ABSTRACT
Title
Knowledge and perceptions of Medical Students about cigarette smoking: a survey in four Italian medical schools
Authors
M.C. Grassi1, C. Chiamulera2, M. Baraldo3,F. Culasso4, A.K. Ferketich5, C. Patrono6, P. Nencini1
1Dept of Physiology and Pharmacology, Sapienza University of Rome, School of Medicine, Rome, italy
2Dept of Public Health and Community Medicine, Sect. Pharmacology, University of Verona, Italy
3Dept of Experimental and Clinical Medical Science, Chair of Pharmacology, School of Medicine, University of Udine, Italy
4Dept of Public Health and Infectious Diseases, Sapienza University of Rome, School of Medicine, Rome, Italy
5Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
6Dept of Pharmacology, Catholic University, School of Medicine, Rome, Italy
1Dept of Physiology and Pharmacology, Sapienza University of Rome, School of Medicine, Rome, italy
2Dept of Public Health and Community Medicine, Sect. Pharmacology, University of Verona, Italy
3Dept of Experimental and Clinical Medical Science, Chair of Pharmacology, School of Medicine, University of Udine, Italy
4Dept of Public Health and Infectious Diseases, Sapienza University of Rome, School of Medicine, Rome, Italy
5Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
6Dept of Pharmacology, Catholic University, School of Medicine, Rome, Italy
Abstract
Tobacco smoking is the leading cause of preventable death in developing countries (WHO, 2008). In Italy 11.1 million adults are current smokers and 27.1% of these smokers tried to stop smoking at least once in their lifetime (Doxa-ISS, 2010).The Italian guidelines (OssFAD-ISS, 2008) recommend the use of both pharmacotherapy and counseling for all quit attempts. In previous studies, we described that group counseling combined with pharmacotherapy improved the rate of smoking abstinence at 1-year follow-up in smokers who wanted to quit (1,2). Advice and assistance by physicians have an important role in helping smokers to quit and several studies have investigated the role that medical schools should play in training students in toxicology of tobacco and how to help smokers to quit (3-6). Little attention has been paid to the issue of tobacco dependence in the Italian medical school core curricula, consequently physicians do not provide strong and unambiguous advice to quit smoking at each visit nor do they prescribe pharmacotherapy for tobacco dependence (7,8). This study was conducted on medical students at four Italian medical schools (Rome Sapienza and Catholic, Udine, Verona) to investigate their smoking behaviors and knowledge. Students were asked to complete a 60-item questionnaire between April and May 2010 before a lecture of Pharmacology.There were four main sections in the questionnaire: demographics and personal smoking history, knowledge of smoking-related epidemiology, knowledge of clinical guidelines, and smoking and life expectancy. Using 15 items a special score (score 1) was computed assigning a value (0-2) to each answer, to classify students for their knowledge of: i) smoking epidemiological aspects, ii) risks associated with smoking, iii) benefits of cessation. Using others 15 items another score (score 2) was computed, to classify students for their knowledge of: i) clinical guidelines on smoking cessation, ii) effectiveness of smoking cessation methods. The questionnaire was completed by 439 students (60.8% female) of which 197 (44.9%) were from Rome Sapienza and 95 (21.6%), 96 (21.9%) and 51 (11.6%) from Rome Catholic, Udine and Verona Medical Schools, respectively. The prevalence of smoking was 15.3%, with difference between males and females (20.5% vs. 11.6% respectively, P<.01) and 59.7% reported that they wish to give up smoking. Our survey shows that Italian medical students have a limited knowledge of the epidemiology of smoking and smoking attributable morbidity and mortality, as well as of the benefits of smoking cessation. Accordingly, 65.6% of the students had a total “score 1” less than 60 (mean 51.1+11.5 SD, with no differences among students of the different medical schools, gender and smoking status). Knowledge of clinical guidelines, perceived competency in counseling smokers and treatment of nicotine addiction was also insufficient as 65.8% of the students had a total “score 2” less than 60 (mean 51.9+10.5 SD, with no differences between the different student sub-groups).Similarly to a recent study conducted in different European medical schools (5), our data highlight the fact that medical schools fail to address the need to improve students’ competence in tobacco dependence pharmacotherapy and counseling. As a result, medical students underestimate the relevant role that a physician may have in assisting smokers during their attempt to quit. In conclusion the current findings provide a rationale for designing and implementing the core curriculum of Italian medical schools on smoking dependence and therapy.
1. Grassi et al. (2006). Drug Dev Res 67,271
2. Grassi et al. (2009). Nicotine Tob Res 11,114
3. Fiore et al. (1994). JAMA 271,624
4. Geller et al. (2008). Gen Intern Med 23,1071
5. Raupach et al. (2009). Nicotine Tob Res 11,92
6. Springer et al. (2008) Acad Med 83,982
7. Ferketich et al. (2008). Am J Prev Med 35,60
8. Ferketich et al. (2009). Eur J of Cancer Prev 18,90
1. Grassi et al. (2006). Drug Dev Res 67,271
2. Grassi et al. (2009). Nicotine Tob Res 11,114
3. Fiore et al. (1994). JAMA 271,624
4. Geller et al. (2008). Gen Intern Med 23,1071
5. Raupach et al. (2009). Nicotine Tob Res 11,92
6. Springer et al. (2008) Acad Med 83,982
7. Ferketich et al. (2008). Am J Prev Med 35,60
8. Ferketich et al. (2009). Eur J of Cancer Prev 18,90