Poster Presentation

Introduction

The Article

Grassi, M.C., Baraldo, M., Chiamulera, C., Culasso, F., Raupach, T., Ferketich, A.K., Patrono, C., & Nencini, P. (2014). Knowledge about health effects of cigarette smoking and quitting among Italian university students: The importance of teaching nicotine dependence and treatment in the medical curriculum. BioMed Research International, 2014(321657), 1-9.

Research Problem

Cigarette smoking causes more avoidable mortalities in the developed world than any other risky behavior. It is also blamed for about 22% of deaths attributed to cancer annually, worldwide. In Italy, there are around 11 million current smokers, all of whom are adults and form 20.7% of the country’s gross adult population. 695,000 people die in Europe annually as a result of diseases linked to smoking. The authors had previously carried out a study whose findings showed that 4th year Italian undergraduate medical students are not adequately knowledgeable about the role of doctors in facilitating smoking cessation, tobacco dependence, and pathologies linked to smoking. Analysis of these results can be strengthened further by juxtaposing them with survey results in which respondents are nonmedical undergraduates. Medical students are naturally expected to be more informed about tobacco use and smoking cessation compared to their nonmedical counterparts, especially since health advocacy is one of their primary roles. Currently, however, there is a knowledge gap because surveys assessing nonmedical undergraduates’ understanding of tobacco are scarce at best.

Research Question and Research Objectives

The paper has no research question. The research objectives are, however, three-pronged. First, the authors intend to ascertain the consistency of their earlier findings. Second, the current study is aimed at determining if similarly-aged nonmedical undergraduates have varying interpretations and attitudes concerning smoking as opposed to medical undergraduates. The third objective is to scrutinize the smoking status of medical undergraduates as well as their knowledge retention one and two years after a brief educational intervention.

Initial Results and Methods

Respondents were required to fill a questionnaire containing 60 items. Each of the items revolved around participants’ awareness of the epidemiology and health ramifications of smoking, which was labeled as Score 1, and the potency of cessation therapies, which was identified as Score 2. Once they had completed their questionnaires 4th year medical undergraduates were sensitized about tobacco dependence. One and two years after the initial study, the respondents were called upon to participate in the same exercise. Findings showed that 5th year medical undergraduates who had undergone sensitization in year 4 posted higher scores compared to their colleagues who had not been briefed. Huge variations were observed one year following the educational interposition. The authors surmised that medical undergraduates are more knowledgeable about tobacco-related conditions and smoking cessation techniques compared to nonmedical undergraduates; however, the difference is minor. A brief educational mediation was linked to greater awareness after one year; nevertheless, the impact was fleeting and marginal.

Evaluation

The study does not have a literature review. In terms of the actual research, the article is broken down into abstract, introduction, methods, results, discussion, conclusions, ethics approval, acknowledgments, references, and copyright sections. The most the authors do in terms of reviewing literature is to refer to their previous study, whose findings they use as a precursor to and justification for the present research.

The research article is current as it was published in April 2014, which makes it less than 6-years-old. The article also appreciates prevailing health issues. Cigarette smoking is one of the most ubiquitous health concerns in the 21st century as it is a major risk factor for a wide range of diseases, including cancer and heart disease. Smoking also comes with a huge financial and economic burden that is normally imposed on governments and the immediate families of people that are ailing because of a history of tobacco use; this cost runs into billions of dollars per year. To date, various stakeholders such as research institutions, nongovernmental organizations (NGOs), health practitioners, and interest groups are aggressively exploring strategies with which they can increase smoking cessation, curtail potential new smokers, and confront the different diseases linked to the practice.

The research type is non-experimental and qualitative in nature. The authors conducted a survey using a questionnaire comprising 60 items. The questionnaire had four parts: awareness of smoking-oriented epidemiologic realities, demographics and individual smoking background, attitudes towards the effect of smoking on individuals’ life expectancy, and awareness of clinical frameworks on smoking cessation therapies and ability to counsel people who want to give up smoking.

The sample size consisted of 1191 undergraduates. The participants were drawn from three main groups. The first group contained medical students, the second group comprised architecture students, and the third cluster was made up of law students. Medical students contributed the largest portion of participants, at 962, followed by architecture and law students at 122 and 107 students, respectively. In terms of gender, female students made up 61%, 57%, and 72% of medical, architecture, and law students. The mean age and range was 23.9 (20-55), 23.2 (20-41), and 21.7 (20-38) for medical, architecture, and law students, respectively. All participants filled the questionnaire, with a 100% response rate. The sample was large and diverse enough for the research. However, the sampling method – such as stratified sampling or simple random sampling – employed by the authors is not expressly identified; this is a serious shortcoming because it casts doubts on the reliability and validity of the sample in terms of scholarly standards.

The study and its findings are adequately practical. The authors hypothesize that the results establish the basis for investigations comparing the impacts of a single educational mediation with other interventions informed by a more elaborate orientation in the health implications of smoking. The authors add that recent studies have shown that the educational approach preferred is significantly less influential for student learning vis-à-vis summative evaluations. Using their findings as a premise, the researchers infer that medical students should participate in comprehensive summative reviews of their understanding of tobacco dependence.

The study could have been improved and there are multiple areas of weakness that could have been addressed by the authors. As an example, the researchers sourced participants from just four Italian universities. Considering that Italy has 89 universities, almost all of which have medical schools, four institutions are neither holistic nor accurate with respect to representation of the total number of medical students in the country. Another aspect that the authors should have addressed or worked to minimize pertains to selection bias. As it has already been mentioned, follow-up tests were conducted after the first one. Due to attrition, the number of students who participated in the first and second follow-up assessments declined by about 25%; as a result, selection bias crept in and promoted the involvement of students who are more curious about smoking-related aspects and also more motivated. This could have distorted the results. The third area in which improvement could have been made relates to the balance between the three clusters of samples. Medical students considerably outnumbered their law and architecture colleagues, and this reduces the representativeness of the research finding in the two smaller constituencies. Apart from this, the authors relied primarily on a self-report to appraise the smoking status of respondents; for this reason, they could have misjudged smoking prevalence. Finally, the researchers should have monitored individual respondents and fluctuations in their responses by incorporating identifying details, which were not captured during the study.

The article is written in a logical, legible, and explicit manner. It is also organized properly, with different sections and subsections. The main headings are emboldened, thus making it easy for readers to navigate through the article, while the subheadings are numbered numerically. The article has a nice flow to it, moving from one section to another in systematic fashion. Further research can be conducted on the subject because more efforts need to be made to enlighten a new breed of health practitioners, especially physicians, who will come up against the effects of the present smoking epidemic.

Conclusion

Smoking cessation enhances quality of life and lowers health risks. For instance, the overall risk of mortality due to lung and cardiovascular diseases as well as cancer can be significantly lowered when smokers quit, including in old age. Medical school syllabuses typically pay little attention to nicotine addiction and tobacco-related matters, which is disappointing given that health advice enables cessation. General practitioners (GPs) do not comply with recommendations for counseling; this is secondarily caused by insufficient training at undergraduate level despite the availability of sound scholarly solutions to leverage the skills, perceptions, and knowledge of undergraduate medical students with respect to strategies of smoking cessation. It is also worth noting that the actualization of academic interventions is constrained by their exorbitant cost in relation to instructor time and resources. This calls for a clear and relatively straightforward yet potent tobacco syllabus that incorporates teaching about smoking-related issues, such as therapy and toxicology. It is necessary to conduct more effective research in this field.

Reference

Grassi, M.C., Baraldo, M., Chiamulera, C., Culasso, F., Raupach, T., Ferketich, A.K., Patrono, C., & Nencini, P. (2014). Knowledge about health effects of cigarette smoking and quitting among Italian university students: The importance of teaching nicotine dependence and treatment in the medical curriculum. BioMed Research International, 2014(321657), 1-9.