Knowledge, beliefs, practices and attitudes regarding tobacco dependence among first year Medical School students in Uruguay, 2009
Keywords:
SMOKING, MEDICINE STUDENTSAbstract
Introduction: upon the new legislation to control tobacco consumption being enforced and the health care center's obligation to include the treatment of tobacco dependence within their health care services, the need to train future physicians in this field significantly increased.
Objectives: to determine knowledge, beliefs, practices and attitudes regarding tobacco dependence among first year Medical Students, and to evaluate the impact of an educational intervention on these beliefs, practices and attitudes.
Method: a survey designed by the World Health Organization was applied to first year Medical Students a year before and a year after the educational intervention. Tutors were trained on tobacco dependence and subsequently, these tutors worked together with the medical students by means of a problem based learning methodology.
Results: 28.1% were smokers and 44.6% wished to quit smoking; 70.7% of non-smokers admitted medical counseling was effective for quitting, whereas 59.1% of smokers did not admit so (p = 0,006), and 79,75% of non-smokers and 64.8% of smokers (p < 0,001) emphasized on the importance of the medical role model.
After the educational intervention significant changes were observed regarding the need to provide training on quitting smoking (p = 0,039), the counselor's role (p = 0,026) and knowledge that counseling contributes to quitting (p = 0,001).
Conclusions: smoking significantly affects students' knowledge and beliefs about tobacco dependence. The intervention turned out to be useful to modify knowledge, beliefs and attitudes regarding the effectiveness of providing counseling and the need for medical doctors to be trained in quitting smoking.
References
(1) World Health Organization. Framework Convention on Tobacco Control. Geneva: WHO, 2003. Disponible en: http://www.who.int/fctc/text_download/en/index.html. Consulta: 3 agosto 2011.
(2) World Health Organization. Tobacco Free Initiative: survey. Geneva, WHO, 1998. Disponible en: http://www.who.int/tobacco/surveillance/en/. Consulta: 17 enero 2012.
(3) Centers of Disease Control and Prevention. Tobacco use and cessation counseling-global health professionals survey pilot study, 10 countries, 2005. MMWR Morb Mortal Wkly Rep 2005; 54(20): 505-9.
(4) Uruguay. Ley 18256: control del tabaquismo. Montevideo: Parlamento, 2008. Disponible en: http://www.parlamento.gub.uy/leyes/AccesoTextoLey.asp?Ley=18256&Anchor =. Consulta: 3 agosto 2011.
(5) Uruguay. Ministerio de Salud Pública. Dirección General de la Salud. División Epidemiología. 1ª Encuesta Nacional de Factores de Riesgo de Enfermedades Crónicas No Transmisibles. Montevideo: MSP, 2009. Disponible en: http://www.msp.gub.uy/ucepidemiologia_5551_1.html. Consulta: 3 agosto 2011.
(6) Uruguay. Ministerio de Salud Pública. Encuesta mundial de tabaquismo en adultos (GATS): fact sheets, Uruguay 2009. Montevideo: MSP, 2010. Disponible en: http://www.msp. gub.uy/ andocasociado. aspx? 3885, 18398. Consulta: 3 agosto 2011.
(7) United States. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA: CDC; 2000.
(8) Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, et al. Treating tobacco use and dependence: clinical practice guideline. Rockville, MD: Department of Health and Human Services, 2000.
(9) Lancaster T, Stead L, Silagy C, Sowden A. Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. BMJ 2000; 321(7257): 355-8.
(10) Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008 (16(2): CD000165. Disponible en: http://cochrane.bvsalud.org/ cochrane/ show.php? db= reviews&mfn=156&id= CD000165⟨=es&dblang=&lib=COC&print=yes. Consulta: 3 agosto 2011.
(11) Uruguay. Ministerio de Salud Pública. Guía Nacional para el Abordaje del Tabaquismo: Uruguay 2009. Montevideo: MSP, 2010. Disponible en: http://www.fnr.gub.uy/sites/default/files/Guia.pdf. Consulta: 1 febrero 2012.
(12) Universidad de la República. Facultad de Medicina. Plan de Estudios de la Carrera de Doctor en Medicina. 2007. Disponible en http://www.claustro.fmed.edu.uy/menu2.html. Consulta: 3 agosto 2011.
(13) Bernadá M. Dossier para los tutores: aprendizaje en pequeños grupos basado en problemas centrados en los estudiantes. Montevideo: Facultad de Medicina. Departamento de Educación Médica, 2009.
(14) Junta Nacional de Drogas. Cuarta encuesta nacional sobre consumo de drogas en estudiantes de enseñanza media. 2010. Disponible en: http://infodrogas.gub.uy/html/encuestas/documentos/IV_encuesta_estudiantes_media_2010.pdf. Consulta: 3 agosto 2011.
(15) Turnes A. Una primera lectura de la Encuesta Médica Nacional. Montevideo: SMU, 2001. Disponible en: http://www.smu.org.uy/dpmc/hmed/estad_med/una_primera_lectura_de_la_encues.htm. Consulta: 3 agosto 2011.
(16) Equipos Mori. Encuesta Médica Nacional. 2004. En línea. Disponible en: http://www.smu.org.uy/sindicales/documentos/estadistica/informefenc2004.pdf. Consulta: 3 agosto 2011.
(17) Huarte A, Torres Esteche V, Peña S, López MV, Piñeyro L, Zabert G. Tobacco consumption in medicine students. Eur Respir J 2010; 36: S54.
(18) Goja B, Saldombide L, Parodi C, Esteves E, Portos M. Estudiantes de Medicina: del hábito a la docencia antitabaco. Segunda Conferencia Europea y Primera Iberoamericana Tabaco o Salud. Las Palma de Gran Canaria, España, 1999.
(19) Nerin I, Guillen D, Más A, Sánchez L. Estudio de tabaquismo en una Facultad de Medicina: prevalencia y actitudes en estudiantes y profesores. Prev Tab 2000; 2(3): 166 -72.
(20) Villalba Y, Franco P, Vera S, Juárez S. Prevalencia del tabaquismo en estudiantes de la Facultad de Medicina de la Universidad Nacional del Nordeste, Corrientes - Argentina. Rev Posgrado Sexta Cátedra Med 2008; 183: 1-5.
(21) Tafur LA, Ordóñez G, Millán JC, Varela JM, Rebellón P. Prevalencia de tabaquismo en estudiantes recién ingresados a la Universidad Santiago de Cali. Colomb Med 2006; 37(2): 126-32.
(22) Nerin I. Los médicos y el tabaco: un problema sin resolver. Prev Tab 2002; 4(2): 62-4.
(23) Esteves E, Goja B, Blanco A, González J. Servicios de Salud con Humo de Tabaco: oxímoron médico, ético y social. Montevideo: Caligráficos, 2004.
(24) Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training. Current Efforts and gaps in US Medical Schools. JAMA 2002; 288: 1102-9.
(25) Prochaska JO, Di Clemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol 1992; 47(9): 1102-14.
(26) Becoña E. Estadios de cambio en la conducta de fumar: su relevancia en el tratamiento de los fumadores. Prev Tab 2000; 2(2): 106-12.
(27) Twardella D, Brenner H. Lack of training as a central barrier to the promotion of smoking cessation: a survey among general practitioners in Germany. Eur J Public Health 2005; 15(2):140-5.
(28) Brotons C, Björkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E, et al. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev Med 2005; 40(5): 595-601.
(29) Kusma B, Quarcoo D, Vitzthum K, Welte T, Mache S, Meyer-Falcke A, et al. Berlin's medical students' smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling. J Occup Med Toxicol 2010; 5:9.
(30) Budden MC, Hossain N. Tobacco demarketing campaigns and role model selection in developing countries: the case of Bangladesh. Health Mark Q 1986; 4(2): 63-7.
(31) Leong SL, Lewis PR, Curry WJ, Gingrich DL. Tobacco world: evaluation of a tobacco cessation training program for third-year medical students. Acad Med 2008; 83(10 Suppl): S25-8.
(32) Barengo NC, Sandström PH, Jormanainen VJ, Myllykangas MT. Changes in smoking prevalence among Finnish physicians 1990-2001. Eur J Public Health 2004; 14(2): 201-3.
(33) Gardner MN, Brandt AM. The doctors' choice is American's choice: the physician in US cigarette advertisements, 1930-1953. Am J Public Health 2006; 96(2): 222-32.
(34) Warner KE. Tobacco industry scientific advisors: serving society or selling cigarettes? Am J Public Health 1991; 81(7): 839-42.
(35) 35. Blumenthal DS. Barriers to the provision of smoking cessation services reported by clinicians in underserved communities. J Am Board Fam Med 2007; 20(3): 272-9.
(36) Careaga A. Glosario de términos para la educación médica. Montevideo: Facultad de Medicina. Departamento de Educación Médica, 2005. Disponible en: http://www.dem.fmed.edu.uy/Unidad%20Psicopedagogica/Documentos/Terminos_educativos_DEM.pdf. Consulta: 1 febrero 2012.
(37) Leone FT, Evers-Casey S, Veloski J, Patkar AA, Kanzleiter L; Pennsylvania Continuum of Tobacco Education work group. Short-intermediate and long-term outcomes of Pennsylvania's continuum of tobacco education pilot project. Nicotine Tob Research 2009; 11(4): 387-93.
(38) Crofton JW, Tessier JF, Fréour PP, Piha T. European medical schools and tobacco. Med Educ 1996; 30(6): 424-7.
(39) Bianco E, Menéndez A, Blanco A, Tucuna G, Roballo L. Estudio sobre consumo de tabaco en los médicos uruguayos. Tercer Congreso de Cardiología por Internet. Buenos Aires, Argentina, 1 set - 30 nov 2003. Disponible en: http://www.fac.org.ar/tcvc/llave/tl089/tl089.pdf. Consulta: 3 agosto 2011.
(40) Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: Department of Health and Human Services, 2008. Disponible en: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf. Consulta: 3 agosto 2011.
(41) Thorndike AN, Rigotti NA, Stafford RS, Singer DE. National patterns in the treatment of smokers by physicians. JAMA 1998; 279(8): 604-8.
(42) Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in US undergraduate medical education. JAMA 1999; 282(9): 825-9.
(43) Geller AC, Brooks DR, Powers CA, Brooks KR, Rigotti NA, Bognar B, et al. Tobacco cessation and prevention practices reported by second and fourth year students at US medical schools. J Gen Intern Med 2008; 23(7): 1071-6.
(44) Strayer SM, Pelletier SL, Martindale JR, Rais S, Powell J, Schorling JB. A PDA-based counseling tool for improving medical student smoking cessation counseling. Fam Med 2010; 42(5): 350-7.
(45) Warren CW, Sinha DN, Lee J, Lea V, Jones NR. Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008. BMC Public Health 2011; 11: 72.
(46) Pbert L. Healthcare provider training in tobacco treatment: building competency. Am J Med Sci 2003; 326(4): 242-7.
(2) World Health Organization. Tobacco Free Initiative: survey. Geneva, WHO, 1998. Disponible en: http://www.who.int/tobacco/surveillance/en/. Consulta: 17 enero 2012.
(3) Centers of Disease Control and Prevention. Tobacco use and cessation counseling-global health professionals survey pilot study, 10 countries, 2005. MMWR Morb Mortal Wkly Rep 2005; 54(20): 505-9.
(4) Uruguay. Ley 18256: control del tabaquismo. Montevideo: Parlamento, 2008. Disponible en: http://www.parlamento.gub.uy/leyes/AccesoTextoLey.asp?Ley=18256&Anchor =. Consulta: 3 agosto 2011.
(5) Uruguay. Ministerio de Salud Pública. Dirección General de la Salud. División Epidemiología. 1ª Encuesta Nacional de Factores de Riesgo de Enfermedades Crónicas No Transmisibles. Montevideo: MSP, 2009. Disponible en: http://www.msp.gub.uy/ucepidemiologia_5551_1.html. Consulta: 3 agosto 2011.
(6) Uruguay. Ministerio de Salud Pública. Encuesta mundial de tabaquismo en adultos (GATS): fact sheets, Uruguay 2009. Montevideo: MSP, 2010. Disponible en: http://www.msp. gub.uy/ andocasociado. aspx? 3885, 18398. Consulta: 3 agosto 2011.
(7) United States. Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, GA: CDC; 2000.
(8) Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, et al. Treating tobacco use and dependence: clinical practice guideline. Rockville, MD: Department of Health and Human Services, 2000.
(9) Lancaster T, Stead L, Silagy C, Sowden A. Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. BMJ 2000; 321(7257): 355-8.
(10) Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2008 (16(2): CD000165. Disponible en: http://cochrane.bvsalud.org/ cochrane/ show.php? db= reviews&mfn=156&id= CD000165⟨=es&dblang=&lib=COC&print=yes. Consulta: 3 agosto 2011.
(11) Uruguay. Ministerio de Salud Pública. Guía Nacional para el Abordaje del Tabaquismo: Uruguay 2009. Montevideo: MSP, 2010. Disponible en: http://www.fnr.gub.uy/sites/default/files/Guia.pdf. Consulta: 1 febrero 2012.
(12) Universidad de la República. Facultad de Medicina. Plan de Estudios de la Carrera de Doctor en Medicina. 2007. Disponible en http://www.claustro.fmed.edu.uy/menu2.html. Consulta: 3 agosto 2011.
(13) Bernadá M. Dossier para los tutores: aprendizaje en pequeños grupos basado en problemas centrados en los estudiantes. Montevideo: Facultad de Medicina. Departamento de Educación Médica, 2009.
(14) Junta Nacional de Drogas. Cuarta encuesta nacional sobre consumo de drogas en estudiantes de enseñanza media. 2010. Disponible en: http://infodrogas.gub.uy/html/encuestas/documentos/IV_encuesta_estudiantes_media_2010.pdf. Consulta: 3 agosto 2011.
(15) Turnes A. Una primera lectura de la Encuesta Médica Nacional. Montevideo: SMU, 2001. Disponible en: http://www.smu.org.uy/dpmc/hmed/estad_med/una_primera_lectura_de_la_encues.htm. Consulta: 3 agosto 2011.
(16) Equipos Mori. Encuesta Médica Nacional. 2004. En línea. Disponible en: http://www.smu.org.uy/sindicales/documentos/estadistica/informefenc2004.pdf. Consulta: 3 agosto 2011.
(17) Huarte A, Torres Esteche V, Peña S, López MV, Piñeyro L, Zabert G. Tobacco consumption in medicine students. Eur Respir J 2010; 36: S54.
(18) Goja B, Saldombide L, Parodi C, Esteves E, Portos M. Estudiantes de Medicina: del hábito a la docencia antitabaco. Segunda Conferencia Europea y Primera Iberoamericana Tabaco o Salud. Las Palma de Gran Canaria, España, 1999.
(19) Nerin I, Guillen D, Más A, Sánchez L. Estudio de tabaquismo en una Facultad de Medicina: prevalencia y actitudes en estudiantes y profesores. Prev Tab 2000; 2(3): 166 -72.
(20) Villalba Y, Franco P, Vera S, Juárez S. Prevalencia del tabaquismo en estudiantes de la Facultad de Medicina de la Universidad Nacional del Nordeste, Corrientes - Argentina. Rev Posgrado Sexta Cátedra Med 2008; 183: 1-5.
(21) Tafur LA, Ordóñez G, Millán JC, Varela JM, Rebellón P. Prevalencia de tabaquismo en estudiantes recién ingresados a la Universidad Santiago de Cali. Colomb Med 2006; 37(2): 126-32.
(22) Nerin I. Los médicos y el tabaco: un problema sin resolver. Prev Tab 2002; 4(2): 62-4.
(23) Esteves E, Goja B, Blanco A, González J. Servicios de Salud con Humo de Tabaco: oxímoron médico, ético y social. Montevideo: Caligráficos, 2004.
(24) Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training. Current Efforts and gaps in US Medical Schools. JAMA 2002; 288: 1102-9.
(25) Prochaska JO, Di Clemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol 1992; 47(9): 1102-14.
(26) Becoña E. Estadios de cambio en la conducta de fumar: su relevancia en el tratamiento de los fumadores. Prev Tab 2000; 2(2): 106-12.
(27) Twardella D, Brenner H. Lack of training as a central barrier to the promotion of smoking cessation: a survey among general practitioners in Germany. Eur J Public Health 2005; 15(2):140-5.
(28) Brotons C, Björkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E, et al. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev Med 2005; 40(5): 595-601.
(29) Kusma B, Quarcoo D, Vitzthum K, Welte T, Mache S, Meyer-Falcke A, et al. Berlin's medical students' smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling. J Occup Med Toxicol 2010; 5:9.
(30) Budden MC, Hossain N. Tobacco demarketing campaigns and role model selection in developing countries: the case of Bangladesh. Health Mark Q 1986; 4(2): 63-7.
(31) Leong SL, Lewis PR, Curry WJ, Gingrich DL. Tobacco world: evaluation of a tobacco cessation training program for third-year medical students. Acad Med 2008; 83(10 Suppl): S25-8.
(32) Barengo NC, Sandström PH, Jormanainen VJ, Myllykangas MT. Changes in smoking prevalence among Finnish physicians 1990-2001. Eur J Public Health 2004; 14(2): 201-3.
(33) Gardner MN, Brandt AM. The doctors' choice is American's choice: the physician in US cigarette advertisements, 1930-1953. Am J Public Health 2006; 96(2): 222-32.
(34) Warner KE. Tobacco industry scientific advisors: serving society or selling cigarettes? Am J Public Health 1991; 81(7): 839-42.
(35) 35. Blumenthal DS. Barriers to the provision of smoking cessation services reported by clinicians in underserved communities. J Am Board Fam Med 2007; 20(3): 272-9.
(36) Careaga A. Glosario de términos para la educación médica. Montevideo: Facultad de Medicina. Departamento de Educación Médica, 2005. Disponible en: http://www.dem.fmed.edu.uy/Unidad%20Psicopedagogica/Documentos/Terminos_educativos_DEM.pdf. Consulta: 1 febrero 2012.
(37) Leone FT, Evers-Casey S, Veloski J, Patkar AA, Kanzleiter L; Pennsylvania Continuum of Tobacco Education work group. Short-intermediate and long-term outcomes of Pennsylvania's continuum of tobacco education pilot project. Nicotine Tob Research 2009; 11(4): 387-93.
(38) Crofton JW, Tessier JF, Fréour PP, Piha T. European medical schools and tobacco. Med Educ 1996; 30(6): 424-7.
(39) Bianco E, Menéndez A, Blanco A, Tucuna G, Roballo L. Estudio sobre consumo de tabaco en los médicos uruguayos. Tercer Congreso de Cardiología por Internet. Buenos Aires, Argentina, 1 set - 30 nov 2003. Disponible en: http://www.fac.org.ar/tcvc/llave/tl089/tl089.pdf. Consulta: 3 agosto 2011.
(40) Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: Department of Health and Human Services, 2008. Disponible en: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf. Consulta: 3 agosto 2011.
(41) Thorndike AN, Rigotti NA, Stafford RS, Singer DE. National patterns in the treatment of smokers by physicians. JAMA 1998; 279(8): 604-8.
(42) Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in US undergraduate medical education. JAMA 1999; 282(9): 825-9.
(43) Geller AC, Brooks DR, Powers CA, Brooks KR, Rigotti NA, Bognar B, et al. Tobacco cessation and prevention practices reported by second and fourth year students at US medical schools. J Gen Intern Med 2008; 23(7): 1071-6.
(44) Strayer SM, Pelletier SL, Martindale JR, Rais S, Powell J, Schorling JB. A PDA-based counseling tool for improving medical student smoking cessation counseling. Fam Med 2010; 42(5): 350-7.
(45) Warren CW, Sinha DN, Lee J, Lea V, Jones NR. Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008. BMC Public Health 2011; 11: 72.
(46) Pbert L. Healthcare provider training in tobacco treatment: building competency. Am J Med Sci 2003; 326(4): 242-7.
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2012-03-31
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Llambí L, Barros M, Parodi C, Blanco L, Esteves E, Cora M, et al. Knowledge, beliefs, practices and attitudes regarding tobacco dependence among first year Medical School students in Uruguay, 2009. Rev. Méd. Urug. [Internet]. 2012 Mar. 31 [cited 2024 Sep. 16];28(1):4-12. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/356
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