities. A relevant aspect to be considered is the stigma and anticipated discrimination attached to mental disorders, which reduce the help-seeking process in medical students.

Prevalence of tobacco use, exposure to secondhand smoke and knowledge on smoking cessation among students of health professions in Central Greece: a cross-sectional study

OBJECTIVES

The aim of this study was to assess the prevalence of tobacco use and exposure to secondhand smoke among students of health professions (SHPs) and determine possible risk factors for current smoking. In addition, we sought to investigate the level of students' knowledge regarding smoking cessation.

DESIGN

Cross-sectional.

SETTING

Central Greece.

PARTICIPANTS

A convenient sample of 822 SHP volunteers were used, composed of 365 medical students, 123 students from a biochemistry department, 71 students from a nursing department, 176 from medical laboratory department and 84 students from a veterinary medicine department.

PRIMARY AND SECONDARY OUTCOME MEASURES

We investigated the prevalence of current smoking and secondhand smoke, their determinants and SHP's knowledge and attitudes regarding smoking cessation. Univariate and logistic regression statistical analysis were used in order to identify risk factors associated with current smoking.

RESULTS

The prevalence of current smoking was estimated at 23.5% (95% CI 20.7% to 26.5%), while 49% of current smokers reported they wanted to quit smoking. The prevalence of current e-cigarette use was 1.2%. In addition, 96.5% (95% CI 94.9% to 97.5%) of SHP have been exposed to secondhand smoke at least 1 day per week. Logistic regression analysis showed that increasing age (p<0.001), alcohol consumption (p<0.001) and exposure to secondhand smoke in the home (p<0.001) were independent risk factors for current smoking. Notably, only 11.6% of the participants had learnt about methods to be used for smoking cessation.

CONCLUSIONS

Our results underline the need for integrated tobacco control initiatives that should discourage tobacco use among SHP, promote smoke free schools of health science, and implement programs that train SHP in effective cessation-counseling techniques.

Smoking Prevalence, Attitudes and Behavior among Dental Students in Poland and Italy

The aim of the study was to perform preliminary research to compare the smoking prevalence, attitudes and behavior between dentistry students in two universities in Europe using the standardized Global Health Professions Student Survey (GHPSS) questionnaire. This was cross-sectional carried out among dentistry students from the Medical University in Bialystok, Poland and Sapienza University of Rome, Italy. There were 582 participants; 282 were Italians, 202 were smokers and 42% were Italians. The response rate was 79.9% of Italian students and 79.6% of Polish students. The prevalence of smoking was significantly higher among Italian students (42% vs. 28.0%). Attitudes and behaviour of smokers and non-smokers differed statistically. Polish and Italian dental students presented statistically different behavior regarding the time to smoke the first cigarette, the willingness to stop smoking and trying to stop smoking in the last year. The multiple logistic regression analysis revealed that two independent variables, exposure to second-hand smoke (SHS) both at home and in public places (OR = 3.26 and OR = 5.9, respectively), showed a significantly higher occurrence of smoking. There is a high use of tobacco among dental students, which is particularly high in Italian dental students. Students realizes the positive perception of their own tobacco counsellor role in a dental setting. Dental students should be role models to their peers and patients.

Prevalence of Smoking among Medical Students in a Tertiary Care Teaching Hospital

Introduction:

Tobacco smoking is one of the most important preventable risk factors for non-communicable diseases. It has been seen that medical students have a higher frequency of smoking compared to the general population. This study aims to determine the prevalence of smoking among third-year medical students in a tertiary care teaching hospital in Nepal.

Methods:

This descriptive cross-sectional study was conducted among the hospital’s third-year undergraduate medical students over a four-month period (October 2019 to January 2020). Ethical clearance was received from the Institutional Review Committee of Kathmandu Medical College and Teaching Hospital. The whole sampling technique was used to collect data. The Global Health Professional Students Survey questionnaire was used to collect data. Data analysis was done in the statistical package for social sciences.

Results:

The prevalence of current smoking among selected medical students of Kathmandu Medical College and Teaching Hospital is 34 (30.1%), majority male 26 (23%). Fifty-six (49.4%) of them had ever smoked cigarettes in their life, and 27 (23.9%) had their first cigarette in late adolescence. The number of students who used other forms of tobacco was comparatively lower i.e. 6 (5.3%). Many of the students 53 (46.9%) were exposed to second-hand smoke both at home and in public, while 18 (15.9) exposed only at public places, and 6 (5.3%) only at home.

Conclusions:

Our study has concluded that there is a notable prevalence of smoking among the participants. This points to the need for specific training sessions in their clinical years about smoking cessation for themselves and regarding counseling for patients.

Smoking in nursing students: A prevalence multicenter study

The role of nursing students as future health promoters of healthy behaviors is influenced by their attitude towards smoking. A cross-sectional study using a self-administered survey was performed to analyze smoking prevalence among undergraduate the nursing students who attend nursing faculties in 2 European countries (Spain and Portugal) during academic period 2015 to 2016. A total of 1469 subjects were surveyed (response rate of 79.8%). An 80% of the students were female with a mean age of 21.9 (4.8) years. The overall prevalence of tobacco use was 18.9%, with an average percentage of 16.2% in Portugal and 18.3% in Spain. Statistical significance was observed in relation to smoke and previous studies (16.4% vs 27.1%; P < .001). Only 1.1% of the students reported using electronic cigarette. 15.8% of smokers started smoking while at university with statistical gender and previous studies differences (P < .001). Fagerström and Richmond test showed low nicotine dependence (2.8 ± 2) and moderate motivation to stop smoking (4.9 ± 3), respectively. Smoking prevalence among nursing students was slightly higher than the general European population. For that reason, measures to reduce tobacco use have to be focused on students and university policies on tobacco control should be a challenge in the future.

First-year French medical students consume antidepressants and anxiolytics while second-years consume non-medical drugs

BACKGROUND

First year exams are a major source of stress amongst first-year medical students.

OBJECTIVE

To explore antidepressant and anxiolytic consumption and addictive behavior of medical students before and after exams.

METHODS

Medical students of the 35 French medical schools were recruited through mailing lists and social networks between December 2016 and May 2017 and completed online Internet anonymized questionnaires.

RESULTS

Overall, 4345 medical students were included (3051 first year vs. 1294 second year). In multivariate analyses, compared to those in the first year of medicine, second year students were found to have lower anxiolytic (adjusted odd ratio (aOR)=0.56, p = 0.01) and antidepressant consumption (aOR=0.21, p<0.0001) but higher psychiatric follow-up (aOR=1.95, p<0.0001) after adjustment for age, gender and relationship status. Whilst second year students reported slightly higher quality of life (especially for mental health), they also reported more daily tobacco smoking (aOR=1.78, p<0.0001), more cannabis use disorders (aOR=2.37, p<0.0001), hazardous drinking (aOR=3.61, p<0.0001), and alcohol dependence (aOR=3.66, p<0.0001). Second year medical students reported fewer difficulties relating to studying in comparison to first year students (aOR=0.60, p<0.0001) yet they reported a higher rate of recreational drugs use with a variety of reasons including self-treatment of anxiety; disinhibition and to copy their peers (all p<0.05).

LIMITS

These results should be confirmed by longitudinal studies.

CONCLUSION

First year medical students who are faced with challenges relating to studying consume more antidepressants and anxiolytics, whilst second year students have a higher consumption of recreational drugs for a range of reasons. This suggests that the first two years at medical school are an important contributor to adverse mental health and therefore present a window of opportunity for preventative intervention.

Prevalence and predictors of tobacco smoking among university students in Sylhet Division, Bangladesh

BACKGROUND

Among university students, large numbers are involved with smoking and suffer from many chronic diseases. This study examined tobacco smoking prevalence and potential predictors among university students in Sylhet Division, Bangladesh.

METHODS

A total of 416 students were selected for face-to-face interviews. Logistic regression analysis was used to fulfil the specific objectives of the study.

RESULTS

It was discovered that the prevalence of smoking among university students in Sylhet Division was 37% and almost half of current male students were smokers. Mother's occupation and peer smoking status were found to be significant factors. Although data were collected using multistage sampling, the stages (type of university, universities, departments and academic levels) were insignificant with smoking status. There is a 2.1 times greater likelihood of a student becoming a smoker if a close friend is a smoker. The adjusted living expenses (>$100) was a proactive factor, though individually it was a significant factor.

CONCLUSIONS

This study and previous studies found that smoking initiation among female students is negligible, so gender-specific health promotion and intervention is needed in Bangladesh. Tobacco control awareness programs and 'No smoking' signage should be displayed within university campuses and sanctioned by university authorities.

Low Back Pain Among Medical Students: A Burden and an Impact to Consider!

STUDY DESIGN

Prospective study.

OBJECTIVE

Determine risk factors and consider impact of low back pain for medical students.

SUMMARY OF BACKGROUND DATA

Low back pain (LBP) is one of the most prevalent complaints among students. The vulnerability of medical students due to stress and numerous hours of studying and training makes them at risk of LBP.

METHODS

We submitted an online self-administered modified version of the Standardized Nordic Questionnaire to 1800 medical students from 2nd to 6th year from December 2017 to March 2018.

RESULTS

A total of 1243/1800 (68.9%) students responded to our survey. Mean age was 23.3 ± 2.9 years ranging from 18 to 44 years. 835 (72.1%) students reported suffering from LBP. In multivariate analysis with logistic regression analysis model, the third year of medical studies (odds ratio [OR]: 0.558, 95% confidence interval [CI] 0.387-0.805; P = 0.002) was identified as an independent prognostic factor of LBP. Moreover, exercising weekly (OR: 1.835, 95% CI 0.933-2.5; P = 0.01) and walking at least 30 minutes a day (OR: 1.458, 95% CI 1.129-1.876; P = 0.01) significantly improve LBP. LBP generate higher monthly consumption of an analgesic (OR: 32.8, 95% CI 4.271-252.2; P < 0.001). Finally, LBP had a severe repercussion on student work (OR: 18.89, 95% CI 10.122-35.253; P < 0.0001), on the quality of sleep (OR: 12.162, 95% CI 6.917-21.386; P < 0.0001) and on their personal life (OR: 12.343, 95% CI 5.681-26.8; P < 0.0001).

CONCLUSION

Medical students reported high prevalence of LBP with severe consequences. Our educational perspective is to identify the risk factors of LBP, fight them, to improve the medical student' work, and welfare.

LEVEL OF EVIDENCE

3.

Susceptibility to smoking and determinants among medical students: A representative nationwide study in China

INTRODUCTION

The rationale behind why the majority of medical students are non-smokers, but some initiate smoking after becoming physicians is not fully understood in China. Exploring factors that may increase susceptibility to smoking initiation among medical students is an essential first step in assessing preventative actions.

METHODS

Participants were 11954 students, who were identified through a multistage survey sampling process that included 50 universities in China. Subsequent analysis focused on 8916 non-smokers among medical students. Both unadjusted and adjusted logistic methods were considered in the data analyses.

RESULTS

The prevalence of susceptibility to smoking was 23.0%. Multivariate logistic regression analyses found that exposure to secondhand smoke (SHS) in domestic places (OR= 1.63) and in public places (OR=1.78), cigarette advertising (OR=1.91) and promotional activities on campus (OR=1.90) were positively associated with susceptibility to smoking. In contrast, positive attitudes toward tobacco control on the part of health professionals, HPs, (OR=0.52) were negatively associated with susceptibility to smoking. Those who received information about the dangers of smoking (OR=0.75) and did not agree that light cigarettes are less harmful to health (OR=0.79) were less susceptible to smoke. Caring about exposure to secondhand smoke (OR=0.68 care, and OR=0.33 very) and advising family members to stop smoking (OR=0.81) were negatively associated with susceptibility to smoking.

CONCLUSIONS

These findings underscore the importance of tobacco control training and establishing smoke-free campuses for reducing susceptibility to smoking among medical students.

Anxiolytic consumption is associated with tobacco smoking and severe nicotine dependence. Results from the national French medical students (BOURBON) study

Tobacco smoking remains common among medical students, something which may impact on their abililty to promote smoking cessation during their future careers.

OBJECTIVES

To determine the prevalence of smoking and consumption among French medical students and explore the link between both the presence of psychosocial factors and consumption of psychotropic medication and the severity of nicotine dependence and daily smoking behavior.

METHODS

Medical students were recruited from 35 French universities of medicine through administration mailing lists and social networks, between December 13, 2016 and May 15, 2017. Data was collected via anonymized Internet questionnaire which included questions regarding current daily tobacco smoking behaviors. Severe nicotine dependence was defined by a short Fagerström test equal or >4.

RESULTS

10,985 medical students with a mean aged of 21.8 years (+/-3.3) were included, 31.6% of which were male. 2078 (18.9%) were identified as current daily tobacco smokers and 59 (2.8%) were classed as having severe nicotine dependence. In multivariate analyses, tobacco smoking was independently associated with anxiolytic consumption, alcohol use disorder, cannabis use disorder, financial difficulties, and history of sexual and physical assault. Severe nicotine dependence was independently associated with anxiolytic consumption, cannabis use disorder, domestic violence, physical assault and financial difficulties.

CONCLUSION

Tobacco smoking has been found in almost one on 5 medical students and is associated with anxiolytic consumption as well as professional and personal factors.

Effectiveness of a training course on smoking cessation knowledge and behaviour for health profession students: the SISMA project

Introduction

University students are at risk of starting smoking or continuing and increasing the consumption of tobacco products. The aim of the study was to assess the impact of the training course, Sisma Project, about smoking in healthcare degree courses, in terms of knowledge, behaviour and to evaluate the course.

Methods

SISMA project was a pre- post study about an intervention delivered to healthcare profession students about smoking and smoking cessation. It had a before-after design and was an online optional course available on the eLearning platform Moodle 2. The course was structured in four lessons of sixty minutes, a debate among experts and a final test of evaluation. The McNemar test was used to measure the effectiveness of Sisma on smoking behaviour of students after the intervention. Students rated the course assigning a score from one to ten, and expressed free comments about point of strength and weakness of Sisma project.

Results

The participants were 365 students, 28.5% males and 71.5% females, most were nursing 194 (53.2%) and dental hygienists students 105 (28.8%). Current smokers were 161 (44.1%) before and 142 (38.9%) after the course, there was statistical significant difference in smoking status after attending the course (p < 0.001). Students evaluated the course giving a high score with a mean of 8.13 (SD: 1.1); the main points of strength were the content (33.2%), the structure (15.6%) and knowledge given by the course (12.6%). The main point of weakness were the online structure 62 (37%), problem related to length and time 17 (10%) and the final test 15 (9%).

Discussion

Given the central role health professionals play in patient care, students need to be aware and trained in tobacco cessation techniques. Our results indicate that smoking behaviour significantly changed after attending a university course for smoking cessation and students appreciated its contents and structure.

Risk behaviors among Italian healthcare students: a cross-sectional study for health promotion of future healthcare workers

Background:

Risk behaviors are frequent among young adults and they are particularly relevant when considering healthcare students.

Objectives:

The study is aimed to examine the prevalence of smoking, binge drinking, physical inactivity, and excessive bodyweight in a population of healthcare students attending an Italian university.

Methods:

Healthcare students filled an anonymous multiple-choice questionnaire on the occasion of the occupational health visit that preceded their hospital internship. The questionnaire covered socio-demographic characteristics (including student’s working status and cohabitation) and risk behaviors. We evaluated the prevalence of risk behaviors and their association with socio-demographic characteristics.

Results:

The sample consisted of 494 students (65% women): 23.2% were smokers, 7.9% had excessive bodyweight, 35% did not practice any physical activity and 50% reported binge drinking at least once in the last 12 months. We found associations of male sex (30.5%) and being nursing students (29.9%) with smoking habit. The frequency of binge drinking was higher in men (38.4%), working students (53.9%), and among those who lived without family (50%). Physical inactivity was associated with female sex (44.2%) and living without family (57.1%). Finally, the co-presence of 2 risk behaviors or more was higher in men (36.8%), in nursing students (39.6%) and in working students (44.7%).

Conclusions:

Our findings regarding the prevalence of risk behaviors and their potential association with socio-demographic factors may be a clue to the definition of targeted strategies aimed at reducing of risk behaviors among healthcare students.

Perception of health professions students of their role model status in Toombak cessation: A cross-sectional study from Sudan

INTRODUCTION

Health professionals are to play an essential and effective role in tobacco control. Toombak is a popular form of smokeless tobacco, locally made and used among Sudanese. It is associated with oral and systemic health hazards, particularly oral cancer. This study was set out to assess health professions students' perception of their status as future role models for their patients and the public regarding Toombak use cessation and to explore socio-cognitive covariates of perceived role model status.

MATERIALS AND METHODS

A cross-sectional study was conducted in 2013-2014 using a self-administered questionnaire among health professions students enrolled in Medicine, Pharmacy, Dentistry and Nursing colleges in Khartoum state, Sudan. A total of 1530 participants were recruited from colleges using a cluster stratified sampling procedure.

RESULTS

The majority of the participants (88.2%) were 19-22 year old, females showed predominance (66.1%). Most of the participants (69.7%) scored good knowledge of Toombak-related therapies. The majority (97%) had a positive attitude towards banning Toombak use in public. Half of the participants (50.4%) confirmed availability of Toombak control policy in their college, while 66% reported receiving training in Toombak cessation. Only 9.2% of the participants reported that they have ever used Toombak; among them, 69.5% were current daily users. Less than half (47.8%) reported a positive perception of their status as a role model. Logistic regression model revealed that tobacco cessation training, availability of college policy and positive attitudes towards banning Toombak use in public were strong predictors of with a positive perception of role model status.

CONCLUSION

Imposing Toombak control policies within colleges combined with formal training in cessation methods, would reinforce the positive perception of health professions students as a role model, particularly the students themselves seem to be ready for such systematic training.

ALDH1 as a prognostic marker for lymph node metastasis in OSCC

Long-term survival in cases of head and neck squamous cell carcinoma, particularly oral squamous cell carcinoma (OSCC), remains a rare achievement in the field of clinical oncology. In recent years, the theory of cancer stem cells (CSCs) has emerged and been used to offer explanations for tumour recurrence and metastasis. The present aim was to investigate the role of aldehyde dehydrogenase 1 (ALDH1) as a CSC-marker for OSCC and to determine the role of p16^ink4a, which is also a surrogate marker of human papilloma virus (HPV), in the expression of ALDH1. The study cohort comprised of 186 surgically-treated cases of OSCC. The primaries were located in the oral cavity. The expression of the CSC marker (CSCM) ALDH1 was evaluated via immunohistochemistry (IHC) of a tissue microarray. HPV detection was performed by polymerase chain reaction and an HPV Array kit. Furthermore, the IHC expression of p16^ink4a was also analysed. Risk regression models as the Kruskal Wallis test was used to assess the association of CSCM and p16^ink4a expression with tumour size and lymph node metastasis, and cox proportional hazards were analysed. Additionally, coexpression of the markers ALDH1 and p16^ink4a was analysed with regard to associations with tumour classification. Overall, high expression of ALDH1 in lymph nodes was significantly associated with Union for International Cancer Control (UICC) stage IV (P=0.044) and T4 stage cancer (P=0.03). p16^ink4a positivity, in cases of HPV negativity, was associated with worse survival rate compared with that of the total cohort (P=0.048). Collectively the data indicate that ALDH1 expression may be suitable for detection of unfavourable prognosis in OSCC patients, based in part on its apparent role as a marker of metastasis. HPV status was not statistically predictive of patient outcome or CSCM expression; however, p16^ink4a remains a potential marker in HNSCC Further in vitro studies with ALDH1 and p16^ink4a should be performed to evaluate the expression of ALDH1 and HPV in cell culture and to clarify the role of ALDH1 as a marker for increased invasiveness of OSCC cells.

Short-term impact of the EuroPean Accredited Curriculum on Tobacco Treatment Training (EPACTT) program

INTRODUCTION

The aim of this pilot study was to assess the short-term effectiveness of the EuroPean Accredited Curriculum on Tobacco Treatment Training intervention in improving health care providers' knowledge, attitudes and self-efficacy related to tobacco dependence treatment.

METHODS

A pre-post pilot study was conducted. The two-day training intervention took place in Brussels in April 2016. Health care professionals from six European countries (Russia, Ukraine, Georgia, Armenia, Romania and Greece) were purposively invited to participate in the study. Evaluation was performed before the intervention, immediately after, and at approximately two months following the intervention. Changes in outcomes of interest were examined before and after exposure to the intervention program.

RESULTS

In all, 47 health care professionals participated in the training of which 40 completed the evaluation surveys. Significant increases in providers' self-efficacy and perceived behavioral control related to tobacco treatment delivery were documented immediately following the training and at the 2 months follow-up. Significant improvement in provider knowledge and attitudes were observed in some items assessed.

CONCLUSIONS

The results demonstrate that training is able to improve provider self-efficacy related to tobacco treatment delivery in this cross-national European sample of health care professionals. Additional research is required to examine the generalizability of our findings.

Cigarette, waterpipe and e-cigarette use among an international sample of medical students. Cross-sectional multicenter study in Germany and Hungary

Background

Tobacco use is the leading preventable cause of death worldwide. Besides cigarette smoking, waterpipe and e-cigarettes are gaining popularity among young adults. Medical students’ smoking behavior is of particular interest because of their impending role in health promotion as future physicians. Aim of our study is to examine the prevalence and predictors of cigarette, waterpipe and e-cigarette use and the association of tobacco use with self-reported health status in an international sample of medical students.

Methods

In a multicenter cross-sectional study data on different aspects of health behavior were collected from medical students of 65 nationalities using a self-administered questionnaire in Germany (Dresden, Munich) and Hungary (Budapest, Pécs). The survey was conducted among 1st, 3rd and 5th year students. To explore associations between smoking behavior and socio-cultural factors Pearson’s chi²-tests and multivariate binary logistic regression analyses were performed.

Results

The largest subpopulations were formed by German (n = 1289), Hungarian (n = 1055) and Norwegian (n = 147) students. Mean age was 22.5 ± 3.3 years. Females represented 61.6% of the sample. In the whole sample prevalence of cigarette smoking was 18.0% (95% CI 16.6–19.4%), prevalence of waterpipe use was 4.8% (95% CI 4.0–5.7%), that of e-cigarette 0.9% (95% CI 0.5–1.2%). More males (22.0%) than females (15.5%) reported cigarette smoking. The lowest prevalence of cigarette smoking was found among Norwegian students (6.2%). Cigarette smokers were older, waterpipe users were younger than non-users. E-cigarette use was not associated with age of the students. Religious involvement was protective only against cigarette smoking. Financial situation showed no association with any kind of tobacco consumption. Cigarette smokers and e-cigarette users were less likely to report very good or excellent health status.

Conclusions

Cigarette smoking is still the most popular way of consuming tobacco, although alternative tobacco use is also prevalent among medical students. To further health consciousness, medical schools should pay more attention to students’ health behavior, especially their smoking habits. Tobacco prevention and cessation programs for medical students should consider not only the health risks of cigarette smoking but the need to discourage other forms of tobacco use, such as waterpipe.

GHPSS Multicenter Italian Survey: Smoking Prevalence, Knowledge and Attitudes, and Tobacco Cessation Training among Third-Year Medical Students

Aims and background

Healthcare professionals have an important role to play both as advisers – influencing smoking cessation – and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach.

Methods and study design

A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows.

Results

Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03–3.97).

Conclusions

This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Air pollution as a catalyst for supporting tobacco control policies? Evidence from a nationwide study on Chinese medical students

PURPOSE

Few studies have discussed how the increasing ambient air pollution may affect policy-related attitudes. Medical professionals constitute an important interest group who analyse and solve public issues within a medicalised framework. The current study investigates whether ambient air pollution is associated with a greater likelihood of supporting tobacco control measures among medical students.

METHODS

We conducted multistage sampling among the medical students from 42 cities in China. We employed propensity-score matching to eliminate the selection bias and used multilevel logistic regressions for the main analysis (n1=9458, n2=42).

RESULTS

we found that city-level air particulate matter is consistently associated with the support for tobacco control among medical students, net of other individual-level and city-level covariates. For one standard increase in air particulate matter, people are 1.21 times more likely to fully support tobacco control measures (p<0.05). This association is significantly stronger among medical students who are financially worse-off and are ethnic majority.

CONCLUSIONS

Environmental pollution has a significant correlation with people's attitudes towards health policies, even when such policies are not directly concerned with the natural environment. Policy makers may use this opportunity to implement tobacco control measures against the backdrop of China's pollution crisis.

Smoking-Related Attitudes and Knowledge Among Medical Students and Recent Graduates in Argentina: A Cross-Sectional Study

BACKGROUND

Physicians in Argentina smoke at rates similar to the general population, and do not have a clear role in tobacco control strategies.

OBJECTIVE

To describe the attitudes and knowledge of medical students and recent graduates towards smoking behavior in Argentina.

DESIGN

Cross-sectional self-administered online survey conducted in 2011.

PARTICIPANTS

Medical students and recent medical graduates from the University of Buenos Aires.

MAIN MEASURES

Attitudes and knowledge were evaluated by responses to 16 statements regarding the effects of smoking cigarettes and the role of physicians in tobacco control. Rates of agreement with a full ban on indoor smoking in different public settings were assessed.

KEY RESULTS

The sample included 1659 participants (response rate: 35.1 %), 453 of whom (27.3 %) were current smokers. Only 52 % of participants agreed that doctors should set an example for their patients by not smoking, 30.9 % thought that medical advice had little effect on patients' cessation behavior, and 19.4 % believed that physicians could decline to care for smoking patients who failed to quit. In adjusted logistic regression models, current smokers had less supportive attitudes about tobacco control and were less likely than non-smokers to agree with a full indoor smoking ban in hospitals (OR: 0.30; 95 % CI 0.16-0.58), universities (OR: 0.55; 95 % CI 0.41-0.73), workplaces (OR: 0.67; 95 % CI 0.50-0.88), restaurants (OR: 0.42; 95 % CI 0.33-0.53), cafes (OR: 0.41; 95 % CI 0.33-0.51), nightclubs (OR: 0.32; 95 % CI 0.25-0.40), and bars (0.35; 95 % CI 0.28-0.45). Recent medical graduates had more accurate knowledge about cessation and were more likely to agree with a full smoking ban in recreational venues.

CONCLUSIONS

Although most participants reported a strong anti-tobacco attitude, a proportion still failed to recognize the importance of their role as physicians in tobacco control strategies. Current smokers and current students were less likely to support indoor smoking bans. Specific educational curricula could address these factors.

Attitudes of students of a health sciences university towards the extension of smoke-free policies at the university campuses of Barcelona (Spain)

OBJECTIVE

To assess attitudes towards the extension of outdoor smoke-free areas on university campuses.

METHODS

Cross-sectional study (n=384) conducted using a questionnaire administered to medical and nursing students in Barcelona in 2014. Information was obtained pertaining to support for indoor and outdoor smoking bans on university campuses, and the importance of acting as role models. Logistic regression analyses were performed to examine agreement.

RESULTS

Most of the students agreed on the importance of health professionals and students as role models (74.9% and 64.1%, respectively) although there were statistically significant differences by smoking status and age. 90% of students reported exposure to smoke on campus. Students expressed strong support for indoor smoke-free policies (97.9%). However, only 39.3% of participants supported regulation of outdoor smoking for university campuses. Non-smokers (OR=12.315; 95% CI: 5.377-28.204) and students ≥22 years old (OR=3.001; 95% CI: 1.439-6.257) were the strongest supporters.

CONCLUSIONS

The students supported indoor smoke-free policies for universities. However, support for extending smoke-free regulations to outdoor areas of university campuses was limited. It is necessary to educate students about tobacco control and emphasise their importance as role models before extending outdoor smoke-free legislation at university campuses.

Do socio-cultural factors influence medical students' health status and health-promoting behaviors? A cross-sectional multicenter study in Germany and Hungary

BACKGROUND

Physical and mental health is important for coping with the high requirements of medical studies that are associated with a higher risk for severe stress, insomnia, smoking, harmful alcohol consumption and easier access to drugs. Health behaviors of medical students influence not just their own health but also the health of their future patients. We examined whether socio-cultural factors can explain differences in students' health status and health-promoting behaviors.

METHODS

A multicenter cross-sectional survey in Germany (Dresden, Munich) and Hungary (Budapest, Pécs) enclosed international medical students in their 1st, 3rd and 5th academic years. The students were invited to voluntarily and anonymously complete a questionnaire on different aspects of health behavior during obligatory seminars and lectures in 2014. The response rate of the total sample was 56.2 % (n = 2935); the subgroup analysis enclosed data of German (n = 1289), Hungarian (n = 1057) and Norwegian (n = 148) students.

RESULTS

A high number of Norwegian students (84.5 %) assessed their health status as very good/excellent. In comparison, only 60.3 % of the Hungarian and 70.7 % of the German participants reported a very good/excellent health status. The distributions were comparable between the study sites. Although gender, financial situation and nationality were significant health status predictors, they could explain only 8.2 % of the total variance of health status in the multivariable model. A comparably high number of Hungarian students (95.3 % vs. 67.4 % German and 56.7 % Norwegian) reported that they can currently do a lot/very much for their health. In contrast, a significant number of Norwegians (73.0 % vs. 63.7 % Hungarian and 51.5 % German) reported that they currently do a lot/very much for their health (chi(2)-test, p ≤ 0.001). Financial situation, study site and study year were the strongest predictors for health promotion activities (Nagelkerkes R(2) = 0.06).

CONCLUSIONS

Based on our study, gender and study year played only a minor role in the health status and health promotion beliefs and activities of medical students. Structural (study site) and somewhat socio-cultural factors (nationality, financial situation) mainly explained the differences regarding health promoting behaviors. Obligatory, free-of-charge courses for health promotion (activity and relaxation) should be included in study curriculums.

Medical students' health behaviour and self-reported mental health status by their country of origin: a cross-sectional study

BACKGROUND

Numerous previous studies have investigated the lifestyle and self-perceived health status of medical students. This study examined whether students' country of origin contributed to their mental health and health risk behaviour.

METHODS

We conducted our cross-sectional questionnaire survey over four consecutive years (2009-2012). The target population was fourth-year English- and Hungarian-language course medical students at Semmelweis University, Hungary. We gathered data on medical students' health behaviour (tobacco smoking, alcohol consumption, dietary habits and exercise) and mental health status and used analysis of variance (ANOVA) to examine the association between country of origin and mental health.

RESULTS

The response rate was 76.1 % for the Hungarian and 63.4 % for the English course students. The mean age of our sample was 24.1 years (SD = 2.42). Only 15.3 % of students reported following dietary recommendations, but 75.0 % reported engaging in vigorous and regular physical exercise. The prevalence of tobacco smoking was 18.6 % and 13.8 % overconsumed alcoholic beverages. Hungarian and Iranian students reported lower mental well-being than Mediterranean, Israeli and Scandinavian students (F(4) = 18.943, p < 0.001, η(2) = 0.103). Results of the multiway ANOVA indicated that both country of origin and exercise showed a significant relationship with mental health: vigorous exercise was associated with better mental health status (F(1) = 5.505, p = 0.019).

CONCLUSIONS

Medical students' mental health and health behaviour are associated with multiple factors. One of these is country of origin but exercise may also influence mental health. Health promotion programmes organised for medical students should take their country of origin into consideration and should include physical activity.

[Prevalence and factors associated with clinical counselling on drug use among internal specialists residents of Andalusia (Spain)]

OBJECTIVES

To determine the frequency of offering clinical counseling against the consumption of alcohol, tobacco and illegal drugs by internal specialist residents (EIR) of Andalusia, and the factors related to such advice.

DESIGN

Multicenter cross-sectional study by self-administered questionnaire sent by mail.

SETTING AND PARTICIPANTS

EIR of Andalusia.

MAIN MEASUREMENTS

The questionnaire collected the frequency of counseling against the use of alcohol, tobacco and illegal drugs (dependent variable).

INDEPENDENT VARIABLES

age/gender, specialty, drug consumption and Fagerström test.

RESULTS

Out of a total of 4245 participants, 66% responded, 29% did not respond, and 5% poorly completed questionnaires. The mean age was 29.1(±SD 5.1) years, 69% female, 89% Spanish nationality, 84% in medical training (73% hospital, 27% family medicine). The frequency of counseling against tobacco (85%) and alcohol (82%) is higher than illegal drugs (56%, p<.001, χ(2) test). Counseling against alcohol consumption is related to family medicine (OR=2.8; 95% CI [1.4-4.6]) and nursing (OR=2.5 [1.7-4.4]), and the age of first alcohol consumption (OR=1.07 [1.03-1.1]). Counseling against smoking is related to family medicine (OR=12.9;[7.6-21.9]) and nursing (OR=8.4;[4.3-16.5]), personal consumption of tobacco (OR=1.5 [1.2-2.0]), and wine (OR=1.1 [1.04-1.3]), and age of first alcohol consumption (OR=1.06 [1.01-1.1]). Counseling against illegal drugs is related to the age of first alcohol consumption (OR=1.09 [1.05-1.1]) and smoking (OR=.58 [.4-.7]).

CONCLUSION

There is a high frequency of counseling against consumption of tobacco and alcohol by EIR, although remarkably smaller for illegal drugs. The influencing factors are both formative elements of their own specialty such as personal consumption of alcohol and tobacco, which should be considered for improvement of this preventive activity.

Alcohol, cigarette, and illegal substance consumption among medical students: a cross-sectional survey

This study investigated addictive substance use by French medical students. A cross-sectional survey was distributed to 255 participants randomly selected from 1,021 second- to sixth-year medical students. Questionnaires were self-administered and included questions on sociodemographic characteristics, mental health, and alcohol (The Alcohol Use Disorders Identification Test [AUDIT test]), tobacco (Fagerstrom test), and illegal substance consumption (Cannabis Abuse Screening Test [CAST test]). The AUDIT scores indicated that 11% of the study participants were at risk for addiction and 21% were high-risk users. Tobacco dependence was strong or very strong for 12% of the participants. The CAST score showed that 5% of cannabis users needed health care services. Cannabis users were also more likely than non-users to fail their medical school examinations (89% vs. 39%, p<.01). One quarter of medical student participants (n=41) had used other illegal drugs, and 10% of study participants had considered committing suicide during the previous 12 months. Psychoactive substance consumption by French medical students requires preventive measures, screening, and health care services.

Tobacco Smoking Habits Among First Year Medical Students, University of Prishtina, Kosovo: Cross-sectional Study

Introduction:

Tobacco smoking remains the leading causes of preventable morbidity and mortality in the world, requiring intensified national and international public health response. World Health Organization (WHO) has urged health professional organizations to encourage and support their members to be models for not using tobacco products and promote tobacco-free culture. Healthcare students are the future authority of the health society, they are in a position to play a vital role and have impact on social norms related to smoking.

Aim:

To determine the prevalence of tobacco smoking among healthcare students of Medical Faculty, University of Prishtina in Kosovo, so that recommendations can be made for its cessation among healthcare providers and thereafter the community.

Materials and methods:

Descriptive cross-sectional study was conducted using self-administrated questionnaire prepared for this purpose. A total of 284 first year healthcare students of Medical Faculty, University of Prishtina in Kosovo were enrolled in the study. The data were analyzed using SPSS 22.

Results:

All respondents completed the questionnaire, giving a response rate of 100% (general medicine=180, dentistry = 104). The prevalence of students who have ever smoked was 53.2%. However, only 8.9% (9.1% M vs. 8.7% F) of the general medicine students and 5.8% (4.8% M vs. 6.5% F) of dentistry students declared that smoke tobacco every day. Overall, the research shows that the prevalence of occasional smokers among medical students in Kosova is quite high.

Cigarette smoking behavior and the related factors among the students of mashhad university of medical sciences in iran

Background:

Tobacco consumption is the second major cause of death and the fourth most common risk factor for diseases, worldwide. Epidemiologic studies have traced the use of alcohol, tobacco, and illicit substances among medical students and physicians.

Objectives:

The current study aimed to investigate the prevalence of cigarette smoking and the related factors among the students of medical sciences in Mashhad University of Medical Sciences, Mashhad, Iran.

Patients and Methods:

This cross-sectional study was conducted on 946 health professional students in Mashhad University of Medical Sciences (MUMS, Iran) in autumn 2008. A standard self-administered questionnaire consisting of socio-demographic data, participant smoking status, family and peer smoking, attitudes and beliefs about smoking, awareness of cigarette negative effects and reasons for smoking cessation was used in the current study.

Results:

Among the students, 18.3% reported having ever tried or experienced with cigarette smoking. The overall prevalence of cigarette smoking was 9.8% with significant differences in prevalence rates by gender, 17.6% among males and 4.2% among females. Starting and continuing smoking was significantly correlated with the family cigarette consumption habits. The most common reason to start smoking was friends (24.9%) and the most important reason to continue smoking was personal life distress (17.6%). The majority of participants (92.3%) reported that they were aware of the hazards of smoking. A significant difference regarding awareness of smoking hazards was observed between smokers and non-smokers. The most important preventive factor for cigarette smoking was religious beliefs (69.1%).

Conclusions:

Although the prevalence of regular smokers among health professions students of MUMS was lower than general populations, but this level is still alarming and points at the rapid growth of cigarette use, especially among female students. Medical schools should work harder to tackle this phenomenon and address it more efficiently in their curricula.

[Characteristics of smoking, nicotine dependence and motivation for change in specialists training in health sciences (residents) in Andalusia (Spain)]

OBJECTIVE

As there are few studies on the smoking habits of specialists training in health sciences (residents), it is of interest to determine the prevalence of smoking, nicotine dependence and motivation for change, and their relationship with other variables (personal, work and consumption of other drugs).

MATERIAL AND METHODS

A multicentre, cross-sectional study using a questionnaire was conducted in 2012. All the residents who were studying in Teaching Health Centres in Andalusia (Spain) completed a questionnaire, which was sent by e-mail, collecting: age, sex, specialty, country of origin, qualitative-quantitative consumption of tobacco, age of onset/cessation, Fagerström test and stage of change (Proschaka).

RESULTS

A total of 2667 residents (63% of total) completed the questionnaire. The mean age was 29.1 years (± 5.2), 69% female, 89% Spanish, and 86% physicians. Of the 17% who smoked (daily pattern-47%, intermittently-41%, related to leisure-3%), starting at 17.4 years (±3.5) and mean of 7.5 cigarettes per day (±7.1), higher medical specialties (P=.067 ANOVA), and in men (P=.074, Student-t). More than three-quarters (82%) had a low nicotine dependence, being higher in hospital medical specialties (P=.078 χ(2)). Of the total, 7% were former smokers, and 48% wanted to quit smoking (contemplation 38%, preparation 10%). In the multivariate analysis there was a link between smoking and alcohol consumption (OR 2.84) and illegal drugs (OR 3.57). There were no differences by age or country.

CONCLUSIONS

The consumption of tobacco in residents is less than the general population, with a low dependence and better willingness to change. The period of specialised training is a good time to offer tobacco interventions.

Fighting against cigarette smoking among medical students: a success story

A survey in the year 2007 among medical students of Ankara University Medical School to assess the smoking rates showed that 25.1 % of them were smoking. Moreover, the smoking rate was 35 % at sixth grade students and 60 % of the smokers specified that they started smoking at medical school. This report provides a successful approach to decrease smoking among medical students by measures against starting smoking. An "Antismoking Group" composed of voluntary academic staff, nurses, students, psychologists, and a social worker of the medical school was established to engage in lowering the smoking rate and eliminating it eventually among our students. Several methods including regular monthly meetings, annual "Smoking or Health" symposiums, and lectures to first, second, and third grade students to increase their awareness related to harms of smoking and their role in the fight against smoking were carried out. Our surveys in the years 2009 (641 students) and 2012 (975 students) showed that total smoking rates dropped to 15.0 and 11.0 %, respectively (p < 0.0002). Moreover, the smoking rate for the sixth grade students dropped from 35.0 % in 2007 to 21.8 and 8.8 % in the years 2009 and 2012, respectively (p < 0.0002). In 2012, the smoking rates of first year and sixth year students were 7.8 and 9.0 %, respectively. These close rates of smoking at the first and last years of medical school training and the significant drop in smoking rates in 5 years confirm that our group pursued a realistic and successful strategy against smoking.

Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies

BACKGROUND

To investigate the efficacy and the adverse effects (AEs) of the electronic cigarette, we performed a systematic review of published studies.

METHODS

We selected experimental and observational studies examining the efficacy (as reduction of desire to smoke and/or number of cigarettes smoked and/or quitting or as reduction of nicotine withdrawal symptoms) and the safety of EC (AEs self-reported or clinical/laboratory). The following search engines were used: PubMed, ISI Web of Knowledge and Cochrane Controlled Trials Register.

RESULTS

Finally, six experimental studies and six cohort studies were included. In the prospective 12-month, randomized controlled trial, smoking reduction was documented in 22.3 and 10.3% at Weeks 12 and 52, respectively (P < 0.001 versus baseline). Moreover, two cohort studies reported a reduction in the number of cigarette/day (from 50 to 80%) after the introduction of the EC. 'Mouth and throat irritation', 'nausea', 'headache' and 'dry cough' were the most frequently AEs reported.

CONCLUSIONS

The use of the EC can reduce the number of cigarettes smoked and withdrawal symptoms, but the AEs reported are mainly related to a short period of use. Long-term studies are needed to evaluate the effects of the EC usage after a chronic exposure.