Smoke Free Health Establishments and Determinants of Tobacco Use Among Medical Students In South Africa

Context: Health establishments render critical care and should contribute to health promotion. On the other hand, tobacco use among medical students is of public health concern, given their role as future role models for healthy lifestyles. This study sought to determine the prevalence and determinants of tobacco use and nicotine dependence in medical students in Pretoria. This study explored the role of sense of coherence and the students’ perceptions with regards to the availability and adequacy of tobacco control curricula. Further, the study sought to develop an institutional policy for smoke free-health establishments.

Methods: The medical student cross-sectional analytical study involved undergraduate medical students in their 2^nd and 6^th year of study at the Universities of Pretoria and Limpopo (MEDUNSA). A six-item Antonovsky’s sense of coherence scale (SOC) was included to measure respondents’ ability to cope with stress. Nicotine dependence was measured using the (DSM-IV). Two health establishments in the Gauteng region were used for the smoke free health establishment study.

Results: Prevalence of cigarette smoking in medical students was 17.3%. Only 22% of students felt their training curriculum contained tobacco control (TC) issues. Factors independently associated with the current smoking status were having lower support for TC legislation (OR=0.49; 95%CI=(0.41-0.59), attaching less importance to being seen as a role model by patients (0.62; 0.41-0.91), having a drinking problem (2.17; 1.28-3.68) and three other factors.Younger age (0.86; 0.77-0.97) and two other factors were independently associated with nicotine dependence. Both hospitals were found not to have comprehensive institutional policies on tobacco use.

Conclusions: This study’s findings suggest that tobacco use is prevalent among medical students and tobacco use is strongly associated with alcohol abuse.