The use of drugs and medical students: a literature review

Factors associated with substance use among preclinical medical students in Turkey: a cross-sectional study

Introduction

Medical students experience high levels of stress due to their rigorous training, which can negatively affect their mental health. This study aimed to investigate substance use habits of medical students at Istanbul University-Cerrahpaşa and the association on their mental health and demographic factors.

Methods

This cross-sectional survey study was conducted in March-April 2022 among preclinical medical students (years 1-3 of a 6-year program). A confidential, anonymous online survey consisting of four sections on sociodemographic and educational characteristics, nicotine use and dependence [Fagerström Test for Nicotine Dependence (FTND)], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)], mental health status [12-item General Health Questionnaire (GHQ-12)], was distributed to 1131 students via WhatsApp and Telegram text messages. Mann-Whitney U and Kruskal Wallis tests compared variables' distribution in the questionnaire categories. Spearman's correlation assessed associations between scales. Significance was p < 0.05.

Results

The study included 190 medical students. A total of 26.3% of the participants were smokers, with 8.4% showing moderate to high levels of nicotine dependence. An estimated 45.8% and 8.4%reported low-risk consumption and risky usage of alcohol, respectively. There were statistically significant associations between substance use and demographic factors such as sex, GPA, and religious belief. The study found a statistically significant correlation between FTND scores and GHQ-12 scores, and, between FTND scores and AUDIT scores.

Conclusion

The findings of this study will inform the development of interventions to improve the mental health and academic performance of medical students at Istanbul University-Cerrahpaşa. Furthermore, it will raise awareness about the importance of addressing substance use among medical students in Turkey.

Cigarette Smoking, Risky Alcohol Consumption, and Marijuana Smoking among University Students in Germany: Identification of Potential Sociodemographic and Study-Related Risk Groups and Predictors of Consumption

(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide, including among university students. To plan effective evidence-based programs to prevent the risky consumption of these substances among university students, the present study aimed to identify potential sociodemographic and study-related risk groups and predictors of consumption. (2) Methods: A cross-sectional online health survey with approximately 270 health-related items was conducted among students at the University of Mainz, Germany. Cigarette smoking, risky alcohol consumption (AUDIT-C score: female ≥ 4, male ≥ 5), and marijuana smoking were chosen as dependent variables. Of the 270 health-related items, 56 were chosen as independent variables and collated into five groups (sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior). The prevalence of cigarette smoking, risky alcohol consumption, and marijuana smoking was assessed using established and validated instruments. Pearson's chi-square test was used to analyze the differences in prevalence between the sociodemographic and study-related groups, and binary logistic regression was used for analyses with stepwise inclusion of the five variable groups. (3) Results: Of the 3991 university students who entered the analyses, 14.9% reported smoking cigarettes, 38.6% reported risky alcohol consumption, and 10.9% reported smoking marijuana. The prevalence of these differed between genders, fields of study, and aspired degree level, among other factors. Binary logistic regression analyses revealed nine significant predictors (p ≤ 0.05) of cigarette smoking (Nagelkerke R2 = 0.314), 18 significant predictors of risky alcohol consumption (Nagelkerke R2 = 0.270), and 16 significant predictors of marijuana smoking (Nagelkerke R2 = 0.239). (4) Conclusions: This study showed cigarette smoking, risky alcohol consumption, and marijuana smoking among university students in Germany to be associated with multiple factors, especially health behaviors. Furthermore, each of the substances was highly associated with each of the two other substances we examined. Other variable groups, such as psychological or psychosocial variables, seemed to play a rather minor role. Therefore, our recommendation for future prevention programs is that substance use among university students should be addressed as a whole, not just in terms of specific substances.

Drug use, risk perceptions and attitudes towards drug use amongst medical and dentistry students

AIMS

To analyse the use of psychoactive substances and the risk perceptions amongst odontology and medical students. To study their perceptions, attitudes and knowledge, and to evaluate their motivation when helping their patients to stop using these substances.

METHODS

A cross-sectional study was conducted amongst 962 students in Spain, using validated questionnaires on an anonymous basis.

RESULTS

Amongst these students, drug use varies and increases with age as assessed by the DAST and CAST tests, with more problematic use being observed as the academic cycle progresses (p < .001). Participants in the 2nd cycle presented higher consumption than those in the 1st cycle, in the univariate model (OR = 1.77, IC 95% 1.27-2.48, p = .001) and in the adjusted model (OR = 1.86, IC 95% 1.32-2.62, p < .001). Regarding CAST, non-problematic use in the 1st cycle versus the 3rd cycle presented an OR = 8.69 (IC 95% 4.50-16.78, p < .001) and for low risk use it presented an OR = 15.18 (IC 95% 1.83-14.68). Only 46.7% considered using marijuana on a regular basis as a high risk, whilst 60.5% stated that smoking a pack of cigarettes represents a high risk. Alcohol was the substance for which the risk perception was lowest. 66.2% are in the maintenance stage "I provide my regular drug-using patients help to give up," with women being more likely to be in this stage (p = .012).

CONCLUSIONS

High risk of drug use increases after the 1st cycle in Dentistry and in Medicine. Training programmes should be implemented in both degrees, focusing on the 1st years in order to simultaneously prevent drug use amongst students.

Gender differences in alcohol abuse/dependence among medical undergraduates during the post-COVID‑19 pandemic period (October 20, 2020-April 5, 2021) in China

BACKGROUND

This study aimed to assess the prevalence and the gender-specific risk factors of alcohol abuse/dependence among medical undergraduates during the post-COVID‑19 pandemic period in China.

METHOD

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was used to identify respondents with alcohol abuse/dependence. A questionnaire on basic demographics and mental distresses (learning burnout, depression symptoms, anxiety symptoms, excessive daytime sleepiness, and history of mental disorders) was used. The logistic regression model was used to explore the associations between the above characteristics and alcohol abuse/dependence.

RESULTS

A total of 3,412 medical undergraduates were included in the analysis. Males showed a higher prevalence of alcohol abuse/dependence than females (16.6% vs 7.4%, p < 0.001). Alcohol abuse/dependence was associated with learning burnout (OR: 2.168, p < 0.001) and having a partner (OR: 1.788 p = 0.001) among female medical undergraduates. Among male medical undergraduates, excessive daytime sleepiness (OR: 1.788 p = 0.001) and older age (OR: 1.788, p = 0.001) were independently associated with alcohol abuse/dependence.

CONCLUSION

Alcohol abuse/dependence was common among medical undergraduates during the post-COVID‑19 pandemic period. Substantial gender differences in the prevalence and risk factors of alcohol abuse/dependence were found among medical undergraduates in this study, which highlighted the need for timely gender-specific screening and interventions. However, the cross-sectional design adopted in this study has limited the examination of causality, thus further longitudinal studies are warranted.

Drug use among medical students in São Paulo, Brazil: a cross-sectional study during the coronavirus disease 2019 pandemic

BACKGROUND

Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use.

OBJECTIVES

Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption.

DESIGN AND SETTING

A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020.

METHODS

Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9.

RESULTS

Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns.

CONCLUSION

The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

A Longitudinal Pilot Study of Stress and Sleep in First-Year Osteopathic Medical Students

OBJECTIVE

Poor sleep quality is thought to be a contributor to medical student stress. The authors evaluated the effect of high and low periods of academic stress on sleep quality and quantity in first-year medical students.

METHODS

A group of 25 students in their first year of medical school were provided Fitbit Charge 3 activity trackers for continual use and were surveyed at 4 intervals to assess stress level, sleep quantity, and sleep quality. Fitbit data were collected through the Fitbit mobile app and uploaded to the Fitabase (Small Steps Labs, LLC) server. Data collection times were scheduled around the academic exam schedule. Weeks in which testing occurred were identified as high-stress periods. Results from assessments were compared to nontesting periods of low stress.

RESULTS

During stressful periods, students slept an average of one hour less per 24-h period, took more naps, and reported poorer sleep quality than during the low-stress periods. No significant change was seen in the 4 surveyed intervals in sleep efficiency or sleep stages.

CONCLUSION

Students slept less and had poorer quality sleep in their main sleep event during stressful periods but attempted to compensate with increased napping and weekend catchup sleep. The objective Fitbit activity tracker data were consistent with and validated the self-reported survey data. Activity trackers could potentially be used to optimize the efficiency and quality of both student napping and main sleep events as one component of a stress reduction program for medical students.

A cross-sectional study: Nitrous oxide abuse in Parisian medical students

BACKGROUND AND OBJECTIVES

Nitrous oxide (N₂ O) has euphoric properties, which are associated with an alarming increasing misuse. A lack of data exists regarding medical students. The objectives are: (i) evaluate the prevalence of N₂ O use and N₂ O use disorder (NUD) among French medical students, (ii) assess whether education about addictions has an impact on consumption, (iii) draw up clinical profiles of N₂ O users with or without NUD, (iv) identify factors associated with use and NUD.

METHODS

A cross-sectional study among medical students at Université de Paris, using an online questionnaire.

RESULTS

Out of the 981 medical students (29% of the total medical students) who completed the questionnaire, 80% had used N₂ O. 19% had a mild use disorder, 4% moderate, and 1% severe. N₂ O use was significantly associated with the use of poppers (p < .0005), alcohol (p < .0005), and cocaine (p = .004). Factors significantly associated with NUD were alcohol use disorder (p = .017), male gender (p = .006), and being part of a student association (p = .0130).

DISCUSSION AND CONCLUSION

This survey shows a high prevalence of N₂ O use and NUD among medical students. It could be explained by the N₂ O pharmacokinetic profile or by a perception of "harmlessness." We also identified associated risk factors that may be useful to better identify and treat students seeking help.

SCIENTIFIC SIGNIFICANCE

This is the first study to evaluate the use of this product among medical students. The evaluation of factors impacting use and dependence is also new in this population, which is at risk of misuse of substances.

Uso de ansiolíticos e antidepressivos entre estudantes de medicina de uma universidade

Objetivou-se identificar o uso de medicamento ansiolítico e/ou antidepressivo e associá-lo às características dos estudantes de medicina de uma universidade. Trata-se de um estudo com 449 estudantes de medicina no interior do estado de São Paulo. O uso de medicamento antidepressivo e/ou ansiolítico era feito por 24,3% dos estudantes, sendo a maior parte do sexo feminino e cursando os dois primeiros anos da faculdade. Não houve associação entre o uso de medicamento e os fatores como: idade, renda, morar com a família, horas de sono, relação com docentes e ter pai e mãe vivos. Observou-se maior chance de fazer terapia entre os estudantes que usavam medicamento (β=1,12, OR=3,07, p<0,001) e uma menor chance de realizar exercício físico (β=-0,051, OR=0,60, p=0,03). Estratégias para o manejo da depressão e da ansiedade devem ser incentivadas e ações para reduzir o estresse durante o curso devem fazer parte de um programa de apoio das universidades. 

Mental health help-seeking among Brazilian medical students: Who suffers unassisted?

INTRODUCTION

Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions.

AIMS

To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment.

RESULTS

Among the 382 students who completed the survey (87.6% completion rate), 38.5% (n = 147) were in treatment, and 33% (n = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% (n = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81]).

DISCUSSION

Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions.

Parental bonding, depression, and suicidal ideation in medical students

Background

The psychological condition of university students has been the focus of research since several years. In this population, prevalence rates of depression, suicidal ideation, anxiety disorders and substance abuse are higher than those of the general population, and medical students are more likely to have mental health issues than other students.

Aims

This study deals with the psychological condition of medical students, with a focus on correlations between depression, suicidal ideation and the quality of the perceived parenting style. Gender differences were also considered.

Methods

A cross-sectional study was conducted on a population of medical students, with an online questionnaire consisting of a personal data sheet for demographic and anamnestic data, and of three self-rating scales: the Beck Depression Inventory II (BDI-II), for the screening of depressive symptoms; the Beck Hopelessness Scale (BHS), to assess suicidal ideation; the Parental Bonding Instrument (PBI), to investigate the memory of the attitude of one’s parents in the first 16 years of life. Two main affective dimensions were considered by PBI: “care” (affection and empathy) and “protection” (intrusiveness, controlling and constraint). Four different patterns of parenting styles are so evidenced: Neglectful Parenting (low care/low protection), Affectionless Control (low care/high protection), Optimal Parenting (high care/low protection), and Affectionate Constraint (high care/high protection).

Results

Overall, 671 students (182 males and 489 females) participated. Females, compared to males, experienced more distress and self-injurious behaviors, while males experienced more drugs or alcohol abuse. The BHS and BDI-II scores correlated positively with the PBI score for “protection” and negatively with that for “care.” Affectionless Control and Neglectful Parenting were associated with higher medians of BHS and BDI-II scores.

Conclusion

The study confirms that the undergraduate medical student population has higher prevalence of depression and suicidal ideation than those detectable in the general population (respectively, 50.2% and 16.7% vs. 15–18% and 9.2%) and that some specific parenting styles correlate with these two clinical variables. The impact of Affectionless Control and Neglectful Parenting on suicidal ideation and depressive symptomatology was more pronounced in females than in males. For males, the role of the father seemed to have less impact on the affective roots of suicidal thoughts and depression.

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.

Avaliação do comportamento suicida em estudantes de Medicina

RESUMO Objetivo O objetivo deste estudo foi avaliar a prevalência de comportamento suicida (ideação, plano e tentativa) nos últimos 12 meses e ao longo da vida e fatores associados entre alunos de Medicina da Universidade Federal do Rio de Janeiro (UFRJ). Métodos Um estudo seccional foi desenvolvido em uma amostra representativa e aleatória (n = 324) de 1.217 estudantes de Medicina da UFRJ entre abril e novembro de 2019. Os dados foram coletados por cinco pesquisadores em uma entrevista presencial com 296 alunos (taxa de participação de 91,4%), usando um questionário do Estudo Multicêntrico de Intervenção no Comportamento Suicida para avaliar o comportamento suicida, o PHQ-9 (Questionário de Saúde do Paciente-9) para avaliar o episódio depressivo maior e o ASSIST (Teste de Triagem do Envolvimento com Substâncias) para aferir o uso e abuso de substâncias. Para a avaliação das associações, utilizou-se o modelo de regressão logística. Resultados As prevalências nos últimos 12 meses foram de 18,9% (IC de 95%: 14,9-23,8) para ideação, 6,1% (IC de 95%: 3,9-9,4) para plano e 1,7% (IC de 95%: 0,7-4,1) para tentativa de suicídio. As prevalências ao longo da vida foram de 27,7% (IC de 95%: 22,9-33,0) para ideação, 12,5% (IC de 95%: 9,2-16,7) para plano e 5,7% (IC de 95%: 3,6-9,0) para tentativa de suicídio. Os resultados encontrados foram maiores que os achados dos estudos nacionais. O episódio depressivo maior e o tratamento psicológico atual foram associados ao comportamento suicida na análise final. Conclusões A associação com tratamento em saúde mental e episódio depressivo maior sugere que as universidades deveriam implementar programas para a prevenção do comportamento suicida.

Does medical school cause depression or do medical students already begin their studies depressed? A longitudinal study over the first semester about depression and influencing factors

OBJECTIVE

In the past, medical students have been found to be at increased risk for depressive symptoms compared to the general population. This study addresses the question, whether medical students already show these elevated depression scores at the beginning of medical school or whether it is the studies of medicine that leads to symptoms of depression.

METHODS

In the winter semester 2018/2019, 148 medical students at a middle-sized German university answered a questionnaire during the first (T0) and last week (T1) of their first semester that examined various risk and resilience factors for initial depressive symptoms and their course. The severity of symptoms was assessed with the Beck´s Depression Inventory II (BDI-II). A subscale of the NEO-FFI was used to investigate the personality factor neuroticism.

RESULTS

Over the study period, the percentage of students suffering from at least mild depressive symptoms increased from 16.3% in the first week of their studies (T0) to 21.4% at the end of the first semester (T1). The use of drugs or medication, loneliness, mental overload, performance pressure and financial burden show the strongest influence on the development of depressive symptoms. Concerning surveyed resilience factors, in particular emotional support, physical workout and sufficient time for social contact appear to be protective. The more risk factors are concentrated on an individual, the higher its increase of depressive symptoms. The opposite is prevailing for the investigated resilience factors. Except for the use of drugs or medication, no other criterion than the BDI-II value at T0 was able to predict the BDI-II score at T1. This underlines that especially the interplay of factors is decisive.

CONCLUSION

The findings of this study could indicate a worsening tendency of the BDI-II score in the further course of medical school. Ultimately, we emphasize the importance of offering preventive measures to medical students as early as possible.

Frequency and Association of Stress Levels with Modes of Commuting Among Medical Students of a Developing Country

Introduction

This study aimed at determining the frequency and association of stress levels with modes of transportation and was likely to reveal the contributing transportation-related factors for stress in medical students.

Methods

This was a questionnaire-based, cross-sectional study that included undergraduate medical students of a public sector medical university in Karachi, Pakistan. A total of 573 students participated voluntarily, of which 300 were provided a manual questionnaire and 273 filled it online. The reliability of the questionnaire was assessed using Cronbach’s alpha at 0.791. The collected data were analysed using IBM SPSS Statistics for Windows, version 21.0.

Results

Out of 573 participants, 99.3% (n = 298) of students filled the questionnaire manually, whereas 100% of students filled the questionnaire online. Almost two-thirds of students used university transport; more than 90% lived more than 5 km from the university and 56% had a traveling time of more than an hour. Approximately 15.4% of students reported physical trauma and some form of harassment. Sheldon Cohen’s stress scale surprisingly revealed 90% of students to be within the moderate-to-high stress category. Risk factors were associated with stress levels and significant associations were observed with noise exposure (P = 0.023) and sleep quality (P = 0.001). The most common reported stressors associated with commuting included overcrowding, long travel, and air and noise pollution. Noise pollution was the main predictor of stress among commuters.

Conclusion

Poor transportation has adverse effects on health and academic performance. Administration in their respective jurisdictions is needed to investigate this matter to make commuting a routine rather than a hassle.

Factors associated with alcohol, tobacco and illicit drug use among Brazilian undergraduate students

OBJECTIVES

to analyze the factors associated with the use of alcohol, tobacco and illicit drugs among Brazilian undergraduate students.

METHODS

observational, cross-sectional study, with convenience sampling, conducted in 2014/2015, involving institutional data and a self-completed online questionnaire, analyzed using measures of frequency, central tendency/dispersion and logistic regression.

RESULTS

among 126,326 students, 62.8% reported alcohol use; 11%, tobacco; and 7.5%, illicit drugs. Several academic factors-such as not residing with family (sororities [alcohol: aOR:2.38;95%CI:2.28-2.48; tobacco: AOR:2.20;95%CI:2.09-2.33; illicit drugs: AOR:2.53;95%CI:2.38-2.70]), acting in university movements (student [alcohol: AOR:1.74;95%CI:1.65-1.83; tobacco: AOR:1.97;95%CI:1.86-2.08; illicit drugs: AOR:2.43;95%CI:2.28-2.59] and religious [alcohol: AOR:0.28;95%CI:0.26-0.29; tobacco: AOR:0.23;95%CI:0.21-0.26; illicit drugs: AOR:0.18;95%CI:0.16-0.21]) and lack of discipline/study habit (alcohol: AOR:1.41;95%CI:1.37-1.45; tobacco: AOR:1.53;95%CI:1.46-1.59; illicit drugs: AOR:1.85;95%CI:1.76-1.94) - were associated with the use of the three categories of substances.

CONCLUSIONS

we identified that a number of academic factors are associated with licit and illicit drug use. These findings may help in designing preventive strategies among college students.

Uso de club drugs entre estudantes de graduação: prevalência, características associadas e a influência dos pares

RESUMO Objetivo Medir a prevalência do uso na vida, no último ano e no último mês de duas club drugs – o ecstasy e o LSD –, bem como as características associadas ao uso dessas substâncias, no último mês, entre estudantes de graduação de uma universidade no Sul do Brasil. Métodos Trata-se de um estudo transversal conduzido no ano de 2015 com amostragem aleatória sistemática por conglomerados. Participaram 1.423 estudantes de graduação. Foi utilizado um modelo de análise multivariável em três níveis hierárquicos por meio da regressão de Poisson com ajuste robusto da variância. Resultados As prevalências de uso na vida, no último ano e no último mês de club drugs foram de 12,7%, 7,8% e 3,8%, respectivamente. Indivíduos do sexo masculino, com orientação sexual homossexual ou bissexual, mais jovens, que moravam com seus pares, solteiros, e que relataram uso no último mês de tabaco e maconha apresentaram maior probabilidade de ter feito uso no último mês de alguma club drug. Entretanto, a variável mais fortemente associada a esse desfecho foi ter algum amigo que já fez uso de alguma droga ilícita na vida (RP = 19,54). Conclusões O ambiente universitário parece ser um terreno fértil para a difusão do uso de club drugs. O fortalecimento de uma rede de apoio institucional da universidade, capaz de propor atividades de prevenção, bem como de identificar, acolher e encaminhar casos em que haja abuso e dependência dessas substâncias, pode ser uma estratégia importante para lidar com essa problemática.

[Cigarette and e-cigarette use among a sample of French health students]

INTRODUCTION

Smoking is one of the leading causes of preventable death worldwide. Data from the literature show that caregivers and health students have a high prevalence. The purpose of this article was to study the prevalence among health students (medicine, dentistry, physiotherapy, nursing) at a University and a Teaching Hospital in France.

MATERIAL AND METHOD

This was a cross-sectional study using a self-administered questionnaire completed at the start of university meetings. This study was carried out as part of a campaign to combat smoking supported by the Brittany Regional Health Agency.

RESULTS

The participation rate was 76.4%: 1349 respondents out of 1766 health students surveyed. The prevalence of smoking 17.8% and that of vaping 5.6%. Nursing students smoked and vaped more than students in other streams: respectively, for smoking, 21.8% (73/335) vs. 16.5% (167/1014) (P<0.001), for vaping, 10.4% (35/335) vs. 4.0% (39/980) (P<0.001). Students in 3rd year nursing smoked and vaped significantly more than those in the first 2 years (P=0.02 and P<0.001).

CONCLUSION

The smoking rate was high, but comparable to the data for health students. Nursing students were significantly greater smokers, especially in the last year. Their vaping rate was higher than in other studies.

Psychiatric Comorbidity and Stress in Medical Students Using Neuroenhancers

Background: Pharmacological neuroenhancement (PN) is a common healthcare problem at least among students. PN seems to be associated with stressful situations. There is a lack of data about personal characteristics, comorbidities, and coping strategies regarding stress and factors of resilience in students and medical staff. Methods: A web-based survey about the non-medical use of PN drugs with a focus on neuroenhancement was developed and distributed among medical students throughout Germany; the questionnaire was open in April and May of 2020. The survey contained questions about the use of well-known PN drugs, frequency, special purposes, reasons for the use, psychiatric disorders, use of psychotropic drugs apart from PN purposes, and factors of resilience using the brief resilience scale. Results: Data of 1,159 students of medicine were analyzed. The most frequently used substances for PN were coffee (78.8% lifetime prevalence rate), energy drinks (45.7%), caffeine tablets (24.3%), methylphenidate (5.2%), illicit amphetamines (2.0%), and cocaine (1.7%). 98.4% suspected that PN drug use could lead to addiction. PN drug use specifically for PN was significantly associated with the use of (a) any psychotropic drug (other than neuroenhancers), (b) any psychiatric disorder, and (c) higher values of feeling pressure to perform in professional/students' life and in private life as well as (d) the subjective feeling of pressure to perform to be burdening and (e) harmful to one's own health. PN drug use in general was significantly associated with being less resilient. The use of illicit PN drugs, over the counter drugs and prescription drugs was associated with being less resilient. Conclusion: This study indicates that PN with legal and illegal drugs is a widespread phenomenon among German medical students. Users seem to be more often burdened by psychiatric disorders, especially addictive disorders, the perception of stress, pressure to perform and low levels of resilience. These aspects should be considered in further investigation of PN drug use.

Prevalence and Socio-Demographic, Academic, Health and Lifestyle Predictors of Illicit Drug/s Use among University Undergraduate Students in Finland

Illicit drug/s use (IDU) among university students is a public health concern. We assessed the associations between socio-demographic, academic, and health and lifestyle characteristics (independent variables) and regular, occasional or never IDU (dependent variables). Data were collected across seven faculties (1177 students) at the University of Turku (Finland) via an online questionnaire. About 1.5% of the sample had regular IDU, 19% occasional IDU, and 79% never IDU. Independent predictors of ever (lifetime) IDU included males [adjusted odds ratio (AOR) 1.82, P = 0.001], not living with parents (AOR 2.59, P < 0.001), singles (AOR 0.51, P < 0.001), lower religiosity (AOR 1.49, P = 0.022), better self-rated general health (AOR 0.41, P = 0.003), higher health awareness (AOR 1.93, P = 0.014), more depressive symptoms (AOR 1.82, P = 0.004), daily smokers (AOR 3.69, P < 0.001), heavy episodic drinking (AOR 2.38, P < 0.001) and possible alcohol dependency (AOR 2.55, P < 0.001). We observed no independent associations between ever IDU with age, study discipline, perceived stress or academic performance. The 20.5% ever IDU is concerning. The compelling independent predictors of ever IDU included not living with parents, lower religiosity, daily smokers, heavy episodic drinking and possible alcohol dependency (AOR range 2.38-3.69). Education and prevention need to emphasize the negative consequences to reinforce abstinence from IDU. Health promotion could focus on beliefs and expectations about IDU and target students at risk for successful efforts.

Successful promotion of physical activity among students of medicine through motivational interview and Web-based intervention

Background

Regular physical activity supports healthy behavior and contributes to the reduction of preventable diseases. Students in their social transition period are the ideal groups for interventions. The higher education period, associated with demanding changes and poor time management, results in a low level of physical activity. In this age, social media usually are a suitable channel of communication and multicomponent interventions are the most desirable. It has not been sufficiently investigated how effective a Web-based approach is among university students when it comes to physical activity in the long-term period. We combined a Web-based approach with motivational interviews and tested these two interventions together and separate to assess their impact on improving the physical activity of medical students 1 year after the intervention.

Methods

All 514 first-year students at the Faculty of Medicine in Belgrade were invited to fill in a baseline questionnaire. Also, they underwent measurement of weight, height and waist circumference. After that, students selected a 6 months intervention according to their preference: Intervention through social media (Facebook) (Group 1) or combined with a motivational interview (Group 2). Group 3 consisted of students without any intervention. One year after completion of the 6 months intervention period, all students were invited to a second comprehensive assessment. Analyses were performed employing a wide range of statistical testing, including direct logistic regression, to identify determinants of increased physical activity measured by an average change of Metabolic Equivalent of Task (MET). This outcome measure was defined as the difference between the values at baseline and one year after completion of the 6 months intervention period.

Results

Due to a large number of potential determinants of the change of MET, three logistic regression models considered three groups of independent variables: basic socio-demographic and anthropometric data, intervention and willingness for change, and health status with life choices. The only significant model comprised parameters related to the interventions (p < 0.001). It accurately classified 73.5% of cases. There is a highly significant overall effect for type of intervention (Wald = 19.5, df = 2, p < 0.001) with high odds for the increase of physical activity. Significant relationship between time and type of intervention also existed (F = 7.33, p < 0.001, partial η² = 0.091). The influence of both factors (time and interventions) led to a change (increase) in the dependent variable MET.

Conclusion

Our study confirmed the presence of low-level physical activity among students of medicine and showed that multicomponent interventions have significant potential for positive change. The desirable effects of the Web-based intervention are higher if an additional booster is involved, such as a motivational interview.

A Systematic Umbrella Review on the Epidemiology of Modifiable Health Influencing Factors and on Health Promoting Interventions Among University Students

Background: Universities represent an important setting for health promotion. The unique collective of university students is of particular relevance since they are the leaders, decision-makers, and parents of tomorrow. In this context, modifiable health influencing factors as well as interventions to prevent these, play a crucial role. Therefore, the present umbrella review aims to (i) provide an overview of review articles addressing epidemiological issues (prevalence and determinants) of modifiable health influencing factors in university students and (ii) to provide an overview of review articles addressing the evidence of interventions to promote/enhance modifiable health influencing factors in university students. Methods: A systematic literature search was performed in the databases PubMed, Cochrane Reviews Library und Web of Science according to the PRISMA guidelines. Only systematic reviews and meta-analyses were included. The AMSTAR-2-Tool was used for the quality assessment. Result: The initial search resulted in 10,726 records of which 81 fulfilled the inclusion criteria, with a further distinction in articles with an epidemiological focus (n = 39) and in articles with interventional approaches (n = 42). Topics of the different review articles ranged from physical activity over mental health, substance use, sleep, diet and nutrition, and media consumption. Many review articles had a specific focus on medical and nursing students and originated from the U.S.A., U.K., or China. Discussion: This umbrella review provides an overview of review articles on the epidemiology of modifiable health influencing factors and on the evidence of interventions targeting these factors among university students. Thereby, experts as well as stakeholders in the field could gain insights into crucial target points for health promotion. It identifies research gaps in terms of study region and groups of students.

Wellbeing and mental health among medical students in Paraguay

Medical students' wellbeing and mental health are of extreme importance. Studies from around the world have shown that the rates of burnout appear to be high. It is also well recognized that individuals with mental illnesses frequently avoid seeking help for fear of stigma, affecting their careers and being rejected or treated differently by their peers, or due to the perception that they will be deemed unfit for practice or rejected from their preferred specialty. Students who are open about their mental health conditions are often ostracized by their own peers and dismissed or even mistreated by teachers who consider mental 'toughness' to be a requirement for success in the medical arena. The impact of socioeconomic conditions cannot be under-estimated. We carried out a survey of mental health and wellbeing of medical students in the National University of Asuncion. A sample of 180 students across different years showed that 21% had sought help and 4% had been diagnosed with a mental condition before entering medical school; 3% had been previously diagnosed with Attention Deficit Hyperactivity Disorder or Autism Spectrum Disorders; 14% currently consult with a health professional specifically about their mental health; and 8% reported currently taking medication for their mental health. The most common medication was Escitalopram at 21%, followed by Sertraline with 11%. Various sources of stress were identified, all of which were noted to be concerning four specific domains: financial difficulties, familial issues, housing issues, and difficulties surrounding studies. Of these students, 20% were CAGE positive and 9.4% reported using substances to feel better. These findings indicate that medical students need better support to ensure that they function better. They require in-depth exploration of the potential causes of their illnesses.