Knowledge and perceptions of Medical Students about cigarette smoking: a survey in four Italian medical schools

Tobacco smoking is the leading cause of preventable death in developing countries . In Italy 11.1 million adults are still current smokers and only 27.1% of these smokers tried to stop smoking at least once in their lifetime (Doxa-ISS, 2010). The Italian guidelines (OssFAD-ISS, 2008) recommend the use of both pharmacotherapy and counseling for all quit attempts. In previous studies, we described that group counseling combined with pharmacotherapy improved the rate of smoking abstinence at 1-year follow-up in smokers who wanted to quit. Advice and assistance by physicians have an important role in helping smokers to quit and several studies have investigated the role that medical schools should play in training students in toxicology of tobacco and how to help smokers to quit. In core curricula of the Italian medical schools little attention has been paid to the issue of tobacco dependence; hence, physicians neither consistently assist smokers in their attempt to quit nor do they prescribe pharmacotherapy for tobacco dependence . This study was conducted on medical students at four different Italian medical schools (Rome Sapienza, Rome Catholic, Udine, Verona) to investigate their smoking behaviors and knowledge. Students were asked to complete a 60 items questionnaire between April and May 2010 before a lesson of Pharmacology. There were four main sections in the questionnaire: demographics and personal smoking history, knowledge of smoking-related epidemiology, knowledge of clinical guidelines, and smoking and life expectancy. Using 15 items, a special score (score 1) assigning a value (0-2) to each answer, was computed to classify students for their knowledge of: i) smoking epidemiological aspects, ii) risks associated with smoking, iii) benefits of cessation. Using others 15 items another score (score 2) was computed, to classify students for their knowledge of: i) clinical guidelines on smoking cessation, ii) effectiveness of smoking cessation methods. The questionnaire was completed by 439 students (60.8% female) of which 197 (44,9%) were from Rome Sapienza and 95 (21,6%), 96 (21,9%) and 51 (11,6%) from Rome Catholic, Udine and Verona Universities, respectively. The prevalence of smoking was 15.3%, with difference between males and females (20.5% vs. 11.6% respectively, P<.01), 59,7% reported that they wish to give up smoking. Our survey shows that Italian medical students have a low level of information of the epidemiology of smoking and smoking attributable morbidity and mortality, as well as of the benefits of smoking cessation. Accordingly, 65.6% of the students had a total “score 1” less than 60 (mean 51.1+11.5, with no differences among students of the different universities, gender and smoking status). Knowledge of clinical guidelines, perceived competency in counseling smokers and treatment of nicotine addiction was also insufficient as 65.8% of the students had a total “score 2” less than 60 (mean 51.9+10.5, with no differences between the different student groupings). Similarly to a recent study conducted in different European medical schools (5), our data highlight that medical schools fail to address the need to improve students’ competence in tobacco dependence pharmacotherapies and counseling. As a result, medical students underestimate the relevant role that a physician may have in assisting smokers during their attempt to quit. In conclusion current findings strongly support the need of inserting in the core curriculum of Italian medical schools credits on smoking dependence and therapy