- About this Journal
- Abstracting and Indexing
- Aims and Scope
- Article Processing Charges
- Articles in Press
- Author Guidelines
- Bibliographic Information
- Citations to this Journal
- Contact Information
- Editorial Board
- Editorial Workflow
- Free eTOC Alerts
- Publication Ethics
- Submit a Manuscript
- Subscription Information
- Table of Contents
ISRN Public Health
Volume 2013 (2013), Article ID 706451, 5 pages
Health Professionals’ Role in Helping Patients Quit Tobacco Use: Attitudes among Iranian Dental Students
1Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Hakim-Karegar Cross, North Karegar Avenue, Tehran 1439955991, Iran
2Department of Community Dentistry, University of Oulu, P.O. Box 5281, 90014 Oulu, Finland
3Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland
Received 25 May 2013; Accepted 24 July 2013
Academic Editors: A. R. Mawson and M. H. Stigler
Copyright © 2013 Hooman Keshavarz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Health professionals play an essential role in tobacco control. Our objective was to assess Iranian dental students' attitudes towards tobacco control. Methods. Eight dental schools were randomly selected, and a survey using Global Health Professions Student Survey (GHPSS) instrument was conducted among dental students in 2010 in Iran. The chi-square test served for statistical analyses. Results. Of the participants (325 students, 66% female), about one-fifth (21%) were current tobacco (including cigarettes and waterpipe) users. A clear majority (over 80%) of the students agreed as to the responsibility of health professionals on serving as role models for patients and the public, routinely advising patients using tobacco to quit, and giving patients advice about smoking cessation. Over 75% believed that cigarette-smoking health professionals are less likely to advise their patients to stop smoking. Current tobacco users were significantly less likely to agree with these beliefs (). Conclusion. Future oral health professionals have generally positive attitudes towards tobacco control. However, their own current tobacco use has a significant negative impact on these attitudes, an impact which ought to be taken into account in tobacco control.
Globally, one of the greatest health challenges of today is the tobacco epidemic. Worldwide, the number who dies from tobacco-related diseases each year is higher than the number of victims of tuberculosis, malaria, and HIV/AIDS added together . In developing countries, the situation is even worse than in today’s developed countries . In Iran, with its population of about 75 million, tobacco-related diseases kill more than 75,000 people per year . Economically, the expenses associated with tobacco, that is, treatment of tobacco-related diseases together with tobacco production and import, constitute a considerable cost for society. Furthermore, individuals and families have high expenditures from smoking [4, 5].
Health professionals’ involvement in the tobacco epidemic is an essential and effective way of dealing with it . Even a brief advice from health professionals to smoking patients can significantly increase the quit rate [7–9]. One way to make health professionals’ involvement even more effective in tackling tobacco use is a multiprofessional approach which has been advocated by the World Health Organization (WHO) [10, 11]. Physicians usually undertake more cessation counseling than do the other health professionals , but other groups of health professionals can be effective, as well [13, 14]. Research has shown that a clear majority of dental, medical, and nursing students consider health professionals to play a role in giving patients advice about smoking cessation [15–17].
To be able to effectively participate in the antitobacco effort, health professionals’ attitudes towards tobacco use cessation are important. Attitudes are a mixture of beliefs, thoughts, and feelings that predetermine health professionals’ behaviour and clinical practice [18, 19]. In addition, a bilateral relation exists between attitudes and behaviour. Health professionals’ negative beliefs and their own unhealthy behaviour, for example, smoking, may have both direct and indirect consequences for their successful preventive work [20, 21].
The objective of our study was to explore attitudes towards health professionals’ role in tobacco control among Iranian dental students.
2. Subjects and Methods
2.1. Study Subjects and Data Collection
A national survey was implemented among students selected from all dental schools in December 2010 in Iran. All fourth-year students () of eight randomly selected schools (six state and two private) were invited to participate in the study. One of the authors (Hooman Keshavarz) distributed a self-administered anonymous questionnaire among the participants in one of their ordinary classroom settings. A detailed description of the survey has been presented .
The data collection instrument was the Global Health Professions Student Survey (GHPSS) questionnaire , modified for Iranian conditions; after translation into Persian, the modified questionnaire was tested in a pilot study .
In addition to age and gender, the questionnaire queried students on the following items.
2.2.1. Tobacco Use in the Previous 30 Days
The number of days on which use of tobacco products (cigarette, waterpipe, and other tobacco products) had occurred during the previous 30 days involved three questions with seven alternatives (0 days, 1 or 2 days, 3 to 5 days, 6 to 9 days, 10 to 19 days, 20 to 29 days, and all 30 days). For each tobacco product, those students who had used the product at least once during the previous 30 days were considered as current users.
2.2.2. Attitudes towards Health Professionals’ Role in Tobacco Control
The students were asked seven attitudinal questions on health professionals’ role in tobacco control (Table 1). To make the answers clearer, in contrast to the yes/no form of the original GHPSS questionnaire , we used a five-point Likert scale from “Completely agree” to “Completely disagree” as alternative.
2.3. Statistical Methods
The data were analyzed with SPSS for Windows, version 16 (SPSS Inc., Chicago, IL, USA). The chi-square test served for comparing subgroups. For exploring the association between gender and the students’ attitudes, we split our dataset into two categories according to current tobacco use status and tested the association in each of the two categories separately. The statistical significance was set at .
About 84% of the students (325 students, 66% female) participated in the survey. Most of them (92%) were from 19 to 24 years old. The dental students had generally positive attitudes towards health professionals’ role in tobacco control (Figure 1). A clear majority of them (88%), completely or partially, agreed as to their responsibility to serve as role models for patients and the public. Similarly, most of the students (>80%) recognized the responsibility of health professionals to routinely advise tobacco-using patients to quit and to give patients advice about smoking cessation. A clear majority of the students (78%) believed that health professionals’ advice can promote patients’ chances to quit smoking. More than three-fourth of the students expressed their agreement on the lower likelihood of advising patients to stop smoking if the health professionals are cigarette smokers themselves and believed that advising patients to stop smoking is less likely to be done by health professionals who use other tobacco products.
Current tobacco users, however, reported significantly () less agreement with health professionals’ serving as role models for patients (Table 2). Current tobacco users also reported significantly less agreement with the following health professionals’ responsibilities: routinely advising smoking patients to quit (), routinely advising patients who use other tobacco products to quit (), and playing a role in giving patients advice about smoking cessation (). Regarding the lower likelihood of advising patients to quit smoking if the professional is a cigarette smoker, current tobacco users expressed significantly () less agreement as well (Table 2).
Among the students who did not use tobacco currently, female students reported their agreement on the responsibility of health professionals to serve as role models significantly more often than did male students (). Except for this association, no significant association emerged between gender and students’ attitudes.
Our study investigating Iranian dental students’ attitudes towards health professionals’ role in tobacco control showed generally positive attitudes towards tobacco control by health professionals. Current tobacco use, however, had a significant negative impact on attitudes among the respondents.
Health-profession students’ attitudes are of high importance, since they will take on important responsibilities in the future. These students often recognize that they play a role in advising patients on smoking cessation and believe they should receive training on counseling patients to quit using tobacco, but few report receiving such formal training [15–17]. Iranian dental students have not been studied well regarding attitudes towards tobacco control, even though a recent national study showed that more than half of all Iranian dental students had tobacco-use experience with either cigarettes, waterpipes, or other tobacco products and that about one-fifth were current tobacco users .
Our findings are in line with earlier research assessing health-profession students’ attitudes towards health professionals’ role in tobacco control [15–17]. Studies done on health professionals who had graduated also report similar results regarding attitudes towards health professionals’ role in tobacco control [24, 25]. However, physicians’ central role and responsibility has been emphasized in some studies .
Health professionals’ own tobacco use status has an influence on their attitudes towards health professionals’ role in tobacco control, with current tobacco users less likely to express positive attitudes [24, 27, 28]. Sreeramareddy et al.  showed that never-smokers agreed with the role modeling of medical professionals significantly more than did ever-smokers. Smoking health sciences students in Kuwait were also significantly less likely to agree with their professional responsibility to help smokers quit than were nonsmoking students . Findings from Gulf Arab states, in line with our results, showed significantly different attitudes between never-smokers and current smokers regarding health professionals’ role model position, whereas, in contrast to our results, they showed no significant difference as to the responsibility of health professionals to routinely advise smoking patients to quit . In contrast to our results, the difference between never- and current smokers’ agreement that patients’ chances of quitting smoking are increased if a health professional advises them to quit was significant in Gulf Arab states .
While a pronounced gender difference has been reported in earlier tobacco use and in current tobacco use among Iranian dental students , overall, we found no significant gender difference in the students’ attitudes. However, among the current non-tobacco-users, female students highlighted health professionals’ responsibility as role models significantly more than did male students.
Our random sample, as it includes both state and private dental schools as its target population, offers reliable and comprehensive views of students’ attitudes. Although our high response rate (84%), random sampling, and anonymous questionnaire increase validity for our findings, as with any other questionnaire surveys collecting data on tobacco use status, its results should be treated with caution. In particular, the social unacceptability of tobacco use among women in Iran  and the possibility of social desirability bias are factors to be taken into account.
Future oral health professionals’ generally positive attitudes towards tobacco control are affected by their current tobacco use. Considering the relationship between attitudes and performance to improve future oral health professionals’ performance in tobacco control, the focus of training should be on tobacco users among these students.
This research has been supported by Tehran University of Medical Sciences & Health Services Grant no. 90-01-69-12893.
- World Health Organization, WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER Package, World Health Organization, Geneva, Switzerland, 2008.
- World Health Organization, The World Health Report: Shaping the Future, World Health Organization, Geneva, Switzerland, 2003.
- K. Mohammad, A. A. Nourbala, and R. Madjdzadeh, “Trend of smoking prevalence in Iran from 1991 to 1999 based on two national health survey,” Hakim Research Journal, vol. 3, no. 4, pp. 290–297, 2000.
- S. F. Tafti, H. R. Jamaati, H. Heydarnejad et al., “Daily expenditure on cigarette smoking in Tehran,” Tanaffos, vol. 5, no. 4, pp. 65–70, 2006.
- D. Efroymson, S. Ahmed, J. Townsend et al., “Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh,” Tobacco Control, vol. 10, no. 3, pp. 212–217, 2001.
- World Health Organization, Framework Convention on Tobacco Control, World Health Organization, Geneva, Switzerland, 2003.
- P. Aveyard, R. Begh, A. Parsons, and R. West, “Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance,” Addiction, vol. 107, no. 6, pp. 1066–1073, 2012.
- M. Amemori, J. Virtanen, T. Korhonen, T. H. Kinnunen, and H. Murtomaa, “Impact of educational intervention on implementation of tobacco counselling among oral health professionals: a cluster-randomized community trial,” Community Dentistry and Oral Epidemiology, vol. 41, no. 2, pp. 120–129, 2013.
- A. B. Carr and J. O. Ebbert, “Interventions for tobacco cessation in the dental setting,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD005084, 2012.
- P. E. Petersen, “Global policy for improvement of oral health in the 21st century—implications to oral health research of World Health Assembly 2007, World Health Organization,” Community Dentistry and Oral Epidemiology, vol. 37, no. 1, pp. 1–8, 2009.
- P. E. Petersen, “Oral cancer prevention and control—the approach of the World Health Organization,” Oral Oncology, vol. 45, no. 4-5, pp. 454–460, 2009.
- M. Tremblay, D. Cournoyer, and J. O. Loughlin, “Do the correlates of smoking cessation counseling differ across health professional groups?” Nicotine and Tobacco Research, vol. 11, no. 11, pp. 1330–1338, 2009.
- M. M. Walsh and J. A. Ellison, “Treatment of tobacco use and dependence: the role of the dental professional,” Journal of dental education, vol. 69, no. 5, pp. 521–537, 2005.
- C. A. Ramseier, S. Warnakulasuriya, I. G. Needleman et al., “Consensus report: 2nd European workshop on tobacco use prevention and cessation for oral health professionals,” International Dental Journal, vol. 60, no. 1, pp. 3–6, 2010.
- C. W. Warren, D. N. Sinha, J. Lee, V. Lea, N. Jones, and S. Asma, “Tobacco use, exposure to secondhand smoke, and cessation counseling training of dental students around the world,” Journal of Dental Education, vol. 75, no. 3, pp. 385–405, 2011.
- C. W. Warren, D. N. Sinha, J. Lee, V. Lea, and N. R. Jones, “Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005–2008,” BMC Public Health, vol. 11, article 72, 2011.
- C. W. Warren, D. N. Sinha, J. Lee, V. Lea, and N. R. Jones, “Tobacco use, exposure to secondhand smoke, and training on cessation counseling among nursing students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005–2009,” International Journal of Environmental Research and Public Health, vol. 6, no. 10, pp. 2534–2549, 2009.
- G. Brown, M. Manogue, and M. Rohlin, “Assessing attitudes in dental education: is it worthwhile?” British Dental Journal, vol. 193, no. 12, pp. 703–707, 2002.
- P. McGlone, R. Watt, and A. Sheiham, “Evidence-based dentistry: an overview of the challenges in changing professional practice,” British Dental Journal, vol. 190, no. 12, pp. 636–639, 2001.
- A. Pipe, M. Sorensen, and R. Reid, “Physician smoking status, attitudes toward smoking, and cessation advice to patients: an international survey,” Patient Education and Counseling, vol. 74, no. 1, pp. 118–123, 2009.
- F. Vogt, S. Hall, and T. M. Marteau, “General practitioners' and family physicians' negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review,” Addiction, vol. 100, no. 10, pp. 1423–1431, 2005.
- H. Keshavarz, M. R. Khami, A. Jafari, and J. I. Virtanen, “Tobacco use among Iranian dental students: a national survey,” Eastern Mediterranean Health Journal, vol. 19, no. 8, pp. 702–708, 2013.
- Centers for Disease Control and Prevention, “Global Health Professions Student Survey (GHPSS): core questionnaire,” http://apps.nccd.cdc.gov/GTSSData/Ancillary/Documentation.aspx?SUID=1&DOCT=1.
- N. N. Behbehani, R. R. Hamadeh, and N. S. Macklai, “Knowledge of and attitudes towards tobacco control among smoking and non-smoking physicians in 2 gulf arab states,” Saudi Medical Journal, vol. 25, no. 5, pp. 585–591, 2004.
- A. J. Ampt, C. Amoroso, M. F. Harris, S. H. McKenzie, V. K. Rose, and J. R. Taggart, “Attitudes, norms and controls influencing lifestyle risk factor management in general practice,” BMC Family Practice, vol. 10, article 59, 2009.
- C. Squier, V. Hesli, J. Lowe, V. Ponamorenko, and N. Medvedovskaya, “Tobacco use, cessation advice to patients and attitudes to tobacco control among physicians in Ukraine,” European Journal of Cancer Prevention, vol. 15, no. 5, pp. 458–463, 2006.
- C. T. Sreeramareddy, S. Suri, R. G. Menezes et al., “Self-reported tobacco smoking practices among medical students and their perceptions towards training about tobacco smoking in medical curricula: a cross-sectional, questionnaire survey in Malaysia, India, Pakistan, Nepal, and Bangladesh,” Substance Abuse, vol. 5, no. 1, article 29, 2010.
- M. Waheedi, A. M. Al-Tmimy, and H. Enlund, “Preparedness for the smoking cessation role among health sciences students in Kuwait,” Medical Principles and Practice, vol. 20, no. 3, pp. 237–243, 2011.
- N. Sarraf-Zadegan, M. Boshtam, S. Shahrokhi et al., “Tobacco use among Iranian men, women and adolescents,” European Journal of Public Health, vol. 14, no. 1, pp. 76–78, 2004.