Rauchgewohnheiten von deutschen Medizinstudierenden in Deutschland und Ungarn

Background

Although many anti-tobacco measures have reduced the number of smokers in Germany, every fourth person still smokes and smoking is still an enormous burden for both the affected person and their relatives as well as for the healthcare system and society. Physicians have a key position in tobacco cessation, their health and smoking behavior is therefore of great importance.

Objective

To provide information about the distribution of tobacco consumption among medical students and to examine the influence of study site on tobacco consumption.

Material and methods

In a multicenter cross-sectional study, data on the health behavior of German medical students in two German and two Hungarian universities were collected in 2014 using a questionnaire.

Results

Of the 1384 students, 7.3% smoked daily, 9.1% occasionally and 11.9% were ex-smokers. The consumption of e?cigarettes was rare, whereas shisha smoking was more widespread among medical students. Among the study locations Munich had the lowest rates of occasional smoking for men and for women consuming shisha.

Conclusions

Medical students must be encouraged not to smoke. Our results highlight the need for smoking cessation programs at medical schools, including education about detrimental health effects of shisha use.

     

Comparing the preferences of health professionals and members of the public for setting healthcare priorities

Introduction

This article reports on a priority-setting exercise involving members of the general public and health professionals. The aim is to compare the healthcare priorities of these two groups, as well as their attitudes towards public involvement in priority setting.

Methods

A convenience sample of 373 members of the public attending two central Sydney, Australia, medical clinics were asked to complete a structured, interviewer-administered questionnaire. Forty-four purposively sampled healthcare professionals working in central Sydney completed the same questionnaire. Both groups were asked whether the preferences of the public should inform priority-setting decisions. They then had to allocate an additional (but fixed) amount of healthcare resources across competing programmes, medical procedures and population groups and their preferences were compared.

Results

The health professionals and members of the public strongly supported using public preferences to inform priorities in healthcare. Both groups expressed a slightly stronger preference for using public preferences to inform priorities across healthcare programmes and population groups than for medical interventions.

Discussion/conclusion

Considerable uniformity of preferences was revealed between the health professionals and the members of the public. However, it is argued that, even where the preferences of health professionals are consistent with and representative of those of the wider community, public involvement is important in terms of procedural justice, as it helps to legitimise both the process and the resultant priorities.     

Effect of training program regarding smoking cessation counseling for primary health care physicians in Port Said City,Egypt

Background

Smoking is a major risk factor for death-related diseases. Not all healthcare professionals are following evidence-based guidelines for smoking cessation counseling in primary care settings. The WHO, Framework Convention on Tobacco Control (FCTC), and United States Public Health Service (USPHS) guidelines recommend that all healthcare professionals, including students in healthcare training programs, receive education in the management of tobacco use and dependence.

Objective

To evaluate the effect of training programs for primary healthcare physicians on the knowledge, attitude, and practice of smoking cessation counseling.

Methods

This was a pre-post intervention study. The study included 74 primary care physicians working in primary healthcare centers affiliated with the Ministry of Health and Suez Canal University Hospitals in Port Said City. The study was conducted between June 2015 and March 2016 using a structured questionnaire and observation checklist to assess counseling of patients willing to quit smoking.

Results

There were highly statistically significant improvements in the physicians’ median scores of knowledge (30%–80%), attitude (65% -100%), and practice (20%–70%) (p?<?0.001) pre-post intervention. The most frequent correct knowledge was consequences of smoking (73%–87.3%) (p?<?0.001) pre-post intervention. The most favorable attitude was the importance of smoking cessation (70.3%–100%) (p?<?0.001) pre-post intervention. The best observed correct practice was asking about smoking (70.3%–100%) (p?<?0.001) pre-post intervention.

Conclusion

Knowledge, attitude, and practice skills regarding smoking cessation counseling among primary healthcare physicians were markedly improved after implementation of the education program.

     

Tobacco use and cessation among medical students in Croatia – results of the Global Health Professionals Pilot Survey (GHPS) in Croatia, 2005

Summary Objectives: To collect information from third year medical students attending Croatian medical schools on prevalence of cigarette smoking and other tobacco use, exposure to secondhand smoke, desire to quit using tobacco, attitudes and training concerning counselling patients on tobacco cessation. Methods: Global Health Professionals Survey (GHPS) was conducted in 2005 in all four Croatian medical schools with a census of third year medical students (404 out of 409, response rate 98.5 %) using an anonymous, confi dential and self-reported questionnaire. Results: More than two thirds (67.4 %) of medical students in Croatia have ever smoked cigarettes, and over one third (36.6 %) are smoking cigarettes currently. Half of the medical students (50.4 %) report exposure to second hand smoke at home. Less than a third of current smokers (30.9 %) have received cessation assistance when they tried to quit. Conclusions: Our findings indicate significant tobacco use among medical students in Croatia. There is an urgent need to reduce this harmful behaviour through more comprehensive public health initiatives, provision of support for cessation among health professionals who smoke and provision of training to health professionals to assist their patients with cessation. Submitted: 09 February 2007; Revised: 06 June 2007; Accepted: 03 January 2008     

Smoking behaviour,knowledge and attitudes among Family Medicine physicians and nurses in Bosnia and Herzegovina

Background

Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies.

Methods

The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses.

Results

Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77%) completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking cessations strategies, but about two thirds of health professionals felt very or somewhat prepared to counsel their patients on how to quit smoking.

Conclusions

Our study indicates that almost half of Family Medicine health professionals in Bosnia and Herzegovina are smokers. This indicates a severe public health problem throughout the country. Steps need to be taken at a national level to address the fight against tobacco.

     

Am Anfang überwiegen die positiven Effekte

Background

In this study we investigated whether motives for smoking tobacco and for giving up changed over the early years of use and what conclusions can be drawn for the structuring of ways of giving up tobacco.

Methods

An exploratory, one-off investigation based on a questionnaire was carried out at three vocational schools in Bavaria in early 2006. In all 1097 pupils were interviewed, from whom we selected 97 to represent “beginners” (who had been smoking for up to 2 years) and 87 to represent “long-term smokers” (who had been smoking for more than 5 years) to allow a comparison between groups at these two extremes.

Results

Beginners smoke less frequently and smoke fewer cigarettes than long-term smokers. The two groups differ in their motives for both smoking and giving up. Beginners give more positive motives for smoking (e.g., “social motivation” and “pleasure”), while long-term smokers are more likely to cite “boredom” and “force of habit” as their motives for smoking. Beginners are more likely to see physical fitness as a reason for giving up than are long-term smokers.

Conclusions

An offer of help to stop smoking is useful at any stage of the smoking career. The results of the survey provided suggestions for the design of programmes to help young people give up smoking.     

Potential impact of a pilot training program on smoking cessation intervention for tuberculosis DOTS providers in Malaysia

Background

The association between tuberculosis (TB) and tobacco smoking is becoming increasingly important. Smoking cessation may yield substantial positive effects on TB treatment outcomes, relapse, and future lung disease. Thus, TB directly observed therapy, short-course (TB DOTS) providers are uniquely positioned to intervene with those TB patients who are smokers. Unfortunately, most health care professionals are inadequately trained to provide such service.

Aim

This study aimed to determine the feasibility of developing and implementing a customized training program related to the delivery of an integrated smoking cessation intervention (SCI) for TB DOTS providers and to evaluate its potential impact on their knowledge, attitudes, and perceived competence.

Method

We developed and delivered a structured training program and materials about treating tobacco use and dependence in TB settings. The training was offered to DOTS providers from six chest clinics in Penang and Wilayah Persekutuan Kuala Lumpur health districts, Malaysia, who were planned to be involved in a larger project, known as the SCIDOTS Project. A pretest-posttest survey of a single group was conducted. Changes in scores before and after the training program in knowledge and attitude were measured.

Results

Ten DOTS providers participated in the program and completed both the pretest and posttest survey questionnaire. The trainees’ median scores in knowledge of health risks of tobacco and tobacco-related diseases, the association between TB and tobacco, and overall knowledge significantly increased compared to the baseline (p?<?0.05). Upon completion of the program, the majority of the trainees (70–100%) believed that they were competent and confident in performing most SCI activities.

Conclusion

This preliminary study suggests that a customized in-service training program on SCI designed for and delivered to TB DOTS providers could significantly improve their knowledge, attitude, and practice related to SCI. It has also highlighted the gap related to SCI in nursing education and calls for urgent curricula reforms.     

Prevalence,habits and personal attitudes towards smoking among health care professionals

Background

Tobacco use is the second major cause of morbidity and the 4th most common health risk factor in the world. Medical professionals have a critical role in the process of smoking cessation both as advisers and behavioural models for the citizens. The aim of this study was to investigate the prevalence of smoking among health care professionals, their smoking habits and personal attitudes toward smoking, role and the responsibility of health care professionals in the prevention of smoking.

Results

Out of the total number of examinees, 175 (35,1%) are active smokers, 29 (5,8%) are former smokers, and 295 (59,1%) are non-smokers. Nurses with secondary education disagree the most with the claim that passive smoking is more harmful to health (χ2 test, p = .008), also with the claim that the introduced Smoking Act is fair to smokers (χ2 test, p = .021). More nurses with secondary education disagree completely or partially that one should pay attention to smoking in the presence of non-smokers (χ2 test, p = .012).

Conclusion

Training programs for health care workers are needed to improve their ability in smoking cessation techniques to provide active support to their patients.

     

Support for tobacco control interventions: do country of origin and socioeconomic status make a difference?

Objective

To examine the attitudes to various tobacco control regulations among smokers from four different countries and explore differences by country and socioeconomic status.

Methods

Questions relating to tobacco regulation were asked of adult smokers from the 2007–2008 International Tobacco Control Four Country Survey (ITC4). Measures included attitudes to tobacco industry and product regulation, and measures of socioeconomic status and economic disadvantage.

Results

Overall smokers supported greater regulation of the tobacco industry with least supportive US smokers and most supportive Australian smokers. Reporting smoking-related deprivation and a lower income was independently associated with increased support for regulation of the tobacco industry (both p?≤?0.01).

Conclusions

Policy-makers interested in doing more to control tobacco should be reassured that, for the most part, they have the support of smokers, with greatest support in countries with the strongest regulations. Smokers economically disadvantaged by smoking were more supportive of government policies to regulate the tobacco industry suggesting that reactance against regulation is not likely to differentially contribute to lower cessation rates in this group.     

Risk factors for bone mineral density at the calcaneus in 40–59 year-old male workers: A cross-sectional study in Korea

Background

Anecdotal reports suggest waterpipe smoking is becoming common in students in western countries. The aim was to examine prevalence, risk factors, symptoms of addiction, and smoke intake.

Methods

This was a cross-sectional survey of students with subsidiary survey of regular waterpipe user and survey of exhaled carbon monoxide (CO) before and after waterpipe smoking in customers of a waterpipe café. 937 students of Birmingham University completed the initial survey with a follow up of 21 regular waterpipe smokers. 63 customers of a waterpipe café near the University completed the study of CO intake.

Results

355 (37.9%, 95% confidence intervals (CI) 34.8 to 41.1%) students had tried waterpipes, the prevalence of trying rising with duration at University. 75 (8.0%, 95%CI 6.4 to 10.0%) were regular smokers, similar to the prevalence of cigarette smoking (9.4%). Although cigarette smoking was the major risk factor for being a regular waterpipe smoker, odds ratio (95%CI) 2.77 (1.52 to 5.06), 65% of waterpipe smokers did not smoke cigarettes. Seven of 21 (33.3%) regular waterpipe smokers experienced cravings. Nearly all regular waterpipe users thought it less harmful than smoking cigarettes. The mean (standard deviation) rise in CO was 37.4 (25.8)ppm, nearly twice as high as a typical cigarette smoker seeking cessation treatment.

Conclusion

Waterpipe smoking is a common part of student culture in one British university, as in the Middle East and in the United States. It poses a potential threat to public health, with evidence of dependence and high smoke intake.     

Kurzintervention zum Rauchverzicht bei jungen Frauen in gynäkologischen Praxen

Background

Gynecological practices offer good access to young female smokers. Immediate health risks of smoking while using hormonal contraceptives are a promising approach to be used in interventions to increase motivation towards smoking cessation.

Methods

A randomized controlled study with 12-month follow-up, testing the efficacy of a smoking cessation intervention for a proactively recruited sample of female smokers aged 14–25 in gynecological practices, is outlined.

Results

Selected results regarding the feasibility of the intervention are presented. Participation rates were 94.7% for gynecological practices; 98.3% of patients in the age group could be screened. The participation rate of young female smokers was 83.9%. Of these, 93% have so far completed follow-up.

Conclusions

The extraordinarily high participation rates show the feasibility of such an intervention to increase motivation towards smoking cessation for young female smokers in gynecological practices.     

Peer Reviewed: State-Level Prevalence of Cigarette Smoking and Treatment Advice, by Disability Status, United States, 2004

Introduction

To our knowledge, no study has determined whether smoking prevalence is higher among people with disabilities than among people without disabilities across all U.S. states. Neither do we know whether people with disabilities and people without disabilities receive the same quality of advice about tobacco-cessation treatment from medical providers.

Methods

We analyzed data from the 2004 Behavioral Risk Factor Surveillance System to estimate differences between people with and people without disabilities in smoking prevalence and the receipt of tobacco-cessation treatment advice from medical providers.

Results

We found that smoking prevalence for people with disabilities was approximately 50% higher than for people without disabilities. Smokers with disabilities were more likely than smokers without disabilities to have visited a medical provider at least once in the previous 12 months and to have received medical advice to quit. More than 40% of smokers with disabilities who were advised to quit, however, reported not being told about the types of tobacco-cessation treatment available.

Conclusion

Ensuring that people with disabilities are included in state-based smoking cessation programs gives states an opportunity to eliminate health disparities and to improve the health and wellness of this group. Ways to reduce unmet preventive health care needs of people with disabilities include provider adoption of the Public Health Service''s clinical practice guideline for treating tobacco use and dependence and the provision of smoking cessation services that include counseling and effective pharmaceutical treatment.     

Risk factors associated with smokeless tobacco use and cigarette smoking among teenagers in a sub-urban area of south west Nigeria

Aims

To evaluate the prevalence of, and identify risk factors associated with smokeless tobacco (SLT) use and cigarette smoking (CS) among Nigerian teenagers.

Methods

Using a validated self-administered questionnaire adapted from the Global Youth Tobacco Survey, we surveyed 1,272 teenagers selected from the five schools in Ilisan-Remo Nigeria regarding use of CS and SLT products. We used the Pearson chi-squared test and logistic regression to assess correlates of both SLT use and CS. Adjusted odds ratios (AOR) with 95?% confidence intervals (CI) were used to measure magnitudes of associations.

Results

Prevalence of ever users of SLT and CS were 5.0?% (CI: 3.8, 6.2) and 6.9?% (CI: 5.5, 8.3) respectively. Higher prevalence of SLT user was recorded among male (7.9?%), 18–19?years (11.1?%), those who had parents cigarette smokers (35.9?%), those whose best friends were cigarette smokers (47.1?%) and those working after school (9.4?%) compared with their counterparts (p?<?0.05). Similarly, higher prevalence of CSwas recorded among male (9.6?%), 18–19?years (12.7?%), those whose parents smoke (56.4?%), those whose best friends were cigarette smokers (100.0?%) and Muslims (11.1?%) compared with their counterparts. Major factors associated with SLT use were being a cigarette smokers (AOR?=?29.9; CI: 16.5, 54.4), parents smoking (AOR?=?16.1; CI: 9.0, 29.8) and having best friends who smoke (AOR?=?15.1; CI: 7.0, 32.4). Main factors associated with CS included SLT use (AOR?=?29.9; CI: 16.5, 54.4), parent smoking (AOR?=?31.7; CI: 18.2, 55.4 and Muslim (AOR?=?1.8; CI: 1.1, 2.9).

Conclusion

Prevention programmes aimed at reducing cigarette smoking need to be improved to reduce SLT use. The home and places of after school work must also be factored.     

Proaktive Interventionen zur Förderung der Tabakabstinenz in der hausärztlichen Praxis

Aim

This study examines characteristics of target groups that can be reached by proactive smoking interventions in general practices.

Methods

A total of 9,896 consecutive patients from 34 general practices in West Pomerania were registered in this study. The participation in an intervention study including smoking cessation counselling was offered to all smoking patients aged 18–70 years (n=2,016).

Results

Compared to the general population, smokers in the general practice are younger. Among the eligible patients, 82% (n=1,653) gave consent to participate in the intervention study. A total of 65% of the participants did not intend to quit smoking. Patients refusing participation were older, less ready to quit smoking and consumed less tobacco.

Conclusions

Proactive smoking interventions are highly accepted by general practice patients.     

A multilevel examination of factors of the school environment and time spent in moderate to vigorous physical activity among a sample of secondary school students in grades 9–12 in Ontario, Canada

Objective

To examine associations between students’ time spent in moderate to vigorous physical activity (MVPA) and the school built environment while also considering features of the schools’ social environment and student-level characteristics.

Methods

Using surveys and GIS measures, multilevel linear regression analysis was applied to examine the environment- and student-level characteristics associated with time spent in MVPA among grade 9–12 students (n?=?22,117) attending 76 secondary schools in Ontario, Canada as part of the SHAPES-Ontario study.

Results

Statistically significant between-school random variation in student MVPA was identified [ $ \sigma^{2}_{\mu 0} $ ?=?9,065.22 (250.64)]; school-level differences accounted for 3.0% of the variability in student MVPA. Students attending a school that offered daily physical education or provided an alternate room for physical activity spent more time in MVPA than students attending a school without these resources. Moreover, as land-use mix diversity and walkability of the school neighbourhood increased, students’ time spent in MVPA decreased.

Conclusion

Developing a better understanding of the environment- and student-level characteristics associated with students’ time spent in MVPA is critical for informing school-based physical activity intervention programmes and policies.     

Association between infection early in life and mental disorders among youth in the community: a cross-sectional study

Background

Surveys have provided evidence that tobacco use is widely prevalent amongst the youth in Pakistan. Several reviews have evaluated the effectiveness of various tobacco control programs, however, few have taken into account the perceptions of students themselves regarding these measures. The aim of this study was to determine the most effective anti-smoking messages that can be delivered to high-school students in Pakistan, based on their self-rated perceptions. It also aimed to assess the impact of pictorial/multi-media messages compared with written health warnings and to discover differences in perceptions of smokers to those of non-smokers to health warning messages.

Methods

This study was carried out in five major cities of Pakistan in private English-medium schools. A presentation was delivered at each school that highlighted the well-established health consequences of smoking using both written health warnings and pictorial/multi-media health messages. Following the presentation, the participants filled out a graded questionnaire form, using which they rated the risk-factors and messages that they thought were most effective in stopping or preventing them from smoking. The Friedman test was used to rank responses to each of the questions in the form. The Wilcoxon Signed Rank test used to analyze the impact of pictorial/multi-media messages over written statements. The Mann Whitney U test was used to compare responses of smokers with those of non-smokers.

Results

Picture of an oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator, were perceived to be the most effective anti-smoking messages by students. Addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective messages. Pictorial/multi-media messages were perceived to be more effective than written health warnings. Health warnings were perceived as less effective amongst smokers compared to non-smokers.

Conclusion

Graphic pictorial/multi-media health warnings that depict cosmetic and functional distortions were perceived as effective anti-smoking messages by English-medium high school students in Pakistan. Smokers demonstrated greater resistance to health promotion messages compared with non-smokers. Targeted interventions for high school students may be beneficial.     

Was limitiert schulische Tabakprävention?

Background

The school is seen as an important setting for tobacco prevention. What limitates the success of school-based preventive measures?

Instruments and methods

In a naturalistic-controlled cohort study, N?=?1359 students in fifth or sixth grade from college preparatory (“Gymnasium”), secondary modern (“Realschule”) or comprehensive secondary schools (“Gesamtschule”) participated in the universal educational program “Not smoking is cool!” (NiC). They were surveyed before the program as well as three and nine months after with standardized instruments on tobacco intake, academic achievements, and social behavior.

Results

NiC is effective in “Gymnasium” fifth-/sixth graders but shows, as expected, small effect sizes. The percentage of new smokers increased more strongly in the “Gymnasium” control than in the “Gymnasium” intervention group. Pre-existing tobacco intake, academic achievements and behavioral difficulties influenced NiC’s effectiveness regardless of school type.

Conclusions

Significant limitations on the effectiveness of a school-based tobacco prevention program in fifth-/sixth graders exist. These are risk factors that are not addressed by the intervention measure. NiC should be informed by selective and/or behaviour-based prevention program content when conducted in the less academically oriented secondary schools.