FREQUENCY OF TOBACCO USE AND THE ATTITUDES OF HEALTH PROFESSIONS STUDENTS ON TOBACCO USE IN MONTENEGRO: GLOBAL HEALTH PROFESSIONS STUDENT SURVEY IN MONTENEGRO
Abstract
Introduction: Health professionals play a significant role in advising patients on the harmful effects of tobacco on human health and on the ways of abandoning this bad habit. However, tobacco consumption is also a challenge for health professionals themselves, as well as for medical students.
Aim: The objective of this study was to estimate the prevalence of smoking among students of health sciences in Montenegro, as well as to examine their attitudes related to tobacco control mechanisms.
Methods: This is a secondary analysis of the Global Health Professions Student Survey, which was conducted by the Ministry of Health of Montenegro, in the period between October 2010 and March 2011.
Results: In the 30 days preceding the survey, 25% of respondents had used tobacco. During the year preceding the survey, 38% smokers had consumed cigarettes on school premises. Of the respondents, 44.6% of smokers and 52.9% of non-smokers had been taught on the subject of the importance of providing educational material to patients, as a form of support to smoking cessation, but only 35% of smokers and 28% of non-smokers had received formal training on how to instruct patients to give up smoking. A total of 63.7% smokers and 81.7% non-smokers (p < 0.001) expressed the belief that health professionals who smoked cigarettes were less suited to advise patients on smoking cessation. There was a 72% lower probability that sixth year students would support the above stated attitude. Also, there was a 43% lower probability that the same attitude would be supported by students who felt that smoking in restaurants should not be banned in restaurants, and a 52% lower probability that this attitude would be supported by those students who believed that health workers do not need special training in smoking cessation techniques.
Conclusion: The study showed that it was necessary to improve the curricula at health sciences faculties and improve formal training on the harmful effects of tobacco on human health, as well as to improve the training for acquiring evidence-based smoking cessation skills, which would have an indirect effect of reducing tobacco use among students.
References
Al Hosani S, Al Ali M, Al-Marashda K, Al-Shamsi N, Al-Ansari Th, Al-Behandy A, et al. Smoking Prevalence, Attitudes and Behaviors of Primary Healthcare Providers and its Impact on Their Smoking Cessation Counseling Practices. Ibnosina J Med BS 2015;7(2):47-55.
WHO. World Health Organization report on the global tobacco epidemic 2021: addressing new and emerging products. 2021. [Internet]. Available from: https://www.who.int/publications/i/item/9789240032095
Gowing LR, Ali RL, Allsop S, Marsden J, Turf EE, West R, et al. Global statistics on addictive behaviours: 2014 status report. Addiction. 2015 Jun;110(6):904-19. doi: 10.1111/add.12899.
Doll R, Hill AB. A study of the aetiology of carcinoma of the lung. Br Med J. 1952 Dec 13;2(4797):1271-86. doi: 10.1136/bmj.2.4797.1271.
Lancaster T, Stead L, Silagy C, Sowden A. Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. BMJ. 2000 Aug 5;321(7257):355-8. doi: 10.1136/bmj.321.7257.355.
A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. JAMA. 2000 Jun 28;283(24):3244-54.
Ferrante M, Saulle R, Ledda C, Pappalardo R, Fallico R, La Torre G, et al. Prevalence of smoking habits, attitudes, knowledge and beliefs among Health Professional School students: a cross-sectional study. Ann Ist Super Sanita. 2013;49(2):143-9. doi: 10.4415/ANN_13_02_06.
Surani NS, Pednekar MS, Sinha DN, Singh G, Warren CW, Asma S, Gupta PC, Singh PK. Tobacco use and cessation counseling in India-data from the Global Health Professions Students Survey, 2005-09. Indian J Cancer. 2012 Oct-Dec;49(4):425-30. doi: 10.4103/0019-509X.107751.
Gallaway MS, Huang B, Chen Q, Tucker T, McDowell J, Durbin E, et al. Identifying Smoking Status and Smoking Cessation Using a Data Linkage Between the Kentucky Cancer Registry and Health Claims Data. JCO Clin Cancer Inform. 2019 May;3:1-8. doi: 10.1200/CCI.19.00011.
Williams JK, Smith DC, Gotman N, Sabri B, An H, Hall JA. Traumatized youth and substance abuse treatment outcomes: a longitudinal study. J Trauma Stress. 2008 Feb;21(1):100-8. doi: 10.1002/jts.20302.
Aryal UR, Lohani SP. Perceived risk of cigarette smoking among college students. J Nepal Health Res Counc. 2011 Oct;9(2):176-80.
Seigers DK, Terry CP. Perceptions of risk among college smokers: relationships to smoking status. Addic Res Theory, 2011;19:504–9.
Chassin L, Presson CC, Rose JS, Sherman SJ. The natural history of cigarette smoking from adolescence to adulthood: demographic predictors of continuity and change. Health Psychol. 1996 Nov;15(6):478-84. doi: 10.1037//0278-6133.15.6.478.
US Preventive Services Task Force, Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2020 Apr 28;323(16):1590-1598. doi: 10.1001/jama.2020.4679.
GTSS Collaborative Group. Tobacco use and cessation counselling: Global Health Professionals Survey Pilot Study, 10 countries, 2005. Tob Control. 2006 Jun;15 Suppl 2(Suppl 2):ii31-4. doi: 10.1136/tc.2006.015701.
World health organization (WHO), Regional office for Europe. [Internet]. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/tobacco/data-and-statistics/effective-surveillance-and-monitoring/global-tobacco-surveillance-system-gtss/global-health-professions-student-survey-ghpss/implementation-of-the-global-health-professions-student-survey
Institut za javno zdravlje Crne Gore. Izvještaj Crne Gore 2018. godine. Globalno istraživanje pušenja kod mladih (GYTS). Podgorica, Montenegro, 2019.
Mugoša B. Epidemiologija pušenja. Medicinski Zapisi 2011;60 (33-43):11.
Đurišić T, Golubović Lj, Mugoša B. Istraživanje o kvalitetu života, životnim stilovima i zdravstvenim rizicima stanovnika Crne Gore: Nacionalni izvještaj istraživanja. Institut za javno zdravlje Crne Gore i Monstat. Podgorica, 2017.
Villanova CA. Tab gismo Como factor de risco. In: Silva LC, editor. Condutas em Pneumologia. Rio de Janeiro: Revinter; 2001.
International Consultation on Tobacco and Youth. International Consultation on Tobacco and Youth: What the world works? 28-30 September 2000 Singapore: final conference report. Geneva: WHO, 2000.
Green WL, Potvin L. Education, health promotion and social lifestyle determinants of health and disease. In: McEver DJ, Beaglehole R, Tanaka H, eds. Oxford textbook of public health. Vol. 1: the scope of public health. 4th ed. New York: Oxford University Press; 2004. p. 113-30.
Warren CW, Sinha DN, Lee J, Lea V, Jones NR. Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008. BMC Public Health. 2011 Feb 1;11:72. doi: 10.1186/1471-2458-11-72.
Jovanovska T, Prodanovska-Stojcevska V. The Attitudes of Students - Future Health Professionals Regarding Tobacco Usage. Macedonian Journal of Medical Sciences 2011 Jun 15; 4(2):196-200.
Institut za javno zdravlje. Survey on use of tobacco products among health professional students in Montenegro. Podgorica, Montenegro, 2011.
U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Atlanta 2012.
Courtenay, W. H. Engendering health: A social constructionist examination of men’s health beliefs and behaviors, 2000, Psychology of Men & Masculinity, 1, 4–15.
Mahalik JR, Burns SM. Predicting health behaviors in young men that put them at risk for heart disease. Psychology of Men & Masculinity, 2011, Vol. 12, No. 1, 1–12
Mahalik JR, Lagan H, Morrison JA. Health behaviors and masculinity in Kenyan and U.S. male college students, 2006, Psychology of Men & Masculinity, 7, 191–202.
Pleck JH, Sonenstein FL, Ku LC. Attitudes toward male roles among adolescent males: A discriminant validity analysis. Sex Roles, 1994, 30, 481–501.
Nikolić D. Bolesti zavisnosti: pušenje, alkoholizam i narkomanija. Narodna knjiga Alfa. Beograd, 2007.
Zakon o ograničavanju upotreba duvanskih proizvoda. "Službeni list RCG" br. 52/04 od 02.08.2004 i "Službeni list Crne Gore", br. 32/11 od 01.07.2011.
Ljubicic D, Schneider NK, Vrazic H. Attitudes and knowledge of third year medical students in Croatia about tobacco control strategies: results of the Global Health Professionals Pilot Survey in Croatia, 2005. Public Health. 2008 Dec;122(12):1339-42. doi: 10.1016/j.puhe.2008.05.017.
Inandi T, Caman OK, Aydin N, Onal AE, Kaypmaz A, Turhan E, Erguder T, Warren WC. Global Health Professions Student Survey--Turkey: second-hand smoke exposure and opinions of medical students on anti-tobacco law. Cent Eur J Public Health. 2013 Sep;21(3):134-9. doi: 10.21101/cejph.a3851.
Yang T, Yu L, Bottorff JL, Wu D, Jiang S, Peng S, et al. Global Health Professions Student Survey (GHPSS) in Tobacco Control in China. Am J Health Behav. 2015 Sep;39(5):732-41. doi: 10.5993/AJHB.39.5.14.
Al-Haqwi AI, Tamim H, Asery A. Knowledge, attitude and practice of tobacco smoking by medical students in Riyadh, Saudi Arabia. Ann Thorac Med. 2010 Jul;5(3):145-8. doi: 10.4103/1817-1737.65044.
Cauchi D, Mamo J. Smoking health professional student: an attitudinal challenge for health promotion? Int J Environ Res Public Health. 2012 Jul;9(7):2550-61. doi: 10.3390/ijerph9072550.
Vanderhoek AJ, Hammal F, Chappell A, Wild TC, Raupach T, Finegan BA. Future physicians and tobacco: an online survey of the habits, beliefs and knowledge base of medical students at a Canadian University. Tob Induc Dis. 2013 Apr 4;11(1):9. doi: 10.1186/1617-9625-11-9.
Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000165. doi: 10.1002/14651858.CD000165.pub3. Update in: Cochrane Database Syst Rev. 2013;5:CD000165.
Sreeramareddy CT, Ramakrishnareddy N, Rahman M, Mir IA. Prevalence of tobacco use and perceptions of student health professionals about cessation training: results from Global Health Professions Students Survey. BMJ Open. 2018 May 26;8(5):e017477. doi: 10.1136/bmjopen-2017-017477.
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 Oct;83(10):982-9. doi: 10.1097/ACM.0b013e3181850b68.
Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in US undergraduate medical education. JAMA. 1999 Sep 1;282(9):825-9. doi: 10.1001/jama.282.9.825.
Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training: current efforts and gaps in US medical schools. JAMA. 2002 Sep 4;288(9):1102-9. doi: 10.1001/jama.288.9.1102.
Conroy MB, Majchrzak NE, Regan S, Silverman CB, Schneider LI, Rigotti NA. The association between patient-reported receipt of tobacco intervention at a primary care visit and smokers' satisfaction with their health care. Nicotine Tob Res. 2005 Apr;7 Suppl 1:S29-34. doi: 10.1080/14622200500078063.
Rigotti NA, Thorndike AN. Reducing the health burden of tobacco use: what's the doctor's role? Mayo Clin Proc. 2001 Feb;76(2):121-3. doi: 10.1016/S0025-6196(11)63116-9.
Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, 2008.
Pederson LL, Blumenthal DS, Dever A, McGrady G. A web-based smoking cessation and prevention curriculum for medical students: why, how, what, and what next. Drug Alcohol Rev. 2006 Jan;25(1):39-47. doi: 10.1080/09595230500459503.
Ferketich AK, Khan Y, Wewers ME. Are physicians asking about tobacco use and assisting with cessation? Results from the 2001-2004 national ambulatory medical care survey (NAMCS). Prev Med. 2006 Dec;43(6):472-6. doi: 10.1016/j.ypmed.2006.07.009.
Thorndike AN, Regan S, Rigotti NA. The treatment of smoking by US physicians during ambulatory visits: 1994 2003. Am J Public Health. 2007 Oct;97(10):1878-83. doi: 10.2105/AJPH.2006.092577.
Thorndike AN, Rigotti NA, Stafford RS, Singer DE. National patterns in the treatment of smokers by physicians. JAMA. 1998 Feb 25;279(8):604-8. doi: 10.1001/jama.279.8.604.
La Torre G, Saulle R, Unim B, Angelillo IF, Baldo V, Bergomi M, Cacciari P, Castaldi S, Del Corno G, Di Stanislao F, Panà A, Gregorio P, Grillo OC, Grossi P, La Rosa F, Nante N, Pavia M, Pelissero G, Quarto M, Ricciardi W, Romano G, Schioppa FS, Fallico R, Siliquini R, Triassi M, Vitale F, Boccia A. Knowledge, attitudes, and smoking behaviours among physicians specializing in public health: a multicentre study. Biomed Res Int. 2014;2014:516734. doi: 10.1155/2014/516734.
Dania MG, Ozoh OB, Bandele EO. Smoking habits, awareness of risks, and attitude towards tobacco control policies among medical students in Lagos, Nigeria. Ann Afr Med. 2015 Jan-Mar;14(1):1-7. doi: 10.4103/1596-3519.148701.
Richmond R, Zwar N, Taylor R, Hunnisett J, Hyslop F. Teaching about tobacco in medical schools: a worldwide study. Drug Alcohol Rev. 2009 Sep;28(5):484-97. doi: 10.1111/j.1465-3362.2009.00105.x.
Grassi MC, Baraldo M, Chiamulera C, Culasso F, Raupach T, Ferketich AK, et al. Knowledge about health effects of cigarette smoking and quitting among Italian university students: the importance of teaching nicotine dependence and treatment in the medical curriculum. Biomed Res Int. 2014;2014:321657. doi: 10.1155/2014/321657.
Kawane H. Antismoking education for medical students. Chest. 1992 May;101(5):1480. doi: 10.1378/chest.101.5.1480-a.
Cummings KM, Giovino G, Sciandra R, Koenigsberg M, Emont SL. Physician advice to quit smoking: who gets it and who doesn't. Am J Prev Med. 1987 Mar-Apr;3(2):69-75.
Aslam SK, Zaheer S, Shafique K. Health professional students' perceptions regarding their role in tobacco control: findings from the Global Health Professional Students Survey, Pakistan, 2011. Subst Abuse Treat Prev Policy. 2014 Jun 23;9:25. doi: 10.1186/1747-597X-9-25.
Xinguang Chen, Xiaolan Tang, Bonita Stanton, Hanwu Li, Weiqing Chen. Cigarette smoking among medical students in China and modifiable risk factors for smoking prevention. Health Education. 2012; 112 (4): 333 – 34. doi:10.1108/09654281211237162