The 1964 Surgeon General's Report and Americans' Beliefs about Smoking

Marshall, Thomas R.

doi:10.1093/jhmas/jrt057

Cited by 8 publications

(20 citation statements)

References 48 publications

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“…Another potential limitation is that we compared the results only to other chiropractic institutions and not with a similar healthcare profession. Perhaps a fraction of medical students also believe in nineteenth century medical concepts such as smoking is good for you, and 'miasmas' are the cause of cholera, and other theories that became obsolete around the same time as chiropractic conservatism emerged [33][34][35].…”

Section: Methodological Considerationsmentioning

confidence: 99%

Chiropractic conservatism among chiropractic students in Denmark: prevalence and consequences

et al. 2020

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Background The chiropractic profession is split between those practicing evidence-based and those whose practice is honed by vitalism. The latter has been coined ‘chiropractic conservatism’. In Denmark, the chiropractic education program is university-based in close collaboration with a medical faculty. We wanted to investigate if such conservative attitudes were present in this environment. Our objectives were to i) determine the level of chiropractic conservatism, ii) investigate if this was linked to academic year of study, iii) determine the level of clinical appropriateness, and iv) to investigate if this was affected by the level of conservatism among students in a chiropractic program, where the students are taught alongside medical students at the University of Southern Denmark (SDU). Methods A cross-sectional survey of 146 (response-rate 76%) 3rd to 5th year pre-graduate students and 1st year postgraduate clinical interns from the chiropractic degree course at the University of Southern Denmark was conducted during autumn of 2019. The students’ levels of conservatism were dichotomized into appropriate/inappropriate, summed up, and used in a linear regression model to determine the association with academic year of study. Thereafter, the conservatism score was categorized into four groups (from low -1- to high -4-). Conservatism groups were cross-tabulated with the ability to answer appropriately on nine cases concerning i) contra-indications, ii) non-indications, and iii) indications for spinal manipulation and analyzed using logistic regression. Results Generally, the Danish chiropractic students had low conservatism scores, decreasing with increasing academic year of study. Seventy percent of the students were placed in the two lowest conservative groups. The level of conservatism (categories 1–3) was moderately (but not statistically significantly) associated with an inability to recognize non-indications to treatment. Three outliers (category 4), however, revealed a highly inappropriate handling of the clinical cases. Conclusions Chiropractic students enrolled at a university-based course closely integrated with a medical teaching environment are not immune to chiropractic conservatism. However, the course appears to attenuate it and limit its effect on clinical decision-making compared to other educational institutions.

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Section: Methodological Considerationsmentioning

confidence: 99%

Chiropractic conservatism among chiropractic students in Denmark: prevalence and consequences

et al. 2020

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“…This is likely related to the fact that farmers have lifelong exposure to multiple air contaminants (organic dusts, saprophytic microorganisms and/or chemical toxins) that may contribute to the development of respiratory diseases by allergic, inflammatory and/or pharmacological mechanisms [ 4 , 5 ]. Tobacco smoking is in its own right a well-established risk factor for the development of chronic respiratory diseases, especially chronic bronchitis and COPD [ 6 , 7 ]. Notably, there is an additive or even a synergistic effect on the decline in lung function and on the development of COPD [ 8 ] between tobacco and some occupational farming exposures.…”

Section: Introductionmentioning

confidence: 99%

Smoking habits in French farmers: a cross-sectional study

et al. 2017

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BackgroundFarmers are exposed to multiple air contaminants that may interact with tobacco smoking in the development of respiratory diseases. Farmers are currently considered to smoke less than non-farmers, but precise data in different categories of age and farming activities are lacking.MethodsSmoking habits were studied in a cross-sectional study involving 4105 farmers and 996 non-farming controls aged 40–74 years in 9 French departments between October 2012 and May 2013. Three age groups were defined (40–54, 55–64 and 65-74years). Farmers were divided into four activity groups, namely cattle breeders, livestock farmers working in confined spaces, crop farmers and others. Smoking prevalence was compared between farmers and controls, and odds ratios (ORs) for smoking adjusted for age were calculated.ResultsThe adjusted OR for ever-smoking was lower among farmers than among non-farmers in all age categories, but the ORs for current smoking were similar in farmers and controls. Smoking prevalence varied according to the type of farming activity, and was lower than in non-farming controls only among cattle breeders and confined livestock farmers. In farmers, the proportion of smokers was higher in the youngest age categories compared with the older age classes.ConclusionsOur results confirm that the prevalence of ever-smokers is lower in farmers than in non-farmers. Nevertheless, our data show that active smoking prevalence is similar in farmers and in non-farmers. This suggests that farmers, just like non-farmers, should be targeted by primary prevention campaigns against smoking.

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“…Another potential limitation is that we only compared the results to another chiropractic school and not with a similar heath care profession. Perhaps a fraction of medical students also believes in 19th century medical concepts such as, smoking is good for you and 'miasmas' are the cause of cholera; theories that became obsolete around the same time as chiropractic conservatism emerged (3,24,25).…”

Section: Methodological Considerationsmentioning

confidence: 99%

The Association Between Chiropractic Conservatism and the Ability to make Appropriate Clinical decisions: A Survey on Chiropractic Students in Denmark

Nim

O’Neill

Lauridsen

et al. 2020

Preprint

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Background We investigated whether a university-based educational system would overrule the strong link (odds ratios >20) between chiropractic conservatism and the inability to recognize non-indications to chiropractic treatment that had been shown to exist in a previous study of a private chiropractic college. We i) sought to define the clinical decision profile of the students in a university-based course embedded in a medical school, and ii) investigated whether students’ clinical judgment was affected by their conservatism score determined from a ten item questionnaire and collapsed into four categories.Methods In a cross-sectional survey, 3 rd to 5 th year chiropractic students, attending the University of Southern Denmark and recently graduated interns were categorized into four levels of conservatism, which were cross-tabulated with the ability to answer appropriately on 9 cases concerning i) contra-indications, ii) non-indications and iii) indications to chiropractic treatment. Data were analyzed using logistic regression.Results In all, 146 participants (76%) completed the survey, of which 70% belonged in the two lowest conservatism groups with three outliers (group 4). Their ability to answer correctly to the clinical cases was generally acceptable. The level of conservatism (categories 1-3) was moderately (but not statistically significantly) associated with an inability to recognize non -indications to treatment (odds ratios ~3.5). Three outliers (category 4), however, answered inappropriately on the majority of the 9 clinical cases.Conclusions The Danish students’ clinical acumen in correctly judging the appropriateness of spinal manipulation in the clinical cases was fairly similar to that shown in the previous survey on chiropractic students attending a private college. Contrary to the findings at the private college, the level of conservatism did not have a strong association with the inability to recognize non-indications. Although a university-based education does not immunize its students against chiropractic conservatism, it does appear to attenuate its consequences on their clinical judgment.

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The 1964 Surgeon General's Report and Americans' Beliefs about Smoking

Cited by 8 publications

References 48 publications

Chiropractic conservatism among chiropractic students in Denmark: prevalence and consequences

Chiropractic conservatism among chiropractic students in Denmark: prevalence and consequences

Smoking habits in French farmers: a cross-sectional study

The Association Between Chiropractic Conservatism and the Ability to make Appropriate Clinical decisions: A Survey on Chiropractic Students in Denmark

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