We conducted the GHPSS (Global Health Professions Student Survey) to obtain information regarding health profession students’ smoking habits and perceptions, exposure to secondhand smoke (SHS) as well as level of knowledge and training on tobacco use and smoking cessation counseling. GHPSS is a survey for third-year students in the following fields: health visitors, dentistry, medicine, nursing and/or pharmacy. The highest tobacco use prevalence rate and exposure to SHS were recorded among health visitor students with 46.4% and 33.3% respectively. The majority of the respondents believed that their profession serves as a role model for their patients. Formal training on cessation counseling ranged between 10.7% for health visitor students to 22.4% for nursing students. The relatively high percentage of health profession students who currently smoke and the alarmingly high percentage of those exposed to SHS indicate lack of concerted efforts for implementation and effective enforcement of the anti-tobacco policy measures. Despite its significance, formal training on cessation counseling for students is strikingly low. These results indicate the urgent need to train health professional students on tobacco cessation counseling and educate them on the dangers of tobacco use, SHS and the positively influential role they can play to affect their patients’ smoking habits.
tobacco; smoking; prevalence; students; secondhand smoke; health profession; cessation; survey
GHPSS is a school-based survey that collects self-administered data from students in regular classroom settings. GHPSS produces representative data at the national or city level in each country. This study aims to investigate the prevalence of tobacco use, exposure to secondhand smoke, and cessation counseling among medical students using the GHPSS data.
The Global Health Professions Student Survey (GHPSS) was conducted among 3rd year medical students in 47 countries and the Gaza Strip/West Bank from 2005-2008 to determine the prevalence of tobacco use and amount of formal training in cessation counseling.
In 26 of the 48 sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 37 sites. Over 70% of students reported having been exposed to secondhand smoke in public places in 29 of 48 sites. The majority of students recognized that they are role models in society (over 80% in 42 of 48 sites), believed they should receive training on counseling patients to quit using tobacco (over 80% in 41 of 48 sites), but few reported receiving formal training (less than 40% in 46 of 48 sites).
Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train medical students in effective cessation-counseling techniques.
The Nursing Global Health Professions Student Survey (GHPSS) has been conducted in schools in 39 countries and the Gaza Strip/West Bank (identified as “sites” for the remainder of this paper). In half the sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 22 sites. Over 60% of students reported having been exposed to secondhand smoke in public places in 23 of 39 sites. The majority of students recognized that they are role models in society, believed they should receive training on counseling patients to quit using tobacco, but few reported receiving any formal training. Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train health professionals in effective cessation-counseling techniques.
tobacco use; health professionals; nursing students; counseling training
Objectives. To determine the impact of health professions students’ participation in interprofessional activities on their knowledge of the roles of community pharmacists and community pharmacist-provided services.
Methods. Students at the Medical University of South Carolina were surveyed via a self-administered online survey tool to determine their participation in interprofessional activities as well as their knowledge of the role of community pharmacists and community pharmacist-provided services.
Results. Over 600 students completed the survey instrument. Nonpharmacy students who attended the university-sponsored Interprofessional Day were more knowledgeable of pharmacist-provided services. Previous interaction with a pharmacist increased nonpharmacy students’ awareness of the services that pharmacists provide.
Conclusion. Participation in interprofessional activities increased health professions students’ awareness of the role of pharmacists. Continued education among healthcare professions about the role of and services provided by pharmacists is needed to ensure that pharmacists have the greatest possible impact on patient care.
community pharmacy; health professions; interprofessional education
Secondhand smoke is a major cause of morbidity and mortality. It has been associated with serious health problems in both children and adults. Efforts to reduce exposure to secondhand smoke in Nebraska have included programs to prevent tobacco use among young people and campaigns for smoke-free workplaces and homes. Despite these interventions, young people continue to be exposed to secondhand smoke at an unacceptably high rate. The objective of this study was to examine the extent to which Nebraska public middle and high school students were exposed to secondhand smoke in 2002 and 2006, to evaluate factors associated with this exposure, and to propose interventions.
The Nebraska Youth Tobacco Survey was administered in 2002 and 2006 to a representative sample of students from public middle and high schools. All students who chose to participate completed an anonymous, self-administered survey that included questions on demographics, tobacco use, tobacco-related knowledge and attitudes, and exposure to secondhand smoke. Data were weighted to account for nonresponses at both student and school levels and to ensure generalizability of the estimates for public school students in Nebraska according to their grade, sex, and race/ethnicity. This study analyzed a subset of responses on secondhand smoke exposure, which was defined as being in a room or vehicle during the previous 7 days with someone who was smoking cigarettes.
Secondhand smoke exposure in a room, a vehicle, or both declined significantly among all students from 2002 (69.0%) to 2006 (61.3%). In both 2002 and 2006, students were significantly more likely to be exposed to secondhand smoke in a room than in a vehicle (64.4% vs 48.2% in 2002 and 56.9% vs 40.2% in 2006). Among racial and ethnic groups, only white students experienced a significant decline in exposure from 2002 (70.0%) to 2006 (61.4%). Girls were significantly more likely to be exposed to secondhand smoke in 2006 than were boys, and only boys experienced a significant overall decline in exposure from 2002 (69.3%) to 2006 (57.7%). Smoking behaviors and attitudes continued to influence secondhand smoke exposure from 2002 to 2006, although students experienced significant declines whether they were smokers or nonsmokers, and whether they lived with a smoker or not. Those with close friends who smoked and those who did not perceive secondhand smoke as harmful, however, did not benefit.
These data indicate reductions in exposure to secondhand smoke among Nebraska's middle and high school students, but exposure remains a problem, particularly in rooms. Adoption of a comprehensive statewide smoke-free policy will contribute to significantly reduced exposure to secondhand smoke among young people in public places, but other measures to address exposure in the home and private vehicles are needed or should be strengthened. These include physician counseling based on behavioral change theory to encourage cessation and home-based no-smoking rules, in addition to interventions that target minorities, who are disproportionately affected by secondhand smoke exposure. Evaluation of existing measures, such as programs to prevent tobacco use among young people and campaigns to collect pledges for smoke-free homes, will be required to determine their effectiveness in reducing exposure to secondhand smoke among youth in Nebraska.
Health profession schools in the United States have to be able to meet the health and pharmaceutical care demands of a rapidly growing racial and multiethnic population. One tactic is to develop and implement or expand existing resources and didactic courses to address cultural competence in the curricula of every college and school of pharmacy. The curriculum should require a focus on the reality of evidence-based health disparities among racial and ethnic minority populations; importance of providing culturally competent care and communication to meet the health needs of diverse patient populations; and exposure to cultural diversity. Students should be grounded in cultural awareness and cultural sensitivity. This article establishes a case for integrating cultural competence into the curricula of health professions schools.
health disparities; cultural competence; health professions; education
To develop and evaluate a classroom-based curriculum designed to promote interprofessional competencies by having undergraduate students from various health professions work together on system-based problems using quality improvement (QI) methods and tools to improve patient-centered care.
Students from 4 health care programs (nursing, nutrition, pharmacy, and physical therapy) participated in an interprofessional QI activity. In groups of 6 or 7, students completed pre-intervention and post-intervention reflection tools on attitudes relating to interprofessio nal teams, and a tool designed to evaluate group process.
One hundred thirty-four students (76.6%) completed both self-reflection instruments, and 132 (74.2%) completed the post-course group evaluation instrument. Although already high prior to the activity, students' mean post-intervention reflection scores increased for 12 of 16 items. Post-intervention group evaluation scores reflected a high level of satisfaction with the experience.
Use of a quality-based case study and QI methodology were an effective approach to enhancing interprofessional experiences among students.
interprofessional education; quality improvement
Practitioner-level educational approaches that promote screening and brief intervention (SBI) seldom consider providers’ profession and medical specialization. Strategies that consider these variables may be better equipped to affect change in beliefs and behavior. The aim of this study was to identify beliefs that predict stated likelihood of practicing SBI by specialty and health profession in order to guide the direction of educational strategies. Physicians and nurse practitioners were studied that specialized in family, internal, obstetric gynecology (ObGyn), and pediatric medicine. The results indicated that independent of amount of previous postgraduate alcohol education and knowledge, self-rated competence mediated between specialty and likelihood of practicing SBI. For instance, low self-rated competence for ObGyn was a barrier that suppressed likelihood of practicing SBI. Other findings were that role legitimacy mediated the association between profession and likelihood of SBI, so that lack of role legitimacy was a barrier for physicians but not for nurse practitioners. We suggest that targeted educational strategies for ObGyn and pediatric clinicians may prove more effective than the prevalent one-size-fits all approaches aimed at general adult populations.
alcohol screening and brief intervention; physicians; nurse practitioners; attitudinal barriers; education
Purpose. To help integrate traditional, complementary and alternative medicine (TCAM) into health systems, efforts are being made to educate biomedical doctors (BMD) and medical students on TCAM. We systematically evaluated the effect of TCAM education on BMD and medical students' attitude, knowledge, and behavior towards TCAM utilization and integration with biomedical medicine.
Methods. Evaluative studies were identified from four databases. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Study outcomes were classified using Kirkpatrick's hierarchy.
Results. 3122 studies were identified and 12 studies of mediocre quality met inclusion criteria. Qualitative synthesis showed usage of diverse approaches including didactic, experiential learning, varying length, teacher background and intensity of exposure. More positive attitudes and improved knowledge after intervention were noted especially when teachers were BM trained. However, few studies assessed behavior change objectively. Finally, longer-term objective outcomes such as impact on patient care were not assessed.
Conclusions. Lack of use of objective and reliable instruments preclude firm conclusion on
the effect of TCAM education on study participants. However, positive changes, although mostly subjectively reported, were noted in most studies. Future evaluation should use validated or objective outcome assessments, and the value of using dual trained instructors.
To develop and implement a health fair and educational sessions for elementary school children led by health professions students.
The structure and process were developed with elementary school administration to determine the health topics to be covered. Students and faculty members created a “hands-on,” youth-oriented health fair and interactive health educational sessions. Quantitative and qualitative data were collected on learning outcomes from the underserved child population and health professions students.
The health fair and educational sessions increased awareness of underserved youth in the areas of critical health behaviors, purposeful education on health issues facing their community, and exposure to careers in various health professions. The activities provided meaningful learning experiences for the health professions students.
The health education program model is an excellent way to teach health education, communication and critical thinking skills, and service learning to health professions students.
health fair; youth education; service learning; health disparities; community service
The current “Millennial Generation” of college students majoring in the health professions has unprecedented access to the Internet. Although some research has been initiated among medical professionals to investigate the cognitive basis for health information searches on the Internet, little is known about Internet search practices among health and medical professional students.
To systematically identify health professional college student perspectives of personal eHealth search practices.
Q methodology was used to examine subjective perspectives regarding personal eHealth search practices among allied health students majoring in a health education degree program. Thirteen (n = 13) undergraduate students were interviewed about their attitudes and experiences conducting eHealth searches. From the interviews, 36 statements were used in a structured ranking task to identify clusters and determine which specific perceptions of eHealth search practices discriminated students into different groups. Scores on an objective measure of eHealth literacy were used to help categorize participant perspectives.
Q-technique factor analysis of the rankings identified 3 clusters of respondents with differing views on eHealth searches that generally coincided with participants’ objective eHealth literacy scores. The proficient resourceful students (pattern/structure coefficient range 0.56-0.80) described themselves as using multiple resources to obtain eHealth information, as opposed to simply relying on Internet search engines. The intermediate reluctant students (pattern/structure coefficient range 0.75-0.90) reported engaging only Internet search engines to locate eHealth information, citing undeveloped evaluation skills when considering sources of information located on the Internet. Both groups of advanced students reported not knowing how to use Boolean operators to conduct Internet health searches. The basic hubristic students (pattern/structure coefficient range 0.54-0.76) described themselves as independent procrastinators when searching for eHealth information. Interestingly, basic hubristic students represented the only cluster of participants to describe themselves as (1) having received instruction on using the Internet to conduct eHealth searches, and (2) possessing relative confidence when completing a search task.
Subjective perspectives of eHealth search practices differed among students possessing different levels of eHealth literacy. These multiple perspectives present both challenges and opportunities for empowering college students in the health professions to use the Internet to obtain and appraise evidence-based health information using the Internet.
eHealth literacy; college students; Q methodology; Internet search; health professionals; medical education
The health education profession has come to a critical point in its development. If health education is to fulfill its promise as a worthwhile strategy to improve health, the specific competencies of health education specialists and, concomitantly, the educational preparation that they need must be clearly defined. In the past, no clear definition was possible because of the diversity of preparatory programs, the absence of commonly accepted accreditation standards, educators, inconsistent employment requirements, inadequate manpower data, and poor mechanisms for quality assurance. Health educators are examining the various forms of credentialing--accreditation, licensure, and certification--with a view to their use as a means of strengthening the profession's preparation and practice standards. A Role Delineation Project undertaken by the National Center for Health Education, San Francisco, under a contract with the Bureau of Health Professions of the Health Resources Administration, has been completed. Activities that will be carried out subsequent to role delineation are expected to enable the health profession to resolve systematically fundamental issues in respect to manpower standards.
African Americans, Hispanics, service and blue-collar workers, and residents of rural areas are among those facing higher rates of workplace secondhand smoke exposure in states without smokefree workplace laws. Consequently, these groups also experience more negative health effects resulting from secondhand smoke exposure. The objective of this study was to examine disparities in workplace secondhand smoke exposure in a state without a comprehensive statewide smokefree workplace law and to use this information in considering a statewide law.
We developed a logistic multilevel model by using data from a 2007-2008 county-level study to account for individual and county-level differences in workplace secondhand smoke exposure. We included sex, age, race, annual income, education level, smoking status, and rural or urban residence as predictors of workplace secondhand smoke exposure.
Factors significantly associated with increased exposure to workplace secondhand smoke were male sex, lower education levels, lower income, living in a small rural or isolated area, and current smoking. For example, although the overall rate of workplace exposure in Missouri is 11.5%, our model predicts that among young white men with low incomes and limited education living in small rural areas, 40% of nonsmokers and 56% of smokers may be exposed to secondhand smoke at work.
Significant disparities exist in workplace secondhand smoke exposure across Missouri. A statewide smokefree workplace law would protect all citizens from workplace secondhand smoke exposure.
Relative to the overall population, older adults consume a disproportionally large percentage of health care resources. Despite advocacy and efforts initiated more than 30 years ago, the number of providers with specialized training in geriatrics is still not commensurate with the growing population of older adults. This contribution provides a contemporary update on the status of geriatric education and explores how geriatric coverage is valued, how geriatric competence is defined, and how students are evaluated for geriatric competencies.
Design and Methods:
Semi-structured interviews were conducted with curriculum representatives from 7 health profession disciplines in a case study of one academic medical center.
Geriatric training varies across health professions’ disciplines. Although participants recognized the unique needs of older patients and valued geriatric coverage, they identified shortage of time in packed curricula, lack of geriatrics-trained educators, absence of financial incentive, and low student demand (resulting from limited exposure to older adults and gerontological stereotyping) as barriers to improving geriatric training.
Progress in including geriatric training within curricula across the health professions continues to lag behind need as a result of the continuing presence of barriers identified several decades ago. There remains an urgent need for institutional commitment to enhance geriatric education as a component of health professions curricula.
Geriatric education and training; Barriers; ; Institutional commitment
Despite the prevalence of pain in most clinical settings, it is relatively under-represented in health professions education. To be most effective, new approaches to pain education must acknowledge the affective content of pain experience. The authors hypothesize that, by virtue of the emotional impact of pain, more attention should be devoted to the emotional development of health professions students by incorporating not only fact-intensive curricula, but also the use of, among others, humanities-based materials with strong medical ties. The authors describe two new courses in pain, and stress that developing opportunities for fuller expression of medically relevant emotional experiences will require commitment to innovation and a willingness to expand the boundaries of conventional medical education.
Pain is prevalent in clinical settings, and yet it is relatively under-represented in the education of most students in the health professions. Because pain includes both sensory-discriminative and affective features, teaching students about pain presents unique challenges and opportunities. The present article describes the evolution of a new blueprint for clinical excellence that, among other competencies, incorporates a need for the emotional development of clinical trainees. The framework has been applied to the development and implementation of two new courses in pain. The first course is designed to provide a comprehensive foundation of medical knowledge regarding pain, while integratively introducing students to the affective dimensions of pain. The second course is designed to enhance students’ appreciation for the protean effects of pain through use of the humanities to represent medical experience. It is concluded that, to be most effective, fostering the emotional development of trainees in the health professions necessitates the incorporation of affect-focused learning objectives, educational tasks and assessment methods.
Affect; Clinical skills; Content; Curriculum; Education; Empathy; Knowledge
As the diversity of the United States (US) population continues to change, concerns about minority health and health disparities grow. Health professions must evolve to meet the needs of the population. The purpose of this editorial is to review current trends in the diversity of chiropractic students, faculty, and practitioners in the United States. This editorial was informed by a search of the literature, to include PubMed, using the terms chiropractic and diversity, minority, and cultural competency. Demographic information for the chiropractic profession was obtained from the National Board of Chiropractic Examiners and The Chronicle of Higher Education. These data were compared to diversity data for medical doctors and the national and state populations from the American Association of Medical Colleges and the US Census, respectively. Surprisingly little has been published in the peer-reviewed literature on the topic of diversity in the chiropractic profession. For the variables available (sex and race), the data show that proportions in the US chiropractic profession do not match the population. State comparisons to associated chiropractic colleges show similar relationships. No reliable data were found on other diversity characteristics, such as gender identity, religion, and socioeconomic status. The chiropractic profession in the United States currently does not represent the national population with regard to sex and race. Leaders in the profession should develop a strategy to better meet the changing demographics of the US population. More attention to recruiting and retaining students, such as underrepresented minorities and women, and establishing improved cultural competency is needed.
Chiropractic; Cultural Competency; Cultural Diversity; Education; Faculty; Minority Health; Students; Health Occupations
More than thirty-five sub-Saharan African countries have severe health workforce shortages. Many also struggle with a mismatch between the knowledge and competencies of health professionals and the needs of the populations they serve. Addressing these workforce challenges requires collaboration among health and education stakeholders and reform of health worker regulations. Health professional regulatory bodies, such as nursing and midwifery councils, have the mandate to reform regulations yet often do not have the resources or expertise to do so. In 2011, the United States of America Centers for Disease Control and Prevention began a four-year initiative to increase the collaboration among national stakeholders and help strengthen the capacity of health professional regulatory bodies to reform national regulatory frameworks. The initiative is called the African Health Regulatory Collaborative for Nurses and Midwives. This article describes the African Health Regulatory Collaborative for Nurses and Midwives and discusses its importance in implementing and sustaining national, regional, and global workforce initiatives.
The African Health Profession Regulatory Collaborative for Nurses and Midwives convenes leaders responsible for regulation from 14 countries in East, Central and Southern Africa. It provides a high profile, south-to-south collaboration to assist countries in implementing joint approaches to problems affecting the health workforce. Implemented in partnership with Emory University, the Commonwealth Secretariat, and the East, Central and Southern African College of Nursing, this initiative also supports four to five countries per year in implementing locally-designed regulation improvement projects. Over time, the African Health Regulatory Collaborative for Nurses and Midwives will help to increase the regulatory capacity of health professional organizations and ultimately improve regulation and professional standards in this region of Africa. The African Health Regulatory Collaborative for Nurses and Midwives will measure the progress of country projects and conduct an annual evaluation of the initiative’s regional impact, thereby contributing to the global evidence base of health workforce interventions.
The African Health Regulatory Collaborative for Nurses and Midwives is designed to address priority needs in health workforce development and improve regulation of the health workforce. This model may assist others countries and regions facing similar workforce challenges.
Health workforce; Regulation; Health profession; Human resources for health; Collaborative; Global health; Regional approach; Strengthening; Nursing; Midwifery
The urgent need to expand the ability of health professionals to improve the quality and safety of patient care in the USA has been well documented. Yet the current methods of teaching quality and safety to health professionals are inadequate for the task. To the extent that quality and safety are addressed at all, they are taught using pedagogies with a narrow focus on content transmission, didactic sessions that are spatially and temporally distant from clinical work, and quality and safety projects segregated from the provision of actual patient care. In this article an argument for a transformative reorientation in quality and safety education for health professions is made. This transformation will require new pedagogies in which a) quality improvement is an integral part of all clinical encounters, b) health professions students and their clinical teachers become co-learners working together to improve patient outcomes and systems of care, c) improvement work is envisioned as the interdependent collaboration of a set of professionals with different backgrounds and perspectives skilfully optimising their work processes for the benefit of patients, and d) assessment in health professions education focuses on not just individual performance but also how the care team's patients fared and how the systems of care were improved.
Graduate medical information; health professions education; graduate medical education
Peer tutoring programs may be one method of maintaining quality of pharmacy education in the face of growing student enrollment and a small faculty body. A critical review of the literature was performed to ascertain whether peer tutoring programs improve or maintain the academic performance of health care professional students.
Various electronic databases and abstracts from past American Association of Colleges of Pharmacy's annual meetings were searched to identify pertinent research. Only those articles with quantitative data, an experimental design, and comparative statistical analysis were included for review.
Most studies found that peer tutoring had a positive impact on academic performance. These results may not be readily generalizable as there were numerous methodological flaws and limited descriptions of the programs and participants.
Studies with better designs and more detail are needed to answer definitively whether peer tutoring is of benefit. Details of what resources were required should be included in the study to allow the reader to determine the feasibility of the intervention.
peer tutoring; peer-assisted learning; evidence-based education; tutor
Competency-based education (CBE) provides a useful alternative to time-based models for preparing health professionals and constructing educational programs. We describe the concept of ‘competence’ and ‘competencies’ as well as the critical curricular implications that derive from a focus on ‘competence’ rather than ‘time’. These implications include: defining educational outcomes, developing individualized learning pathways, setting standards, and the centrality of valid assessment so as to reflect stakeholder priorities. We also highlight four challenges to implementing CBE: identifying the health needs of the community, defining competencies, developing self-regulated and flexible learning options, and assessing learners for competence. While CBE has been a prominent focus of educational reform in resource-rich countries, we believe it has even more potential to align educational programs with health system priorities in more resource-limited settings. Because CBE begins with a careful consideration of the competencies desired in the health professional workforce to address health care priorities, it provides a vehicle for integrating the health needs of the country with the values of the profession.
The subject of research methods is not commonly covered in continuing professional development (CPD) courses in spite of its emphasis in undergraduate education. This initiative aimed to develop postgraduate research competency and recruit chiropractors to musculoskeletal research.
The program was delivered as a university-based program with 20 credits over seven contact weekends covering topics of evidence-based practice, research methods, statistics, ethics, resources, and funding. Students were assessed through assignments showing competency in critical literature review, case report writing, and production of a research protocol as the final assessment. Non-student participation for CPD points was possible. A student evaluation survey was completed after the end of the academic year.
There were 26 participants: 16 as students handing in assignments, 10 as non-student participants for up to 94 CPD points. Three submitted a final protocol and two registered at a university PhD program. A network of research clinics was established for data collection for future multicenter studies.
The program was well received by the participants and gave them the tools and resources to perform research. The two-level attendance system afforded a basis for setting up a network of research clinics with a fundamental understanding of optimal data collection. This initiative has shown that research skills can be revisited through CPD programs as part of evidence-based lifelong learning.
Chiropractic; Continuing; Education; Research
Objective: To evaluate the association between smoke-free regulations in public places and secondhand smoke exposure and related beliefs, awareness, attitudes, and behavior among urban residents in China. Methods: We selected one city (Hangzhou) as the intervention city and another (Jiaxing) as the comparison. A structured self-administered questionnaire was used for data collection, and implemented at two time points across a 20-month interval. Both unadjusted and adjusted logistic methods were considered in analyses. Multiple regression procedures were performed in examining variation between final and baseline measures. Results: Smoke-free regulations in the intervention city were associated with a significant decline in personal secondhand smoke exposure in government buildings, buses or taxis, and restaurants, but there was no change in such exposure in healthcare facilities and schools. In terms of personal smoking beliefs, awareness, attitudes, and practices, the only significant change was in giving quitting advice to proximal family members. Conclusions: There was a statistically significant association between implementation of smoke-free regulations in a city and inhibition of secondhand tobacco smoking exposure in public places. However, any such impact was limited. Effective tobacco control in China will require comprehensive laws implemented fully and supported by penalties and a combination of strong public health education.
tobacco control; smoke-free regulations; secondhand smoke
Intimate partner violence (IPV) is a widespread public health problem and training of health professions students has become common. Understanding students' prior knowledge, attitudes and personal exposure to IPV will aid educators in designing more effective curriculum. As interprofessional educational efforts proliferate, understanding differences across disciplines will be critical.
Students in the schools of Medicine, Nursing and Rehabilitation at a university in Ontario attend an annual daylong interprofessional IPV training. To measure perceived role and comfort with IPV and prior personal exposure, we administered a brief Likert scale survey to a convenience sample of students over three years. 552 students completed the survey; the overall response rate was 73%. The majority (82%) agreed that it was their role to intervene in cases of IPV; however Rehabilitation students expressed lower overall comfort levels than did their peers in other schools (p < .0001). Gender, age and prior training on the subject were not significant predictors of comfort. Seven percent reported lifetime IPV and one-fifth had witnessed IPV, but these exposures did not predict comfort in adjusted logistic regression models.
While the majority of professional students believe it is their role to address IPV in clinical practice, comfort level varied significantly by field of study. More than one fifth of the students reported some personal exposure to IPV. However this did not impact their level of comfort in addressing this issue. Educators need to take students' preexisting attitudes and personal exposure into account when planning curriculum initiatives in this area.
Secondhand smoke or environmental tobacco smoke is a combination of smoke from a burning cigarette and exhaled smoke from a smoker. This substance is an involuntarily inhaled mix of compounds that causes or contributes to a wide range of adverse health effects, including cancer, cardiovascular diseases, respiratory infections, adverse reproductive effects, and asthma. This paper presents findings from Global Youth Tobacco Surveys (GYTS) conducted in 132 countries between 1999 and 2005. GYTS data indicate that a large proportion of students in every World Health Organization Region are exposed to secondhand smoke at home (43.9%) and in public places (55.8%), and many have parents (46.5%) or best friends who smoke (17.9%). GYTS data have shown widespread and strong support among students for bans on smoking in public areas all over the world (76.1%). Countries should engage this positive public health attitude among youth to promote and enforce policies for smoke‐free public places and workplaces, including restaurants and bars.
secondhand smoke; youth; school; surveillance
Exposure to secondhand smoke during adulthood has detrimental health effects, including increased lung cancer risk. Compared with adults, children may be more susceptible to secondhand smoke. This susceptibility may be exacerbated by alterations in inherited genetic variants of innate immunity genes. We hypothesized a positive association between childhood secondhand smoke exposure and lung cancer risk that would be modified by genetic polymorphisms in the mannose binding lectin-2 (MBL2) gene resulting in well-known functional changes in innate immunity.
Childhood secondhand smoke exposure and lung cancer risk was assessed among men and women in the ongoing National Cancer Institute-Maryland Lung Cancer (NCI-MD) study, which included 624 cases and 348 controls. Secondhand smoke history was collected via in-person interviews. DNA was used for genotyping the MBL2 gene. To replicate, we used an independent case-control study from Mayo Clinic consisting of 461 never smokers, made up of 172 cases and 289 controls. All statistical tests were two-sided.
In the NCI-MD study, secondhand smoke exposure during childhood was associated with increased lung cancer risk among never smokers [odds ratio (OR), 2.25; 95% confidence interval (95% CI), 1.04-4.90]. This was confirmed in the Mayo study (OR, 1.47; 95% CI, 1.00-2.15). A functional MBL2 haplotype associated with high circulating levels of MBL and increased MBL2 activity was associated with increased lung cancer risk among those exposed to childhood secondhand smoke in both the NCI-MD and Mayo studies (OR, 2.52; 95% CI, 1.13-5.60, and OR, 2.78; 95% CI, 1.18-3.85, respectively).
Secondhand smoke exposure during childhood is associated with increased lung cancer risk among never smokers, particularly among those possessing a haplotype corresponding to a known overactive complement pathway of the innate immune system.