Personal and clinical tobacco-related practices and attitudes of U.S. medical students.

Abstract

Medical students' tobacco-related practices particularly matter because practicing physicians' smoking predicts their tobacco counseling; the objective of this study was to determine when this relationship between personal and clinical tobacco practices develops, and to determine predictors of medical students' personal smoking habits, and predictors of their patient tobacco counseling practices. We surveyed the Class of 2003 between 1999 and 2003, at freshman orientation (n=1836), entrance to wards (n=1616), and senior year (n=1441) in a nationally representative sample of 16 U.S. medical schools (response rate=80.3%). Tobacco use questions came from Centers for Disease Control and Prevention datasets, and tobacco counseling questions from validated instruments. 12% of female and 15% of male U.S. medical students report smoking, with no differences in usage over time. More tobacco counseling training and strongly believing in prevention significantly predicted both more perceived counseling relevance and frequency. Additionally, intention to practice primary care predicted relevance (OR=3.5, 95% CI: 2.5-4.9), and tobacco users were 77% (95% CI: 64%-94%) as likely as non-users to report frequently counseling smokers. U.S. medical students are less likely to smoke than other young U.S. adults, but more likely than U.S. physicians, and showed no clear decrease during medical school. It is encouraging that medical students with more exposure appreciate tobacco counseling's importance more, and are more likely to counsel. Students' personal tobacco use was also associated with counseling frequency. These data should help educators seeking better methods to reduce tobacco use.