Future physicians and tobacco: an online survey of the habits, beliefs and knowledge base of medical students at a Canadian University
More details
Hide details
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
School of Public Health, University of Alberta, Edmonton, Canada
Department of Cardiology and Pneumology, University Hospital Göttingen, Göttingen, Germany
Barry A. Finegan   

Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
Publish date: 2013-04-04
Tobacco Induced Diseases 2013;11(April):9
Little is known about the knowledge and attitudes towards tobacco use among medical students in Canada. Our objectives were to estimate the prevalence of tobacco use among medical students, assess their perceived level of education about tobacco addiction management and their preparedness to address tobacco use with their future patients.

A cross-sectional online survey was administered to University of Alberta undergraduate medical school trainees. The 32-question survey addressed student demographics, tobacco use, knowledge and attitudes around tobacco and waterpipe smoking, tobacco education received in medical school, as well as knowledge and competency regarding tobacco cessation interventions.

Of 681 polled students, 301 completed the survey. Current (defined as “use within the last 30 days”) cigarette, cigar/cigarillo and waterpipe smoking prevalence was 3.3%, 6% and 6%, respectively. One third of the respondents had ever smoked a cigarette, but 41% had tried cigars/cigarillos and 40% had smoked a waterpipe at some time in the past. Students reported moderate levels of education on a variety of tobacco-related subjects but were well-informed on the role of tobacco in disease causation. The majority of students in their final two years of training felt competent to provide tobacco cessation interventions, but only 10% definitively agreed that they had received enough training in this area.

Waterpipe exposure/current use was surprisingly high among this sample of medical students, a population well educated about the role of tobacco in disease causation. The majority of respondents appeared to be adequately prepared to manage tobacco addiction but education could be improved, particularly training in behavioral modification techniques used in tobacco use cessation.

Canadian Medical Association: The role of physicians in prevention and health promotion. CMAJ. 1995, 153 (2): 208A-D.
Yentz S, Klein RJ, Oliverio AL: The impact of tobacco cessation training of medical students on their attitude towards smoking. Med Teach. 2012, 34: 11-10.3109/0142159X.2011.614293.
Pipe A, Sorensen M, Reid R: Physician smoking status, attitudes toward smoking, and cessation advice to patients: an international survey. Patient Educ Couns. 2009, 74 (1): 118-23. 10.1016/j.pec.2008.07.042.
Frank E, Segura C, Shen H: Predictors of Canadian physicians’ prevention counseling practices. Can J Publ Health. 2010, 101 (5): 390-5.
Frank E, Rothenberg R, Lewis C: Correlates of physicians’ prevention-related practices. Findings from the Women Physicians’ Health Study. Arch Fam Med. 2000, 9 (4): 359-67. 10.1001/archfami.9.4.359.
Frank E, Carrera JS, Elon L: Predictors of US medical students’ prevention counseling practices. Prev Med. 2007, 44 (1): 76-81. 10.1016/j.ypmed.2006.07.018.
White MJ, Ewy BM, Ockene J: Basic skills for working with smokers: a pilot test of an online course for medical students. J Cancer Ed. 2007, 22 (4): 254-8. 10.1007/BF03174126.
Hauer KE, Carney PA, Chang A: Behavior change counseling curricula for medical trainees: a systematic review. Acad Med. 2012, 87 (7): 956-68. 10.1097/ACM.0b013e31825837be.
Thakore S, Ismail Z, Jarvis S: The perceptions and habits of alcohol consumption and smoking among Canadian medical students. Acad Psych. 2009, 33 (3): 193-7. 10.1176/appi.ap.33.3.193.
Roskin J, Aveyard P: Canadian and English students’ beliefs about waterpipe smoking: a qualitative study. BMC Publ Health. 2009, 9: 10-10.1186/1471-2458-9-10.
Raupach T, Shahab L, Baetzing S: Medical students lack basic knowledge about smoking: findings from two European medical schools. Nicotine Tobacco Res. 2009, 11 (1): 92-8. 10.1093/ntr/ntn007.
Springer CM, Tannert Niang KM, Matte TD: Do medical students know enough about smoking to help their future patients? Assessment of New York City fourth-year medical students’ knowledge of tobacco cessation and treatment for nicotine addiction. Acad Med. 2008, 83 (10): 982-9. 10.1097/ACM.0b013e3181850b68.
Strobel L, Schneider NK, Krampe H: German medical students lack knowledge of how to treat smoking and problem drinking. Addiction. 2012, 107 (10): 1878-82. 10.1111/j.1360-0443.2012.03907.x.
World Health Organization: Tobacco Control Country Profiles.
Canadian Tobacco Use Monitoring Survey (CTUMS): Summary of Annual Results for 2011. 2012,
Maziak W: The global epidemic of waterpipe smoking. Addict Behav. 2011, 36 (1–2): 1-5.
Noonan D: Exemptions for hookah bars in clean indoor air legislation: a public health concern. Public Health Nurs. 2010, 27 (1): 49-53. 10.1111/j.1525-1446.2009.00826.x.
Maziak W, Eissenberg T, Ward KD: Patterns of waterpipe use and dependence: implications for intervention development. Pharmacol Biochem Behav. 2005, 80 (1): 173-9. 10.1016/j.pbb.2004.10.026.
Lumley J, Chamberlain C, Dowswell T: Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2009, 3 (3): CD001055.
Burke H, Leonardi-Bee J, Hashim A: Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics. 2012, 129 (4): 735-44. 10.1542/peds.2011-2196.
Heneghan C, Perera R, Mant D: Hypertension guideline recommendations in general practice: awareness, agreement, adoption, and adherence. Br J Gen Pract. 2007, 57 (545): 948-52. 10.3399/096016407782604965.
Beaulieu MD, Brophy J, Jacques A: Physicians’ attitudes to the pharmacological treatment of patients with stable angina pectoris. QJM. 2005, 98 (1): 41-51. 10.1093/qjmed/hci006.
CAN-ADAPTT: Canadian Smoking Cessation Clinical Practice Guideline. 2011, Toronto, Canada: Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment, Centre for Addiction and Mental Health.
Sauvageau C, Groulx S, Pelletier A: Do you counsel your patients on their health behaviors?. Can J Public Health. 2008, 99 (1): 31-5.
Vogt F, Hall S, Marteau TM: General practitioners’ and family physicians’ negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review. Addiction. 2005, 100 (10): 1423-31. 10.1111/j.1360-0443.2005.01221.x.
Raupach T, Merker J, Hasenfuss G: Knowledge gaps about smoking cessation in hospitalized patients and their doctors. Eur J Cardiovasc Prev Rehabil. 2011, 18 (2): 334-41. 10.1177/1741826710389370.
Stead LF, Bergson G, Lancaster T: Physician advice for smoking cessation. Cochrane Database Syst Rev. 2008, 2 (2): CD000165.
Heerwegh D, Loosveldt G: Face-to-face versus web surveying in a high-internet-coverage population. Public Opin Q. 2008, 72 (5): 836-46. 10.1093/poq/nfn045.
Kreuter F, Presser S, Tourangeau R: Social desirability bias in CATI, IVR and web surveys: The effects of mode and question sensitivity. Public Opin Q. 2008, 72 (5): 847-65. 10.1093/poq/nfn063.
Minen MT, Duquaine D, Marx MA: A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microb Drug Resist. 2010, 16 (4): 285-9. 10.1089/mdr.2010.0009.
Grava-Gubins I, Scott S: Effects of various methodologic strategies: survey response rates among Canadian physicians and physicians-in-training. Can Fam Phys. 2008, 54 (10): 1424-30.
A Study of the Use, Knowledge, and Beliefs About Cigarettes and Alternative Tobacco Products Among Students at One U.S. Medical School
Sherry Zhou, Nancy Van Devanter, Michael Fenstermaker, Philip Cawkwell, Scott Sherman, Michael Weitzman
Academic Medicine
Comparison of oral Candida carriage in waterpipe smokers, cigarette smokers, and non-smokers
Zohaib Akram, Abdulaziz A. Al-Kheraif, Sergio V. Kellesarian, Fahim Vohra, Fawad Javed
Journal of Oral Science
Smoking Cessation Education and Training in U.K. Medical Schools: A National Survey
Tobias Raupach, Ghada Al-Harbi, Ann McNeill, Alex Bobak, Andy McEwen
Nicotine & Tobacco Research
A patient perspective
Martin H. Johnson, Sarah Franklin
Reproductive BioMedicine Online
Experimentation with and knowledge regarding water-pipe tobacco smoking among medical students at a major university in Brazil
Stella Regina Martins, Renato Batista Paceli, Marco Antônio Bussacos, Frederico Leon Arrabal Fernandes, Gustavo Faibischew Prado, Elisa Maria Siqueira Lombardi, Mário Terra-Filho, Ubiratan Paula Santos
Jornal Brasileiro de Pneumologia
The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally
E A Akl, K D Ward, D Bteddini, R Khaliel, A C Alexander, T Lotfi, H Alaouie, R A Afifi
Tobacco Control
Nursing Education to Reduce Use of Tobacco and Alternative Tobacco Products: Change Is Imperative
Nancy VanDevanter, Carina Katigbak, Madeline Naegle, Sherry Zhou, Scott Sherman, Michael Weitzman
Journal of the American Psychiatric Nurses Association
Waterpipe (Hookah) Smoking Among Youth and Women in Canada is New, not Traditional: Table 1.
Fadi Hammal, T. Cameron Wild, Candace Nykiforuk, Khadija Abdullahi, Dawit Mussie, Barry A. Finegan
Nicotine & Tobacco Research
Comparison of Clinical and Radiographic Periodontal Status Between Habitual Water-Pipe Smokers and Cigarette Smokers
Fawad Javed, Abdulaziz A. Al-Kheraif, Irfan Rahman, Lorena Teresa Millan-Luongo, Changyong Feng, Michael Yunker, Hans Malmstrom, Georgios E. Romanos
Journal of Periodontology
Knowledge, Beliefs, Behaviors, and Social Norms Related to Use of Alternative Tobacco Products Among Undergraduate and Graduate Nursing Students in an Urban U.S. University Setting
Nancy VanDevanter, Sherry Zhou, Carina Katigbak, Madeline Naegle, Scott Sherman, Michael Weitzman
Journal of Nursing Scholarship
Peri-operative cessation of smoking: time for anaesthetists to act
J. Wong, F. Chung
Waterpipe Tobacco Smoking among Dental Practitioners: Prevalence and Health Perceptions
Najla Dar-Odeh, Ahmad Alnazzawi, Noora Shoqair, Mohammad H. Al-Shayyab, Osama Abu-Hammad
Tobacco Use Insights
Nicotine addiction management following surgery: a quality improvement approach in the post anesthesia care unit
Barry A Finegan, Daniel Roblin, Fadi Hammal
International Journal for Quality in Health Care
Structured Smoking Cessation Training for Medical Students: A Prospective Study
Ronja Herold, Sarah Schiekirka, Jamie Brown, Alex Bobak, Andy McEwen, Tobias Raupach
Nicotine & Tobacco Research
‘Herbal’ but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafés where they are served
Fadi Hammal, Alyssa Chappell, T Cameron Wild, Warren Kindzierski, Alan Shihadeh, Amanda Vanderhoek, Cong Khanh Huynh, Gregory Plateel, Barry A Finegan
Tobacco Control
Self-reported Oral Health Behaviour among Scandinavian and Polish Medical Students Studying in Poland
Ewa Rodakowska, Anna Kierklo, Jacek Jamiołkowski
Central European Journal of Public Health
Impact of anxiety on the prevalence of tobacco use among medical students, Ain Shams University, Egypt
Amany H. El-Rasheed, Doaa N. Radwan, Mahmoud M. Elhabiby, Hebatallah M. Nosir, Michael Elnemais Fawzy
Middle East Current Psychiatry
Evidence-based Implant Dentistry and Systemic Conditions
Smoking cessation in community pharmacy practice–a clinical information needs analysis
Maya Saba, Renee Bittoun, Vicky Kritikos, Bandana Saini