Psychosocial factors associated with tobacco use among a population of medical students in Pretoria

Abstract

Context: Tobacco use among medical students is of public health concern, given their role as future role models for healthy lifestyles. This study sought to determine the prevalence and determinants of tobacco use and nicotine dependence in medical students in Pretoria. In particular, this study explored the role of sense of coherence – a measure of stress-coping ability – on tobacco use patterns among medical students. Furthermore, we examined the students’ knowledge of smoking cessation approaches, their perceptions with regard to the availability and adequacy of tobacco control curricula, and their perception of their role as ”role models” for their patients. Methods: This cross-sectional analytical study, involving undergraduate medical students in their 2nd and 6th year of study at the universities of Pretoria and Limpopo (MEDUNSA), was conducted during August and September 2008. Consenting participants completed a self-administered questionnaire (N=722). Information obtained included: demographic characteristics of respondents, alcohol use, past and current use of various tobacco products, perception of availability and adequacy of training in tobacco control (TC), support for various TC legislation and perception of the role of doctors in smoking cessation. A six-item Antonovsky’s sense of coherence scale (SOC) was also included to measure respondents’ ability to cope with stress. Nicotine dependence was measured using the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). Data analysis included chi-square statistics, t-test and multiple logistic regression analysis. Level of significance was set at p<0.05. Results: Prevalence of cigarette smoking in medical students was 17.3%. Cigarette smoking was significantly higher among the 6th (21.5%) than among the 2nd year (14.1%) students and was also significantly higher among males (20.4%) than among females (14.4%). In a bivariate analysis, problem drinkers were more likely to be smokers (37.5%) as compared to non-problem drinkers (13%). Compared to non-smokes, smokers were more likely to have a lower SOC [Mean(sd); 26.8 (8.8) vs 28.8 (7.4); p=0.019] and were less likely to attach importance to being seen as a role model by patients. Only 21.9% felt their training curriculum contained TC issues and of these a little over half felt the TC content was inadequate. After controlling for potential confounders, the factors that were independently associated with the current smoking status were, having lower support for TC legislation (OR=0.49; 95% CI= (0.41-0.59) and attaching less importance to being seen as a role model by patients (0.62; 0.41-0.91). Other factors associated with cigarette use included: being a 6th year student (OR=2.17; 95% CI; 1.32-3.58), having a drinking problem (2.17; 1.28-3.68), reporting exposure to others smoking at home (3.29; 1.91-5.66) and having received previous formal training in cessation (0.55; 0.32-0.95). Younger age (0.86; 0.77- 0.97), lower SOC (0.94; 0.90-0.99), and lower level of support for TC legislation (0.56; 0.40-0.79) were independently associated with nicotine dependence. Conclusions: This study’s findings suggest that tobacco use is prevalent among medical students and tobacco use is strongly associated with alcohol abuse. In addition to offering tobacco cessation services to these students, these findings highlight the need to institute a curriculum on tobacco control that includes not only teaching cessation counselling skills to medical students, but that also encourages them to become advocates for TC legislation and to recognise themselves as important role models in the society. Copyright