Fakhfakh R, Hsairi M, Ben Romdhane H, Achour N, Ben Ammar R, Zouari B, Nacef T
Centre national de formation pédagogique des cadres de la santé, El Omrane, Tunisie.
Sante. 1996 Jan-Feb;6(1):37-42.
We report a cross sectional survey to analyze the effects of medical training on the smoking habits of Tunisian medical students, and their attitudes and knowledge about smoking. Two groups of medical students were studied. One group was 257 first year students at the Medical Faculties of Tunis and Sfax, in 1987, the other 211 final year students at the same Faculties in 1994 and who had been in the first year in 1987. A questionnaire bases on that of the WHO and International Union against Lung Disease for health professionals was administered. It was completed by 95% of the students. Fifty-four % were men and 46% women, and 70.2% lived in an urban area before attending university (table 1). Nonsmokers were defined as those who had never smoked. Exsmokers were those who had formerly smoked but no longer did so. Smokers were divided into those who smoked occasionally and those who smoked daily. The prevalence of smoking was higher among the final year students than the first year students. Combined daily and occasional smoking was 24.1% among first year students and 37.1% among final year students (table 2). The rates among men for daily smoking were 19.2% in the first year and 38.9% in the final year, whereas for women the corresponding rates were 1.8% and 2% (table 3). The prevalence of occasional smoking among men was 17.8% for the first year and 17.7% in the final year. Among women, this behavior increased from 5.5% to 16.8%. Men exsmokers increased from 6.2% to 16.8% and women from 4.6% to 13.4% from the first to the final year. The proportion of first year smokers who reported a serious attempt to stop was 64.8% and that of final year students was 50%. Protected personal health was the most common reason (table 4). In the final year, 94.1% of te students agreed strongly with the view that smoking is harmful to health (table 5). However, there was substantial underestimation of the contribution of tobacco to causing serious diseases including bladder cancer, coronary artery disease, peripheral vascular disease, emphysema and neonatal morality (table 6). The study evidences insufficient awareness of medical students about their responsibility for health education and prevention. There was little interest in preventive action for patients. Only 4.5% of the final year students felt that they were equipped to advise patients about smoking. Similarly, 65.7% would not advise patients to stop smoking if they had no smoking-related symptoms and did not raise the question themselves (table 7). There were major deficiences in knowledge of preventive measures. Only 45.5% of final year students considered that they had adequate knowledge to advise patients about smoking (table 8) and 72.5% thought that they should have received more specific training about counseling (table 9). This work shows that, like in Africa, Asia and Europe, Tunisian medical students have an unsatisfactory knowledge of tobacco and its effects. There were no substantial changes in the students' knowledge of, or attitude to, smoking between the first and final year of training. Simply stimulating the interest of these future doctors in the problem of smoking is insufficient.
我们报告了一项横断面调查，以分析医学培训对突尼斯医科学生吸烟习惯的影响，以及他们对吸烟的态度和知识。研究了两组医科学生。一组是1987年在突尼斯和斯法克斯医学院的257名一年级学生，另一组是1994年同一医学院的211名最后一年学生，他们在1987年是一年级学生。采用了一份基于世界卫生组织和国际抗肺病联盟为卫生专业人员设计的问卷。95%的学生完成了问卷。54%为男性，46%为女性，70.2%的学生在上大学前居住在城市地区（表1）。非吸烟者定义为从未吸烟的人。曾经吸烟者是指以前吸烟但现在不再吸烟的人。吸烟者分为偶尔吸烟者和每日吸烟者。最后一年学生的吸烟率高于一年级学生。一年级学生中每日吸烟和偶尔吸烟的综合比例为24.1%，最后一年学生中为37.1%（表2）。男性每日吸烟率在一年级为19.2%，在最后一年为38.9%，而女性相应的比例分别为1.8%和2%（表3）。男性偶尔吸烟率在一年级为17.8%，在最后一年为17.7%。女性中，这种行为从5.5%增加到16.8%。从一年级到最后一年，男性曾经吸烟者从6.2%增加到16.8%，女性从4.6%增加到13.4%。报告曾认真尝试戒烟的一年级吸烟者比例为64.8%；最后一年学生的这一比例为50%。保护个人健康是最常见的原因（表4）。在最后一年，94.1%的学生强烈同意吸烟有害健康的观点（表5）。然而，对于烟草导致包括膀胱癌、冠状动脉疾病、外周血管疾病、肺气肿和新生儿死亡等严重疾病的贡献，存在严重低估（表6）。该研究表明医科学生对其健康教育和预防责任的认识不足。对患者的预防行动几乎没有兴趣。只有4.5%的最后一年学生认为自己有能力就吸烟问题向患者提供建议。同样，65.7%的学生表示，如果患者没有吸烟相关症状且自己没有提出问题，他们不会建议患者戒烟（表7）。在预防措施知识方面存在重大缺陷。只有45.5%的最后一年学生认为自己有足够的知识就吸烟问题向患者提供建议（表8），72.5%的学生认为他们应该接受更多关于咨询的具体培训（表9）。这项研究表明，与非洲、亚洲和欧洲的情况一样，突尼斯医科学生对烟草及其影响的了解不尽人意。在培训的第一年和最后一年之间，学生对吸烟的知识和态度没有实质性变化。仅仅激发这些未来医生对吸烟问题的兴趣是不够的。
