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An advice to medicos -- quit smoking

By Bobby Ramakant in New Delhi
May 17, 2007 17:11 IST
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The prevalence of tobacco use is more among medical students than in general population, a recent study has revealed.

This becomes more paradoxical when India's 25 crore tobacco users look up at existing healthcare providers for assistance in quitting tobacco. Also, it questions how serious people are to prevent needless diseases and deaths attributed to tobacco use.

The survey carried out by the All India Institute of Medical Sciences among students of major medical colleges in North India conclusively proves that smoking in medical students increases as their medical schooling goes ahead.

'Tobacco Kills,' 'Tobacco causes Cancer' -- say the new health warnings on every cigarette pack. With young doctors and medical students not heeding to this health warning, has the tobacco control strategy went fundamentally awry?

Results of the survey reveal the chilling fact -- 56 per cent of medical students smoke.

The most alarming fact was that 35 per cent of medical students surveyed were found to be 'nicotine-dependent'!

The year-long survey, done by Department of Medicine at AIIMS, probed students on their smoking habits.

"This survey used the Fagerstrom test for nicotine dependence," Dr Randeep Guleria, professor of medicine at AIIMS, said. This test was developed by Dr Karl Fagerstrom, a globally-acclaimed authority in tobacco cessation.

"Dependence on smoking was assessed by the quantitative method with questions like number of cigarettes smoked daily and the time of lighting up the first cigarette after waking up," Dr Guleria said.  

"The motivation to stop smoking was assessed qualitatively by direct questions about intentions to quit," he further added. 

37.5 per cent medical students took to cigarettes after seeing others smoke, a further 32.5 per cent smoked since they felt it was a stress-buster; 8.75 per cent started due to 'peer pressure'; 11 per cent were found to be 'heavy smokers'; and 45 per cent had a 'family history of smoking.'

Clearly the need for strong tobacco control and health education programme within healthcare settings is most compelling. Unless there is a health education programme in place, how else could the number of medical students taking up tobacco use during medical schooling be reduced?

If public health campaigns cannot bring in a change in medical students who 'believe' that tobacco is a stress-buster and smoke because of peer pressure or lifestyle imagery, then how effective will they be in general community?

However, an overwhelming majority had tried to quit tobacco use. Sixty five per cent had made attempts to quit, while 62 per cent were willing to quit if assisted. Are we prepared and geared up enough to provide this 'assistance'?

That throws up the glaring gap in tobacco cessation services within healthcare settings. Unless tobacco cessation skills are imparted to mainstream healthcare providers utilising and building upon existing infrastructure and health systems, how can quality assistance be provided to 62 per cent of medical students who want to quit tobacco use?

Professor (Dr) Rama Kant, Head of the Tobacco Cessation Clinics at King George's Medical University, says: "Doctors who use tobacco, endanger their own health, and send a misleading message to patients and to the public. The best way forward is to invest in building training capacities of existing tobacco cessation clinics so that these can impart not only cessation services, but also impart tobacco cessation skills in healthcare staff from different settings. It is also vital to integrate tobacco cessation counseling in routine medical practice."

The AIIMS survey indicates that the mean age of starting smoking was 18.65 years.

With deceptive tobacco advertising and misconceptions associated with tobacco use, the addiction takes roots before the age of 18, says Prof Kant.

By the time tobacco-related hazards begin to manifest, the person, including medical students, is already addicted to nicotine dose. Nicotine is as addictive as heroin and cocaine, stated a US Surgeon General Report in 1988. It is not easy to quit tobacco, but it is also not impossible, asserts Prof Kant.

So far India has about 20 tobacco cessation clinics supported by World Health Organization across the country.

According to the Indian Council of Medical Research, tobacco use is responsible for over 10 lakh deaths in India each year, which is about 3000 deaths every day. The urgency to reduce or decimate preventable burden of life-threatening diseases attributed to tobacco is compelling.

Prof Kant points to a possible way forward -- 'A combination of health education programme with tobacco control in focus to alarm new medical students and encourage them not to use tobacco should be incorporated while we scale up tobacco cessation services across the country.'

The author is a senior health and development journalist. He is a member of the Network for Accountability of Tobacco Transnationals. He can be reached at:

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Bobby Ramakant in New Delhi