Self-reported tobacco smoking practices among medical students and their perceptions towards training about tobacco smoking in medical curricula: A cross-sectional, questionnaire survey in Malaysia, India, Pakistan, Nepal, and Bangladesh

Non-communicable disease risk reduction training for medical graduates in India: context, challenges and opportunities

Physicians' hold pivotal roles in improving non-communicable diseases (NCDs). Studies conducted in India revealed that physicians' feel unprepared to address NCDs risk reduction and provide counseling. We conducted a gap analysis using desk reviews to identify inclusion of NCD risk reduction in medical curricula, and a scoping review to assess knowledge, attitude, perception, and practice related to NCD risk reduction among the undergraduate medical students in India. We also conducted key-informant interviews to understand perceptions among medical students and physicians. We found a lack of knowledge about NCDs and strong interest and perceived need for NCD risk reduction training among both medical students and their teachers. Our findings suggest promoting NCD prevention by physicians and allied health workers in clinical settings can enable the learning environment for medical students to adopt these practices.

Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial

BACKGROUND

Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings.

OBJECTIVE

We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling.

DESIGN

Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India.

PARTICIPANTS

Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking.

INTERVENTION

A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge.

MAIN MEASURES

The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training.

KEY RESULTS

Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001).

CONCLUSIONS

Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates.

TRIAL REGISTRATION

URL: http://www.

CLINICALTRIALS

gov . Unique identifier: NCT03521466.

Tobacco Cessation Curriculum in Medical Schools: a Scoping Review

This scoping review aims to identify interventional training courses on tobacco cessation counseling skills of medical students, identify the most appropriate teaching method, and the ideal stage to provide such training. We retrieved articles published since 2000 from two electronic peer-reviewed databases (PubMed and Scopus) and hand-searched reference lists of selected articles. Articles published in English, with a clearly defined curriculum, reporting knowledge, attitude, cessation counseling skills of medical students post-training, and cessation-related outcomes of patients participating in student-led counseling sessions, were considered for inclusion. We used the York framework to guide this scoping review. First, data from studies meeting the inclusion criteria were charted using a standardized form. Subsequently, related studies were organized under three themes that emerged in the review process-lectured-based, web-based, and multi-modal curriculum. We concluded that a short but focused lecture-based curriculum combined with peer role-play or standardized/real patient interactions effectively develops the necessary knowledge and skills of undergraduate medical students to provide tobacco cessation counseling to patients. However, studies consistently report that the gains in knowledge and skills after cessation training is acute. Therefore, continued participation in cessation counseling and periodic review of cessation-related knowledge and skills post-training is warranted.

Perceptions and preparedness toward tobacco cessation counseling amongst clinical medical students in Chongqing, Southwest China: A cross-sectional study

Background

Medical students play an indispensable role in providing smoking cessation counseling. Despite the rapid increase in tobacco use, there is little data on what Chinese medical students know or are taught about it. This study aims to investigate the relationship between medical students' tobacco education level, clinical experience, and tobacco cessation counseling (TCC) provided by medical students.

Methods

This cross-sectional study was carried out among clinical medical students of Chongqing medical university. An anonymous, self-administered questionnaire included items on demographic information, perceptions, and perceived preparedness, clinical medical students' self-reported level of education about alternative tobacco products, and traditional cigarettes. We assessed their perspectives toward TCC using a 5-point Likert scale. Descriptive and binary logistic regression analyses were carried out.

Results

A total of 1,263 medical students completed the questionnaire. The majority of students (85%) expressed a willingness to provide TCC to patients in need. However, only half of the students stated unequivocally that they knew some ways and methods of tobacco cessation, while 18% stated that they did not know methods of tobacco cessation. Tobacco education and clinical experience were significantly associated with the ability to provide TCC. Our findings revealed that students with more clinical experience (undergraduates: B = 0.326, P &lt; 0.001; postgraduates: B = 0.518, P &lt; 0.001) were significantly more likely to have a greater self-reported comprehensive ability to provide TCC.

Conclusion

Tobacco education and clinical experience can enhance the ability of medical students to provide smoking cessation counseling. There is a need to focus on alternative tobacco products with changing times, and curriculum planners should collaborate to incorporate comprehensive tobacco prevention and cessation training into the medical school curriculum.

Magnitude of Substance Use and Its Associated Factors Among the Medical Students in India and Implications for Medical Education: A Narrative Review

BACKGROUND

Medical students are at an increased risk of developing substance use and related problems (SURP) because of the inherent stress associated with the professional medical course apart from the developmental risk factors. However, this is under-researched. Moreover, a comprehensive review on the prevalence of SURP among the medical undergraduates (UGs) and associated factors is lacking from India. To fill this gap, the current research work is aimed to review the existing literature on the magnitude of the SURP among UGs of India and its determinants.

METHODS

PubMed, Medline, and Google Scholar databases were searched for the original articles studying the prevalence of SURP among medical UGs of India, published from inception till date. Non-original articles, studies on behavioral addictions, and those not directly assessing the prevalence of SURP among the medical UGs were excluded.

RESULTS

A total of 39 studies were found eligible for the review. Alcohol (current use: 3.2%-43.8%), followed by tobacco (3.7%-28.8%) and cannabis (1.6%-15%), were the common substances used by the medical students. Among the females, an increasing trend of substance use, particularly of nonprescription sedatives (even higher than males), alcohol, and smoking, was seen. Family history, peer pressure, transition from school to college life, and progression in the medical course were important associated factors.

CONCLUSION

Sensitizing medical students and college authorities, increasing the duration of training on SURP in medical curricula, and providing psychological support for the students with SURP could address this issue.

Evaluation of smoking prevalence, secondhand smoke exposure, attitudes of tobacco control, and smoking cessation knowledge among pharmacy and medical students in a private university, Malaysia

Background:

Tobacco use is one of the leading causes of premature morbidity and mortality globally, causing over eight million deaths per year. One of the best approaches to reduce smoking-related deaths is to encourage future health-care professionals in tobacco control programs.

Objectives:

To assess the smoking prevalence, secondhand smoke exposure, attitudes toward tobacco control, and smoking cessation knowledge and associated factors among pharmacy and medical students in a private university in Malaysia.

Methodology:

A cross-sectional study was conducted at two campuses of a private University in Malaysia, and the data were collected online using the Global Health Professionals Students Survey questionnaire and analyzed using IBM-SPSS Version 20.

Results:

The overall smoking prevalence was 1.6% (P = 0.009). The exposure to secondhand smoke was 21% and 39% at home and in public places, respectively. About 92% of respondents had a good attitude toward tobacco control, whereas 53.4% had good smoking cessation knowledge. However, only 39.4% of the respondents had received formal smoking cessation training. Logistic regression revealed that significant predictors toward tobacco control are the ban of tobacco sales to adolescents, ban on the advertising of tobacco products, ban of smoking in restaurants, and obtaining a specific training on cessation techniques.

Conclusions:

The prevalence of smoking among pharmacy and medical students was low, but exposure to secondhand smoke was higher. Most of the respondents had a positive attitude and good knowledge of smoking cessation. However, future training needs to be conducted among upcoming health-care professionals to act as a role model for community transformation.

The extent of formal tobacco cessation training received by student health professionals and the prevalence of tobacco use among them: a cross-sectional study

Background: Advice from health care professionals (HCPs) is critical for tobacco prevention and cessation efforts. The academic curricula for health care professional students (HCS) lack comprehensive training in assisting patients in tobacco cessation. Tobacco use among HCP’s deters them from giving proper tobacco prevention and cessation guidance. The objective of this study was to determine the prevalence and determinants of tobacco consumption in third-year students of four health care disciplines (medical, dental, pharmacy, and nursing) and to assess their undergraduate education on tobacco control and cessation. Methods:  A web-based survey (response rate 84.4%) employing the Global Health Professions Student Survey (GHPSS) questionnaire; n= 838; [20.89 (SD± 0.94) years] was conducted in Mysore, India. A descriptive, comparative and multivariate analysis was performed. Results: The number of students who received formal training in smoking cessation approaches was only 14.04%. In total, two-thirds of medical students, compared to 38.9% of dental, 29.7% of pharmacy, and 11.40 % of nursing students, learned “the reasons why people smoke” as a part of their formal training. However, only less than a quarter of the study population were aware of the role of antidepressants in nicotine cessation medications. The total prevalence of tobacco use was 28.9%. A total of 37.72% wanted to quit smoking, while a mere 1.2% had sought any professional help to do so. Conclusions: Tobacco use in HCS, apart from personal health risks to themselves, may potentially affect their future commitment to support patients in tobacco cessation. There is a need for further research into tobacco prevention and cessation programs tailored to the needs of student groups. There is a need for an updated curriculum for tobacco cessation strategies and more research into better cessation strategies.

The extent of formal tobacco cessation training received by student health professionals and the prevalence of tobacco use among them: a cross-sectional study

Background: Advice from health care professionals (HCPs) is critical for tobacco prevention and cessation efforts. The academic curricula for health care professional students (HCS) lack comprehensive training in assisting patients in tobacco cessation. Tobacco use among HCP’s deters them from giving proper tobacco prevention and cessation guidance. The objective of this study was to determine the prevalence and determinants of tobacco consumption in third-year students of four health care disciplines (medical, dental, pharmacy, and nursing) and to assess their undergraduate education on tobacco control and cessation. Methods:  A web-based survey (response rate 84.4%) employing the Global Health Professions Student Survey (GHPSS) questionnaire; n= 838; [20.89 (SD± 0.94) years] was conducted in Mysore, India. A descriptive, comparative and multivariate analysis was performed. Results: The number of students who received formal training in smoking cessation approaches was only 14.04%. In total, two-thirds of medical students, compared to 38.9% of dental, 29.7% of pharmacy, and 11.40 % of nursing students, learned “the reasons why people smoke” as a part of their formal training. However, only less than a quarter of the study population were aware of the role of antidepressants in nicotine cessation medications. The total prevalence of tobacco use was 28.9%. A total of 37.72% wanted to quit smoking, while a mere 1.2% had sought any professional help to do so. Conclusions: Tobacco use in HCS, apart from personal health risks to themselves, may potentially affect their future commitment to support patients in tobacco cessation. There is a need for further research into tobacco prevention and cessation programs tailored to the needs of student groups. There is a need for an updated curriculum for tobacco cessation strategies and more research into better cessation strategies.

Burden, prevention and control of tobacco consumption in Nepal: a narrative review of existing evidence

Tobacco consumption is one of the major public health problems in the world. Annually, 27 100 premature deaths are attributed to tobacco-related diseases in Nepal. Despite enacting different policies and strategies, the prevalence of tobacco consumption is still high. This study aims to synthesize prevalence, factors associated with its consumption and the policy initiatives for prevention and control in Nepal. This review includes peer-reviewed studies retrieved from two databases (PubMed and EMBASE) and published from 2000 to 2018, and policy initiatives on tobacco prevention and regulations in Nepal. A total of 32 studies and 5 policy documents were reviewed. Findings suggest that tobacco consumption was higher among men, illiterates, older people, people living in rural and mountainous areas and those who initiated smoking as adolescents. Peer pressure and parental/family smoking were major contributing factors for tobacco initiation. Policy analysis showed that low excise tax, weak monitoring mechanisms, poor compliance to bans on the advertisement and promotion of tobacco, smoke-free zones and insufficient programs on tobacco cessation were the major factors behind weak implementation of tobacco-control policies. Hence, targeted and high-risk group tobacco-cessation interventions, increasing taxation and strict policy implementation are crucial for effective tobacco prevention and control in Nepal.

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.

Predictors of health behaviours among Indian college students: an exploratory study

Purpose

The purpose of this study is to understand the association between health behaviours of diet, physical activity, smoking cigarettes, alcohol consumption, safe sex and sleep quality with demographic (e.g. age, gender) and psychological (i.e. stress, self-esteem and sense of coherence) factors in Indian residential college students.

Design/methodology/approach

Students studying for Bachelor of Technology at residential colleges in India were invited to complete an online questionnaire regarding their health behaviours, demographics and psychological variables. Each health behaviour was regressed onto demographic and psychological factors to determine which of them were associated with performing each behaviour.

Findings

There was no clear pattern of predictors for the health behaviours overall. Self-esteem was related to healthy diet, being single was related to adequate sleep, higher parental income was related to safer sex and being older was related to more alcohol use and safer sex.

Research limitations/implications

This study revealed that health education efforts may need to be designed for specific behaviours and correlates among Indian college students. Interventions regarding (1) healthy eating should target students with lower self-esteem, (2) sleep should target students in a relationship and (3) safer sex should target younger students and those from less affluent backgrounds.

Originality/value

This research is one of the first attempts to study the predictors of health behaviours among Indian college students. The study highlighted that psychological factors (e.g. self-esteem) and demographic factors (e.g. relationship status, parental income, age) affect different health behaviours. These findings can help health educators to design tailored interventions and aid in health education and promotion among Indian college students.

Cigarette smoking dose-response and suicidal ideation among young people in Nepal: a cross-sectional study

BACKGROUND

Worldwide, tobacco smoking is a major risk factor for morbidity and early mortality among adult population. The present study aimed to find out the association between current smoking and suicidal ideation among young people in Nepal.

MATERIALS AND METHODS

A cross-sectional questionnaire-based survey was carried out among 452 youths from Pokhara, Nepal. The present study included both genders (age 18-24 years) who were smokers as well as non-smokers.

RESULTS

Across the study period, 452 participants were identified after matching for age, and sex (226 in the smoking group and 226 in the non-smoking group). The mean age of participants was 21.6±1.2 years and 58.8% were males. The overall rate of suicidal ideation in our cohort was 8.9%. Smokers were slightly more likely to report suicidal ideation than non-smokers (aOR 1.12). The risk of developing suicidal ideation was 3.56 (95% CI 1.26-10.09) times more in individuals who smoked greater than 3.5 cigarettes per week (p=0.01).

CONCLUSION

The rate of suicidal ideation was slightly higher among smokers and a dose-response relationship was identified with the number of cigarettes smoked per week. Being aware of the link between smoking and suicidal ideation may help health care professionals working with young people to address more effectively the issues of mental well-being and thoughts about suicide.

Tobacco - Use Prevalence, Exposure, Attitudes, Behaviour/Cessation, Curriculum among Health Professional Students in Mangalore City, Karnataka, India

Background

Tobacco use is one of the leading preventable causes of premature death, disease and disability around the world. Medical and Dental graduates have an important role to play in tobacco cessation and prevention. Hence, the present study was undertaken to assess the tobacco use prevalence, practice, attitudes towards policy making and curriculum in medical and dental interns (house surgeons).

Methods

A cross sectional questionnaire based survey was carried out among interns in all the medical and dental colleges of Mangalore city. Global Health Professional Students Survey (GHPSS) questionnaire given by the Center for Disease Control (CDC) was modified and adopted.

Results

In the present study among 512 interns, 263 and 249 interns belonged to dental and medical fraternity respectively The prevalence of current smokers of cigarette was significantly higher among medical interns (32.1%) than the dental interns (20.2%), whereas no significant difference was evident amongst the dental (44.9%) and medical (41.8%) interns under the ever smokers category. A significant difference (p < 0.001) in the attitude of dental and medical college interns was observed towards tobacco use, policy making and their knowledge about the curriculum.

Conclusion

This study shows health professionals lacking specific training in tobacco counseling, all of which indicate a need for including a standardized syllabus to train health professionals in medical and dental schools related to tobacco its ill-effects, cessation and policy making.

Design and Validation of an Instrument to Evaluate the Learning Acquired by Nursing Students from a Brief Tobacco Intervention (BTI-St©)

The aim of this study was to design and validate an instrument, based on the WHO 5As+5Rs model, to test the acquisition by nursing students of a brief tobacco intervention (BTI) learning. A validation design of an instrument following the criterion referenced tests model using videos of simulated BTIs in the primary care setting was carried out. The study included 11 experts in smoking prevention/care and 260 second-year nursing students. The study was in two stages: (1) selection and recording of clinical simulations (settings), and (2) test construction. Content was validated by applying the Delphi consensus technique and calculating the Content Validity Ratio (CVR) and Content Validity Index (CVI). A pilot test was conducted for item analysis. Reliability was evaluated as internal consistency (Kuder-Richardson [KR-20]) and test-retest temporal stability (intraclass correlation coefficient [ICC]). Three simulation settings were recorded. An instrument (BTI-St^®) was developed with 23 items for dichotomous (yes/no) response. CVR was >70% for all items, KR-20 of 0.81-0.88, and ICC between 0.68 and0.73 (p < 0.0001). The BTI-St^® is a robust and reliable instrument that is easily and rapidly applied. It follows the WHO 5As+5Rs model and offers objective criterion-referenced evaluation of BTI learning in nursing students.

Smoking Perceptions and Practice among Nursing Students in Kabupaten Kupang, Indonesia

Objective:

Several studies have offered evidence of the importance of nursing-led interventions in smoking cessation. However, other studies have found that negative perceptions and smoking among nurses were barriers to them providing such interventions. The purpose of this study is to investigate smoking prevalence among nursing students and the demographic predictors of smoking, as well as perceptions about their roles with regard to smoking behaviour.

Methods:

A cross-sectional, self-administered, anonymous survey was conducted with all nursing students of the Maranatha School of Health Science in Indonesia. Smoking status, individual and familial characteristics including socio-economic status, and smoking cessation-related knowledge and attitudes were examined.

Result:

From the population of 313 students, 197 (62.9%) completed questionnaires were included in the analysis. The prevalence of current smoking for participants overall (25.9%) and males (52.4%) were similar to general population smoking rates in East Nusa Tenggara Province (25.9% overall and 52% for males) but lower than national rates (39% and 75.2%). However, the smoking rate among female participants (7%) was higher than national (2.9%) and regional (0.8%) female smoking rates. The majority of participants were aware of smoking health-related risk (87.3%) and supportive of giving smoking cessation advice (96.4%). In terms of seeing themselves as role models by not smoking at all, approximately 97% non-smokers agreed whereas only 60.8% of smokers agreed. Gender and being supportive of being role models by not smoking at all were significant predictors of the smoking status.

Conclusion:

This study suggests that smoking prevalence among nursing students is high. Despite most of the students having good smoking-related knowledge and having supportive attitudes towards providing smoking cessation services, high smoking prevalence is known to be an impediment to being effective in delivering cessation services. Personal smoking behaviour among nurses needs to be addressed to encourage critical nursing-led smoking cessation interventions.

Prevalence of tobacco use and perceptions of student health professionals about cessation training: results from Global Health Professions Students Survey

INTRODUCTION

Health professionals play an important role in providing advice to their patients about tobacco prevention and cessation. Health professionals who use tobacco may be deterred from providing cessation advice and counselling to their patients. We aimed to provide prevalence estimates of tobacco use among student health professionals and describe their attitudes towards tobacco cessation training.

METHODS

Country-wise aggregate data from the Global Health Professions Student Survey on 'current cigarette smoking' (smoking cigarettes on 1 or more days during the past 30 days), and 'current use of tobacco products other than cigarettes' (chewing tobacco, snuff, bidis, cigars or pipes, 1 or more days during the past 30 days) were analysed. For each WHO region, we estimated mean prevalence rates of tobacco use weighted by the population of the sampling frame and aggregate proportions for 'health professionals' role' and 'cessation training' indicators using 'metaprop' command on Stata V.11.

RESULTS

A total of 107 527 student health professionals participated in 236 surveys done in four health profession disciplines spanning 70 countries with response rates ranging from 40% to 100%. Overall, prevalence of smoking was highest in European countries (20% medical and 40% dental students) and the Americas (13% pharmacy to 23% dental students). Other tobacco use was higher in eastern Mediterranean (10%-23%) and European countries (7%-13%). In most WHO regions, ≥70% of the students agreed that health professionals are role models, and have a role in advising about smoking cessation to their patients and the public. Only ≤33% of all student health professionals in most WHO regions (except 80% dental students in the Eastern Mediterranean region) had received formal training on smoking cessation approaches and ≥80% of all students agreed that they should receive formal cessation training.

CONCLUSIONS

Tobacco control should take place together with medical educators to discourage tobacco use among student health professionals and implement an integrated smoking cessation training into health professions' curricula.

Tobacco use among Kyrgyzstan medical students: an 11-year follow-up cross-sectional study

BACKGROUND

Medical students are the first line active force to combat tobacco epidemic, but they may suffer from high smoking prevalence and wrong attitude themselves. The aim of the study was to assess the effect of current curriculum on smoking behavior of medical students in Kyrgyzstan.

METHODS

20% random sample of all 6 years of the School of Medicine in Kyrgyz State Medical Academy were interviewed in spring 2016. The questionnaire included sections on tobacco products consumption and knowledge and attitude to counseling. We verified smoking status with exhaled CO measurement using Bedfont Smokelyzer.

RESULTS

In 618 students (48% female), the overall daily cigarette smoking prevalence was 21% (34% in males and 6% in females), being highest in years 1 and 3 and least in year 5 (prevalence difference 14%). With very low smokeless products and electronic cigarettes use prevalence, ever-smoking prevalence of waterpipe use was very high, reaching 85% in 6-year male students with alarmingly high prevalence in female students also. Only 74% students responded there was 100% evidence of harmful effects of tobacco, unchanged throughout the course of study.

CONCLUSIONS

The use of tobacco products, especially smoking waterpipe, in Kyrgyzstan medical students remains very high. Coupled with poor knowledge and high demand for more information, this demonstrates urgent need for more active and advanced training on tobacco control in medical school.

Prevalence of Tobacco Smoking and Factors Associated with the Initiation of Smoking among University Students in Dhaka, Bangladesh

Introuduction

Tobacco smoking is considered to be the key preventable risk factor for morbidity and mortality at the global level. The aim of this study was to determine the prevalence of tobacco smoking and factors associated with the initiation of smoking among university students in Dhaka, Bangladesh.

Methods

A cross-sectional survey study was conducted with 264 students of Jahangirnagar University, Dhaka, Bangladesh in 2015. A standard, self-administered questionnaire consisting of questions on socio-demographic variables, tobacco smoking status, family and peer tobacco smoking history, attitudes and beliefs about tobacco smoking, as well as knowledge about the negative health consequences of tobacco smoking was administered to participants. Data were analyzed using logistic regression models, chi square, and Fisher exact tests.

Results

The overall prevalence of tobacco smoking was 60.2%, where males smoked at higher rates than females (68.81% and 19.56%, respectively). The influence of friends was the most significant reason for initiating tobacco smoking (OR: 0.862; CI: 0.810-0.917). Perception regarding tobacco smoking was significantly related to continuing tobacco use. Logistic regression models identified that smoking-related attitudes, potential health problems, and family members dying from cardiovascular disease and cancer were significantly associated with tobacco smoking.

Conclusion

The current tobacco smoking prevalence among university students in Bangladesh is over 60%. We suggest adopting WHO Framework Convention on Tobacco Control (FCTC) policies, especially for university students.

Effect of Religious Beliefs on the Smoking Behaviour of University Students: Quantitative Findings From Malaysia

The Malaysian official Islamic authorities have issued a "fatwa" (Islamic ruling) regarding smoking practice which prohibits Muslims from smoking because of its potential harm to health. Since the prevalence of smoking among Malaysian students is high, this study was designed to explore the perceptions and opinions of Malaysian Muslim students towards smoking in International Islamic University of Malaysia. A prospective, cross-sectional study was conducted among School of Science students in International Islamic University Malaysia. Convenience sampling approach was used to recruit 323 students based on sample size calculation. A content- and face-validated questionnaire was used to collect the data from the participants. Non-smokers highly supported the fatwa on smoking forbiddance than smokers (94 vs 64.3 %, p = 0.001). A significant proportion of non-smokers believed that Islam prohibits smoking because of its potential harm (94.9 vs 71.4 %, p = 0.001). Majority of smokers agreed that addiction is the main barrier towards smoking cessation (78.6 vs 61.5 %, p = 0.019). The results showed positive influences of Islamic beliefs on the non-smokers. Further studies are required to validate these findings by surveying other universities of Malaysia.

Prevalence and Associated Factors of Smoking Among Final Year Medical Students: A Multicentric Survey From Pakistan

Introduction

Smoking is the leading cause of lung cancer around the world. In a developing country like Pakistan with low levels of literacy and general awareness about adverse effects of smoking, doctors play a pivotal role in educating the masses about its harmful consequences and providing support for smoking cessation. However, their efficacy is affected if they smoke themselves, and oftentimes the habits cultivated during educational recourse are carried into the professional careers. The aim of this study was to document the prevalence of smoking among final year medical students of Lahore, Pakistan, and the factors associated with it.

Methodology

Study approval was obtained from Combined Military Hospital (CMH) Lahore Medical College, Ethics Review Committee. A cross-sectional survey was carried out in four medical colleges and hospitals of Lahore, Pakistan. A questionnaire consisting of 14 questions related to basic demographics and smoking was used after being pilot tested on 20 students of CMH. The overall response rate was 74.89%. Data was collected from 337 respondents, of which 38 forms were discarded and 299 forms were analyzed by SPSS V21.

Results

Among the 299 respondents, there were 128 males (42.81%) and 171 females (57.19%) with 32 (10.70%) smokers. Male students reported smoking (n = 27, 21.09%) more than their female counterparts (n = 5, 0.02%). The mean age of participants was 23.01 years. Students having an active smoker at home had statistically significant positive correlations with current smoking status and the number of cigarettes smoked per day. Students with household smoking contacts were also more likely to smoke if they belonged to the male gender.

Conclusion

Prevalence of smoking in medical students is lower than in the general population but still considerable in the male students. There is a need to target this particular population with interactive counseling sessions, education campaigns, and anti-smoking rules to decrease smoking among them and through them in the society.

Prevalence of Tobacco Consumption and Its Contributing Factors among Students of a Private Medical College in Belgaum: A Cross Sectional Study

BACKGROUND

Tobacco consumption epidemic is one of the biggest public health threats that the world is facing and attracts the attention of researchers to identify the cause for the same in specific groups. Medical students act as mentors to fight against tobacco use, but several reports suggest that a good number of medical undergraduates are themselves addicted to tobacco use. Thus, the objective of the study was to determine the prevalence of tobacco consumption and its association with various factors among undergraduate medical students.

MATERIALS AND METHODS

A cross-sectional study was conducted on 372 undergraduate medical students from first to fourth year during November 2013 to January 2015. A pre-designed, pre-tested, structured and self-administered questionnaire was used. Statistical analysis was done using SPSS software version 16. Data was analyzed for percentage, Chi-square test and regression analysis to find association between tobacco use and various independent variables.

RESULT

The mean age of the participants was 21.2 (SD=2.28) years with a male-female ratio of 1.92:1. The prevalence of tobacco use was 27.1% (n=101). The overall prevalence of smoking and smokeless tobacco use was 22.6% (n=84) and 7.8% (n=29) respectively. The prevalence of current tobacco use was 24.2% (n=90). Among the ever tobacco users, about 3% (n=11) had quit using tobacco. Tobacco consumption was observed to be significantly associated with male gender (p<.001), increasing age (p<0.01), residing in hostels (p<.001) and with a parental history of using tobacco (p<.001).

CONCLUSION

The prevalence of tobacco use in smoking and smokeless form among undergraduate medical students was high.This has important implications in the strict implementation and monitoring of smoking-related rules in hostels of medical colleges, especially those related to peer-support.

Knowledge and practices of tobacco dependence treatment among junior doctors in a Malaysian teaching hospital

Introduction: Junior doctors are ideally placed to assist smokers quit yet little is known about their knowledge and practices.

Aims: To determine knowledge and practices in providing smoking cessation support, among junior doctors in a Malaysian teaching hospital.

Methods: In 2012, all junior doctors at University Malaya Medical Centre were invited to complete a self-administered questionnaire. The data were collated and analysed using standard descriptive methods.

Results/Findings: Seventy per cent (n = 122/173) of those eligible completed the questionnaire, 71% reporting cessation training at medical school. Most (90%) asked patients their smoking status but only 52% asked about quitting. Sixty-one per cent lacked confidence in providing assistance to quit, especially female doctors (70.8%, p<0.01). Most (80%) were unaware of local cessation clinics, and over half (59%) were unaware of the existence of guidelines for smoking cessation (p<0.001).

Conclusions: Asking about smoking was undertaken at satisfactory levels, but low knowledge, confidence and skills among this group of junior doctors indicates that cessation education should be included in undergraduate and in postgraduate curriculum training programmes. Awareness of specialist services and guidelines should be raised. Our findings are unlikely to be unique to this hospital, suggesting the need for a nationally consistent approach.

Gender differences and clustering of modifiable risk factors of non-communicable diseases among medical students: a cross sectional study in Nepal

The objective of the study was to explore gender differences in the risk factors of non-communicable diseases among medical students in Nepal. We randomly selected two private and one government medical college located in Kathmandu Valley. All the third year medical students (n = 191) from these selected colleges were requested to participate in an anonymous cross sectional survey. We gathered information about different risk factors for non-communicable diseases including smoking and drinking habits, physical activity and fruit and vegetable consumption. We identified significant gender differences in the clustering of modifiable risk factors among our study population (p value = 0.032). Logistic regression model showed that male and female medical students were significantly different in terms of smoking status [aOR = 4.12, 95 % confidence interval (CI) 1.57; 10.85] and high level of physical activity (aOR = 4.50, 95 % CI 1.80; 11.21). Male medical students should be targeted in future behavioral interventions for smoking cessation, while physical activity among female medical students needs to be promoted.

Perceived benefits and health risks of cigarette smoking among young adults: insights from a cross-sectional study

Background

Perceptions of smoking-related health risks and benefits among young adults (18–24 years) and their smoking behaviour have not been adequately studied in low-income countries like Nepal. This study has examined the perceived risks and the benefits of smoking among young adults who smoke vs. don’t smoke.

Methods

A cross-sectional study was carried out from August to September 2013 among 315 young adults (18–24) from four conveniently selected private colleges of different faculties in Kathmandu Metropolis. The anonymous, self-administrated and semi structured questionnaire contained the information on individual information; smoking behaviour; and perceptions on smoking-related risks and benefits. Kaplan-Meier analysis was used to identify the mean age of smoking initiation. Cox proportion hazard regression was used to assess the relationship between current smoking behaviours and the perceived risks and the benefits of smoking.

Results

Overall, the prevalence of current smoking was 16.2 % (Male =28.4 % and female =5.38 %). The mean age of smoking initiation was 16.6 and 17.7 years for male and female respectively. The risk of becoming a current smoking being a management student was higher (HR = 4.72, 95 % CI: 2.19; 10.20) than being a medical student. The risk of current smoking behaviour significantly increased with those who believed that smoking was enjoyable (HR = 4.74, 2.58; 8.72); would help to deal with problems or stress (3.19, 1.76; 5.79); would feel comfortable with friends (4.29, 2.33; 7.92); would be relaxing (6.95, 3.60; 13.43); and something to do when feel bored (3.42, 1.91; 6.13). The young adults who believed that smoking would make yellow teeth (0.53, 0.30; 0.94) and yellow nail (0.53, 0.29; 0.95); and would be bad to their health (0.45, 0.21; 0.98) were significantly at lower risk of becoming a current smoking.

Conclusion

Positive perceptions related to smoking are common among young adults. To discourage smoking, future intervention programs should focus communicating not only health risks but also counteract perception of benefits related to smoking.

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.

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.

Health professional students' perceptions regarding their role in tobacco control: findings from the Global Health Professional Students Survey, Pakistan, 2011

Background

An important way of reducing tobacco use is to train the health professional (HP) students to assist in tobacco cessation by educating patients and public. In order to shape their thoughts for the desired role, it is vital to understand their existing perceptions regarding HP’s role in tobacco control. Thus, the aim of our study was to find out the perceptions of Pakistani HP students regarding their future role in tobacco control, and examine factors associated with negative perceptions.

Methods

Secondary data analysis of the Global Health Professional Students Survey, Pakistan, 2011 was performed. Study population included 3445 health professional students in third year of graduate level programs. The dependent variable (perceptions of HP students), was developed using four questions from the survey. Students who did not regard HP’s role in tobacco control were labeled as having negative perceptions. Logistic regression analyses were conducted to analyze association between HP students’ perceptions and various socio-demographic, attitudinal and knowledge related factors; and were reported as adjusted odds ratios with 95% confidence interval.

Results

We found that 44.8% (n = 1542) of students do not regard HPs as role model for their patients and public, and perceive that HPs do not play an important part in patient’s quitting tobacco use. These negative perceptions were associated with male sex (OR = 1.25, 95% CI 1.02 – 1.53, p value 0.028), and poor knowledge about tobacco cessation techniques (OR = 1.32, 95% CI 1.12 – 1.55, p value < 0.001). Negative perceptions were also associated with their attitudes towards ban on: tobacco advertisements (OR = 1.67, 95% CI 1.13 – 2.48, p value 0.010); and tobacco use at public places (OR = 1.60, 95% CI 1.26 – 2.03, p value < 0.001).

Conclusion

The role of HPs for tobacco control is fairly under-perceived by HP students, and the undesired negative perceptions are associated with male sex, poor knowledge about tobacco use cessation techniques and negative attitudes towards legislative control. A comprehensive approach, focusing on these aspects should be adopted to train HPs, in order to utilize them as an effective manpower for tobacco control.

Health Professionals’ Role in Helping Patients Quit Tobacco Use: Attitudes among Iranian Dental Students

Background. Health professionals play an essential role in tobacco control. Our objective was to assess Iranian dental students' attitudes towards tobacco control. Methods. Eight dental schools were randomly selected, and a survey using Global Health Professions Student Survey (GHPSS) instrument was conducted among dental students in 2010 in Iran. The chi-square test served for statistical analyses. Results. Of the participants (325 students, 66% female), about one-fifth (21%) were current tobacco (including cigarettes and waterpipe) users. A clear majority (over 80%) of the students agreed as to the responsibility of health professionals on serving as role models for patients and the public, routinely advising patients using tobacco to quit, and giving patients advice about smoking cessation. Over 75% believed that cigarette-smoking health professionals are less likely to advise their patients to stop smoking. Current tobacco users were significantly less likely to agree with these beliefs (P<0.05). Conclusion. Future oral health professionals have generally positive attitudes towards tobacco control. However, their own current tobacco use has a significant negative impact on these attitudes, an impact which ought to be taken into account in tobacco control.

Prevalence of and factors associated with daily smoking among Inner Mongolia medical students in China: a cross-sectional questionnaire survey

BACKGROUND

To date, no study on smoking behavior of medical students in Inner Mongolia has been reported. The aim of the present study was to determine the 1-month prevalence of and factors associated with daily smoking among medical students in Inner Mongolia of China, to assist interventions designed to reduce the smoking behavior of medical college students in this region.

METHODS

During December 2010 and January 2011 a cross-sectional survey was conducted among medical students at the Inner Mongolia Medical College using a self-administered questionnaire. The questionnaire consisted of three sections: students' basic information, attitude on smoking behavior, and smoking status of the student daily smokers. Students who smoked every day in the last 30 days were regarded as daily smokers. Factors associated with smoking were identified using binary logistic regression analysis.

RESULTS

A total of 6044 valid surveys were returned. The overall prevalence of daily smoking was 9.8% while the prevalence of daily smoking among males and females were 29.4% and 1.7%, respectively. Males in the Faculty of Medicine Information Management had the highest daily smoking rate (48.9%). Logistic regression models found that the main factors associated with daily smoking among male medical students were highest year of study (OR = 3.62; CI: 1.18-11.05); attitude towards smoking behavior Do not care about people smoking around you (OR = 2.75; CI: 2.08-3.64); and Smoking is harmful to their health (OR = 4.40; CI: 2.21-8.75). The main factor associated with daily smoking among female medical students was attitude towards smoking behavior Eliminate smoking on campus (OR = 0.11; CI: 0.06-0.23). Both for male and female medical students, there was no association between ethnicity and cigarette daily smoking. In regard to smoking status, more than 60% of daily smokers began smoking in high school, 61.3% smoked less than 5 cigarettes per day, 62.9% of the daily smokers' families opposed their smoking behavior, and after an hour of not smoking 74.6% daily smokers did not feel uncomfortable.

CONCLUSIONS

Antismoking education should be further promoted in Inner Mongolia medical students, with consideration given to the factors associated with daily smoking behavior found in the present study.

Attitudes of Cairo University medical students toward smoking: the need for tobacco control programs in medical education

BACKGROUND

Tobacco smoking rates are increasing in developing countries and so are tobacco-related chronic diseases. Reported figures from the WHO show rates of smoking in Egypt as high as 20% but limited information is available about smoking specifically among physicians and medical students.

MATERIALS AND METHODS

Final-year medical students of Cairo University were surveyed regarding their tobacco behavior and attitudes using a modified Global Health Professions Student Survey. We approached 220 students by randomly selecting clinical units into which they were assigned and requested completion of the survey.

RESULTS

Ever users of some form of tobacco comprised 46.7% of students sampled, current users of cigarettes comprised 17.4%, and current users of water pipe 'sheesha' comprised 17.6%. The vast majority (87.7%) of students believed that smoking is a public health problem in Cairo and supported restriction of tobacco. Yet, only 58.5% stated that they were taught it is important for physicians to provide tobacco education materials to patients. Among ever users of cigarettes, 54.4% believed health professionals do not serve as health role models for patients, and only a small percentage of all students (34.2%) stated that they had received some form of training on smoking cessation in their medical curriculum to be able to instruct patients.

CONCLUSION AND RECOMMENDATIONS

A high rate of smoking was revealed among medical students in Cairo. Overall, approximately 23.4% of students were currently smoking cigarettes and/or sheesha, and 46.7% were ever users of some form of tobacco. A formal antitobacco program for medical students should be incorporated into their medical curriculum to change the attitudes of medical students and overcome the anticipated increase in chronic diseases in Egypt.

Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006

Background

Nearly four-fifths of estimated 1.1 million smokers live in low or middle-income countries. We aimed to provide national estimates for Nepal on tobacco use prevalence, its distribution across demographic, socio-economic and spatial variables and correlates of tobacco use.

Methods

A secondary data analysis of 2006 Nepal Demographic and Health Survey (DHS) was done. A representative sample of 9,036 households was selected by two-stage stratified, probability proportional to size (PPS) technique. We constructed three outcome variables 'tobacco smoke', 'tobacco chewer' and 'any tobacco use' based on four questions about tobacco use that were asked in DHS questionnaires. Socio-economic, demographic and spatial predictor variables were used. We computed overall prevalence for 'tobacco smoking', 'tobacco chewing' and 'any tobacco use' i.e. point estimates of prevalence rates, 95% confidence intervals (CIs) after adjustment for strata and clustering at primary sampling unit (PSU) level. For correlates of tobacco use, we used multivariate analysis to calculate adjusted odds ratios (AORs) and their 95% CIs. A p-value < 0.05 was considered as significant.

Results

Total number of households, eligible women and men interviewed was 8707, 10793 and 4397 respectively. The overall prevalence for 'any tobacco use', 'tobacco smoking' and 'tobacco chewing' were 30.3% (95% CI 28.9, 31.7), 20.7% (95% CI 19.5, 22.0) and 14.6% (95% CI 13.5, 15.7) respectively. Prevalence among men was significantly higher than women for 'any tobacco use' (56.5% versus 19.6%), 'tobacco smoking' (32.8% versus 15.8%) and 'tobacco chewing' (38.0% versus 5.0%). By multivariate analysis, older adults, men, lesser educated and those with lower wealth quintiles were more likely to be using all forms of tobacco. Divorced, separated, and widowed were more likely to smoke (OR 1.49, 95% CI 1.14, 1.94) and chew tobacco (OR 1.36, 95% CI 0.97, 1.93) as compared to those who were currently married. Prevalence of 'tobacco chewing' was higher in eastern region (19.7%) and terai/plains (16.2%). 'Tobacco smoking' and 'any tobacco use' were higher in rural areas, mid-western and far western and mountainous areas.

Conclusions

Prevalence of tobacco use is considerably high among Nepalese people. Demographic and socioeconomic determinants and spatial distribution should be considered while planning tobacco control interventions.