There are around 1.1 thousand million smokers in the world which is approximately one third of the global population who are aged 15 years and over (47% of men and 12% of women).1 Most smokers live in developing countries (800 million) and most are male (700 million).1 While smoking rates have decreased in developed countries over the last 13 years, there has been a corresponding 50% increase in smoking rates in developing countries.2 

The most important determinant of human health trends is the increase in tobacco related mortality and disability. Tobacco related deaths have been projected to increase from 3.0 million in 1990 to 8.4 million in 2020, which will make tobacco the largest single health problem at this time.3 There are 80–90% of deaths from chronic obstructive lung disease attributed to tobacco, and smokers have six times the risk of contracting this disease compared with smokers; similarly, 80–85% of lung cancer deaths are attributed to tobacco use, with smokers having 10 times the risk compared with non-smokers.4-6 

National and international responses to the public health problem of tobacco therefore need to be intensified. Primary care physicians have a vital role to play in advising patients to stop smoking as most smokers visit their doctor.7-9 Studies have shown that very brief advice from the doctor yields one year quit rates of 5–10%,10-12 and interventions that are more comprehensive, including follow up sessions, produce abstinence rates of 20–36%.13-15 

Another important way to control tobacco use is to encourage medical schools to teach about tobacco issues in the curriculum. It is vital that medical students, the future medical practitioners, have adequate knowledge of smoking related diseases and skills in smoking cessation. The purpose of this paper is to review the literature on medical students’ …

https://thorax.bmj.com/content/thoraxjnl/54/1/70.full.pdf

Teaching medical students about tobacco.

Introduction: Since 2004, with the ratification of the Framework Convention on Tobacco Control, Uruguay has implemented a wide range of legal restrictions designed to reduce the devastating impacts of tobacco. This legal process generated an increase in demand for tobacco cessation treatment, which led to the need to train a large number of physicians. Information and Communication Technologies (ICTs) are evolving constantly, creating new opportunities to make online education more interactive. The evolution of ICTs presents an opportunity to develop innovative continuing medical education (CME) experiences to meet the increasing demand for this topic. Methods: A blended-learning course on tobacco cessation was developed and implemented, combining face-toface and online activities. Educational strategy focused on (1) facilitating interaction among generalists and between generalists and experts, and (2) providing high impact CME incorporating multifaceted interventions with wiki-type collaborative construction of practical knowledge. Multiple-choice tests and commitments-to-change were used for evaluation. Results: Three hundred thirty-five health professionals participated in the course. Of these, 145 (43.3%) attended the on-site workshop, 216 (64.5%) participated in the online activities, and 109 (32.5%) completed both phases. Fifty of the 105 (47.6%) participants completing the pretest had a passing score, while 78.1% received a passing score on the final test (p < .001). Differences between mean pretest and posttest scores among those who completed both phases compared with those who only did the online phase were statistically significant (p = .003 and p = .009, respectively). Discussion: The need to train physicians on tobacco cessation skills can be addressed via ICTs and educational activities that include participant interaction.

Teaching Tobacco Cessation Skills to Uruguayan Physicians Using Information and Communication Technologies.

Rationale, aims and objectives

Few studies have examined doctors' views about counselling unmotivated smokers. This study explored doctors' perceptions of useful strategies to motivate patients to quit, how receptive they felt patients were to these strategies, and the benefits and drawbacks of discussing smoking cessation with patients.



Methods

Fourteen semi-structured qualitative interviews were conducted with doctors and resident doctors.



Results

Strategies reported by providers included: educating about the health risks of smoking, using ‘scare tactics’ to highlight the harmful effects and providing advice about how to quit. Providers believed that most patients were receptive to their strategies, but noted that they lacked feedback to know for sure. Providers saw the possibility of improving patients' health and decreasing overall health care costs as potential benefits, but cited the potential to damage rapport, competing priorities during already rushed visits and uncertainty about the effectiveness of their efforts as drawbacks that reduced their motivation to raise the issue with patients.



Conclusions

Doctors believe in the potential benefits of smoking cessation counselling but predominantly report focusing on enhancing patient's risk perceptions. They did not report attempting to use the wider array of recommended and empirically supported methods to counsel their patients. Providing doctors with increased training in motivational counselling and feedback about the efficacy their efforts or supplementing doctor care with behaviour change specialists would likely increase the benefits of counselling to patients.

/pdf/a-qualitative-assessment-of-provider-perspectives-on-smoking-25vd7e0g1b.pdf

A qualitative assessment of provider perspectives on smoking cessation counselling

In this study, we investigated smoking addiction and some risk factors among university students in Istanbul. A questionnaire survey of 236 university students studying in Istanbul Medical Faculty (n: 148) and other faculties (n: 88) was performed with cross-sectional and responding-under-observation methods in March-May 1999. Thirty-six per cent of the university students with mean age 24.0 (2.9 were addicted to smoking (n: 85): 41.3% males and 26.7% females; 67.5% were using imported and 32.5% were using local product cigarettes. Of the subjects, 18.1% were smoking 1-10 cigarettes a day, 61.4% 11-20 cigarettes a day and 20.5% more than 20 cigarettes a day. When alcohol and smoking addiction were compared with logistic regression analysis, with respect to gender, age, school, parents' educational levels, living style and the sources of income, the risk factor for alcohol addicts was found to be more 2.54 times than smoking addicts (OR = 2.54, 95% CI = 1.38-4.67; p = 0.003). The study has emphasized the association of alcohol and smoking addiction in university students and the prevalence of smoking addiction among adolescent females.

Smoking addiction among university students in Istanbul

OBJECTIVES The aim of this study was to assess the prevalence of tobacco use and exposure to secondhand smoke among students of health professions (SHPs) and determine possible risk factors for current smoking. In addition, we sought to investigate the level of students' knowledge regarding smoking cessation. DESIGN Cross-sectional. SETTING Central Greece. PARTICIPANTS A convenient sample of 822 SHP volunteers were used, composed of 365 medical students, 123 students from a biochemistry department, 71 students from a nursing department, 176 from medical laboratory department and 84 students from a veterinary medicine department. PRIMARY AND SECONDARY OUTCOME MEASURES We investigated the prevalence of current smoking and secondhand smoke, their determinants and SHP's knowledge and attitudes regarding smoking cessation. Univariate and logistic regression statistical analysis were used in order to identify risk factors associated with current smoking. RESULTS The prevalence of current smoking was estimated at 23.5% (95% CI 20.7% to 26.5%), while 49% of current smokers reported they wanted to quit smoking. The prevalence of current e-cigarette use was 1.2%. In addition, 96.5% (95% CI 94.9% to 97.5%) of SHP have been exposed to secondhand smoke at least 1 day per week. Logistic regression analysis showed that increasing age (p<0.001), alcohol consumption (p<0.001) and exposure to secondhand smoke in the home (p<0.001) were independent risk factors for current smoking. Notably, only 11.6% of the participants had learnt about methods to be used for smoking cessation. CONCLUSIONS Our results underline the need for integrated tobacco control initiatives that should discourage tobacco use among SHP, promote smoke free schools of health science, and implement programs that train SHP in effective cessation-counseling techniques.

https://bmjopen.bmj.com/content/bmjopen/10/10/e036512.full.pdf

Prevalence of tobacco use, exposure to secondhand smoke and knowledge on smoking cessation among students of health professions in Central Greece: a cross-sectional study.

SUMMARY

Following a survey in 19 European countries of the habits, attitudes and knowledge of medical students regarding tobacco, World Health Organisation European Office and the International Union against Tuberculosis and Lung Disease jointly circulated to the Deans of all European medical schools a summary of the results, including figures for mortality for smoking-related diseases in their countries and a brief questionnaire concerning faculty action on the tobacco problem. The response rate was just over 50%, higher in Northern Europe (66%) than in Southern (35%) or Eastern (38%). Only 8% of faculties had a specific teaching module on tobacco. In most it was either systematically (35%) or unsystematically (55%) integrated in other teaching. Teaching hospitals, teaching areas and faculty meetings were said to be smokefree by over 90%; figures were lower for other areas. Seventy-seven per cent of Deans intended to discuss our approach with their teaching staff; 72% gave the name of a staff member with a particular tobacco interest.

European medical schools and tobacco

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European medical schools and tobacco