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ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 2  |  Page : 161-167

Tobacco, alcohol, and drug consumption practices among medical and paramedical students in a government medical college of New Delhi, India


Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India

Date of Submission11-Jun-2019
Date of Decision01-Jul-2019
Date of Acceptance25-May-2020
Date of Web Publication24-Jun-2020

Correspondence Address:
Dr. Sandeep Sachdeva
Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi - 110 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_70_19

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  Abstract 


Background: Substance abuse is a common practice among health-care workers across the globe. Aim: To assess prevalence and practices of tobacco, alcohol, and non-medicinal drug consumption practices among MBBS (including intern) and medical laboratory technology (MLT) students. Materials and Methods: A cross-sectional study was conducted and students underwent a face-to-face confidential interview using a predesigned, pretested, semi-structured interview schedule adapted from the Global Health Professional Student Survey. Results: A total of 283 (MBBS = 206 and MLT = 77) students participated in the study giving a response rate of 83.3%. The mean age was 20.92 (±1.75) years; 56.9% were male. Among medical students who had “ever” undertaken such practices were as follows: smoking (cigarette) (83, 40.2%), alcohol (98, 47.5%), and drug (38, 18.4%) intake, respectively; current (past 30 days) smokers were 34 (16.5%), and current (past 30 days) alcohol drinkers were 61 (29.6%). Males had a slightly higher prevalence of consumption of all substances in comparison to females except alcohol (P > 0.05). A statistically higher proportion of medical compared to paramedical (29.9% and 3.9%) students had ever drunk alcohol or consumed drug (P < 0.05). About 40 (14.1%) students had consumed all the three substances. On multiple regression analysis it was found that students staying in hostel (OR: 2.57; 95% CI: 1.3–4.8) had ever tried smoking in comparison to day-scholar (P = 0.003). Similarly, medical students (OR: 2.94; 95% CI: 1.1–7.5; P = 0.02) in comparison to paramedical students were ever alcohol drinker, and finally, drug intake was found to be statistically significant with age (above 20 years in reference to <20 years) and current residence (hostel in reference to day-scholar). Conclusion: There is a definitive and palpable unsatisfactory practices of “smoking, alcohol, and drug” consumption among medical in comparison to para-medical students.

Keywords: Addiction, mental health, smoking, substance abuse


How to cite this article:
Taneja N, Singh AP, Sachdeva S, Dwivedi N. Tobacco, alcohol, and drug consumption practices among medical and paramedical students in a government medical college of New Delhi, India. J Indian Assoc Public Health Dent 2020;18:161-7

How to cite this URL:
Taneja N, Singh AP, Sachdeva S, Dwivedi N. Tobacco, alcohol, and drug consumption practices among medical and paramedical students in a government medical college of New Delhi, India. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Jul 7];18:161-7. Available from: http://www.jiaphd.org/text.asp?2020/18/2/161/287637




  Introduction Top


Substance abuse refers to the hazardous or harmful use of psychoactive substances, including alcohol, illicit drugs, and tobacco.[1] The WHO estimates a burden of worldwide psychoactive substance use of around 2 billion alcohol users, 1.3 billion smokers, and 185 million drug users.[2] For youth, the prevalence of alcohol and smoking is 19.0% and 8.3%, respectively.[3] In India, the prevalence of current tobacco smoking among youth has been estimated to be 14.6% (19% in males and 8.3% in females). However, a national survey (2015–2016) in India revealed that 44.5% of adult men and 6.8% of women consume tobacco in some form and 29.2% and 1.2% consume alcohol, respectively.[4]

It has been reported that smoking cessation guidance and intervention by physicians have a significant effect on patients' smoking behavior, and medical professionals can reduce smoking prevalence in society by offering smoking cessation advice to patients.[5],[6] In 1999, the WHO took the position that physicians, as role models of healthy living, should not smoke and not overlook smoking in their patients.[7] More importantly, physicians are expected to play an important role in the campaign against smoking, which means not only giving advice to their patients but also setting an example for them.

Globally, it is observed that consumption of alcohol, tobacco, or drug is common among medical and paramedical personnel in spite of their professional knowledge.[8] In India, it is also known that such practice usually starts during the period of training in medical institution, with equally contributing factor being easy availability of such substances (personal experiences and observations). Owing to various external and internal factors during professional training, students are under a lot of stress which makes them vulnerable for these substances. The increasing abuse and its impact on physical and psychosocial including cardiovascular health is a rising public health concern among medical fraternity. This phenomenon calls for early preventive action, and hence, the study was undertaken to determine the prevalence and practices of consumption of alcohol, tobacco, and nonmedicinal drug usage among medical and paramedical students in a public-funded medical college of New Delhi, India.


  Materials and Methods Top


A cross-sectional descriptive study was conducted in a government medical college of New Delhi, India, during February to March 2018, and the study population included all the medical and paramedical (laboratory technology) students from the 1st year to interns. Every year 50 medical students are admitted to the institution through a national competitive entrance examination; therefore, there are 50 interns and around 200 students in the medical college studying at any given time, and 30 paramedical students are admitted to the institution each year, so at any given time, there are 90 paramedical students. Therefore, out of total of 340 students including both medical and paramedical students, 283 students participated in the study giving a response rate of 83.3%.

All the students underwent a face-to-face interview at their convenient time and were briefed about the study objectives and voluntary nature of participation in the study. Data collection was undertaken in an anonymous, confidential, and nonjudgmental manner after taking clearance from the institutional ethical board (HRH/2017/IEC/8785) and informed consent from each participant. On an encouraging note, none of them declined to participate. An earnest effort was made to mobilize all available students to participate in the study. Three investigators were involved in conducting the interview. Before the process of data collection, all investigators underwent standardization training under supervision of senior medical faculty. The reliability/internal consistency, i.e., Cronbach's alpha value of the study instrument, was found to be 0.82 that was suggestive of high reliability.

The study instrument was adapted from the globally accepted prevalidated Global Health Professional Student Survey[9] and was broadly divided into four subsections that captured (1) sociodemographic details and parental practices, (2) alcohol, (3) tobacco (smoking as well as chewable), and (4) nonmedicinal drug consumption pattern and practices including frequency of intake, type, usual preference, source, expenditure incurred, self-assessment of addiction, quitting intention, health warning, and awareness of adverse consequences of substance. Current smoker or tobacco chewer was defined as a person who had consumed at least one tobacco product (or smoked) in the past 30 days preceding the interview. Similarly, current alcohol consumer was defined as a person who had consumed at least one alcohol-based drink in the past 30 days.

The data were analyzed with SPSS (IBM Inc., New York, USA) software. Descriptive statistics and bivariate (Chi-square test) and multiple regression analysis were carried out and considered significant at P < 0.05.


  Results Top


A total of 283 (medical [including intern] =206 and paramedical = 77) students participated in the study giving a response rate of 83.3%. The mean age was 20.92 (±1.75) years with 161 (56.9%) males and 122 (43.1%) female students. Out of 283 students, 110 (38.9%), 121 (42.8%), and 41 (14.5%) had ever smoked (cigarette), consumed alcohol, or nonmedicinal drugs, respectively. About 40 (14.1%) students had consumed all the three substances. The sociodemographic profile of students is shown in [Table 1].
Table 1: Sociodemographic profile of medical and paramedical students

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Among medical students, high proportion was found to be undertaking such unsatisfactory practice of smoking cigarette (83, 40.2%), alcohol (98, 47.5%), and nonmedicinal drug (38, 18.4%) intake, respectively. Out of 83 medical students who were smoking (cigarette), 4.8% were also involved in chewing tobacco and hookah smoking. A higher proportion of such practices were prevalent in senior students (including intern) in comparison to junior medical students (P < 0.05). A proportion (%) of medical students who have “ever” smoked, drunk alcohol, or consumed nonmedicinal drug according to enrollment batch (year) and gender are shown in [Figure 1] and [Figure 2], respectively.
Figure 1:Proportion (%) of medical students who have “ever” smoked, drunk alcohol, or consumed nonmedicinal drug according to enrollment batch (year)

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Figure 2:Proportion (%) of medical students including interns who have “ever” smoked (tobacco, i.e., cigarette), drunk alcohol, or consumed nonmedicinal drug according to gender

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Nearly10 (9.1%) students had initiated smoking in the age group of 9–15 years, whereas majority (53, 48.1%) had started to smoke after attaining 19 years; 15 (13.6%) had ever tried E-cigarette/nicotine chewing gum. Current smokers were 39 (13.7%) who had smoked at least one cigarette during the past 30 days. Regarding the factors that determine their smoking practices, nearly 39 (35.4%) and 32 (29.0%) students mentioned about parties and stress/examination, respectively, whereas overall 53 (48.1%) cited no specific reason. On an encouraging note, 276 (97.5%) were aware of the health warning on the tobacco product, but only 165 (58.3%) students had actually read and seen the pictorial warning [Table 2].
Table 2: Smoking practices among medical and paramedical students in a government medical college of Delhi, India

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Nearly 8 (6.6%) students had initiated alcohol consumption in the age group of 9–15 years, whereas majority (65, 53.7%) had started alcohol after attaining 19 years; current alcohol drinkers were 115 (40.6%). With regard to usual preference for drinking, majority, i.e., 88 (72.7%), mentioned “small social drinks at parties;” majority (50.4%) preferred whisky; however, only 32 (26.4%) had seen any health warning on the bottle of alcohol. Nearly 23 (19.0%) students had driven a vehicle under the influence of alcohol and even 7 (5.8%) were caught by police in the inebriated state [Table 3].
Table 3: Pattern of usual alcohol consumption practices among students in a medical college

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Out of 283 students, 41 (14.5%) had consumed drugs. Types of drugs consumed were marijuana (39 [95.1%]) and joint (39 [95.1%]), followed by weed (37 [90.2%]); majority, i.e., 20 (48.8%), had consumed drugs only once, whereas 7 (17.0%) were consuming on a monthly basis, but none of the students were found to be addicted to drugs [Table 4].
Table 4: Pattern of nonmedicinal drug consumption practices among students

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Consumption of all the three substances was found to be increasing with increasing age of the students (P < 0.05). A statistically higher proportion of medical (47.6% and 18.4%) in comparison to paramedical (29.9% and 3.9%) were found to be drinking alcohol and consuming drugs, respectively (P < 0.05). Students residing in hostel had higher unsatisfactory practices in comparison to day-scholars (P < 0.05). Students whose parents were more educated (at least graduate) were found to more into drinking and drug in comparison to those whose education was limited to school. Similarly, students of working mothers were more into alcohol and drug intake (P < 0.05).

On multiple regression analysis, statistically significant (P = 0.003) students staying in hostel (odds ratio [OR]: 2.57; 95% confidence interval [CI]: 1.3–4.8) had tried smoking in comparison to day-scholar. Similarly, medical students (OR: 2.94; 95% CI: 1.1–7.5; P = 0.02) in comparison to paramedical students were ever alcohol drinker, and finally, drug intake was found to be statistically significant with age (above 20 years in reference to <20 years) and current residence (hostel in reference to day-scholar) [Table 5].
Table 5: Multiple regression analysis of smoking, alcohol, and drugs with sociodemographic profile of students

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  Discussion Top


Our cross-sectional descriptive study carried out among medical (including intern) and paramedical (medical laboratory technology) students enrolled in a government medical college of New Delhi (India) showed “ever” smoking, alcohol, or nonmedicinal drug consumption as 38.9%, 42.8%, and 14.5%, respectively. Overall, current tobacco smokers and alcohol consumers were 39 (13.7%) and 115 (40.6%), respectively. About 40 (14.1%) students had consumed all the three substances.

Among medical students, a higher proportion of “ever” smokers were found in 83 (40.2%), alcohol – 98 (47.5%), and drug – 38 (18.4%) intake, respectively. Among 83 medical students who were smoking cigarette, 4.8% (10/206) had also chewed tobacco or did hookah smoking. Current smokers (cigarette) and alcohol consumers were 34 (16.5%) and 61 (29.6%) students, respectively. On a depressive note, these medical students as they grow into future physicians would be less inclined to enquire about substance abuse or participate or avoid undertaking active counseling of patients to reduce their risk behavior. This would be a double loss to health system.

Some of the limitations of our study include that this study has been undertaken in a single medical college of Delhi, India, and its findings may not fully reflect the situation for medical students elsewhere, thus lacking external validity and generalizability. Second, cross-sectional nature of our study did not allow us to make conclusions about substance use trends over time, which we propose to assess by future research studies at regular interval.

In a study carried out in a geographically nearby government medical college in Delhi (India), the prevalence of current smokers was 14.6% and current alcohol (28.8%) very similar to our study (16.5% and 29.6%, respectively).[10] In a study carried out among nonmedical Delhi university students (n = 2599), the prevalence of smoking was 16.2% (males = 23.5% and females = 3.9%).[11] Another study among nonmedical Delhi University students (n = 450) found the prevalence of smoking and alcohol consumption of 15.7% and 20.8%, respectively.[12] In nearby district Meerut (Uttar Pradesh, India), the prevalence of substance abuse in medical students was 20.43%.[13] In a government medical college at Haldwani (Uttarakhand, India), tobacco smokers were 14.5%.[14] In a private university of Jaipur (Rajasthan, India), current smoker (15.1%) were similar to our study (13.7%).[15]

Our study showed that 23.3% and 28.2% of students had a positive family history of tobacco and alcohol consumption which is similar from a study in Pune (Maharashtra, India), where medical students who had a positive family history of substance use had also a higher prevalence of substance use. Consistently higher prevalence of all substance abuse is found in males than female medical students across all regions of the country.[16],[17] In our study, males had a slightly higher prevalence of consumption of all substances in comparison to females except alcohol [Figure 2]. This is probably first study in India to report a marginally higher prevalence of alcohol consumption among females than male medical students (including intern); however it did not reach statistical significance (P > 0.05). Whether this is a reality or situation arising due to underreporting needs to be followed overtime to conclude with some confidence.

Studies conducted worldwide have estimated a prevalence rate of substance abuse to be around 20%–40% among students from various streams including medical students.[18],[19],[20],[21],[22] Selected studies at international level among medical students revealed a prevalence of tobacco smokers as 38.6% in Nepal, 38.2% (Italy), males = 27.0% (Bahrain), 23.1% (Pakistan), 21.7% (Nigeria), 16.8% (Saudi Arabia), 14.4% (Iran), and 5.1% (Japan).[23],[24],[25],[26],[27],[28],[29],[30] Meta-analysis results from Iran's universities revealed that smoking frequency among male and female students was 19.8% (17.7–21.9) and 2.2% (1.4–3.02), respectively.[31] An international review suggested that the prevalence of smoking among medical students varied widely between different countries and also between male and female students within the same area. Consistently, low smoking rates were found in Australia and the United States, whereas generally high rates were reported from Spain and Turkey.[32]

Our other published research in the same population observed that 60 (32.0%), 75 (40.1%), and 82 (43.8%) medical students were affected by symptoms suggestive of depression, anxiety, and stress, respectively. However, smoking or alcohol intake had no statistical bearing with any of these mental states.[33] Another study on Internet addiction among the same population revealed that male students (P = 0.001), ever consumed alcohol (P = 0.003), ever smoked (P = 0.02), and physical activity (P = 0.04) were found to be significantly associated with a high risk of Internet addiction based on bivariate analysis, but none was found significant at higher levels of statistical analyses.[34]

The duration of undergraduate medical (MBBS) course in India is of 5½ academic years including 1-year internship. However, during this journey, students are to overcome some of the inherent challenges of medical education such as vastness of course requiring cramming/factual learning or being exposed to inadequate support system, boredom, unsatisfactory social life, and feeling of loneliness and tiredness.[35] Teaching, learning dynamics, and evaluation process form the core activity of student–teacher interaction in any medical institution. Motivated faculties are constantly engaged with students in building knowledge base, transforming attitude, and implementing innovating methods at undergraduate and postgraduate levels in India.[36],[37],[38] It is no surprise that some of the best brains working in developed world received medical training in India. A review based on bibliometric analysis determining frequency and domain of published research among medical students of India revealed some interesting observations.[39],[40] Highest frequency of original published research undertaken among MBBS students was related to medical education (29.2%), mental (13.1%), physical (7.0%) health of student followed by substance abuse among medical students (6.0%). Thus research topic of substance abuse among medical students has received attention from the Indian medical faculty/researcher.

A report indicated that undergraduate medical education in the United States of America falls short of addressing critical health issues, including smoking, diet, alcohol, sedentary lifestyle, and accidents. The report further found that the curriculum in most US medical schools does not provide sufficient training about these behavioral and social risk factors, despite the fact that addressing them in patient care could significantly reduce mortality and morbidity.[41]


  Conclusion Top


The study concludes that there is a definitive and palpable practice of “smoking, alcohol, and non-medicinal drug” consumption among professional students in a government medical college of Delhi, India. It is noted that “ever” smokers, alcohol drinkers, or nonmedicinal drug consumers were 38.9%, 42.8%, and 14.5% of students, respectively. Overall, current tobacco smokers and alcohol consumers were 39 (13.7%) and 115 (40.6%), respectively. Such practices were more prevalent among senior students including interns. Situation warrants continuous monitoring along with implementation of multiprolonged preventive measures.

Recommendations

  • Special drive was undertaken with the help of administration to weed out vendors selling tobacco products “discreetly” in the institution, but availability of drugs in adjoining areas is a matter of concern and hopefully police will take appropriate action in this regard
  • Medical curriculum in India lays adequate emphasis on prevention and control of substance abuse in the society. In this context, medical colleges especially department of Community Medicine, Respiratory/Medicine and Psychiatry, etc., in particular undertake regular sensitization and health education activities to control these menaces among stakeholders including students.[42],[43],[44],[45],[46],[47] In this context, the authors are regularly providing social support, counseling, and holding formal and informal meetings with students to discourage such practices
  • A mentor-mentee system established in medical colleges should regularly supervise wards on personal and social problems including tactful handling of peer pressure, substance abuse practices, and the environmental issues of the college
  • The Government of India through the National Tobacco Control Program and health awareness campaign on drug de-addiction is trying to control these social menaces. However, increasing alcohol consumption among society in general including students is an area of concern and requires comprehensive and integrated management approach.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Materials and Me...
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