Skip Navigation
Skip to contents

JPMPH : Journal of Preventive Medicine and Public Health

OPEN ACCESS
SEARCH
Search

Articles

Page Path
HOME > J Prev Med Public Health > Volume 50(3); 2017 > Article
Original Article
Assessment of Tobacco Habits, Attitudes, and Education Among Medical Students in the United States and Italy: A Cross-sectional Survey
Grayson W. Armstrong1,2,3, Giacomo Veronese4,5orcid, Paul F. George2, Isacco Montroni4, Giampaolo Ugolini4
Journal of Preventive Medicine and Public Health 2017;50(3):177-187.
DOI: https://doi.org/10.3961/jpmph.15.061
Published online: April 14, 2017
  • 6,816 Views
  • 235 Download
  • 23 Crossref
  • 30 Scopus

1Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, MA, USA

2The Warren Alpert Medical School of Brown University, Providence, RI, USA

3Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

4Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

5Department of Emergency Medicine, Ospedale Niguarda Ca’ Granda, University of Milano-Bicocca, Milan, Italy

Corresponding author: Giacomo Veronese, MD 3 Piazza dell’ Ospedale Maggiore, Milano 20162, Italy Tel: +39-2-64441, Fax: +39-2-6420901 E-mail: giacomo.veronese@ospedaleniguarda.it
• Received: November 10, 2015   • Accepted: April 3, 2017

Copyright © 2017 The Korean Society for Preventive Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • Objectives
    Medical students represent a primary target for tobacco cessation training. This study assessed the prevalence of medical students’ tobacco use, attitudes, clinical skills, and tobacco-related curricula in two countries, the US and Italy, with known baseline disparities in hopes of identifying potential corrective interventions.
  • Methods
    From September to December 2013, medical students enrolled at the University of Bologna and at Brown University were recruited via email to answer survey questions assessing the prevalence of medical students’ tobacco use, attitudes and clinical skills related to patients’ smoking, and elements of medical school curricula related to tobacco use.
  • Results
    Of the 449 medical students enrolled at Brown and the 1426 enrolled at Bologna, 174 Brown students (38.7%) and 527 Bologna students (36.9%) participated in this study. Italian students were more likely to smoke (29.5% vs. 6.1%; p<0.001) and less likely to receive smoking cessation training (9.4% vs. 80.3%; p<0.001) than their American counterparts, even though the majority of students in both countries desired smoking cessation training (98.6% at Brown, 85.4% at Bologna; p<0.001). Additionally, negative beliefs regarding tobacco usage, the absence of formal training in smoking cessation counseling, and a negative interest in receiving specific training on smoking cessation were associated with a higher risk of not investigating a patient’s smoking status during a routine history and not offering tobacco cessation treatment to patients.
  • Conclusions
    Medical curricula on tobacco-related health hazards and on smoking cessation should be mandatory in order to reduce smoking among medical students, physicians, and patients, thereby improving tobacco-related global health.
Smoking causes nearly six million deaths worldwide on an annual basis [1]. In the US and in Italy, smoking is responsible for about one in five and one in eight deaths annually, respectively [2,3]. Physicians play a key role in eradicating tobacco abuse. In the US, over 70% of smokers have visited a physician in the past year, and studies demonstrate that smoking cessation advice provided by physicians and other health professionals can have a significant impact on cessation rates among tobacco users [4-8]. Future physicians (i.e., medical students) are therefore an important target for training in tobacco cessation.
A plethora of educational curricula focused on training medical students on smoking cessation techniques have been proposed and successfully implemented [9-11]. However, evidence shows that medical schools are not consistently preparing students to counsel patients on smoking cessation and that, despite the existence of model curricula, vast disparities persist in medical students’ knowledge of smoking-related health risks [12,13]. For example, Italian medical schools have devoted little attention to the treatment of tobacco dependence [14]. As a result, medical students in countries such as Italy have limited knowledge and training in tobacco-related health risks and tobacco dependence management [15]. Ultimately, this has led to a culture in which Italian physicians neither advise tobacco cessation nor prescribe pharmacotherapy for tobacco dependence at the recommended levels, although the recent literature seems to show improvement in these metrics [16-18]. Conversely, studies have concluded that American medical students obtain sufficient knowledge of the negative health effects of tobacco use, although the system still lacks sufficient training in tobacco dependence management strategies [19]. The result is that multiple recent studies have shown that American physicians routinely counsel smokers about tobacco cessation [20,21].
Additionally, the Centers for Disease Control and Prevention and the World Health Organization have reported that the prevalence of tobacco consumption among medical students is a significant problem in many countries [12]. A 2007 review of the literature found evidence that the international prevalence of tobacco smoking among medical students varied from 2 to 58% [22]. In the US and Italy, specifically, the smoking rates among medical students have been estimated to be 2 and 20%, respectively [23,24].
A formal comparison of the prevalence of medical students’ tobacco use, attitudes, clinical skills, and tobacco-related curricula between countries with known baseline disparities in tobacco use or education would provide an opportunity to identify potential policy interventions to correct such disparities; however, no previous studies have done so. This study, therefore, undertook a cross-sectional evaluation of tobacco-related utilization and educational metrics in one American and one Italian medical school. Ultimately, this study aimed to identify opportunities to better educate and help eliminate tobacco usage among the next generation of global physicians and thereby to improve the tobacco-related health of patients globally.
This study adhered to the tenets of the Declaration of Helsinki and received approval from the institutional review board at Brown University, Providence, RI, US and at the University of Bologna, Bologna, Italy.
Study Population
Medical students (n=701) enrolled in either the Warren Alpert Medical School of Brown University, Providence, RI, US or the Alma Mater Studiorum - Università di Bologna, Bologna, Italy during the 2013-2014 academic year participated in this study. Brown is a 4-year private medical school located in Providence, RI, US, with a total enrollment of 449 students during the study period. Bologna is a 6-year public medical school located in Bologna, Italy with a total enrollment of 1727 students during the study period. Students attending the first year of Bologna medical school (n=301) were not enrolled in the study, as the questionnaire was administered in close temporal proximity to their enrollment prior to starting their clinical activities. Therefore, 1426 Bologna students were initially included in our study. Students at Brown typically matriculate into medical school following at least four years of undergraduate education, while students at Bologna typically matriculate following their high school education, resulting in an older average age cohort at Brown.
The International Professional Assessment of Drinking and Tobacco Perceptions among Young Medical Doctors (iPARTY MD) dataset is derived from a cross-sectional survey created through an international collaboration between researchers at Brown and Bologna. This survey of American and Italian medical students assessed the prevalence of alcohol and tobacco use among medical students, attitudes and clinical skills related to smoking and drinking, as well as aspects of the medical school curricula related to alcohol and tobacco (Supplemental Table 1). The questions of the survey were derived from expert opinion and literature review. The survey was developed in both an English-language version and an Italian-language version. From September to December 2013, students were recruited to this study by distributing the iPARTY MD survey via institutional email to all medical students enrolled at both Brown and Bologna. Consent was obtained from all research participants. The medical students then completed the electronic survey, and responses to survey questions were collected anonymously, de-identified, and stored under password protection online. Students had the option of terminating the survey at any point. This study utilized information present within the iPARTY MD dataset related to tobacco.
Statistical Analysis
SPSS version 21 (IBM Corp., Armonk, NY, USA) was used for data analysis. We performed unadjusted tests of means and proportions (the independent t-test and the chi-square test) to compare variables between the Brown and Bologna medical students and between smoking and non-smoking medical students. Using logistic regression, we computed crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) associating students’ demographics, smoking status, beliefs, and curricula with the absence of important tobacco-related skills.
Of the 449 medical students enrolled at Brown and the 1426 enrolled at Bologna, 174 Brown students (38.7%) and 527 Bologna students (36.9%) participated in this study. The demographic makeup of students was similar at each school in regard to sex (37.2% male at Brown, 43.0% male at Bologna). The age distribution, however, was significantly different between the two schools, with younger students attending Bologna’s medical school. Participants who did not provide information about their smoking status (n=84, 11.9%) were excluded from the remaining analysis.
Medical students’ demographics, tobacco-related attitudes and beliefs, experience with tobacco-related curricula, and skills according to their smoking status and school are presented in Table 1. The Bologna medical students were significantly more likely to be smokers than were students at Brown (29.5% at Bologna, 6.1% at Brown; p<0.001). Among medical students who smoked, students at Bologna smoked significantly more cigarettes in an average day. When asked how many cigarettes smoked per day make a medical student concerned about a patient’s health, Brown students more frequently reported lower numbers of cigarettes than Bologna students. Brown students were also more likely to report that a lower number of cigarettes smoked by a physician would likely be sufficient to impact their patients’ opinion of their professionalism. Additionally, Brown students were more likely to believe that cigarette usage by a physician could affect their approach to treating a patient’s smoking habit (93.9% at Brown, 74.7% at Bologna; p<0.001).
In comparing the attitudes of smokers and non-smokers, non-smokers were more likely to report concerns about patients’ health at lower levels of cigarette usage. Additionally, non-smokers reported that they believed that lower levels of physician smoking would be sufficient to impact their patients’ opinions of their professionalism. Non-smokers were also more likely to believe that cigarette usage by a physician could affect the physician’s approach to treating a patient’s smoking habit (non-smokers, 86.5%; smokers, 56.2%; p<0.001). Lastly, among medical student smokers who thought that cigarette usage by physicians could affect their approach to treating a patient’s smoking habit, nearly half (43.4%) reported that they felt that their personal smoking habit had influenced their approach to treating patients who smoked within the past year.
Medical student curricula regarding tobacco differed between the two institutions, with 95.2% of Brown students reporting having received education on the dangers of smoking, in comparison to only 76.4% of Bologna students (p<0.001). Moreover, 80.3% of Brown students and 9.4% of Bologna students reported having received smoking cessation training (p<0.001). The majority of students at both universities, however, indicated that they believed that medical students should receive specific training in smoking cessation techniques (98.6% at Brown, 85.5% at Bologna; p<0.001). Furthermore, as the number of cigarettes smoked by a medical student in an average week increased, support for smoking cessation training declined.
After adjusting for age, sex, and smoking status, no difference according to sex or between smokers or non-smokers was found in relation to asking about a patient’s smoking status during a routine history and physical examination or in the offering of smoking cessation counseling or treatment to patients (Table 2). There was a non-statistically significant trend for better tobacco-related skills to be present among older participants. However, Bologna medical students were less likely to inquire about patients’ smoking status (OR, 2.30; 95% CI, 0.92 to 5.73) or to offer tobacco cessation counseling or treatment (OR, 2.78; 95% CI, 1.90 to 4.07) than their American counterparts. Interestingly, negative attitudes and beliefs were associated with an increased risk of the absence of tobacco-related skills. Furthermore, students who did not receive formal training in smoking cessation counseling or did not believe that medical students should receive specific training on smoking cessation were less likely to investigate a patient’s smoking status during a routine history and physical examination (OR, 1.54; 95% CI, 0.65 to 3.73; and OR, 1.47; 95% CI, 0.75 to 2.85, respectively) or to offer tobacco cessation counseling or treatment to patients (OR, 1.93; 95% CI, 1.15 to 3.25; and OR, 1.64; 95% CI, 0.92 to 2.92, respectively).
Our study identified a higher rate of personal tobacco use among Italian medical students than among American medical students, which is consistent with the prior literature [23,24]. This finding supports claims in the literature that smoking rates among medical students generally mirror countrywide smoking prevalence, as a greater percentage of Italian citizens smoke cigarettes than Americans (24.4% in Italy, 15.8% in the US) [22,25].
The Italian medical students in our study were less likely to offer smoking cessation counseling or treatment to patients. This is likely in part due to the relative lack of tobacco dependence-related education and smoking cessation training provided to Italian medical students, which we identified in our study and which is consistent with prior literature [15]. Indeed, medical students in our study who did not undergo formal tobacco cessation training subsequently did not offer such cessation or tobacco dependence treatment to their patients. This is concerning given the fact that smoking is one of the leading risk factors for negative health outcomes worldwide, and that smoking cessation training has been found to be an effective tool for encouraging smokers to quit [7].
Despite the lack of education on tobacco-related risks and smoking cessation among Italian medical students relative to American students, it is encouraging to know that the majority of students at both Brown and Bologna believe that they should receive smoking cessation training, as do students across the globe [12]. A lack of smoking-related education is not limited to Italian medical students, as studies have demonstrated a lack of knowledge on these topics among medical students worldwide [19,26]. Since smoking cessation counseling has been shown to be an effective intervention in helping patients reduce or quit smoking, and since curricula dedicated to instruction on the risks of tobacco usage and on tobacco counseling training have been shown to significantly increase students’ understanding, acceptance, and practice of smoking cessation counseling, a global effort should be made to implement educational curricula on smoking cessation training within medical schools [7,8,27,28]. Notably, based on the results of our study, Bologna has already implemented changes in their medical school curriculum to provide specific training on both the adverse health effects of smoking and on smoking cessation techniques.
When comparing smokers to non-smokers in our study, we found that smokers were less likely to desire smoking cessation training. This may be because student smokers feel more prepared to successfully counsel their patients given their first-hand tobacco experience. Conversely, it is possible that student smokers are less intent on providing smoking cessation counseling to their future patients. In our study, smokers and non-smokers did not show significant differences in asking patients about their smoking habits or in offering smoking cessation or treatment to patients. However, the fact that smoking seems to impact willingness to undergo smoking cessation training is concerning.
Additionally, medical students who smoked became concerned about potential negative health outcomes in their patients only when relatively larger numbers of cigarettes were consumed. Unfortunately, students in our study who held this belief offered smoking cessation counseling to patients less frequently, regardless of institution or smoking status.
Finally, smokers were less inclined than non-smokers to believe that a physician’s tobacco use could affect the care offered to that physician’s patients. However, this belief runs counter to existing studies indicating that physician smoking undermines the message that quitting smoking is important, and that non-smoking physicians are more successful at getting patients to quit smoking [29,30]. Furthermore, this belief runs directly counter to the finding of our study that a sizable proportion of student smokers believed that their personal tobacco usage had already influenced their approach to patient care, indicating some level of cognitive dissonance among the students who smoked. Since medical students’ tobacco use has the potential to negatively impact patient health outcomes, future interventions should aim at both preventing and eliminating tobacco use among medical students. Future studies should seek to elucidate the impact of medical students’ smoking on patient health outcomes.
Attitudes regarding physicians’ tobacco use were also found to be vastly different between US and Italian medical students. The Italian students in our study indicated that physicians would need to smoke larger numbers of cigarettes before it impacted either their patients’ opinions of their professionalism or the care they provided to their smoking patients. This disparity may in part be explained by cultural differences, as smoking is more prevalent and more widely accepted in Italy. However, these attitudinal differences could also stem from inadequate education on tobacco risks and smoking cessation in Italy [15]. Unfortunately, a direct impact on patient care was seen among students who believed that greater numbers of cigarettes would be required to impact their patients’ view of their professionalism, as these same students offered less smoking cessation to patients even after controlling for academic institution. In order to change physicians’ attitudes toward smoking, educational efforts may need to address the cultural acceptance of smoking as a societal norm.
Of clinical relevance, in our study we observed that negative beliefs related to tobacco usage, the absence of formal training on smoking cessation counseling, and a negative attitude toward receiving specific training on smoking cessation were all factors associated with the absence of tobacco-related skills, including a lack of investigating a patient’s smoking status during a routine history and physical examination and not offering tobacco cessation counseling or treatment to patients. This indicates that specific attitudes towards tobacco and tobacco-dependence training could be screened for in medical students to preemptively remedy future gaps in tobacco-related clinical skills. Additionally, these findings indicate that formal training in tobacco cessation training has a positive impact on patient care and should be mandatory for future physicians.
Limitations
This study has several potential limitations. First, only two medical schools were surveyed in this study. However, we believe that many of the results presented here are likely generalizable to other medical schools within the US and Italy. Second, the response rate at the two schools was less than 40%, potentially leading to selection bias. Third, since Italian students enter medical school after completing high school, while American medical students enter medical school after completing their undergraduate education, Italian medical students are a younger study cohort. This age disparity may be a confounding variable in the smoking-related beliefs and attitudes between these medical schools. Finally, it is notable that all American medical students completed their undergraduate education prior to medical school, while Italian medical students matriculated directly after high school. This study did not assess medical students’ education on the risks of tobacco products prior to medical school, though American students had at least four years of post-high school education where such information could have been taught, either formally or informally. Regarding formal education, many American pre-medical students focus their studies on the biological and life sciences, including basic biology, chemistry, and public health, where the risks of tobacco usage could easily arise in coursework. Informally, many American college students encounter anti-smoking initiatives in the form of 100% smoke-free campus policies or otherwise [31]. These factors may at least partially account for our finding that American medical students smoked less frequently and were more aware of the health risks of tobacco use.
In summary, this study showed that Italian and American medical students had very different habits, attitudes, clinical skills, and medical education related to tobacco usage. Specifically, our study found that Italian medical students were more likely to smoke, were more lenient in their attitudes toward smoking among both patients and physicians, and were less likely to receive formal training on the health risks of smoking or on smoking cessation counseling. Additionally, this study found that the attitudes of medical student smokers and non-smokers related to tobacco usage differed; smokers were less likely to desire formal smoking cessation training and may be less likely to intervene regarding a patient’s smoking habit at relatively low levels of smoking. Finally, relatively lenient beliefs toward tobacco usage, the absence of formal training on smoking cessation counseling, and a negative attitude toward receiving education on smoking cessation were all associated with an absence of fundamental tobacco-related skills such as investigating a patient’s smoking status during a routine history and physical examination and offering tobacco cessation counseling or treatment to tobacco-dependent patients. Medical education curricula and policies focused on increasing knowledge of tobacco health hazards and smoking cessation, while also aiming to decrease medical student tobacco consumption rates, stand to improve global tobacco-related public health. Further research is needed to assess the impact of medical students’ smoking habits on patients’ health outcomes.
The authors thank all the participants for their valuable contributions.

CONFLICT OF INTEREST

The authors have no conflicts of interest associated with the material presented in this paper.

Supplemental Table 1.
iPARTY questionnaire (in English), which was administered in an anonymous and secure electronic survey format to medical students1
jpmph-50-3-177-suppl.pdf
Table 1.
Characteristics of the participants by academic institution and smoking status
Characteristic Brown University (US)
Bologna University (Italy)
Smokers Non-smokers Smokers Non-smokers
Overall 9 138 139 331
Cigarettes (n/d)
 <1 4 (44.4) 0 (0.0) 45 (32.3) 0 (0.0)
 1-5 4 (44.4) 0 (0.0) 47 (33.8) 0 (0.0)
 6-10 1 (11.1) 0 (0.0) 26 (18.7) 0 (0.0)
 11-15 0 (0.0) 0 (0.0) 13 (9.3) 0 (0.0)
 16-20 0 (0.0) 0 (0.0) 8 (5.8) 0 (0.0)
 >20 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Age (y)
 19-21 0 (0.0) 2 (1.4) 41 (29.5) 99 (29.9)
 22-24 5 (55.5) 67 (48.5) 61 (43.8) 172 (51.9)
 25-27 2 (22.2) 51 (36.9) 27 (19.4) 40 (12.1)
 28-30 1 (11.1) 11 (7.9) 6 (4.3) 12 (3.6)
 >30 1 (11.1) 7 (5.1) 4 (2.8) 8 (2.4)
Sex
 Male 6 (66.7) 48 (34.8) 72 (51.8) 131 (39.6)
 Female 3 (33.3) 90 (65.2) 67 (48.2) 200 (60.4)
Attitudes and beliefs
 Believe that cigarette usage by a physician affects approach to a patient’s smoking habit
  Yes 6 (66.7) 132 (95.6) 78 (56.1) 274 (82.8)
  No 3 (33.3) 6 (4.4) 61 (43.8) 57 (17.2)
 Cigarettes smoked per day by a physician needed to influence a patient’s opinion on professionalism (n)
  1-5 6 (66.6) 111 (81.1) 68 (48.9) 220 (66.4)
  6-10 0 (0.0) 15 (10.9) 23 (16.5) 41 (12.4)
  11-15 2 (22.2) 6 (4.3) 14 (10.1) 20 (6.1)
  16-20 0 (0.0) 0 (0.0) 6 (4.3) 10 (3.1)
  >20 0 (0.0) 3 (2.2) 4 (2.9) 4 (1.2)
  No influence 1 (11.1) 2 (1.5) 24 (17.3) 36 (10.8)
 Cigarettes smoked per day needed to make a physician concerned about a patient's health (n)
  1-5 4 (44.4) 102 (73.9) 16 (11.5) 81 (24.4)
  6-10 4 (44.4) 26 (18.8) 40 (28.8) 117 (35.3)
  11-15 0 (0.0) 7 (5.1) 48 (34.5) 82 (24.7)
  16-20 1 (11.1) 2 (1.4) 21 (15.1) 44 (13.3)
  >20 0 (0.0) 1 (0.7) 14 (10.7) 7 (2.1)
Skills
 Ask about smoking habits during a routine H&P
  Yes 9 (100.0) 132 (95.6) 122 (87.7) 291 (87.9)
  No 0 (0.0) 6 (4.4) 17 (12.2) 40 (12.1)
 Discuss cessation counseling or treatment options if a patient smokes
  Yes 5 (55.6) 83 (60.1) 46 (33.1) 118 (35.6)
  No 4 (44.4) 55 (39.9) 93 (66.9) 213 (64.3)
Curricula
 Received formal training in smoking cessation approaches during medical school training
  Yes 6 (66.7) 112 (81.2) 19 (13.7) 25 (7.5)
  No 3 (33.3) 26 (18.8) 120 (86.3) 306 (92.4)
 Believe medical students should receive specific training on smoking cessation
  Yes 9 (100.0) 136 (98.5) 106 (76.3) 296 (89.4)
  No 0 (0.0) 2 (1.5) 33 (23.7) 35 (10.6)

Values are presented as number (%).

H&P, history and physical examination.

Table 2.
Factors associated with the absence of tobacco-related skills
Characteristic Smoking habits during a routine H&P not investigated
Cessation counseling or treatment options not discussed
Crude Adjusted1 Crude Adjusted1
Institution
 Brown University 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
 Bologna University 3.24 (1.36, 7.68) 2.30 (0.92, 5.73) 3.10 (2.01, 4.78) 2.78 (1.90, 4.07)
Smoking status
 Non-smoker 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
 Smoker 1.19 (0.66, 2.15) 1.01 (0.54, 1.86) 1.42 (0.97, 2.09) 1.14 (0.76, 1.73)
Age (y)
 19-24 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
 ≥25 0.46 (0.23, 0.93) 0.57 (0.27, 1.09) 0.58 (0.39, 1.05) 0.72 (0.46, 1.22)
Sex
 Female 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
 Male 1.30 (0.77, 2.20) 1.14 (0.67, 2.25) 1.17 (0.85, 1.63) 1.05 (0.74, 1.48)
Attitudes and beliefs
 Believe that cigarette usage by a physician affects approach to a patient’s smoking habit
  Yes 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
  No 1.40 (0.69, 2.84) 1.31 (0.87, 2.35) 1.81 (1.19, 2.76) 1.55 (0.97, 2.45)
 Cigarettes smoked per day by a physician needed to influence a patient’s opinion on professionalism (n)
  1-10 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
  >10 / no influence 2.01 (0.94, 4.27) 1.71 (0.82, 3.57) 1.94 (1.28, 2.95) 1.62 (1.04, 2.51)
 Cigarettes smoked per day needed to make a physician concerned about a patient's health (n)
  1-10 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
  >10 1.86 (1.02, 3.38) 1.39 (0.80, 2.44) 2.08 (1.47, 2.95) 1.61 (1.10, 2.36)
Curricula
 Received formal training in smoking cessation approaches during medical school training
  Yes 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
  No 2.64 (1.23, 5.68) 1.54 (0.65, 3.73) 2.88 (1.99, 4.17) 1.93 (1.15, 3.25)
 Believe medical students should receive specific training on smoking cessation
  Yes 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
  No 1.77 (0.87, 3.58) 1.47 (0.75, 2.85) 1.99 (1.14, 3.46) 1.64 (0.92, 2.92)

Values are presented as odds ratio (95% confidence interval).

H&P, history and physical examination.

1 Adjusted for age, sex, academic institution, and smoking status.

  • 1. World Health Organization. Tobacco fact sheet. 2016 Jun. 21. [cited 2017 May 13]. Available from: http://www.wpro.who.int/mediacentre/factsheets/fs_201203_tobacco/en/.
  • 2. US Department of Health and Human Services. The health consequences of smoking: 50 years of progress: a report of the Surgeon General. 2014 [cited 2015 Oct 3]. Available from: https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf.Article
  • 3. Gallus S, Muttarak R, Martínez-Sánchez JM, Zuccaro P, Colombo P, La Vecchia C. Smoking prevalence and smoking attributable mortality in Italy, 2010. Prev Med 2011;52(6):434-438.ArticlePubMed
  • 4. Tomar SL, Husten CG, Manley MW. Do dentists and physicians advise tobacco users to quit? J Am Dent Assoc 1996;127(2):259-265.ArticlePubMed
  • 5. US Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. 2000 [cited 2015 Oct 3]. Available from: https://www.cdc.gov/tobacco/data_statistics/sgr/2000/complete_report/pdfs/fullreport.pdf.Article
  • 6. US Department of Health and Human Services. Treating tobacco use and dependence. 2000 [cited 2015 Oct 3]. Available from: http://whyquit.com/pharmacology/June2000Guideline.pdf.
  • 7. Lim G, Park I, Park S, Song S, Kim H, Kim S. Effectiveness of smoking cessation using motivational interviewing in patients consulting a pulmonologist. Tuberc Respir Dis (Seoul) 2014;76(6):276-283.ArticlePubMedPMC
  • 8. Stead LF, Buitrago D, Preciad N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2013;(5):CD000165.ArticlePubMedPMC
  • 9. Roman B, Borges N, Morrison AK. Teaching motivational interviewing skills to third-year psychiatry clerkship students. Acad Psychiatry 2011;35(1):51-53.ArticlePubMed
  • 10. Powers CA, Zapka J, Biello KB, O’Donnell J, Prout M, Geller A. Cultural competency and tobacco control training in US medical schools: many but missed opportunities. J Cancer Educ 2010;25(3):290-296.ArticlePubMed
  • 11. Leone FT, Evers-Casey S, Veloski J, Patkar AA, Kanzleiter L; Pennsylvania Continuum of Tobacco Education Work Group. Short-, intermediate-, and long-term outcomes of Pennsylvania’s continuum of tobacco education pilot project. Nicotine Tob Res 2009;11(4):387-393.ArticlePubMed
  • 12. Centers for Disease Control and Prevention (CDC). Tobacco use and cessation counseling--global health professionals survey pilot study, 10 countries, 2005. MMWR Morb Mortal Wkly Rep 2005;54(20):505-509.ArticlePubMedPDF
  • 13. Richmond R, Zwar N, Taylor R, Hunnisett J, Hyslop F. Teaching about tobacco in medical schools: a worldwide study. Drug Alcohol Rev 2009;28(5):484-497.ArticlePubMed
  • 14. La Torre G, Sandström P, Falkenberg M, Tanskanen P, Patja K, Kauhanen J. Smoking prevention and smoking cessation training in European medical schools. Eur J Public Health 2009;19(Suppl 1):10-127.Article
  • 15. Grassi MC, Chiamulera C, Baraldo M, Culasso F, Ferketich AK, Raupach T, et al. Cigarette smoking knowledge and perceptions among students in four Italian medical schools. Nicotine Tob Res 2012;14(9):1065-1072.ArticlePubMed
  • 16. Ferketich AK, Gallus S, Colombo P, Fossati R, Apolone G, Zuccaro P, et al. Physician-delivered advice to quit smoking among Italian smokers. Am J Prev Med 2008;35(1):60-63.ArticlePubMed
  • 17. Ferketich AK, Gallus S, Colombo P, Apolone G, Rossi S, Zuccaro P, et al. Use of pharmacotherapy while attempting cessation among Italian smokers. Eur J Cancer Prev 2009;18(1):90-92.ArticlePubMed
  • 18. Nobile CG, Bianco A, Biafore AD, Manuti B, Pileggi C, Pavia M. Are primary care physicians prepared to assist patients for smoking cessation? Results of a national Italian cross-sectional web survey. Prev Med 2014;66: 107-12.ArticlePubMed
  • 19. Springer CM, Tannert Niang KM, Matte TD, Miller N, Bassett MT, Frieden TR. Do medical students know enough about smoking to help their future patients? Assessment of New York City fourth-year medical students’ knowledge of tobacco cessation and treatment for nicotine addiction. Acad Med 2008;83(10):982-989.ArticlePubMed
  • 20. Hung DY, Leidig R, Shelley DR. What’s in a setting?: Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use. Health Care Manage Rev 2014;39(2):154-163.ArticlePubMed
  • 21. Kruger J, O’Halloran A, Rosenthal A. Assessment of compliance with U.S. Public Health Service clinical practice guideline for tobacco by primary care physicians. Harm Reduct J 2015;12: 7.ArticlePubMedPMC
  • 22. Smith DR, Leggat PA. An international review of tobacco smoking among medical students. J Postgrad Med 2007;53(1):55-62.ArticlePubMed
  • 23. Mangus RS, Hawkins CE, Miller MJ. Tobacco and alcohol use among 1996 medical school graduates. JAMA 1998;280(13):1192-1195.ArticlePubMed
  • 24. Saulle R, Bontempi C, Baldo V, Boccia G, Bonaccorsi G, Brusaferro S, et al. GHPSS multicenter Italian survey: smoking prevalence, knowledge and attitudes, and tobacco cessation training among third-year medical students. Tumori 2013;99(1):17-22.ArticlePubMedPDF
  • 25. Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014;311(2):183-192.ArticlePubMed
  • 26. Raupach T, Shahab L, Baetzing S, Hoffmann B, Hasenfuss G, West R, et al. Medical students lack basic knowledge about smoking: findings from two European medical schools. Nicotine Tob Res 2009;11(1):92-98.ArticlePubMed
  • 27. Frank E, Elon L, Spencer E. Personal and clinical tobacco-related practices and attitudes of U.S. medical students. Prev Med. 2009. 49(2-3):233-239.ArticlePubMed
  • 28. Gordon JS, Mahabee-Gittens EM, Andrews JA, Christiansen SM, Byron DJ. A randomized clinical trial of a web-based tobacco cessation education program. Pediatrics 2013;131(2):e455-e462.ArticlePubMedPMC
  • 29. Centers for Disease Control and Prevention (CDC). Smoking control among health-care workers--World No-Tobacco Day, 1993. MMWR Morb Mortal Wkly Rep 1993;42(19):365-367.PubMed
  • 30. Garfinkel L. Cigarette smoking among physicians and other health professionals, 1959-1972. CA Cancer J Clin 1976;26(6):373-375.ArticlePubMed
  • 31. American Nonsmokers’ Rights Foundation. Smokefree and tobacco-free U.S. and tribal colleges and universities. [cited 2016 Dec 29]. Available from: http://senate.rutgers.edu/SmokeFreeUniversitiesList.pdf.

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • The Role Of Medical Education in Struggle Against Smoking: The Prevalance of Smoking And Related Factors in Medical Students, Çanakkale
      Buse YÜKSEL, Esen GOKCE, Coşkun BAKAR, Demet Güleç ÖYEKÇİN, Yagmur DUVA
      Türkiye Halk Sağlığı Dergisi.2023;[Epub]     CrossRef
    • Prevalence of Use and Knowledge about Tobacco Products and Their Harmful Effects among University Students in Southern Croatia
      Dora Istenic, Lidia Gavic, Antonija Tadin
      Healthcare.2023; 11(5): 771.     CrossRef
    • Tobacco Cessation Curriculum in Medical Schools: a Scoping Review
      Sufian Elfandi, Hemant Poudyal
      Journal of Cancer Education.2023; 38(5): 1614.     CrossRef
    • Knowledge and Awareness of Smoking Effects and Its Cessation Methods among Medical Students in Telangana: A Questionnaire Study
      Prashanth Panta, Archana Andhavarapu, Tejaswini R Gurram, Santhi P Ravada
      World Journal of Dentistry.2023; 14(5): 447.     CrossRef
    • Prevalence of Cigarette Smoking and Influence of Associated Factors among Students of the University of Banja Luka: A Cross-Sectional Study
      Ivana Todorović, Feng Cheng, Stela Stojisavljević, Sonja Marinković, Stefan Kremenović, Pane Savić, Ana Golić-Jelić, Nataša Stojaković, Svjetlana Stoisavljević-Šatara, Rajko Igić, Ranko Škrbić
      Medicina.2022; 58(4): 502.     CrossRef
    • Cigarette Smoking among Medical Students from the Western Balkan
      Miloš Ilić, Maja Grujičić, Budimka Novaković, Aleksandra Vrkatić, Zagorka Lozanov-Crvenković
      International Journal of Environmental Research and Public Health.2022; 19(5): 3055.     CrossRef
    • Training Tobacco Treatment Specialists through Virtual Asynchronous Learning
      Audrey Darville, Kathy Rademacher, Amanda T. Wiggins, Mary Grace Lenhof, Ellen J. Hahn
      International Journal of Environmental Research and Public Health.2022; 19(6): 3201.     CrossRef
    • Perceptions and preparedness toward tobacco cessation counseling amongst clinical medical students in Chongqing, Southwest China: A cross-sectional study
      Chuang Yang, Wenjin He, Ruihang Deng, Mohan Giri, Haiyun Dai
      Frontiers in Public Health.2022;[Epub]     CrossRef
    • Tobacco Consumption Among Young Population in Rural Indonesia: Prevalence and Associated Factors
      Diyan Ermawan Effendi, Arief Priyo Nugroho, Sri Handayani, Risqa Novita, Sidiq Purwoko, Zulfa Auliyati Agustina
      Open Access Macedonian Journal of Medical Sciences.2022; 10(E): 1178.     CrossRef
    • Assessment of Knowledge, Attitude, and Practice among Subjects Visiting the Tobacco Cessation Clinic
      Aiswarya Vijayakrishna, Sharad Chand, U. P. Nandakumar, Santosh Prabhu, Manoj S. Dikkatwar, B. C. Vinay, Juno J. Joel
      Global Journal of Medical, Pharmaceutical, and Biomedical Update.2022; 17: 19.     CrossRef
    • Assessing Smoking Habits, Attitudes, Knowledge, and Needs among University Students at the University of Milan, Italy
      Laura Campo, Silvia Lumia, Silvia Fustinoni
      International Journal of Environmental Research and Public Health.2022; 19(19): 12527.     CrossRef
    • Tobacco Smoking and Smokeless Tobacco Use among Domestic and International Medical Students in Hungary
      Erika Balogh, Zoltán Wagner, Nóra Faubl, Henna Riemenschneider, Karen Voigt, András Terebessy, Ferenc Horváth, Zsuzsanna Füzesi, István Kiss
      Substance Use & Misuse.2021; 56(4): 493.     CrossRef
    • Tobacco use and related behaviors among staff and students in a university hospital: A large cross-sectional survey
      Emmanuel Grolleau, Véronique Fonteille, Caroline Lebourgeois, Marie Darrason, Philippe Michel, Delphine Ragonnet, Gilles Freyer, Amélie Deculty, Carine Gippet, Céline Leclerq, Carole Neugnot, Radoudja Malek, Odile Perdriolat, Michele Rigaud, Séverine Torr
      Tobacco Prevention & Cessation.2021; 7(July): 1.     CrossRef
    • Knowledge and attitudes towards smoking cessation counselling: an Italian cross-sectional survey on tertiary care nursing staff
      Laura Maniscalco, Salvatore Barretta, Giuseppe Pizzo, Domenica Matranga
      PeerJ.2021; 9: e12213.     CrossRef
    • Validation of a Questionnaire to Assess Smoking Habits, Attitudes, Knowledge, and Needs among University Students: A Pilot Study among Obstetrics Students
      Laura Campo, Francesca Vecera, Silvia Fustinoni
      International Journal of Environmental Research and Public Health.2021; 18(22): 11873.     CrossRef
    • First-year French medical students consume antidepressants and anxiolytics while second-years consume non-medical drugs.
      G. Fond, A. Bourbon, M. Boucekine, M. Messiaen, V. Barrow, P. Auquier, C. Lançon, L. Boyer
      Journal of Affective Disorders.2020; 265: 71.     CrossRef
    • Mental Health Disturbances and Related Problems in Italian University Medical Students from 2000 to 2020: An Integrative Review of Qualitative and Quantitative Studies
      Gaia Sampogna, Giovanni Marcos Lovisi, Francesca Zinno, Valeria Del Vecchio, Mario Luciano, Érika Gonçalves Loureiro Sol, Roberto José Gervásio Unger, Antonio Ventriglio, Andrea Fiorillo
      Medicina.2020; 57(1): 11.     CrossRef
    • Apprentissage de l’aide au sevrage tabagique dans les formations médicales au Liban
      Hala El Kahi, Fady Haddad, Sani Hlais
      Santé Publique.2020; Vol. 32(1): 57.     CrossRef
    • Preferences in Sleep Position Correlate With Nighttime Paresthesias in Healthy People Without Carpal Tunnel Syndrome
      Carrie L. Roth Bettlach, Jessica M. Hasak, Emily M. Krauss, Jenny L. Yu, Gary B. Skolnick, Greta N. Bodway, Lorna C. Kahn, Susan E. Mackinnon
      HAND.2019; 14(2): 163.     CrossRef
    • Perception of health professions students of their role model status in Toombak cessation: A cross-sectional study from Sudan
      Hatim Mohammed Almahdi, Raouf Wahab Ali, Anne Nordrehaug Åstrøm, Elwalid Fadul Nasir, Pranil Man Singh Pradhan
      PLOS ONE.2019; 14(2): e0210837.     CrossRef
    • Anxiolytic consumption is associated with tobacco smoking and severe nicotine dependence. Results from the national French medical students (BOURBON) study
      A. Bourbon, L. Boyer, P. Auquier, M. Boucekine, V. Barrow, C. Lançon, G. Fond
      Progress in Neuro-Psychopharmacology and Biological Psychiatry.2019; 94: 109645.     CrossRef
    • Psychiatry: A discipline at specific risk of mental health issues and addictive behavior? Results from the national BOURBON study
      G. Fond, A. Bourbon, J-A. Micoulaud-Franchi, P. Auquier, L. Boyer, C. Lançon
      Journal of Affective Disorders.2018; 238: 534.     CrossRef
    • Estudio de corte transversal sobre el estado de conocimientos, actitudes y prácticas de médicos colombianos ante el tabaquismo
      Claudia Ximena Robayo-González, Juan Carlos Uribe-Caputi
      MedUNAB.2018; 20(3): 327.     CrossRef


    JPMPH : Journal of Preventive Medicine and Public Health