Knowledge, attitude and prevalence of use of tobacco among medical students in India: A single centre cross sectional study

Background and Objectives: Tobacco is a major cause of increased morbidity and mortality in the world. The medical students represent one of the primary target populations for anti-tobacco programs, and thus we conducted a study to evaluate prevalence of tobacco use among medical students. Materials and Methods: This was a cross-sectional study conducted among the medical undergraduate students. Data was collected through a self-administered questionnaire. Participation in this study was voluntary and kept anonymous and confidential. The questionnaire included information about demographic data of participants and smoking patterns. “Ever use,” “current use,” and “never use” was defined as ‘having used tobacco even once in their lifetime,’ ‘once in the last 30 days preceding the survey,’ and ‘not even once in their lifetime.’ Results: The questionnaire was emailed to 225 students. 52.44% complete responses were found appropriate for analysis. 27.11% students were current tobacco users, 18.64% were ‘ever users’ and 54.23% students were ‘never users.’ 32.5% hostellers admitted using tobacco currently, compared to 15.78% day scholars. 62.5% students with positive family history of smoking were ‘current smokers’ compared to 45.45% ‘ever users,’ and 37.5% ‘never users.’ 68.75% current users of tobacco indicated that they would try to quit tobacco use in the future. 81.25% current users and 93.02% non-current users of tobacco were of opinion that smoking should be banned in public areas. Discussion: The findings of our study are comparable to similar studies done earlier. The preventive effect of parental supervision on the use of tobacco was quite evident in our study. There was also a positive correlation between current use of tobacco and presence of a positive history of tobacco use in family. The role of peer pressure and stress of studies are particularly important, and efforts need to be done to reduce them and to adequately educate medical students.

Keywords: Medical students, smoking, tobacco

Tobacco is a major cause of increased morbidity and mortality in the world. Each year, tobacco products kill many people worldwide and the numbers are increasing at an ever increasing rate. According to estimates of WHO, if current smoking patterns are not reversed, the use of tobacco will be responsible for 10 million deaths per year by the decade 2020-2030, with about 70% of them occurring in developing countries. ^[1] The reports have also indicated that the real impact of tobacco smoking could be underestimated because of high level of exposure of “secondhand” smoke, passive smoking, and increased smoking among youths. The condition is equally worrisome in India, where according to a large study, 5% of females and 37% of males are smokers between age group of 30 to 69, and tobacco use is responsible for 1 out of 5 deaths in male and 1 out of 20 deaths in females in this age group. ^[2] Smoking has increased popularity among teenagers and adolescents too.

The health professionals definitely play an important role in educating patients and public at large about the hazards of tobacco smoking, providing all kind of advice and education to patients regarding hazards of smoking, and helping smokers to quit smoking. Thus, their views and attitude are of great importance to be determined before implementing any anti-tobacco measures. The medical students occupy a vital position in this regard as they are supposed to be key workers in implementing anti-smoking measures and programs in future. But, if the future physicians are themselves gripped in the evil of smoking, anti-smoking programs can be seen having a grave future. Thus, the medical students represent one of the primary target populations for anti-tobacco programs. Therefore, keeping this in mind, we thought of undertaking a study to evaluate the prevalence of tobacco use among the male medical students in one of the leading medical college in capital city of India.

This was a cross-sectional study conducted among the male medical undergraduate students of University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India. Since the college has a majorly male-dominated population, females were excluded from the study. Data were collected through a self-administered questionnaire constructed by the investigators, which was emailed to the students. In order to achieve the highest possible accuracy and to reduce the possibilities of bias, participation in this study was voluntary, and the questionnaire was anonymous. The information on individual students was kept confidential. The questionnaire was in English and included information about demographic data of participants and smoking patterns. The information was collected regarding age, residential background, current place of living, precipitating factor for the initiation, form of product used, pattern of tobacco use, and tobacco use in the family. “Ever use” was defined as ‘having used tobacco even once in their lifetime.’ “Current use” was defined as ‘having used tobacco at least once in the last 30 days preceding the survey.’ “Never use” was defined as ‘having not used tobacco even once in their lifetime.’

The questionnaire was emailed to a total of 225 undergraduate male students. Out of the total 225 students, only 140 students responded with a response rate of 62.22%. Out of 140, 22 responses were incomplete and were thus excluded from study. Thus, only 118 complete responses (52.44%) to questionnaire were used for the analysis out of 225. The mean age of respondents was 22.4 years.

The results in the present study revealed that out of total 118 students, 32 (27.11%) were current tobacco users. Out of these 32, 30 (25.42%) used to smoke tobacco and smokeless form of tobacco, including gutka, khaini, pan masala was used by 9 (7.62%) students. 2 (1.69%) students also admitted to have used tobacco in hookah form once in last 30 days.

22 (18.64%) students reported having ‘ever used’ tobacco but not even once in last 30 days prior to the day of answering questionnaire. 64 (54.23%) students responded as never used tobacco even once in life.

Current place of residence was found to affect current use of tobacco. Out of 118 respondents, 80 (67.79%) were hostellers and 38 (32.20%) were day scholars. 26 out of 80 hostellers (32.5%) admitted using tobacco currently, and 6 out of 38 day scholars (15.78%) admitted current use of tobacco. Positive family history of use of tobacco was also found to correlate positively with the current use of tobacco. 20 out of 32 current users (62.5%) responded with positive family history of use of tobacco. 10 out of 22 ever users (45.45%), and 24 out of 64 never users (37.5%) gave positive family history of use of tobacco.

24 out of 32 students (75%) admitted initiating tobacco use due to peer pressure. 18 out of 32 students (56.25%) felt that smoking helps them reduce stress, especially at time of study.

22 out of 32 (68.75%) current users of tobacco indicated that they would try to quit tobacco use in the future, and 26 out of 32 (81.25%) current users and 80 out of 86 (93.02%) non-current users of tobacco were of opinion that smoking should be banned in public areas.

Health professionals, including doctors and medical students, have a leading role to play in tackling the evil of tobacco use in the community. Thus, it is of utmost importance that their attitude and viewpoint are determined in this aspect. Various efforts have been made do determine the smoking pattern of use among medical students. With the increasing use of the smokeless forms of tobacco as well, it has become very important to bring out the data regarding the overall use of tobacco and its various correlates. Therefore, we tried to find out the overall burden of tobacco use among the male medical students who in future have important role to play in downplaying the use of tobacco in society.

This study has demonstrated that the prevalence of tobacco use among medical students is 27%. The findings of our study are comparable to the results of a similar study done in Pakistan, which revealed a 22% prevalence of smoking among the male medical students. ^[3] Study also showed that students understand the risks of passive smoking and up to 90% agree with banning it in public areas. The preventive effect of parental supervision on the use of tobacco was quite evident in our study with current use of tobacco, more common in hostellers than day-scholars. Similar results have been shown in earlier studies. ^[3],[4] There was also a positive correlation between current use of tobacco and presence of a positive history of tobacco use in family. Similar findings have been reported in earlier studies also. ^[5],[6]

Students indicated that peer pressure is a major factor leading to initiation of tobacco, use and also most of students consume tobacco to overcome the stress experienced during their studies. The effect of peer pressure as a major influencing factor has also been reported in previous studies done. ^[7],[8] The overwhelming effect of peer pressure on the initiation of tobacco use is a matter of serious concern, especially when students, especially in hostels, spend a lot of time together and are easily influenced by their friends. The role of peer pressure and stress of studies are particularly important and efforts need to be done to reduce them to prevent the hazard of smoking among medical students.

It is of utmost importance that to curb the menace of smoking and to reduce the ill-effects caused by it, the prevalence of smoking is reduced. And it is beyond doubt that physicians have a key role to play in this. But, to be an effective counselor, it is important to understand that they should lead and set an example. If they themselves are smokers, then they won’t be effectively able to deliver health message. Efforts should be done to adequately educate medical students the ways to tackle stress during studies and initiation of counseling programs to assist students, especially during exam time may provide encouraging results.

Our study has few limitations. The prevalence of current tobacco users in our study could be an underestimation considering the fact that only 118 complete responses could be obtained from 225 students. The possibility that current tobacco users could have participated less in this study cannot be ruled out.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.102041