Preventing Future Doctors From Smoking: A Success Story

Roxanne Nelson

October 03, 2012

October 3, 2012 (Vienna, Austria) — A program to prevent future doctors from starting to smoke was a great success and was far more effective than a smoking-cessation program.

These findings from a study conducted in Turkey were presented here at the 2012 European Society for Medical Oncology Congress.

Dr. Fikri Icli

"Doctors should not smoke," said lead author Fikri Icli, MD, from Ankara University Medical School in Turkey. "They are role models and health educators. If physicians smoke, it makes it more difficult for them to encourage their patients to quit," he explained.

Dr. Icli reported on a series of strategies aimed at preventing Turkish medical students from starting to smoke. After 5 years, smoking rates dropped 11% among medical students; for students in their sixth year, they dropped from 35.0% to 8.8%.

In contrast, a smoking-cessation clinic established by the university found no increase in the rate of quitting during the same 5-year period.

High Rates of Smoking a Call for Action

In 1997, Dr. Icli and colleagues surveyed 215 medical students at Ankara University to evaluate smoking rates and the factors that contributed to smoking.

They found that one quarter of the medical students were smokers (29.5% of males and 22.6% of females). The smoking rate was even higher for students in their sixth year, the final year before graduation, where it was 35.0%. Notably, 60% of smokers began using tobacco after they were admitted to medical school.

A higher percentage of students who smoked than students who didn't had family members who smoked (66% vs 38%; P < .01) and had friends who smoked (91.5% vs 56.0%; P < .01).

Among the smokers, 44.4% stated that they wanted to quit, and 28.6% requested help to do so.

Cigarette-Fighting Group

To control smoking rates among medical students and nurses and to try to prevent them from starting in the first place, a "cigarette-fighting group" was established. It was comprised of voluntary academic staff, nurses, students, psychologists, and a social worker, and the goal was to reduce the smoking rate and eventually eliminate smoking among medical students.

"Our target was medical students and nurses," said Dr. Icli. "We wanted to stop them from starting to smoke, which is more productive than trying to treat the addiction," he explained.

To this end, several strategies were implemented. Monthly meetings of an antismoking group began in 2007, and an annual symposium on "cigarettes or health" was started in 2008. In addition, lectures on cigarettes or health began in 2010 for the first-, second-, and third-year medical students.

All lectures emphasized the harms of smoking and the diseases that the habit could eventually lead to. The faculty also met with students in their dormitories 2 or 3 times a year. Other activities included occasional parades of students and faculty members with t-shirts and banners against smoking, the placement of banners at cafés and restaurants on the school campus and in hospitals, and the establishment of a smoking-cessation clinic.

Surveys to evaluate the smoking habits of the students were conducted in 2007 (n = 229), 2009 (n = 647), and 2012 (n = 1187).

Overall, there was a significant drop in smoking rates from 2007 to 2012. "This suggests that our strategy aiming to counteract the influence to start smoking was effective," Dr. Icli said.

For the whole group, smoking rates declined from 25.1% to 10.4% during the 5 years that the program has been in place. For the sixth-year medical students, there was a decline from 35.0% in 2007, to 21.8% in 2009, to 8.8% in 2012 (P = .005).

Earlier Start Needed

Dr. Fortunato Ciardiello

"This study shows the importance of preventing smoking before it starts," Fortunato Ciardiello, MD, PhD, professor of medical oncology at the Second University of Naples in Italy, told Medscape Medical News. However, "in many countries, smoking starts at a much earlier age."

Many people begin smoking in high school or even earlier, so by the time they reach the age when they are entering medical school, they are already established smokers. "It might be a good idea to do a program like this among high-school students," he said, "or even younger students."

The authors have disclosed no relevant financial relationships.

2012 European Society for Medical Oncology (ESMO) Congress: Abstract 1448 PD_PR. Presented September 30, 2012.