Elsevier

Public Health

Volume 126, Issue 2, February 2012, Pages 159-164
Public Health

Original Research
Tobacco use among medical students in Europe: Results of a multicentre study using the Global Health Professions Student Survey

https://doi.org/10.1016/j.puhe.2011.10.009Get rights and content

Summary

Objective

To examine smoking prevalence, knowledge and attitudes, and tobacco cessation training among university students attending European medical schools using the Global Health Professional Students Survey approach.

Methods

A cross-country, cross-sectional study was performed among 12 medical schools in four countries in Europe (Germany, Italy, Poland and Spain). The survey was performed during the second semester of the third year of study from March to May 2009.

Results

In total, 2249 subjects entered the study (overall response rate 92%). The overall prevalence of smoking among medical students was 29.3% (95% confidence interval 28.1–34.7), with percentages ranging from 28% in Germany to 31.3% in Italy. This study found that more than two-thirds of medical students believe that health professionals are role models for patients, with different beliefs in Poland (89.6%) and Germany (77.7%) vs Italy and Spain (57.2% and 54.4%, respectively) (P < 0.001). Smoking cessation training at medical school was only reported by 16.5% of students (lowest proportion in Italy, 3.5%) (P < 0.001). In terms of smoking cessation methods, the vast majority (89.8%) of medical students were aware of nicotine patches and gum (highest prevalence in Spain, 96.3%), and 24.4% were aware of the use of antidepressants (highest prevalence in Germany, 33.6%).

Conclusion

This European survey found that the prevalence of smoking was higher among medical students than the general population. There is a strong need to provide medical students with training in smoking cessation techniques.

Introduction

Cigarette smoking is considered to be one of the most important preventable risk factors for the development of chronic diseases1 including cardiovascular and respiratory diseases,2 several types of cancer3, 4 and non-tumoural pathologies.5

Paradoxically, health professionals, while recognizing smoking as the leading preventable cause of death and disability, are not aware of their fundamental role to help people quit smoking,6, 7 and in some countries, the prevalence of smoking is higher among health professionals than the general population.8, 9

It is well recognized that helping patients to stop smoking is cost-effective. Unfortunately, research shows that only one in five patients receive advice and assistance to quit smoking, and a very low percentage receive pharmacotherapy.10 One of the reasons for this could be the lack of comprehensive training in smoking cessation techniques in medical curricula, while there is evidence that introducing tobacco knowledge to the curriculum is effective in reducing the prevalence of smoking among medical students.11

In Europe, several studies have been conducted on knowledge, attitudes and behaviours of students towards tobacco smoking.12, 13, 14, 15, 16, 17, 18, 19, 20 However, the main weakness in many surveys of tobacco use has been the lack of a standard definition for smoking status, or the use of different sampling methods, questionnaires and data collection procedures.21

In order to overcome these limitations, the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC) and the Canadian Public Health Association developed and implemented the Global Health Professions Student Survey (GHPSS).22

The aim of this study was to conduct preliminary research to examine smoking prevalence, knowledge and attitudes, and tobacco cessation training among university students attending medical schools in four European countries using the GHPSS approach.

Section snippets

Study design and population

A cross-country, cross-sectional study was carried out among medical schools in four European countries (Germany, Italy, Poland and Spain). As this survey was a preliminary step for a larger survey, a convenience sample was chosen, enrolling third-year medical students in each country (the standard approach in the GHPSS). The survey was carried out with students in the selected schools during the second semester of the third year of study in March to May 2009 at the medical schools of the

Results

Out of 2443 medical students in the third year of the 12 participating universities, 2249 entered the study (overall response rate 92.0%): 744 (33.2%) from Poland, 655 (29.1%) from Italy, 497 (22.1%) from Germany, and 353 from Spain (15.7%). Females represented 50.4% of the total sample population, with significant differences found between countries (P < 0.001). The mean (SD) age of the sample was 21.34 (1.82) years (range 20–44 years).

Discussion

This European survey found that smoking prevalence among medical students (almost 30%) was higher than that in the general population, with significant differences between countries (highest prevalence in Italy), in line with other GHPSS surveys conducted in other WHO-Europe countries (comparable prevalence in countries such as Republic of Srpska, 32.1%; Croatia, 36.6%; Czech Republic, 21.6%; Lithuania, 27.6%; Republic of Serbia, 34.7%; Slovakia, 30.4%; higher prevalence in Albania, 43.3%;

Acknowledgements

The authors wish to thank WHO-Europe and the US CDC for their valuable help in designing, supporting and conducting the survey in Europe.

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    GHPSS Collaborative Group: R. Siliquini, L. Manzoli, A. Firenze, N. Romano, A. Zscheppang, L.F. Valero Juan.

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