Tanja Jovanovska, Viktorija Prodanovska-Stojcevska

Medical College, University St. Kliment Ohridski, Bitola, Republic of Macedonia

Introduction: Smoking is considered as a lading cause of death it can be avoided of course. But, it seems paradox because in spite of numerous information of harmful effects due smoking, received through educational process, in Medical College of Bitola, smoking is still characteristic in this and other medical schools.

Aim of study: to asses prevalence of smoking among the students of Medical College in Bitola; to asses understanding and attitudes of investigated group about participation of the activities connected with control of tobacco use and quitting of smoking.

Materials and Methods: The study is realized through epidemiological study using cross sectional study for the period march-april 2010, according standardized methodology of Global Health Professional Survey (GHPS). Study population comprised 100 examined of the college students from the first, second and third year of studies.

Results: From the total number of investigated in this study, 75% have declared smokers, but 30% that smoked all 30 days in month. As for the attitudes referring the prohibition of selling tobacco to adolescents, 88% agree, 55% replayed with yes for forbidding smoking in discotheques, and 63% have attitude for forbidding smoking in public places.

Conclusion: Presence of smoking at the students of Medical College in Bitola is significant because from the total number of investigated 30% t have smoked 30 days in the month.

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According to WHO, total annual number of death cases connected to smoking is 5 million. The current tendency is that the smoking epidemic expansion is largely sustained, so in year 2030, this number will increase to 10 million with 70% of death cases in the developing countries. The WHO estimates that number of smokers is high as third of the entire adult population, with 1.2 billion estimated smokers worldwide [1].

In the era of prevention and promotion of health habits associated to the health professionals are worth special attention. Doctors and other health staff are role models for patient behavior to the entire population. The play an advisory role in smoking prevention and quitting of the smoking habits, which is the primary goal group for campaign against smoking as recommended by the WHO [2]. It is quite paradox that in spite of numerous information on the harmful effects, caused by smoking, gained during studies in medical schools, smoking continuous to be practiced among students in these schools [3-5]. Various reviews concerning smoking prevalence among medical students, published in the recent 30 years, that have been analyzed illustrate significant differences in some countries. In the USA for example, the prevalence is 3%, but in Japan 58%. Studies performed in Brazil revealed tendency of decreased smoking prevalence among students [6]. Even though that smoking shows a tendency decreased in the last 50 years it still remains serious disease, so health workers will play the main role in the community in future. Smokers refuse or don’t like any advise by a person who is smoker himself [7]. Smoking among nurses is also a barrier for successful treatment of patients. Prevalence among nurses is around 18% and it is higher than among doctors and dentists [8, 9]. Students of various medical disciplines that belong to health professionals later, should serve as model of health behavior. Health professionals are the real face of the public health infrastructure in many countries. Smoking and health are closely linked and because of that it is an important question for medical students and future health workers. Health professionals should play more active role in prevention of smoking, but also in encouraging smokers to quite. [10].

The aim of study is to asses prevalence of smoking among the students of Medical College in Bitola; to asses understanding and attitudes of investigated group about participation of the activities connected with control of tobacco use and quitting of smoking. To determine the students’ attitude for smoking cessation.

The study is realized through epidemiological study using cross sectional study for the period march-april 2010, according standardized methodology of Global Health Professional Survey (GHPS), established by WHO- Center for Diseases Control (CDC)-USA and Canadian Public Association (CPHA),2005. Fundamental instrument is a Core Questionnaire of Global Health Professional Survey (GHPS), composed of 43 questions. In the structure of this standardized questionnaire there are six segments with different aspects referring to posed questions.

First segment refers to smoking prevalence. Third segment comprises data referring to education, training and knowledge about health effects due to smoking, The fourth segment is composed of questions which should provide data about attitudes of investigated referring to tobacco use. For the needs of this study, the first the third and the fourth part of the questionnaire is used. Target populations are students of the Medical College in Bitola. Study population comprised 100 examined of the college students from the first, second and third year of studies. A simple random sample was selected for the aims of this study. The collected data are shown in tables and figures. Statistical significance was tested using the chi-square test.

The study is realized through epidemiological study using cross sectional study for the period march-april 2010, according standardized methodology of Global Health Professional Survey (GHPS), established by WHO- Center for Diseases Control (CDC)-USA and Canadian Public Association (CPHA),2005. Fundamental instrument is a Core Questionnaire of Global Health Professional Survey (GHPS), composed of 43 questions. In the structure of this standardized questionnaire there are six segments with different aspects referring to posed questions.

First segment refers to smoking prevalence. Third segment comprises data referring to education, training and knowledge about health effects due to smoking, The fourth segment is composed of questions which should provide data about attitudes of investigated referring to tobacco use. For the needs of this study, the first the third and the fourth part of the questionnaire is used. Target populations are students of the Medical College in Bitola. Study population comprised 100 examined of the college students from the first, second and third year of studies. A simple random sample was selected for the aims of this study. The collected data are shown in tables and figures. Statistical significance was tested using the chi-square test.

The students prevalence who tried smoking is 75% and the percentage difference -registered between those who have tried and those who have not tried is statistical significant for p<0.0001, 49% of those who have tried had started their smoking probation at age of 18-24. In total number of those who have tried 64.0% are females, 36.0% are males. From the investigated 60.7% of females are those who have tried but 93.1% males (Table 1).

The majority or 88.0% of investigated students agree with prohibition of selling tobacco to adolescents, Percentage difference which is registered about being against prohibition is statistical significant for p<0.001, 73.9% from those who are to prohibit selling tobacco to adolescents.

Investigated, according their attitudes referring to prohibition of advertisement tobacco products mainly agree -72.0% percentage difference which is registered referring to those who are against prohibition statistical is significant for p<0,0001, 72.2% from those are for prohibition of advertisement tobacco products are smokers.

Investigated, according to their attitudes referring to smoking prohibition in restaurants, generally agree-68.0% percentage difference registered at those who are against prohibition is statistical significant for p<0.001, 66.2% from those who are for prohibition of smoking in restaurants, are smokers.

The majority of investigated according their attitudes towards smoking prohibition in discotheques, night clubs, cafes, agree - 55.0% percentage difference that is registered referring to those who are against prohibition is statistical non significant for p=0.1589, 65.4 from those who are for smoking prohibition in discotheques, night clubs, cafes are smokers.

The biggest percent of investigated according to smoking prohibition in all public spaces agree - 63.0%, percentage difference that is registered in reference who are against prohibition is statistical significant for p=0.003, 66.7% from those who approve smoking prohibition in al public spaces are smokers.

The great majority of investigated students of Medical College in Bitola have an attitude that health workers should get special training of technique for smoking quitting - 86%, percentage difference which registered is in reference to those with opposite attitude is statistical significant for p<0.0001.

The attitude of investigated students mainly is that health workers should serve like an example to their patients, advising them how to quit smoking - 96.0% percentage difference that is registered is in reference to those with opposite attitude is statistical significant for p<0.0001.

The attitude of investigated students of their medical school in general or 80.0% is that health workers should play role to their patients for smoking quilting, percentage difference that is registered is in reference to those with opposite attitude is statistical significant for p<0.0001.

Quite a big percent - 83.0% of investigated of Medical College in Bitola is that health workers have important role to their patients chance to succeed in smoking quitting, percentage difference that is registered is in reference to those with opposite attitude is statistical significant for p<0.0001.

Answers to the questions referring to the instrument about smoking cessation are analyzed only for smokers. The attitudes are estimated through the answers to the questions comprising various aspects of smoking cessation.

The highest percent of females light their first cigarette 60 minutes after waking - 25.5%, 22.6% light their first cigarette in 10 minutes, for the period of 10-30 minutes 16.1%. Percentage difference registered at female smokers, regarding to taming of lighting the first cigarette after waking up, statistical is not significant for p>0.05. Highest percent of males, the first cigarette after waking light in the first 10 min - 23.8, 19% in the period from 10 to 60 minutes, 14.4 %after 60 minutes. Percentage difference registered at male smokers, regarding to taming of lighting the first cigarette after waking up, statistical is not significant for p>0.05. Distribution of investigated smokers according to sex and time that passed after quitting smoking – percentage difference registered between female and male smokers in refer to time of quitting in all cases is statistical non significant for p>0.05.

Health workers and those who prepare to became that, and continue to smoke, send unintelligible and bad message to those to who advise to cease smoking. Especially are important the results received in this study which illustrates the situation with smoking at the future professional activity-current students of Medical College in Bitola. The age and gender distributions in the sample were similar to those in the entire population.

The percent of students at the Medical College in Bitola that have tried smoking is extremely high because from the total number of investigated, even 75.0% have declared that they have tried smoking, and 30.0% that have smoked 30 days in the month. All this shows that the influence of training and educational programs are not sufficient. Public health community, especially academic environment, first of all should address its promotive efforts towards this group of students because this type of behavior not only damage their health but also minimize their ability to follow efficient anti smoking campaign to the patients and wider.

The study shows that the percent of those who have tried smoking among students, is terrific and most frequently their smoking probation starts at the very early age. Smokers prevalence is 30.0% referring to investigated that have smoked the entire month (30 days).

As for the attitudes about prohibition of selling tobacco to adolescents very high percents agree with prohibition. From the investigated more then half of investigated replied with yes, for smoking forbidden in discotheques, and more of them have attitude for forbidding smoking in all public places. These results point out that they are highly conscious about cease of smoking.

Attitudes of investigated students referring to health workers and their role at patient for smoking cease are as follow: 86% think- health workers should have special training for techniques for smoking cease, 96% that they should serve example to their patients and 80,0% have declared that they should have role to patients in their smoking cease.

In the part of questionnaire referring to attitudes for smoking cessation to the question How long is the time from awaking to lighting the first cigarette. The highest percent of female do that 60 minutes after awaking (25.8%), males - 10 minutes after awaking (23.8%).

Situation in some European countries is not much different from ours. According to a study conveyed in Turkey – 39% of medical students smoke [13], but in Spain at the University of Saragossa [14], 31% of medical students smoke. The prevalence there is 20% at students from the first year, 31% at students from the third year. These data confirm the fact that the influence of medical education concerning smoking as a health threat is limited. Ten countries in the world have done completely the same study at the medical students by using the same questionnaire (GHPS) which is used in this study. In ten countries: Albania, Argentina, Bangladesh, Croatia, Egypt, Bosnia and Herzegovina, India, The Filipinas, Serbia, and Uganda, smokers percent varies. Lowest values of smoking prevalence are found in Uganda - 28%, the highest in Albania and Serbia – over 40%.

WHO Framework Convention For Tobacco Control (WHO-FCTC) passed on the 56th assembly of the World Health Organization held in may 2003, is a first international discussion of public health for tobacco control which calls countries – members of the WHO, for standardized access in investigating this problem. The topic of the WHO on the world’s day for fight against smoking in 2005 was exactly the role of health workers in tobacco control.

We wish to thank Professor Mome Spasovski (National coordinator of the fight against smoking in Macedonia) of the Skopje University School of Medicine for helping us for preparing this manuscript.

1. World Health Organization. Tobacco Free Initiative. Geneva: WHO; c 2008.

2. World Health Organization. The role of health professionals in tobacco control. Geneva: WHO; 2005.

3. Villanova CA. Tab gismo Como factor de risco. In: Silva LC, editor. Condutas em Pneumologia. Rio de Janeiro: Revinter; 2001.

4. 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.

5. Green WL, Potvin L. Education, health promotion and social lifestyle determinants of health and disease. In Public Health, ed 2004; 113-130, Oxford University Press.

6. Lancaster T, Stead L, Silagy C, et al. Effectiveness of interventions to help people to stop smoking: findings from Cochrane Library. BMJ. 2000;321:355-8.

7. Smith DR, Leggat PA. An international review of tobacco smoking among medical students. J Postgrad Med. 2007;53(1):55-62.

8. Menezes AM, Hallal PC, Silva F, Souza M, Paiva L et al. Smoking among medical students: temporal trends and related variables. J Bras Pneumol. 2004;30(3):223-8.

9. Guazzelli AC, Terra Filho M, Fiss E. Smoking among physicians in a specific region of the greater metropolitan area Sao Paolo. J Bras Pneumol. 2005;(31) 6: 516-22.

10. World Health Organization. Tobacco country profiles. 2 nd ed. Proceedinngs of the 12th World Conference on Tobacco or Health; 2003 Aug 3-9; Helsinki, Finland: WHO, 2003.

11. Smith DR, Leggat PA. An international review of tobacco smoking in the medical profession: 1974-2004. BMC Public Health. 2007;7:115.

12. The Global Youth Tobacco Survey Collaborative Group. Tobacco use among youth; a cross country comparison. Tab Control. 2002;11;252-70.

13. Oya I, Gul E, Emel C. Knowledge and attitudes about smoking among students in a Medical Faculty. Turk Resp J. 2004;2: 086-091.

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