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1. МАТЕРИАЛЫ 7-ГО КОНГРЕССА ЕВРО-АЗИАТСКОГО РЕСПИРАТОРНОГО ОБЩЕСТВА
СТАТЬИ
SMOKING AMONG MEDICAL AND NON-MEDICAL UNIVERSITY STUDENTS IN TBILISI, GEORGIA:
THE PREVALENCE AND INFLUENCING FACTORS
Chkhaidze IG1, Maglakelidze NT2, Maglakelidze TA2, Chkhaidze NI2 1Tbilisi State Medical University, 2Georgian Respiratory Association, Tbilisi, Georgia
Introduction. Despite its terrifying impact on health, smoking cigarettes is widespread throughout the world. It has already reached a global scale and currently there are more than one billion smokers in the world. Such a rapid increase in consumption of tobacco is described as pandemic. 100 million deaths were caused by tobacco in the 20th century. Use of tobacco kills more than five million people every year - more than HIV/ AIDS, tuberculosis and malaria. If no effective interventions are introduced and implemented against it, one in six adult deaths will be attributable to tobacco consumption by 2030 and up to one billion people will die from tobacco use in 21st century [1, 2, 3, 4].
Although tobacco consumption is proven to be pandemic, the pattern of its distribution tends to be different across the world and as stated in "Global Change and Health" (2005) - "its diverse social, economic and health impacts are becoming increasingly inequitable". It is observed that decline in smoking prevalence in many high-income countries is "compensated" by increase in low- and middle-income ones, where more than 80% of world's smokers live nowadays [5, 6]. Developing countries are projected to contribute 70% of tobacco-related deaths by 2030.
Aim. The purpose of this study was to determine the prevalence of smoking and investigate smoking habits of medical and other students in two major universities of Tbilisi, by using cross-sectional approach. Further interest of the study was to identify the most important risk factors of students' smoking and assess whether medical education has an impact on smoking habits, by comparing the results of two universities.
The study was conducted at Tbilisi State Medical University and Tbilisi State University. It was aimed to include at least 400 respondents from both State Universities. The procedure of surveying them with standardized questionnaires was selected as the most appropriate, which allowed anonymity and voluntary participation [7].
Materials and methods.
It was aimed to include at least 400 respondents from both State Universities (4% from total number of students in TSMU and 0.6% from total number of students in TSU). The procedure of surveying them with standardized questionnaires was selected as the most appropriate, which allowed anonymity and voluntary participation.
Smoking status was established in accordance with WHO criteria WHO (2006): Current smokers were defined as respondents reporting who are currently smoking at least 1 cigarette per day, every day or occasionally; people experimenting with smoking at the moment of the survey but having tried less than 100 cigarettes in their lifetime were also defined as smokers. Non-smokers were called those who at the time of the survey did not smoke, such as ex-smokers or never-smokers. Ex-smokers were called those, who have smoked in past but will not smoke during the survey at all. As non-smokers are defined those individuals, who did not smoke at all or have smoked less than 100 cigarettes in their lifetime but will not smoke at the time and 30 days before the survey. Smokers were also asked about the average number of cigarettes they smoke daily, about the age they have started to smoke and about the attempts to quit, if any. Gender and age-specific smoking prevalence rate will was calculated. Age at smoking initiation was examined among current smokers, as well as number of cigarettes smoked. Level of nicotine dependence, an indication of smoker's ability to quit will be assessed by identifying the percentage of current smokers who smoke more than 20 cigarettes per day and smoke within one hour of waking. This level of use is equivalent to a score of 3 or more on the abbreviated Fagerstorm dependency scale and indicates moderate (score of 3 or4) to severe (score of 5 or above) dependency (Heatherton et al, 1991).
SPSS software version 15.0 was used to calculate the frequencies of each variable. Pearson chi-square test was used for comparing proportions, and Student's t test was used to compare the difference in means. Logistic regression analyses were used to test the relation between smoking and the different demographic and health risk behavioral characteristics. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) are reported.
Results. Study has revealed that there is no statistically significant difference between the smoking prevalence among medical and non-medical university students, which is almost even between those two groups. According to Chi-Square test there is no statistically significant dependency on the university type and smoking status.
Study results showed that smoking is highly associated with sex. Total number of male smokers of study populations constituted 65%, while females were 32.2%. According to Chi-Square test there is statistically significant dependency on smoking and sex P<0.001.
The willingness to quit smoking was expressed by 61.2% of medical students and 56% of non-medical students. Difference is not statistically significant. Chi-Square test P>0.05.
From total number of 200 students 167 of medical students have named the reason of their willingness to quit smoking and 149 out of 200 of non-medical ones. The main reasons of their willingness to quit were almost similar, there was not found statistically significant difference in their answers according to education types. In fact health related reason was mentioned slightly more often among non-medical students than students of medical university.
Willingness to quit smoking was expressed by 60.2% of boys and 56.3% of girls. Difference is not statistically significant. Chi-Square test P>0.05.
On the question if the high price of tobacco would be an incentive for quitting smoking only 169 gave the valid answer out of 400 students. From those 169 students 69.2% answered that they would not quit smoking in case of increasing price of cigarettes and 30.8% answered that they would quit.
It turned out that increased price of tobacco is an equal motivation for quitting smoking for medical and non-medical students. Only 29% of total number of 62 medical students answered that they would quit smoking if price of tobacco would be much higher and only 31.8% out of 107 non-medical students gave the same answer on same question.
The relationship between willingness of smoking cessation and the decision of quitting smoking in case price of tobacco would raise very high looks like this: from the total number of 57 students who want to quit smoking, 43% of students want to quit but are not ready to quit if the price of tobacco rises, while 38.9% who wants quit think that high price on tobacco would be a good motivation for them. From those 77 students who say that that they have no wish to quit smoking 56.1% think that even high price would not influence their decision, but for 61.1% price of tobacco is a factor which would lead them to the decision to quit.
Study has revealed that among 366 students who participated in the study 65% had family members who were smoking and 35% were living with non-smokers, although according to Chi-Square test having smokers in the family does not have statistically significant influence on students smoking habit.
Discussion. This study shows very high prevalence of smoking among medical and other students in Georgia. 48.9% of study population turned out to be smokers. It has also been demonstrated that smoking is highly associated with gender. Total number of male smokers of study populations constituted 65%, while females were 32.2%. Comparison of prevalence of smoking of medical and non-medical students showed that there was no statistically significant difference between them. Moreover, it turned out that prevalence was slightly higher among medical university students with percent of 50.3% compared to 47.5% of non-medical students.
Due to the fact that there are no available literature about studies with same design conduced in Georgia, our results can been compared only with studies which included general population. High prevalence of smoking among youth was already described in the 2001 date of the study examining prevalence of smoking in 8 Countries of the Former Soviet Union. Results of that study show smoking prevalence rate of 62.8% in male and 5.8% in female population in age range between 18-29 years of old. In regards of high rate of male smoking it comes in line with our study, whereas when comparing female smoking rates tendency of increase can be seen obviously.
Similar study was conducted in Greece, which is considered to be a country with highest per-capita consumption of cigarettes among EU member states. Results of that study showed prevalence rates of 26-56% for medical and 44-57% for nonmedical students, depending on gender and year of education. Like our results, Greek study suggests that medical education has a little effect on students' decision not to smoke. Several other authors have suggested the results which also come in accordance with the results we have got, by reporting prevalence rates up to 47% in medical students and even higher among those who study in nonmedical universities [8, 9]. Although, attempts of conducting similar studies have been mostly directed towards surveying solely medical students [10], most of them also revealed high rates of smoking [11, 12], which can been seen as an indicator of superficial enforcement of anti-tobacco measures on University level, as well as on the level of the governmental policies directed towards the reduction of tobacco consumption in general.
On the contrary to the results of our study, several studies carried out in past have shown declining trends of smoking prevalence of about 20%, especially among students of medicine. Study conducted in Brazil registers quite low rate of 9.4% of the medical students who smoke. Some available literature [13, 14, 15] demonstrates that prevalence of smoking among medical students are lower than the results found among students attending courses in other areas. Results of the study conducted in University of Jordan, supports this trend by revealing lower prevalence of smoking among students in the health science college [13]. Similar findings were observed in the study carried out in 1995 among students of Cambridge University. That study, once
again has demonstrated higher levels of smoking prevalence among students attending courses in the area of human sciences in comparison with those who studied medicine (17% vs 7.7%) [14]. These data reinforce the fact, which some authors suggest, that students who study health related subjects, show a higher level of awareness regarding the dangers of smoking [15], although it is important to mention that various smoking prevalence studies conducted in other countries have presented different characteristics from those found in Brazil, Jordan or UK.
However, studies which try to compare and differentiate trends of smoking between medical and nonmedical students are very scarce, therefore, it is not easy to conclude whether the trend of declined smoking rate is due to the in-depth antismoking education in the medical curricula or not.
Results of our study obviously fall in the group where, the prevalence of smoking is alarmingly high pointing to the not strong enough emphasis on smoking hazards in the existing curricula of medical university. In fact, inadequate undergraduate education about tobacco-related health risks has been reported to be one of the main factors that may contribute to missed opportunities [16, 17].
This study shows a very high prevalence of smoking among medical and other students in Georgia.
Our results indicate that current medical education is not effective in terms of realizing smoking hazards and is unable to advocate smoking cessation among students as it is required.
In addition, an important finding of our study was the very early age at which students have contact with their first cigarette. Mean age of starting smoking was 14.14 among smokers and 13.12 among non-smokers, which is well before the university entrance. Although, our study did not find significant relationship with trying first cigarette and becoming daily smoker, it is well know that smoking behavior might initiate as a mild and transient habit and unfortunately could become more serious and lead to an actual dependence. Therefore, from our point of view, age of trying first cigarette is an important subject to be further explored and tackled as necessary.
In regards with influence of gender factor on smoking habit, we have discovered that percentage of male smokers are significantly higher than females, although the proportion of expressing will to quit smoking is equal among both genders. This finding can be useful, when implementing different smoking cessation strategies.
Another important finding of the study was the share of students who have tried to quit smoking so far. Study revealed that 62.7% of smokers did not have attempts of smoking cessation, which again indicates on lack of smoking related knowledge and emphasizes the need of revising existing undergraduate educational programs.
In the present study, it appears that parental smoking was the best predictor of smoking behavior. These results do not come in line with the common perception and finding of many studies that there is a strong negative association between parental on other family members smoking and smoking status of the young adults. Therefore, the further investigation of this subject would be of great importance.
Conclusion. Results of the study have identified the need of enhancement of smoking related education on university level. Special attention should be given to the inclusion of anti-smoking evidence-based information in study curricula. These measures can only be successful if tobacco control policies will be fully enforced on national level as well.
References
1. WHO, 2003a. The World Health Report - Shaping the Future. at: http://www.who.int/whr/2003/en/
2. WHO Framework Convention on Tobacco Control. at: http://www.who.int/fctc/en/
3. WHO, 2008a. WHO report on the global tobacco epidemic, 2008. at: http://whqlibdoc.who.int/ publications/2008/9789241596282_eng.pdf
4. WHO. 2010. Health Effects of Smoking Among Young People. at: http://www.who.int/tobacco/ research/youth/health_effects/en/index.html
5. Bakhturidze, G., Kobeshavidze, G., 2007. Tobacco Consumption and Health Damages in Georgia. Available at: Tobacco Control Alliance in Georgia http://www.fctc.org.ge/
6. Gilmore A., et. al, 2004. Prevalence of Smoking in 8 Countries of the Former Soviet Union: Results From the Living Conditions, Lifestyles and Health Study. American Journal of Public Health, Vol 94, No. 12
7. WHO MONICA Project, Smoking Questionnaire. at: http://www.ktl.fi/publications/monica/manual/ index.htm
8. Mammas I.N., et al., 2003. Cigarette smoking, alcohol consumption, and serum lipid profile among medical students in Greece. Eur J Public Health.;13:278-82.
9. Xiang H., et al. 1999. Cigarette smoking among medical college students in Wuhan, People's Republic of China. Preventive Medicine.;29:210-5.
10. Yang G., et al. 1999. Smoking in China: findings of the 1996 National Prevalence Survey. JAMA.; 282:1247-53.
11. Vakeflliu Y., et al. 2002.Tobacco smoking habits, beliefs, and attitudes among Medical Students in
Tirana, Albania. Preventive Medicine; 34:370-3.
12. Akvardar Y., et al. 2003. Substance use in a sample of Turkish medical students. Drug Alcohol Depend.,72:117-21.
13. Haddad L.G., Malak M.Z. 2002. Smoking habits and attitudes towards smoking among university students in Jordan. Int J Nurs Stud.;39(8):793-802.
14. Willcox ML.,1997. Tobacco control programmes for universities: a feasibility study. J Public Health Med.;19(1):37-44.
15. Baska T., et al., 2000. Smoking habits in university students in Slovakia. Cent Eur J Public Health.;8(4): 245-8.
16. Steptoe A., et al. 2002. Trends in Smoking, Diet, Physical Exercise and Attitudes toward Health in European University Students from 13 Countries, 1990-2000. Preventive Medicine;35:97-104.
17. Lionis C., Wynn-Jones J., 2007. Establishing academic rural practice: a future and challenging target. Rural Remote Health.;7:727.
УДК 616.23/.25
ДИАГНОСТИКА СИНДРОМА ОБСТРУКТИВНОГО АПНОЭ СНА В УСЛОВИЯХ ОБЩЕСОМАТИЧЕСКОГО СТАЦИОНАРА
О.Д. Касымова
Национальный научный медицинский центр, Астана, Казахстан
По данным статистических исследований, каждый 5-й человек старше 30-ти лет постоянно храпит во сне и у каждого 15-го имеется средней или тяжелой степени синдром обструктивного апноэ во сне (СОАС) [1]. Это состояние, характеризующееся наличием храпа, периодически повторяющимся частичным или полным прекращением дыхания во время сна, достаточно продолжительным, чтобы привести к снижению уровня кислорода в крови, фрагментации сна и избыточной дневной сонливости [2]. К сожалению на сегодняшний день диагностика СОАС в широкой лечебной сети не распространена.
В настоящее время в условиях ННМЦ внедрена скрининг-диагностика СОАС (опросник и анкета), а так же для подтверждения результатов скрининг-исследования внедрен метод базовой диагностики СОАС - кардио-респираторный мониторинг (КРМ). При проведении диагностических мероприятий с целью выявления факторов риска СОАС, клинических и инструментальных признаков расстройств дыхания, ритма и проводимости сердца во время сна, помимо сбора анамнеза и объективного осмотра, применяли следующие методы диагностики:
Эпвортский опросник для оценки степени дневной сонливости (табл 1).
Анкета для первичной диагностики СОАС (табл.2).
Кардио-респираторный мониторинг.
Эпфортский опросник (ESS) используется для оценки степени дневной сонливости, характерной для больных с расстройствами дыхания во время сна. Пациенту в соответствии с опросником, представленным в таблице 1, предлагается оценить возможность задремать или даже уснуть в различных ситуациях и оценить вероятность этого в баллах (0 - никогда, 1 - небольшая вероятность, 2 - умеренная вероятность, 3 - высокая вероятность).
Таблица 1 - Эпфортский опросник
Ситуация Баллы
1. Чтение сидя
2. Просмотр телепередач
3. Пассивное участие в общественных мероприятиях
4. Как пассажир в машине
5. Если прилечь после обеда в отсутствие других дел
6. Сидя или разговаривая с кем-либо
7. Сидя спокойно после обеда
8. За рулем автомобиля, остановившегося на несколько минут, в дорожной пробке или во время короткого перерыва в работе
Интерпретация ESS
<10 баллов Нет признаков избыточной дневной сонливости
>10 и < 14 баллов Умеренна дневная сонливость
>14 и < 20 баллов Значительная дневная сонливость
>20 баллов Резкая дневная сонливость
