Report on Global Youth Tobacco Survey (GYTS) and Global School Personnel Survey (GSPS) 2007 in Bangladesh World Health Organization Regional Office for South-East Asia New Delhi 11 June 2008 Preface The study is about tobacco related behavior of dental students in Bangladesh. It tries to assess the smoking prevalence, knowledge and attitudes towards tobacco use and role of dental health professionals in tobacco control. All the 3rd year students of seven out of nine dental colleges have been surveyed for this study.Results indicates relatively high smoking prevalence among dental students and suggests a strong need for tobacco cessation training among health professionals to help their patients to quit smoking. The study has been undertaken as part of Global Tobacco Surveillance System (GTSS) initiated by the World Health Organization (WHO), Canadian Public Health Association (CPHA), and Center for Disease Control and Prevention (CDC), USA in 1999.
The author is grateful to a number of organizations and individuals, too numerous to na me, for their support for successful completion of this study.The study would not have been possible without the support from WHO South-East Asia Region Office (SEARO) and CDC. The author would particularly like to thank Dr. Khalil Rahman of WHO-SEARO and Dr. Samira Asma, Dr. Wick Warren, Dr. Nathan Jones, and Dr.
Mark Tabladillo of CDC for their support throughout the study. The author would also like to thank Dr. Mostafa Zaman of WHO-Bangladesh for his support. Finally, the author would also like to thank the Principals, Executives, Teachers and 3rd year students of all the Dental Colleges of Bangladesh for their kind and cordial cooperation in carrying out the survey.While credit goes to all, the errors and omissions are completely of the author. The author also appreciates any comments on this report. (Dr.
Zilfiqar Ali) 29 April 2005 1 Table of Contents Preface Table of Contents Fact Sheet I. II. III. IV.
V. Introduction Methods Results Discussion Conclusion and Recommendation Text Tables References 1 2 3 4 6 7 9 11 13 17 2 Fact Sheet 3 HEALTH PROFESSIONALS IN TOBACCO CONTROL: EVIDENCE FROM GLOBAL HEALTH PROFESSIONAL SURVEY (GHPS) OF DENTAL STUDENTS IN BANGLADESH 2005 I. IntroductionHealth professionals can play a significant role in preventing tobacco initiation, encouraging current smokers to quit, and facilitating cessation attempts. Studies have shown that even brief counseling by health professionals on the dangers of smoking and the importance of quitting is one of the most cost-effective methods of reducing smoking1 .
Health professionals serve as role models for healthy behavior to the public. Licensed health professionals are acknowledged sources of accurate information to maintain and improve health because they require specialized training to achieve their credentials.Health professionals are the most personal face of the public health infrastructure in many countries.
During routine visits, health professionals can persuade patients not to start smoking, provide cessation assistance to patients who want to quit smoking, and counsel patients who have not decided to quit smoking. Throughout the world, some health professionals smoke cigarettes or use other forms of tobacco. Evidence has shown a wide range of prevalence among health professional students in several countries2-5 .
Health professionals who ignore epidemiologic evidence and continue to use a substance that is harmful to health send an inconsistent message to patients they counsel to quit smoking. Studies have shown that health professional students who smoke are less likely to acknowledge tobacco as a serious health threat6-7 , less willing to provide cessation assistance to patients8 , and more likely to practice other unhealthy behaviors than non-smoking health professional students9-11 .When health professionals smoke, their ability to convey strong anti-tobacco messages may be diminished.
Tobacco use among health professionals should be targeted by the public health community because tobacco causes personal harm to the smokers and reduces their ability to deliver effective anti- tobacco counseling to patients. Health professionals can be more effective anti-tobacco counselors if they receive training in methods to convince their patients not to smoke and techniques to help their patients who smokes but wants to quit.Some studies indicate that health professional students do not think they receive enough specialized training to provide cessation counseling to patients12-13 . In spite of this lack of training, health professional students are highly motivated to receive training in tobacco control measures and use this training in practice. Health professional students have embraced the goal of tobacco control and are willing to help patients avoid using tobacco. Special training to provide counseling techniques and pharmacological aides will greatly enhance health professionals’ ability to reduce smoking among their patients.Tobacco Use in Bangladesh In Bangladesh, one of the mo st socially accepted health-damaging behaviors is tobacco use, mainly cigarette and bidi smoking.
Adult prevalence of daily tobacco use is 48. 3% 4 among adult males14 . About 1 in 5 adult women is also a regular user of some forms of tobacco products (20. 9%).
Compared to the most countries of this region these figures are not less. This extensive tobacco use has considerable and serious adverse health outcomes.Tobacco and the Dentistry Profession in Bangladesh Oral health is strongly related to tobacco smoking and chewing practices. The numerous detrimental effects of habitual tobacco use on oral health range from stained teeth, halitosis, implant failure, periodontal disease and precancerous mucosal lesions to fatal oral cancer. In South and South-East Asia, cigarette and bidi smoking and the chewing of tobacco with areca nut are common and are strongly associated with cancer of the oral cavity as well as other upper-aerodigestive sites.
South and Southeast Asia have some of the highest age adjusted incidence rates of oral cancers and other upper aero digestive sites in the world and the highest numbers of person affected15 . As members of an important health profession, dentists have a duty to promote oral health and healthy lifestyles among their patients, by raising their awareness about the harmful effects of tobacco on health and guiding them in conquering tobacco addiction. Dentists, therefore, ought to be role model for their patients.As health professionals, dentists’ involvement in curtailing tobacco use is critical. The fact that tobacco use often creates telltale signs in the mouth and contributes to oral diseases provides dentists with valuable points for helping their patients to become or remain tobacco- free. Dentists can also use their influence in society to encourage governments to put in place tobacco control measures.
The dentists of tomorrow will shape tomorrow’s dental practice, and their curriculum will shape them.Thus, there is a need to assess tobacco use prevalence among the dental students of today, along with their knowledge and attitudes on tobacco control and role in it. Aims and objectives of the GHPS among dental students in Bangladesh The aims of the survey in Bangladesh is to provide a factual basis for improving the dental curriculum on topics of the dangers of tobacco use, the need for tobacco control and methods of counseling in tobacco use cessation.The objectives of the GHPS in Bangladesh are the following: 1) To assess the tobacco- use prevalence among dental students; 2) To assess the level of knowledge of dental students about the harmful effects of tobacco; 3) To assess the perceptions and attitudes of dental students towards participating in tobacco control and cessation activities; 4) To assess skills and training in tobacco cessation counseling and intervention among dental students; 5) To suggest measures to involve dentists in tobacco cessation and other antitobacco interventions. Background of GHPS The Global Health Professionals Survey (GHPS) was developed by World Health Organization (WHO), the U. S.
Centers for Disease Control and Prevention (CDC), the Canadian Public Health Association (CPHA), and the American Cancer Society (ACS) in 2004 to collect information from 3rd year health professional students attending dental, medical, nursing, and pharmacy courses.GHPS collects information on prevalence of cigarette smoking and other tobacco use, knowledge and attitudes concerning cigarette smoking, exposure to second-hand smoke, desire to quit using tobacco, attitudes and training concerning counseling patients on tobacco cessation, and course curriculum related to the dangers of tobacco taught during health professional teaching/training programs.The GHPS was conducted among health professional students in 10 countries during January-April 2005: Albania (dental, medical, nursing, and pharmacy); Argentina (medical); Bangladesh (dental); Croatia (medical); Egypt (medical); Federation of Bosnia & Herzegovina (nursing); India (dental); Philippines (pharmacy); Republic of Serbia (dental, medical, and pharmacy); and Uganda (medical and nursing).
This report presents findings from the 2005 Bangladesh GHPS, as part of the Global Tobacco Surveillance System (GTSS) initiated by the WHO, CPHA, and CDC in 1999.II. Methods The sampling strategy used for Bangladesh GHPS included census of dental colleges (both government and private) and students. It was a classroom-based survey with a census of third year dental students in all dental colleges (n=9). All colleges that offered dental degrees were included. However, because of suspension of 3rd year classes in two colleges, only 7 colleges were surveyed.
All students in the third year of study were eligible to participate in the survey.Altogether, 205 students were interviewed. The overall response rates are shown in the table below: All colleges Colleges (%) Colleges (N) Students (%) Students (N) Questionnaire The questionnaire consists of 72 items that cover 6 major topics: – prevalence of cigarette and other tobacco use – environmental tobacco smoke exposure – cessation – knowledge and attitudes about tobacco – tobacco-related curriculum in professional training – college policies regarding tobacco use 77. 8% 7 65. 7% 205 6Field Procedures, Data Collection, and Processing Before data collection began, all dental colleges received a letter from the research coordinator introducing the survey and requesting their cooperation to implement the survey. WHO SEARO and WHO Bangladesh Country Offices also provided necessary support in this respect. College authorities were also informed about the purposes of the survey, procedures emphasizing the assurance of privacy (voluntary and anonymous participation), and information for the participants.
Three survey administrators were trained fo r data collection during a one-day training.They received written instructions and all of the documents needed for fieldwork. Data collection was administered in the classrooms using an anonymous, self-reported questionnaire and answer sheets. Students recorded their responses directly on the Answer Sheet using a machine-readable pencil.
Data collection was completed in March-April 2005. Completed survey materials were sent to the CDC in Atlanta, GA, USA. Data scanning and compilation were conducted by the CDC. Statistical Analysis The SAS statistical software package was used for calculation of prevalence estimates, standard errors, and a finite population correction factor.The 2005 Bangladesh GHPS was conducted as a census of 3rd year dental students and the research team obtained interviews from a large proportion of the entire population. In general, when a survey collects information from more than 5% of the total population, a finite population correction factor can be applied to adjust the standard error16 .
The formula for the finite population correction factor: N ? n N ? 1 Prevalence and other statistics are described in this report along with 95% confidence intervals (CI) for the estimates. Confidence intervals are calculated with the following formula: p ± CI N ? n N ? where CI is the 95% confidence interval, n is the sample size, and N is the population size. Statistically significant differences are described in the results section. Statistical differences are determined by non-overlapping confidence intervals.
III. Results About one-third of the total students (30. 2%) ever smoked cigarettes. This figure is significantly higher for males than that of females. Nearly six in ten male students (58. 0%) and one in ten female students (8.
4%) reported that they have ever smoked cigarettes. While it is not surprising that proportion of male ever smokers is significantly 7 igher than their female counterpart, it is indeed a matter of concern that about one in every ten female students ever smoked cigarettes. Results also show that among the ever smokers, nearly four in ten (38.
4%) started daily cigarette smoking before age 15, which means that a sizable proportion of the students started smoking at a very young age. Beside cigarettes, use of other tobacco products is also mentioned. About 21% of the male students and 3% of the female students reported ever using tobacco products other than cigarettes (see Table 1 for details). Table 2 presents current prevalence of tobacco use.Among the current users, smoking cigarettes is the dominant form.
Results show that over one in five students (22. 2%) currently smoke cigarettes. For male students, it is nearly half and for female students it is 3. 3%. That means, among the male students the current prevalence of cigarette smoking if fairly high and among the female students, although the prevalence rate is low, there are some regular smokers. Among the current smokers (for both male and female), nearly 55% report a strong nicotine dependency (desire a cigarette within 30 minutes of awaking in the morning).There are also other forms of tobacco, which are also currently being used though the prevalence is less (only 3. 9%).
Nearly three in four ever smokers (74. 3%) reported smoking in the college premises. This means that there was/is hardly any restriction in smoking in the college building or premises (Table 3). About two-thirds of students report second hand smoke exposure at home (Table 4).
Current smokers are significantly more likely than never smokers to be exposed to smoke at home (95. 2% for current smokers against 55. %, for never smokers). Males are significantly more likely than females to be exposed to second hand smoke at home (80. 0% and 53. 6%, respectively). Over three quarters of students are exposed to smoke in public.
This figure for female alone is also quite high (68%). Smokers are significantly more likely than never smokers to be exposed to second hand smoke in public (94. 6% and 69. 7%, respectively). Only half of students attend a college with an official policy banning smoking in college buildings and clinics (Table 5).Of students attending a college with a ban on smoking in buildings and clinics, about 80% of students reported that the policy is enforced.
A similar pattern is found for bans on smoking in indoor public areas. About half of students report a ban on smoking in indoor public areas and about 70% of students in colleges with policies report that these policies are enforced. Over 90% of students favor banning smoking in hospitals, buses and trains, colleges/colleges, playgrounds, sports arenas, and all enclosed public places (Table 6). Over 80% of students favor banning smoking in restaurants.About 67% of students also think smoking should be banned in discos, bars, and pubs as well. Over 86% of students think tobacco sales to minors should be banned. And, about 93% of students think there should be a total ban on advertising of tobacco products.
Females are significantly more likely than males to support several of these tobacco control policies (banning smoking in restaurants, discos, pubs, and bars, and sales to minors). 8 Over two thirds of dental students who smoke in Bangladesh would like to quit (Table 7). Over 80% of current smokers have also tried to quit in the last year, but failed.Nearly 90% of current smokers have also received cessation assistance when they tried to quit. Dental students indicate a high level of knowledge regarding the health effects of tobacco use (Table 8). Almost all students report that smoking is harmful to a person’s health, smoking during pregnancy can increase the risk of adverse outcomes for the baby, smoke from other people’s cigarettes is also harmful, second hand smoke increases the risk of heart disease to non-smokers, lung disease, second hand smoke also increases this risk of illnesses in exposed children, and that smoking increases the risk of cancer.No significant gender difference is observed in this respect, which imply both male and female students are almost equally aware of the harmful effects of smoking. Over three quarters of dental students (for both male and female students) were taught about the dangers of smoking in college (Table 9).
However, only about 40% of students discussed reasons why people smoke. Only about three in five students had heard of nicotine replacement therapies used in cessation programs. Over 90% of dental students indicate that health professionals serve as role models for the patients and the public (Table 10).Almost all the students say health professionals play a role in counseling patients on tobacco cessation programs.
Over 95% of students think health professionals should routinely advise patients who smoke to quit. About seven in ten students think health professionals who smoke or use other tobacco products are less likely than health professionals who do not smoke to advise patients to quit smoking. Over 85% of students believe that patients’ chances of quitting smoking are increased if a health professional advises them to quit.However, only 25% of students reported receiving any training on specific cessation approaches to use with patients. There is strong demand for this training among students. Over 95% of students said health professionals should receive training to provide cessation techniques to patients (Table 10). IV.
Discussion Prevalence The findings above show fairly high level of lifetime and current tobacco use among the male health professiona l students in Bangladesh. Even among the female students, there are both lifetime and current smokers.The observed prevalence among male health professional students is also close to that of adult smoking prevalence in the country.
A higher proportion of nicotine dependency also indicates the severity of the problem. Tobacco use to this extent by the members of society who provide health care is indeed a matter of concern. In addition to contributing to excess morbidity and mortality among future health professionals, tobacco use by this respected group provides wrong signals to the general population that health risks associated with tobacco use are not serious. Also, a high proportion of students who began to smoke prior to age 15 confirms that early tobacco initiation continues to be a problem in Bangladesh if banning of tobacco sales to the minors is not enforced.
Environmental Tobacco Use Restricting smoking in public places and on college premises protects non-smokers from second hand smoke exposure, creates a strong incentive for smokers to quit, and reinforces the cessation efforts among smokers trying to quit. The majority of health professional smokers reported smoking at college building/premises.And, also the majority of health professional students reported second hand smoke exposure at home and in public. This exposure directly impacts their health and can be reduced by expanding smoke free areas and enforcing restrictions currently in place. Only a half of students reported that their institutions have an official tobacco policy, even though a majority of them reported full enforcement of these regulations. The good news in Bangladesh is a new law banning smoking in all public places including school/college buildings.College authority should work with tobacco control experts to design effective bans on smoking in common areas and improve enforcement of these rules in the college buildings/premises. Tobacco Cessation Health professional students who smoke in Bangladesh are highly motivated to quit.
The majority of smokers expressed a desire to quit smoking and received cessation assistance, but many of these students have failed to quit in the past year. This finding suggests that cessation programs available to students are not sufficient or effective.Current programs should be revised and possibly expanded to help about 70% of smokers trying to quit and persuade the remaining 30% who are not yet willing to quit smoking. Attitudes towards Tobacco Control Health professional students in Bangladesh are very supportive of tobacco control efforts. The majority of students (over 90%) supported banning smoking in a variety of public areas including hospitals, schools/colleges, restaurants, and in all enclosed public places.
The majority of students also supported banning sales of tobacco products to minors and a complete ban on tobacco advertising. Overall, these findings suggest health professionals in Bangladesh have positive attitudes towards controlling tobacco use and exposure. The Ministry of Health should use this evidence to expand and enforce current tobacco control efforts because restricting second hand smoke exposure, sales to minors, and tobacco advertising reduces the social acceptability of tobacco use and fosters a smoke free environment.Knowledge about Health Effects of Tobacco Knowledge about the health effects of tobacco use is high among health professionals in Bangladesh, as one would expect. In general, health professional students are well aware of the causal role tobacco plays in many diseases (Table 8). Most of them indicated that 10 tobacco smoke is harmful to smokers and non-smokers and causes heart disease, cancer, and maternal health problems. The majority of health professional students were taught about the dangers of tobacco but not so much on why people smoke. Also, about 40% have never heard about nicotine replacement therapies.
Health Professionals’ Role in Tobacco Control Over 90% of students think health professionals have a vital role to play in tobacco cessation and should play a role model among their patients in addition to helping patients to quit smoking. Over 95% students want training in cessation techniques, though only about 25% at present have reportedly been trained. These findings suggest a large gap in tobacco cessation training among health professional students in Bangladesh. The Ministry of Health officials should work with college curriculum developers to design and implement a cessation assistance module.V. Conclusions and Recommendations The present study covers all the 3rd year students (who were present on the day of survey) of 7 out of 9 dental colleges in Bangladesh.
The high participation rate makes this study representative to the dental students in Bangladesh. The methods and the field procedures (self-administered and anonymous) also suggest that the responses and the opinions expressed in the survey were free from any fear and dictation. The results can therefore be considered as true reflection of what the dental students do, face and think with respect to tobacco use and cessation.The findings of the present study indicate significant tobacco use among health professional students in Bangladesh. There is an urgent need to reduce this harmful behavior, not only to prevent tobacco related morbidity and mortality among these groups, but also to enhance their moral ability to provide effective and convincing counseling to their patients. To reduce prevalence of smoking among the future health professionals, more comprehensive public health initiatives are needed focusing primarily on these groups of people.
The Ministry of Health may work closely with the college administration and in order to provide support for cessation among health professional students who smoke. Efforts should also be made to provide adequate training to the health professional students to tobacco cessation so that they can effectively counsel the patients who smoke and assist them with cessation. Considering the strong desire among health professional students to provide counseling and their willingness to undergo training in this area, curriculum should be developed and implemented to deliver cessation training to them.To achieve the above, the following actions may be taken into consideration for immediate effect: 11 • Enforce the recently passed anti-smoking law (banning smoking in public places) in all the health professional training institutes strictly. Both the Ministry of Health and the authority of the institutes may join hands in this respect.
There is an urgent need to develop and promote effective cessation programs (counseling, cessation techniques and aides) to reduce tobacco use among health professionals. The majority of current smokers intend to quit and many have already tried unsuccessfully.Improve curriculum regarding cessation techniques for all health professional programs.
Health professional training programs have an essential role in tobacco control and health professional training institutes are ideal settings for training future health professionals in tobacco control and cessation techniques to use with patients. Undertake a motivational program (using classroom lectures, seminars, publishing booklets/newsletters) to encourage the health professionals to apply cessation techniques to their patients who smoke. These means can effectively help smokers to quit smoking nd also encourage the non-smokers to not initiate smoking because the public respects what health professionals have to say. Finally, regular surveillance should be conducted to monitor the effectiveness of tobacco control and prevention programs. • • • • 12 TEXT TABLES Table 1 Lifetime Prevalence of Tobacco Use – 3 rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Ever smokers who initiated daily cigarette smoking before age 15 38.
4 (29. 4 – 48. 2) 39. 2 (29. 8 – 49. 4) * Ever used other tobacco products 11. 2 (8. 4 – 14.
8) 21. 2 (15. 6 – 28.
2) 3. 4 (1. 7 – 6. 9)Ever smoked cigarettes Total Male Female * < 10 cases in the denominator 30. 2 (25. 7 – 35. 1) 58.
0 (50. 1 – 65. 4) 8. 4 (5. 2 – 13. 1) Table 2 Current Prevalence of Tobacco Use – 3 rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Current Use Cigarette smokers who desire a cigarette within 30 minutes of awaking in the morning 54.
6 (42. 5 – 66. 2) 57.
3 (44. 8 – 68. 9) * Cigarettes Other tobacco products Total Male Female * < 10 cases in the denominator 22. 2 (18. 2 – 26. 8) 46.
7 (39. 0 – 54. 7) 3. 3 (1. 6 – 6. 7) 3. 9 (2.
4 – 6. 5) 7. 8 (4. 6 – 13. 1) 0.
9 (0. 2 – 3. ) Table 3 Tobacco Use on College Premises/Property – 3rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Ever Cigarette Smokers Smoked on college premises/property during the past year Total 74. 3 (64.
9 – 81. 8) Male 79. 1 (69.
3 – 86. 3) Female * * < 10 cases in the denominator * NA NA 68. 3 (58. 1 – 76. 9) NA NA 62. 1 (52. 6 – 70. 8) NA NA Smoked in college buildings during the past year Ever Users of Other Tobacco Products Used other tobacco products on college premises/property during the past year Used other tobacco products in college buildings during the past year 3 Table 4 Exposure to Second-Hand Smoke — 3 rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Exposure to smoke at home, during the past week Exposure to smoke in public places, during the past week Total Total Male Female Never Cigarette Smokers 55.
6 (49. 4 – 61. 7) 63. 0 (50.
6 – 73. 8) 53. 0 (45. 7 – 60. 1) Current Cigarette Smokers 95. 2 (87. 5 – 98. 3) 94.
8 (86. 4 – 98. 1) * Total Never Cigarette Smokers 69. 7 (63. 6 – 75. 1) 76. 7 (64. 7 – 85.
5) 67. 1 (59. 9 – 73. 6) Current Cigarette Smokers 94. 6 (85. 9 – 98. 1) 94. 1 (84.
7 – 97. 9) * 65. 1 (60.
1 – 69. ) 80. 0 (72. 9 – 85. 5) 75. 5 (70. 8 – 79.
7) 85. 3 (78. 8 – 90. 1) 67. 9 (61. 2 – 73. 9) 53. 6 (46.
9 – 60. 3) * < 10 cases in the denominator Table 5 College Policy Regarding Smoking at College and Enforcement — 3rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Of colleges with an official policy banning smoking in college buildings and clinics – the percent with enforcement 81. 1 (74. 3 – 86. 5) 86.
3 (77. 0 – 92. 2) 75. 9 (65. 2 – 84. 2) Of colleges with an official policy banning smoking in indoor public or common areas – the percent with enforcement 68.
(60. 8 – 74. 8) 69. 7 (59. 4 – 78.
4) 66. 5 (55. 4 – 76.
0) Percent of colleges with an official policy banning smoking in college buildings and clinics Total Male Female 49. 5 (44. 0 – 55.
0) 52. 4 (44. 3 – 60. 3) 46. 9 (39. 5 – 54. 5) Percent of colleges with official policy banning smoking in indoor public or common areas 53. 1 (47.
6 – 58. 6) 59. 5 (51. 3 – 67. 2) 47. 5 (40. 1 – 55. 1) Table 6 Attitudes Toward Banning Smoking in Public Places — 3rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Percent Answering “Yes” to “Should Smoking Be Banned in .
… Hospitals Restaurants Buses and Trains Schools/ Colleges Playgrounds Gyms and Sports Arenas Discos, Bars, Pubs All Enclosed Public Places Percent think tobacco sales to adolescents should be banned Percent think there should be a complete ban on advertising of tobacco products 92. 9 (89. 7 95. 1) Total 96. 8 (94.
6 98. 2) 82. 8 (78. 7 86. 3) 99. 0 (97. 4 99.
7) 98. 9 (95. 4 99. 7) 99. 2 (96. 6 99. 8) 98. 5 (96.
6 99. 3) 92. 0 (88.
8 – 94. 3) 95. 4 (92. 7 – 97. 1) 67.
4 (62. 5 – 72. 0) 96. 0 (93. 4 97.
6) 86. 6 (82. 7 89. 8) Male 96. 2 (92.
5 98. 2) 67. 8 (60. 3 74. 4) 100. 0 91. (86.
6 – 95. 0) 94. 2 (89. 3 – 96. 9) 48. 8 (41. 2 – 56.
5) 94. 3 (89. 5 97.
0) 92. 5 (86. 9 95. 8) 94. 4 (89.
6 97. 0) Female 97. 3 (93. 9 98.
8) 94. 4 (90. 6 96. 7) 97.
3 (94. 0 98. 8) 92. 2 (87.
7 – 95. 1) 96. 4 (92. 7 – 98. 2) 81.
8 (76. 0 – 86. 4) 97. 3 (93. 9 98. 8) 82.
2 (76. 3 86. 8) 91. 7 (87. 1 94. 8) 14 Table 7 Cessation Attitudes and Attempts Among Current and Former Tobacco Users — 3rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Current Cigarette Smokers Former Cigarette Smokers Current Users of Other Tobacco Products Want to quit smoking cigarettes nowTried to stop smoking cigarettes this year Ever Received Help/Advice to Stop Smoking Cigarettes Stopped smoking 3 or more years ago Want to quit using other tobacco products now Total Male 69. 8 (57.
6 – 79. 8) 69. 5 (56. 5 – 80. 0) 83. 7 (73.
8 – 90. 3) 87. 2 (77. 4 – 93.
2) * 88. 3 (79. 1 – 93. 7) 92. 3 (83. 4 – 96. 6) * * * * * * * Female * * < 10 cases in the denominator Table 8 Knowledge of Harmful Effects of Tobacco Use — 3rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Percent Answering “Yes” Is smoking cigarettes harmful to a person’s health?Is smoking other tobacco products harmful to a person’s health? Does smoking during pregnancy increase risk of adverse outcomes for the baby? Do you think the smoke for other people’s cigarettes is harmful to people who do not smoke? 99. 0 (97.
3 – 99. 6) Does second-hand smoke increase the risk of heart disease in nonsmokers? Does second-hand smoke increase the risk of lung disease in nonsmokers? Does any smoking at home increase the risk of illnesses in exposed children? Does any smoking increase the risk of cancer? Total Male Female 97. 6 (95. 4 – 98. 7) NA 98. (95. 9 – 99.
0) 98. 9 (97. 1 – 99. 6) 99. 5 (98. 0 – 99. 9) 99. 5 (98.
0 – 99. 9) 99. 5 (98.
0 – 99. 9) 98. 9 (95. 4 – 99.
7) NA 98. 9 (95. 6 – 99. 7) 98. 9 (95. 4 – 99.
7) 100. 0 100. 0 100.
0 100. 0 96. 6 (93.
1 – 98. 3) NA 97. 3 (94. 0 – 98. 8) 99.
1 (96. 2 – 99. 8) 98. 1 (95. 0 – 99.
3) 99. 2 (96. 6 – 99. 8) 99. 2 (96. 5 – 99.
8) 99. 2 (96. 5 – 99. 8) 15 Table 9 Percent Taught About Harmf ul Effects of Smoking During College — 3rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 During dental college training were you taught about the dangers of smokingDuring dental college training did you discuss reasons why people smoke 44.
1 (39. 1 – 49. 2) 38. 2 (31. 1 – 46. 0) 48.
6 (41. 9 – 55. 4) Have you heard of nicotine replacement products for use in tobacco cessation programs? Total Male Female 81. 9 (75. 8 – 86. 7) 81.
0 (69. 9 – 88. 7) 82. 4 (74. 7 – 88. 1) 62. 9 (57. 9 – 67. 6) 68. 4 (60. 9 – 75. 0) 58. 8 (52. 0 – 65. 2) Table 10 Opinion About Effect of Patient Counseling by Health Professionals — 3rd Year Students Studying Dentistry, Bangladesh, GHPS, 2005 Percent Answering “Yes” Do HPs serve as role models for their patients and the public?Do HPs have a role in giving advice or information about smoking cessation to patients? Should HPs routinely advise their patients who smoke to quit smoking? Are HPs who smoke less likely to advise patients to stop smoking? Should HPs routinely advise their patients who smoke to quit using other tobacco products? 91. 4 (88. 1 93. 9) 90. 6 (84. 9 94. 3) 92. 0 (87. 5 95. 0) Are HPs who use other tobacco products less likely to advise patients to stop smoking? Are a patient’s chances of quitting smoking increased if a HP advises him/her to quit? Should HPs get specific training on cessation techniques?During medical college training, percent received formal training in smoking cessation approaches 24. 9 (20. 7 29. 5) 12. 6 (8. 3 – 18. 7) 34. 5 (28. 3 41. 1) Total Male Female 93. 3 (90. 2 95. 4) 90. 4 (85. 0 94. 0) 95. 4 (91. 5 97. 6) 98. 1 (96. 1 – 99. 1) 96. 7 (92. 6 – 98. 5) 99. 2 (96. 5 – 99. 8) 95. 4 (92. 7 97. 1) 96. 6 (92. 3 98. 5) 94. 5 (90. 4 96. 9) 71. 6 (66. 9 75. 9) 64. 9 (57. 3 71. 8) 76. 7 (70. 5 82. 0) 69. 0 (64. 1 73. 4) 63. 3 (55. 7 70. 3) 73. 3 (66. 9 78. 8) 86. 5 (82. 6 89. 6) 88. 6 (82. 7 92. 6) 84. 9 (79. 3 89. 1) 97. 5 (95. 4 – 98. 7) 98. 9 (95. 4 – 99. 7) 96. 5 (93. 0 – 98. 3) 16References 1. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U. S. Department of Health and Human Services. Public Health Service. June 2000. 2. HP article 3. HP article 4. HP article 5. HP article 6. Suzuki et al, 2005 7. Cardon Granados, et al 1992 8. Jenkins and Ahijevych, 2003 9. Chalmers, et al, 2002 10. Flores and Luis, 2004 11. Ndiaye, et al 2003 12. Curbing the Epidemic (1999): Governments and the Economics of Tobacco Control. World Bank Publication, Washington D. C. 13. asdf 14. Yunus 2002 15. Shah 2005 16. FPC Citation 17