Smoking behaviour and attitudes of medical students towards smoking and anti-smoking campaigns: a survey in 10 African and Middle Eastern countries

Abstract

Objective To assess the behaviour, knowledge, and attitudes towards smok ing of medical students in Africa and to stimulate interest in the problem among both students and their teachers. Design As part of a global survey, first and final year medical students in one centre in each of five sub-Sahar?n Afri can (southern Africa) and five North African and Middle Eastern countries (northern Africa) replied anonymously to a multiple choice questionnaire in French or English according to country. Subjects 87 % of first year students and 84% of final year students participated in the survey. A total of 1564 replies were analysed, 875 from first year students and 689 from final year students. Women comprised 37 % of the overall sample, but with considerable differences between countries. Results In northern Africa the preva lence of daily smoking (both sexes com bined) was 8 % among first year students and 19% among final year students; in southern Africa the corresponding figures were 9% and 20%, respectively. For men the figures were 13% and 22%; for women, 2 % and 6 %. Combining daily with occasional smoking, overall figures for both sexes combined were 19% for the first year and 27 % for the final year. 9 % of male students were ex-smokers in northern Africa and 20% in southern Africa; for women the corresponding figures were 5 % and 12 %, respectively. A serious attempt to quit had been made by 53% of smokers; 49% thought that they would no longer smoke in five years' time. Over 80% of students thought smoking was harmful to health, but there was considerable underestimation of its causal role in a number of diseases notably, oral, laryngeal, and bladder cancer; emphysema; coronary and peri pheral arterial disease; and neonatal mortality. There were important defects both in knowledge and motivation re garding counselling patients to stop smoking. Only a minority appreciated the value of tobacco taxation in de creasing consumption. Conclusions The proportion of daily smokers in male medical students was similar in Africa to that in Europe, previously reported, but in females the rate was much lower. As in Europe, overall there was much ignorance of smoking as a cause of specific diseases; lack of knowledge and motivation re garding counselling patients; and only a partial grasp of preventive measures. We hope that the survey will stimulate rel evant improvements in medical educa tion.