Title:
Medical students' tobacco use and attitudes towards tobacco control.

Abstract:
Despite their important roles as future doctors in tobacco cessation counselling, the high prevalence of tobacco use among medical students may hinder them from advocating tobacco control policies and providing cessation counselling. Promoting this role among medical students is especially important in low- and middle-income countries with high burdens of tobacco use but limited resources for cessation programmes. This study examined the associations between medical students' tobacco use and their attitudes towards tobacco control policies and the roles of health professionals in the provision of tobacco cessation advice.
This cross-sectional study included data from the large multi-country dataset generated by the Global Health Professions Student Survey, 2005-2008 (n = 36,533 medical students). Thirteen binary dependent variables related to medical students' attitudes towards tobacco control policies and the health professional's role in cessation counselling were examined using random-effects logistic regression, with tobacco use status as the key explanatory variable. Covariates included gender, receipt of cessation training, country-level and gender-specific smoking prevalence, region, and country income group.
Current tobacco use was consistently associated with less favourable attitudes towards tobacco control policy and cessation advice. Compared with never users, daily users were less likely to agree that the sale of tobacco products to adolescents should be banned (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.39-0.58) and that health professionals should routinely advise patients to quit smoking (OR = 0.48, 95% CI 0.41-0.52) or other forms of tobacco use (OR = 0.84, 95% CI 0.72-0.97). Daily users were less likely to agree that health professionals who smoke are less likely to advise patients to stop smoking (OR = 0.44, 95% CI 0.39-0.41).
Medical schools may benefit from a thorough re-evaluation of the scope of tobacco cessation training in their curricula in order to support students in smoking cessation and to shape their attitudes towards tobacco control. Targeting medical students who are current tobacco users in tobacco control efforts may be beneficial, given the cost-effectiveness of providing cessation advice.