Linda Kehoe

Worldwide survey of education on tobacco in medical schools

OBJECTIVES To determine the extent of teaching about tobacco, tobacco-related diseases, and smoking cessation techniques in medical schools around the world; and to ascertain the problems of getting the teaching about tobacco onto the medical curriculum. DESIGN Cross-sectional survey. Questionnaires were sent to the 1353 medical schools in 143 countries around the world using the World Health Organization’s Directory of Medical Schools. The questionnaire was translated from English into French, Russian, Mandarin, and Japanese. SUBJECTS Deans of medical schools worldwide, or their nominees. MAIN OUTCOME MEASURES Extent and format of teaching about tobacco in the medical curriculum, objectives and content of the courses on tobacco, and problems encountered in introducing the topic of tobacco. RESULTS 493 medical schools responded, representing 64% of countries and 36% of schools. Only 12% of medical schools did not cover the topic of tobacco in the medical curriculum. 58% of medical schools taught about tobacco during the teaching of other subjects. 40% taught tobacco by systematically integrating teaching with other modules. 11% had a specific module on tobacco. The medical schools reported on the objectives and content of their courses on tobacco, which commonly included knowledge about tobacco-related diseases and pharmacological issues. Only a third taught about smoking cessation techniques. 22% had encountered problems in introducing the topic of tobacco, and respondents offered solutions to overcome these problems. CONCLUSIONS Medical schools need continued encouragement to include tobacco issues in their curricula, with particular emphasis on teaching about smoking cessation techniques.

One-year evaluation of three smoking cessation interventions adminidtered by general practitioners

Three smoking cessation interventions designed for use by general practitioners (GPs) within the routine consultation were evaluated in a field setting using 26 GPs throughout metropolitan Sydney. A total of 450 smoking patients were allocated to either Structured Behavioral Change with nicotine gum (Group SBCN), Structured Behavioral Change without nicotine gum (Group SBC), or GP advice with nicotine gum (Group AN). Although significant differences in the percentage of abstainers were observed between Groups SBCN and SBC three weeks after treatment (39% vs. 26%), the point prevalence abstinence rate for patients at 12 months declined to 19, 18, and 12% for Groups SBCN, SBC, and AN, respectively. Continuous abstinence to the end of the 12-month period was 9% for Groups SBCN and SBC, and 6% for Group AN. Forty-eight percent of the 450 patients made an attempt to stop smoking, and 89% reduced their cigarette consumption at some point during the study. Examination of 132 self-selecting patients who fully participated in the three interventions and attended all scheduled visits, revealed significantly larger proportions of abstainers within Groups SBCN (34%) and SBC (33%) than in Group AN (15%) at the 12-month follow-up.

Smoking behaviour and attitudes among Australian medical students

Teaching about tobacco and related diseases is essential in the undergraduate medical course in order for students to gain knowledge about smoking and how to intervene with patients who smoke. The objective of the study was to assess studentssmoking‐related behaviour, knowledge and attitudes towards tobacco, and perceptions of their future role as doctors. Data were collected from two consecutive years of year 1 and year 5 medical students at the University of New South Wales, Sydney.

EFFECT OF TRAINING ON GENERAL PRACTITIONERS' USE OF A BRIEF INTERVENTION FOR EXCESSIVE DRINKERS

Objective: To determine among general practitioners (GPs) the effect of three different types of training on utilisation of a brief, controlled drinking intervention. Design: A non‐randomised intervention study.

Three year continuous abstinence in a smoking cessation study using the nicotine transdermal patch

A total of 305 subjects from Sydney were randomly allocated to receive either an active (24 hour transdermal nicotine patch over a 10 week course) or placebo nicotine patch. All subjects participated in a multicomponent cognitive–behavioural smoking cessation programme over five weeks in two-hour group sessions. The continuous abstinence rates at three years (validated by expired carbon monoxide) were 13.8% for the active group and 5.2% for placebo group (p = 0.011). The active nicotine patch with behavioural therapy achieved more than double the abstinence rates early in treatment compared with placebo and this difference was maintained throughout the three year follow up.

Ten-year survival outcome of the nicotine transdermal patch with cognitive behavioural therapy

Objective: To follow‐up abstainers from the end of their initial treatment over seven points to 10 years.

The Worldwide Survey of the Training of Medical Students About Tobacco

While knowledge about the physical harm and societal damage caused by cigarette smoking has existed for years, the enormity of the problem has not yet been fully perceived by the broader global community. Indeed, the numerous research studies and surveys conducted at medical schools across the world have revealed a general lack of knowledge. The topic of tobacco and related diseases is included in medical curriculum in only a minority of medical schools, and in some cases students and lecturers themselves continue to smoke. Some medical schools cover the issue in other topics (for example in cardiovascular health). Smoking is the single largest preventable factor in premature death, disablement and disease in the world. In light of this, the teaching of tobacco and related diseases should be a priority in all medical schools worldwide.