The smoking rate among health professional students in this survey was lower than reported when compared to other parts of the globe's previous studies, using the same questionnaire, findings from GHPSS showed that over 20% of students currently smoked cigarettes in 47 of 80 sites surveyed, although, the prevalence ranges from 1.3% in Ghana among medical students to as high as 47% in Bosnia and Herzegovina federation.[18
] The findings in Africa are generally lower than their counterpart in Europe and in the Middle Eastern countries.
In Africa, the smoking prevalence varies from region to region, rate being the highest in North African countries when compared to other parts of Africans, the GHPSS study result showed the following prevalence of current smoker among medical students: Tunisia 11.1%; Egypt 7.9%; Uganda 2.8% and Ghana I.3%. This might be due to the difference in socio-economic factors and influence of westernization, more so, in North Africa smoking is culturally acceptable.
The smoking rate among health-professional students is low compared to general population in Nigeria and other category of people that have been studied, Fawibe and Shittu[21
] reported that the prevalence of smoking among medical students is significantly low compared to other non-medical students 0.9% compared to 6.4% this may be due to a number of factors Firstly, they may recognize the negative medical consequences more quickly than the general public. Secondly, their devotion to health naturally conflicts with unhealthy behaviors. Thirdly, tobacco smoking usually incurs a negative image in the health-care profession long before it does so in the wider community.
Of importance in this study is that one-third of all the ever smokers are females; Previous investigation conducted among physicians showed females smoked less compared to their male[21
] counterparts while other research revealed no female smokers[23
] however, other study found a comparable rate between male and female physicians.[26
] In fact a study[28
] reveal that more female smoked compared to the males. In a study conducted exclusively among female secondary school students, a prevalence 7.7% was reported in South-Eastern Nigeria.[7
] Generally, there is an increasing prevalence of smoking among females health professionals which might be attributable to improvement in women's social factor such as education, employment, and urbanization.
Majority of the ever smokers initiated smoking before 15-year of age and this is in consonance with other studies, this is corroborated by Ibeh study[7
] and Fawibe and Shittu[21
] study with mean age of smoking 12.6 years and 15.4 years respectively. Adolescent first cigarette is usually obtained from friends and family members and smoking can be viewed as rite of passage from childhood to adulthood.[29
] However, a quarter of them also started smoking between 20 years and 24 years of age, which may be related to peer pressure in the university.
The attitudes of these students are essential as it is going to affect how seriously they are likely to adopt smoking cessation program and patients’ counseling. Only three-fourth of the students believed that smoking should be completely banned. This is similar to 63% reported by Awotedu[30
] among tertiary institutions in South Africa and also as might be expected, these clear difference between smokers and non-smokers attitudes with regards to banning and advertising of tobacco in public places, this in consonance with other studies.[12
] Smoking by health-care professional may actually hamper their capacity to render smoking cessation counseling to their patients, more so three-quarters of them believed that health professional serve as models.
Majority of them reported that they were taught about the dangers of smoking and that it is important to record tobacco use history, this is off-set by the fact that only about 50% have ever heard of using anti-depressant, although, about 70% of them claimed they had formal training in smoking cessation approaches. The percentage of students who claimed they had formal training is rather high compared to the study of Warren,[18
] where less than 40% of the students in 73 of 80 sites reported that they have received such training but when school administrators were asked, 25 out of 31 countries had no formal training at any time. This difference might be due to the fact that students in our study were over reporting, probably to please the faculty. Even, in a study conducted among practicing physicians, only 30% had knowledge of smoking cessation therapy and 70% reported that tobacco education content in the medical school curriculum was inadequate.[9
] This underscores the importance of training of professional health students in courses that detailed the harmful health effect of tobacco use and exposure to second smoke and specific training in counseling on tobacco cessation techniques.
Although, our study has demonstrated smoking habits, attitudes, and training among tomorrow's health care professionals, this should be interpreted in the light of some limitations. First, this study reports behavior rather than the behavior itself, which might be influenced by recall or by perception of social desirability and may under-estimate smoking compared to cotinine measurement[33
] and over-estimate smoking attitude and behavior. Secondly, our results may not be applicable to all health professional students in Nigeria as we only sampled cluster of students in south-western region. Thirdly, although, participation is voluntary, we still cannot rule out some selection bias. Nevertheless, our study would serve as bench mark for further studies in other regions of Nigeria.
In conclusion, this study revealed that smoking rate is relatively low among our health professional students, compared to other developing world; it identified the need for attitudinal change in this set of students who should consider themselves pivotal to global tobacco control. It also highlighted the need for a detailed professional training to include, dangers of smoking, counseling on smoking cessation, act of legislation, and tobacco tax policy. Ensuring smoking cessation best practice into health professional students’ curriculum will not only alter their attitudes but it may also prevent new physician smokers.