Changes in smoking habits and new alternative product use among first year medical students between 2016 and 2020
Abstract
Introduction: Medical students will have an important role in the fight against smoking. Therefore, it is particularly important to monitor cigarette use and the use of new alternative products (electronic cigarettes, heated tobacco products) among them. The aim of this study is to examine cigarette smoking and the use of new alternative products among first-year Hungarian medical students studying at the University of Pécs.
Methodology: Repeated cross-sectional, anonymous, self-administered questionnaire surveys were carried out in 2016, 2018, and 2020. The rate of trial and current use (past 30-day use) of products were examined.
Results: The proportion of those who tried smoking decreased between 2016 and 2018 but did not change significantly thereafter (79% in 2016, 67% in 2018, 69% in 2020; Cochran–Armitage trend test, p = 0.039). In 2020, the proportion of those who tried e-cigarettes was 58% among men, 51% among women, and 53% in the total sample, while the proportion of those who tried a heated tobacco product was 27% among men, 11% among women, and 16% in the total sample. Between 2016 and 2018, the prevalence of current cigarette smoking decreased significantly, but no further change was observed between 2018 and 2020 (36% in 2016, 25% in 2018 and 2020; Cochran–Armitage trend test, p = 0.040). The proportion of male medical students using new alternative products increased significantly during the study period (5% in 2016, 21% in 2020, Z-test, p < 0.05). In 2020, 11.5% of men and 4.3% of women (6.8% of the total sample) used e-cigarettes, whereas 11.5% of men and 3.2% of women (6.2% of the total sample) used heated tobacco products.
Conclusions: Among first-year medical students in Pécs, the popularity of cigarettes declined, however, we have found significant interest in new alternative products. We consider it important to provide information and prevention about e-cigarettes and heated tobacco products, as well as to further monitor the use of these products.
References
Ali, F., Agaku, I. T., Sharapova, S. R., Reimels, E. A., & Homa, D. M. (2020). Onset of regular smoking before age 21 and subsequent nicotine dependence and cessation behavior among US adult smokers. Preventing Chronic Disease, 17, E06. https://doi.org/10.5888/pcd17.190176.
Balogh, E., Wagner, Z., Faubl, N., Riemenschneider, H., Voigt, K., Terebessy, A., Horváth, F., Füzesi, Z., & Kiss, I. (2020). Increasing prevalence of electronic cigarette use among medical students. Repeated cross-sectional multicenter surveys in Germany and Hungary, 2016-2018. Substance Use & Misuse, 55(13), 2109–2115. https://doi.org/10.1080/10826084.2020.1790011
Birge, M., Duffy, S., Miler, J. A., & Hajek, P. (2018). What proportion of people who try one cigarette become daily smokers? A meta-analysis of representative surveys. Nicotine & Tobacco Research, 20(12), 1427–1433. https://doi.org/10.1093/ntr/ntx243
Bozier, J., Chivers, E. K., Chapman, D. G., Larcombe, A. N., Bastian, N. A., Masso-Silva, J. A., Byun, M. K., McDonald, C. F., Crotty Alexander, L. E., & Ween, M. P. (2020). The evolving landscape of e-cigarettes: A systematic review of recent evidence. Chest, 157(5), 1362–1390. https://doi.org/10.1016/j.chest.2019.12.042
Caputi T. L. (2016). Industry watch: heat-not-burn tobacco products are about to reach their boiling point. Tobacco Control, 26(5), 609–610. https://doi.org/10.1136/tobaccocontrol-2016-053264
Cselkó, Zs. & Kovács, G. (2020). Az új típusú nikotintartalmú és dohánytermékek elterjedése és káros hatásai. Orvosképzés, 4, 585–676.
Demjén, T. (E.d.). (2016). Dohányzás visszaszorítása. Nemzeti Egészségfejlesztési Intézet, Budapest https://fokuszpont.dohanyzasvisszaszoritasa.hu/sites/default/files/dohanyzas_visszaszoritasa_2016_dohanyzas_fokuszpont.pdf
Duaso, M. J., McDermott, M. S., Mujika, A., Purssell, E., & While, A. (2014). Do doctors' smoking habits influence their smoking cessation practices? A systematic review and meta-analysis. Addiction, 109(11), 1811–1823. https://doi.org/10.1111/add.12680
Egészségügyi Szakmai Kollégium. (2019). Tüdőgyógyászat Tagozat hevített dohánytermékekkel kapcsolatos állásfoglalása. https://kollegium.aeek.hu/Hirek/Details/40
Euromonitor International. (2020). Smokeless Tobacco, E-Vapour and Heated Tobacco in Hungary. Country Report. https://www.euromonitor.com/smokeless-tobacco-e-vapour-products-and-heated-tobacco-in-hungary/report
European Commission. (2017). Special Eurobarometer 458. Attitudes of Europeans towards tobacco and electronic cigarettes. https://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/ResultDoc/download/DocumentKy/79003
European Commission. (2021). Special Eurobarometer 506. Attitudes of Europeans towards tobacco and electronic cigarettes. https://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/survey/getsurveydetail/instruments/special/surveyky/2240
Gallus, S., Lugo, A., Liu, X., Borroni, E., Clancy, L., Gorini, G., Lopez, M. J., Odone, A., Przewozniak, K., Tigova, O., Van Den Brandt, P., Vardavas, C., Fernandez, E., & TackSHS Project Investigators. (2021). Use and awareness of heated tobacco products in Europe. Journal of Epidemiology, 10.2188/jea.JE20200248. Advance online publication. https://doi.org/10.2188/jea.JE20200248
GBD 2019 Risk Factors Collaborators (2020). Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2.
German Cancer Research Center (E.d.). (2013). Electronic cigarettes – an overview. Heidelberg https://www.dkfz.de/en/presse/download/RS-Vol19-E-Cigarettes-EN.pdf
Hair, E. C., Bennett, M., Sheen, E., Cantrell, J., Briggs, J., Fenn, Z., Willett, J. G., & Vallone, D. (2018). Examining perceptions about IQOS heated tobacco product: consumer studies in Japan and Switzerland. Tobacco Control, 27(Suppl 1), s70–s73. https://doi.org/10.1136/tobaccocontrol-2018-054322
Hori, A., Tabuchi, T., & Kunugita, N. (2020). Rapid increase in heated tobacco product (HTP) use from 2015 to 2019: from the Japan 'Society and New Tobacco' Internet Survey (JASTIS). Tobacco Control, tobac-cocontrol-2020-055652. Advance online publication. https://doi.org/10.1136/tobaccocontrol-2020-055652
Kapan, A., Stefanac, S., Sandner, I., Haider, S., Grabovac, I., & Dorner, T. E. (2020). Use of electronic cigarettes in European populations: A narrative review. International Journal of Environmental Research and Public Health, 17(6), 1971. https://doi.org/10.3390/ijerph17061971
Központi Statisztikai Hivatal. (n.d.-a) A népesség megoszlása dohányzási szokások szerint (2009–). http://www.ksh.hu/docs/hun/xstadat/xstadat_eves/i_fek009.html?lang=hu
Központi Statisztikai Hivatal. (n.d.-b) A 2019. évi Európai lakossági egészségfelmérés. https://www.ksh.hu/docs/hun/xftp/idoszaki/elef/te_2019/index.html#dohnyzssalkoholfogyaszts
Kuwabara, Y., Kinjo, A., Fujii, M., Imamoto, A., Osaki, Y., McNeill, A., & Beckley-Hoelscher, N. (2020). Comparing factors related to any conventional cigarette smokers, exclusive new alternative product users, and non-users among Japanese youth: a nationwide survey. International Journal of Environmental Research and Public Health, 17(9), 3128. https://doi.org/10.3390/ijerph17093128
Magyarországi Ifjúsági Dohányzás Felmérés. (2020). https://fokuszpont.dohanyzasvisszaszoritasa.hu/sites/default/files/2020-08/01_MIDF_2020_Tanulmany_20200706.pdf
Maria Lotrean, L., Trofor, A., Radu-Loghin, C., Eremia, M., Mihaltan, F., Driezen, P., Kyriakos, C. N., Mons, U., Demjén, T., Fernández, E., Katsaounou, P. A., Przewoźniak, K., Filippidis, F. T., Gravely, S., Fong, G. T., Vardavas, C. I., & EUREST-PLUS Consortium (2020). Awareness and use of heated tobacco products among adult smokers in six European countries: findings from the EUREST-PLUS ITC Europe Surveys. European Journal of Public Health, 30(Suppl_3), iii78–iii83. https://doi.org/10.1093/eurpub/ckz228
McMillen, R. C., Gottlieb, M. A., Shaefer, R. M., Winickoff, J. P., & Klein, J. D. (2015). Trends in Electronic Cigarette Use Among U.S. Adults: Use is Increasing in Both Smokers and Nonsmokers. Nicotine & Tobacco Research, 17(10), 1195–1202. https://doi.org/10.1093/ntr/ntu213
Meshefedjian, G. A., Gervais, A., Tremblay, M., Villeneuve, D., & O'Loughlin, J. (2010). Physician smoking status may influence cessation counseling practices. Canadian Journal of Public Health, 101(4), 290–293. https://doi.org/10.1007/BF03405288
National Academies of Sciences, Engineering, and Medicine. (2018). Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems, Eaton, D. L., Kwan, L. Y. & Stratton, K. (Eds.). Public Health Consequences of E-Cigarettes. National Academies Press (US).
Office of the Surgeon General. (2014). The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention (US), National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf
Orth, B. & Merkel, C. (2020). Die Drogenaffinität Jugendlicher in der Bundesrepublik Deutschland 2019. Rauchen, Alkoholkonsum und Konsum illegaler Drogen: aktuelle Verbreitung und Trends. BZgA-Forschungsbericht. Köln: Bundeszentrale für gesundheitliche Aufklärung.
Pénzes, M. & Urbán, R. (2019). E-Cigaretta - Információk gyakorló ovosok számára. Orvostovábbképző Szemle, 26:58–64.
Pénzes, M., Foley, K. L., Balázs, P., & Urbán, R. (2016). Intention to experiment with e-cigarettes in a cross-sectional survey of undergraduate university students in Hungary. Substance Use & Misuse, 51(9), 1083–1092. https://doi.org/10.3109/10826084.2016.1160116
Pénzes, M., Pongor, V., Kimmel, Zs., & Balázs, P. (2016). Elektronikus cigaretta használat felsőoktatásban tanuló hallgatók körében. Lege Artis Medicinae, 26: 107–114.
Philip Morris International. (n.d.) Reports and filings, 2019 Second-Quarter Results. https://philipmorrisinternational.gcs-web.com/static-files/e8bcf906-8865-4e8a-8aaf-00fbba222aeb
Rinfel, J., Oberling, J., Tóth, I., Prugberger, L., & Nagy, L. (2011). Az I. és az V. évfolyamos orvostanhallgatók dohányzási szokásai és leszoktatással kapcsolatos attitűdjei [Medical students' smoking habits and attitudes about cessation]. Orvosi Hetilap, 152(12), 469–474. https://doi.org/10.1556/OH.2011.29039
Schaller, K., Kahnert, S., & Mons, U. (2020). E-Zigaretten und Tabakerhitzer – ein Überblick. Heidelberg: Deut-sches Krebsforschungszentrum. https://www.dkfz.de/de/tabakkontrolle/Buecher_und_Berichte.html
Simonavicius, E., McNeill, A., Shahab, L., & Brose, L. S. (2019). Heat-not-burn tobacco products: a systematic literature review. Tobacco Control, 28(5), 582–594. https://doi.org/10.1136/tobaccocontrol-2018-054419
St Helen, G., Jacob Iii, P., Nardone, N., & Benowitz, N. L. (2018). IQOS: examination of Philip Morris Interna-tional's claim of reduced exposure. Tobacco Control, 27(Suppl 1), s30–s36. https://doi.org/10.1136/tobaccocontrol-2018-054321
Tobacco control scale. (n.d.) https://www.tobaccocontrolscale.org
Torma, A., Fazekas-Pongor, V., Terebessy, A., & Pénzes, M. (2019). Alternatív dohánytermékek használata fesztiválon részt vevő fiatal felnőttek körében. Egészségfejlesztés. 60: 5–18.
U. S. Food and Drug Administration. (2020). Center for Tobacco Products. Modified Risk Orders. https://www.fda.gov/tobacco-products/advertising-and-promotion/modified-risk-orders
U.S. Department of Health and Human Services. (2016). E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_508.pdf
World Health Organization. (2012). Tobacco control in practice - Article 8: Protection from exposure to tobacco smoke: the story of Hungary. http://www.euro.who.int/en/health-topics/disease-prevention/tobacco/publications/2012/tobacco-control-in-practice/article-8-protection-from-exposure-to-tobacco-smoke-the-story-of-hungary
World Health Organization. (2020a). Newsroom. Tobacco https://www.who.int/news-room/fact-sheets/detail/tobacco
World Health Organization. (2020b). Electronic nicotine and non-nicotine delivery systems: a brief. https://www.euro.who.int/en/health-topics/disease-prevention/tobacco/publications/2020/electronic-nicotine-and-non-nicotine-delivery-systems-a-brief-2020
World Health Organization. (2020c). Heated tobacco products: a brief. https://www.euro.who.int/en/health-topics/disease-prevention/tobacco/publications/2020/heated-tobacco-products-a-brief-2020
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