Smoking behaviour and attitudes towards smoking of medical students in Australia, Japan, USA, Russia, and Estonia

Abstract

University of Edinburgh, Edinburgh, Scotland, UK J W Crofton Abstract Objective -To assess the behaviour, knowledge and attitudes of medical stu dents towards smoking, and to stimulate interest in the problem among students and their teachers. Design As part of a global survey, first and final-year students from eight cen tres in five industrialized countries (Australia, Japan, USA, Russia and Estonia [formerly part of the USSR]) replied anonymously to a structured questionnaire in their own teaching lang uage. Subjects-A total of 1280 replies was analysed. Participation was 94 % for first year students, 82% for final year. The percentage of females overall was 44% but varied widely, from 12 % in Tohoku, Japan, to 78 % in Moscow. Results The prevalence of daily smok ing in male medical students varied from nil in the USA to 48% in St Petersburg; in females from nil in Japan to 14 % in St Petersburg. Many smokers had already made serious attempts to quit; many, except in Japan, expected to have succeed ed within 5 years. Most considered smok ing harmful to health (with lower rates in smokers), but, even in the USA and Australia, there was important ignorance about tobacco as a major cause of certain conditions, notably cardiovascular dis ease, laryngeal and bladder cancer, and neonatal mortality, with some differences between countries; in Japan and the former USSR the figures were low (53 % and 51%, respectively) even for lung cancer. High proportions in Australia and the USA, but much lower proportions in Japan and Estonia, would give routine advice on quitting to smoking patients, but in all countries most lacked con fidence in their counselling skills. Aus tralian and US students were most, and Japanese students least, conscious of their exemplar roles. There were similar trends between countries in support of preventive legislation. There was wide spread ignorance of the preventive effect of tobacco taxation. Conclusions Trends in smoking behav iour, and to some extent in knowledge and attitudes, reflected the history of the anti-smoking campaigns in these coun tries. US and Australian students had lower smoking rates than those in Japan and the former USSR. The former were more co scious of their exemplar role and more ready to counsel patients on quitting (though lacking confidence in their skill to do so); they were more aware of, and supportive of, preventive measures. There were similar trends between countries in knowledge of smoking-related diseases, but important gaps in knowledge remained even in Australian and US students. In all the countries the great majority of students lacked confidence in their counselling skills and most were ignorant of the value of taxation as a preventive measure. These results provide an important chal lenge to medical education in Japan, Russia and Estonia; some significant de ficiencies also need to be remedied in Australia and the USA.