Cigarette, waterpipe and e-cigarette use among an international sample of medical students. Cross-sectional multicenter study in Germany and Hungary

Abstract

BackgroundTobacco use is the leading preventable cause of death worldwide. Besides cigarette smoking, waterpipe and e-cigarettes are gaining popularity among young adults. Medical students’ smoking behavior is of particular interest because of their impending role in health promotion as future physicians. Aim of our study is to examine the prevalence and predictors of cigarette, waterpipe and e-cigarette use and the association of tobacco use with self-reported health status in an international sample of medical students.MethodsIn a multicenter cross-sectional study data on different aspects of health behavior were collected from medical students of 65 nationalities using a self-administered questionnaire in Germany (Dresden, Munich) and Hungary (Budapest, Pécs). The survey was conducted among 1st, 3rd and 5th year students. To explore associations between smoking behavior and socio-cultural factors Pearson’s chi2-tests and multivariate binary logistic regression analyses were performed.ResultsThe largest subpopulations were formed by German (n = 1289), Hungarian (n = 1055) and Norwegian (n = 147) students. Mean age was 22.5 ± 3.3 years. Females represented 61.6% of the sample. In the whole sample prevalence of cigarette smoking was 18.0% (95% CI 16.6–19.4%), prevalence of waterpipe use was 4.8% (95% CI 4.0–5.7%), that of e-cigarette 0.9% (95% CI 0.5–1.2%). More males (22.0%) than females (15.5%) reported cigarette smoking. The lowest prevalence of cigarette smoking was found among Norwegian students (6.2%). Cigarette smokers were older, waterpipe users were younger than non-users. E-cigarette use was not associated with age of the students. Religious involvement was protective only against cigarette smoking. Financial situation showed no association with any kind of tobacco consumption. Cigarette smokers and e-cigarette users were less likely to report very good or excellent health status.ConclusionsCigarette smoking is still the most popular way of consuming tobacco, although alternative tobacco use is also prevalent among medical students. To further health consciousness, medical schools should pay more attention to students’ health behavior, especially their smoking habits. Tobacco prevention and cessation programs for medical students should consider not only the health risks of cigarette smoking but the need to discourage other forms of tobacco use, such as waterpipe.

Oral Health Attitudes among Preclinical and Clinical Dental Students in Germany

“…Although the higher prevalence of smoking among clinical students is in agreement with previous studies, the result of the current survey displayed a mean smoking rate of dental students in Germany (11.30%) lower than in Bangladesh (22%), Holland (24%) Norway (24%), Greece (47%), Serbia (43%), Hungary (34%), France (33%), Italy (33%) and Turkey (26%). Furthermore, the numbers of daily smokers of 10 or more cigarettes per day among preclinical students (1.79%) and their clinical colleagues (5.17%) seem comparable to the mean rate reported among medical students in Germany (3%) [38]. Similarly, the frequency and length of smoking reported in the current study show lower rates compared to other countries [4].…”

“…In the present investigation, the prevalence of smoking was 5.36% in preclinical and 8.62% in clinical students. Both groups showed much lower percentages of smoking than the general German population (28%) [37] and the recorded rates of cigarette smoking among German medical students (16%) [38]. Although the higher prevalence of smoking among clinical students is in agreement with previous studies, the result of the current survey displayed a mean smoking rate of dental students in Germany (11.30%) lower than in Bangladesh (22%), Holland (24%) Norway (24%), Greece (47%), Serbia (43%), Hungary (34%), France (33%), Italy (33%) and Turkey (26%).…”

First-year French medical students consume antidepressants and anxiolytics while second-years consume non-medical drugs.

“…The prevalence of tobacco smoking in our study sample is much lower than national rates, with a prevalence of 15.7% amongst first year students and 19.6% amongst second years. However it is comparable to the prevalence of 18% found in a recent cross national survey carried out in German and Hungarian medical students (Balogh et al, 2018). It is also similar to the prevalence of 17.2% found in a worldwide literature review on 74,001 questionnaires from 1988 to 2013 (Roncero et al, 2015).…”

Comparison of cotinine levels in the peri‐implant sulcular fluid among cigarette and waterpipe smokers, electronic‐cigarette users, and nonsmokers

“…23 However, this form of tobacco smoking has gained social popularity particularly among the youth in Western countries including Germany, Norway, United Kingdom, and the United States. [24][25][26] Waterpipe smokers often perceive that this form of tobacco smoking is less hazardous to health as the tobacco smoke initially filters through water, which absorbs toxins. 27 However, studies 15,28…”

“…Moreover, nicotine induces a state of oxidative stress in oral fibroblasts thereby compromising their protective functions 21. However, this form of tobacco smoking has gained social popularity particularly among the youth in Western countries including Germany, Norway, United Kingdom, and the United States [24][25][26]. This may serve as an explanation for the significantly lower scores of BoP among cigarette and waterpipe smokers and electronic-cigarette users compared with nonsmokers.Waterpipe smoking is a cultural norm in Mediterranean countries including Jordan, United Arab Emirates, Oman, and Palestine 23.…”