Healthcare students often uninformed about smoking dangers, cessation

05 Jul, 2015 10:25 am

MADRID – Nursing and physiotherapy students may be smoking less than they were a decade ago, but they also know less about the health consequences of tobacco and how to help patients quit the habit, a new study from Spain suggests.

“The fact that less than 40 percent of students knew that smoking caused emphysema and only 10 percent identified smoking as a major cause of coronary artery disease in 2013 is quite astonishing,” said Dr. Michael Steinberg, who heads the Tobacco Dependence Program at Rutgers Cancer Institute of New Jersey.

“The most concerning finding might be the degree to which this lack of knowledge is increasing over time,” said Steinberg, who was not involved in the research.

“Knowledge and attitudes have barely changed despite the years and the laws,” said Beatriz Ordas, a staff nurse at the University Hospital of Leon, who led the new research. “Those results provided evidence that suggests more attention by health authorities is necessary in order to develop specific programs to improve knowledge, attitudes and beliefs in nursing and physiotherapy students.”

The researchers note in the Journal of Advanced Nursing that smoking kills nearly 6 million people yearly and has huge economic costs, according to the World Health Organization. The U.S. spends nearly $170 billion in medical care for adults who smoke, according to WHO. Health care professionals play an important role in reducing smoking, but need more knowledge to help patients quit, the authors write.

For the study, students reported their own smoking habits and beliefs, knowledge, attitudes and opinions on anonymous questionnaires in 2003, 2008 and 2013 during lab sessions. In each of the study years, about 300 students answered the questionnaires.

In 2003, almost 30 percent of the students were smokers themselves, but that proportion dropped to about 25 percent in 2008 and 18 percent in 2013 – a decline that paralleled smoking rates in the general Spanish population, the study team notes.

The number of students who failed to recognize the link between smoking and pulmonary emphysema, bladder cancer, coronary artery disease and white patches in the mouth all increased significantly, however, between 2003 and 2013.

In 2003, for instance, 10 of the roughly 300 students were unaware of the link between smoking and pulmonary emphysema, which rose to 34 students in 2013. Similarly, in 2003, 85 students didn’t know about the connection between smoking and bladder cancer, and in 2013 it was 146. Again, in 2003, 10 missed the link with coronary artery disease and six were unaware of the link to oral white patches, while in 2013, it was 22 and 58, respectively.

The number of students who failed to recognize the association between second-hand smoke and cardiovascular disease, childhood asthma and underweight newborns also grew significantly.


When it came to chronic bronchitis, throat cancer, peripheral vascular disease and larynx cancer, the proportion of students who recognized the connections to smoking increased over the years, but there were still a handful in 2013 who were unaware of the links to those diseases.

The students tended to understand that healthcare professionals can play a major role in preventing smoking, but 63 percent doubted that smokers would listen to their warnings about dangers. About the same proportion also didn’t feel they had the strategies necessary to help smokers stop.

“I think this speaks to professionals’ belief that their advice has little impact on patients,” said Steinberg, an internist, in an email to Reuters Health. “Health professionals often expect their advice to lead to immediate behavior change. Often patients are not ready or able to make a change right away . . . however, the evidence does indicate that advice does impact change.”

Steinberg said he thought healthcare providers probably smoked less in the U.S. than in other parts of the world, but that there is probably “also a lack of knowledge regarding the full extent to which tobacco causes disease among U.S. health care students.”

The 2014 Surgeon General’s Report on Tobacco and Health identifies new causal links between tobacco and such diseases as diabetes and colon cancer – links that many health professionals may be unaware of, Steinberg pointed out.

Both Ordas and Steinberg said healthcare professionals could have an influential role in helping patients quit if they better understood the dangers of tobacco.

“Their own smoking status influences their attitudes towards being role models,” Ordas said by email. “From our point of view cessation interventions by healthcare professionals are one of the most important factors in successfully encouraging patients to stop smoking.

“The acquisition of many skills, attitudes and techniques for helping patients to stop smoking takes place during academic education,” Ordas added. – Reuters




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