臺灣博碩士論文加值系統

Abstract


Background: Over half of Mongolia's urban adult population (67.8% men; 25.5% women) routinely smokes. Smoking is also an escalating problem among young people. Surveys show 19% of boys and 8% of girls in their teens (14 – 17) are smokers. Tobacco-related diseases have been increasing and have become a leading cause of death. As of year 2005 estimate, the incidence of smoking-related diseases and deaths reached 504.38 and 38.3 per 10,000 population respectively. Because heath professionals play important roles in tobacco control, their attitude and practice toward tobacco use can affect the health of the community. The aim of this study is to find out knowledge, attitude and practice on smoking and smoking cessation among health profession students and family doctors in Mongolia.

Method: A cross sectional survey conducted among 975 third-year health profession students and 152 family doctors in Mongolia. The study used questionnaire from Global Health Professional Survey (GHPS) which was developed by the World Health Organization, US Center for Disease Control and the Canadian Public Health Association. Response rates among health profession students and family doctors were 88.9% and 97% respectively.

Results:
Survey 1: Knowledge, attitude and practice on smoking and smoking cessation among third year health profession students.
The current cigarette smoking prevalence among health profession students is 11.5%. Female students were significantly less likely (5.9% vs. 38.5%, p<0.00) than their male counterparts to smoke cigarette. Overall 69.4% students reported that their school has an official policy banning on smoking in school buildings and clinics and among them 36% said that the policy is enforced. The vast majority of participants believed that health professionals have the responsibility of giving advice or information about smoking cessation to patients. However, only almost half (58.6%) of students had heard about nicotine replacement therapies (NRT), and no more than 33.9% of students reported that they have received formal training in cessation approaches. Most of them (93.7%) expressed that health professionals should be given specific training on cessation techniques.
Survey 2: Knowledge, attitude and practice on smoking and smoking cessation among family doctors.
The current cigarette smoking prevalence among family doctors is 10.5%. Female doctors were significantly lower (7.9% vs. 46.2%, p<0.00) than their male counterparts to smoke cigarette. Most family doctors (92.1%) said they were willing to counsel patients to quit smoking and 95.4% said that they advised smoker to stop smoking during most or all consultations. Only a third of family doctors said they had recommended NRTs to patients. However, only 11.2% of participants received formal training in cessation, and most of them (95.4%) would like to attend such a training course.
Some difficulties and barriers were reported in smoking cessation practice such as perceived ineffectiveness of smoking cessation techniques, lack of family doctors’ time, lack of knowledge about smoking cessation techniques, lack of space in their office to counsel patients, lack of smoking cessation materials and lack of patients’ interest to quit smoking.

Conclusion: The preliminary results suggest that the degree of awareness about their duty of counseling patients on smoking cessation is high among Mongolia’s medical students and doctors. However, their knowledge about smoking and smoking cessation techniques needs to be improved. Family doctors need assistances and incentives to increase their involvement in smoking cessation.

Abstract


Background: Over half of Mongolia's urban adult population (67.8% men; 25.5% women) routinely smokes. Smoking is also an escalating problem among young people. Surveys show 19% of boys and 8% of girls in their teens (14 – 17) are smokers. Tobacco-related diseases have been increasing and have become a leading cause of death. As of year 2005 estimate, the incidence of smoking-related diseases and deaths reached 504.38 and 38.3 per 10,000 population respectively. Because heath professionals play important roles in tobacco control, their attitude and practice toward tobacco use can affect the health of the community. The aim of this study is to find out knowledge, attitude and practice on smoking and smoking cessation among health profession students and family doctors in Mongolia.

Method: A cross sectional survey conducted among 975 third-year health profession students and 152 family doctors in Mongolia. The study used questionnaire from Global Health Professional Survey (GHPS) which was developed by the World Health Organization, US Center for Disease Control and the Canadian Public Health Association. Response rates among health profession students and family doctors were 88.9% and 97% respectively.

Results:
Survey 1: Knowledge, attitude and practice on smoking and smoking cessation among third year health profession students.
The current cigarette smoking prevalence among health profession students is 11.5%. Female students were significantly less likely (5.9% vs. 38.5%, p<0.00) than their male counterparts to smoke cigarette. Overall 69.4% students reported that their school has an official policy banning on smoking in school buildings and clinics and among them 36% said that the policy is enforced. The vast majority of participants believed that health professionals have the responsibility of giving advice or information about smoking cessation to patients. However, only almost half (58.6%) of students had heard about nicotine replacement therapies (NRT), and no more than 33.9% of students reported that they have received formal training in cessation approaches. Most of them (93.7%) expressed that health professionals should be given specific training on cessation techniques.
Survey 2: Knowledge, attitude and practice on smoking and smoking cessation among family doctors.
The current cigarette smoking prevalence among family doctors is 10.5%. Female doctors were significantly lower (7.9% vs. 46.2%, p<0.00) than their male counterparts to smoke cigarette. Most family doctors (92.1%) said they were willing to counsel patients to quit smoking and 95.4% said that they advised smoker to stop smoking during most or all consultations. Only a third of family doctors said they had recommended NRTs to patients. However, only 11.2% of participants received formal training in cessation, and most of them (95.4%) would like to attend such a training course.
Some difficulties and barriers were reported in smoking cessation practice such as perceived ineffectiveness of smoking cessation techniques, lack of family doctors’ time, lack of knowledge about smoking cessation techniques, lack of space in their office to counsel patients, lack of smoking cessation materials and lack of patients’ interest to quit smoking.

Conclusion: The preliminary results suggest that the degree of awareness about their duty of counseling patients on smoking cessation is high among Mongolia’s medical students and doctors. However, their knowledge about smoking and smoking cessation techniques needs to be improved. Family doctors need assistances and incentives to increase their involvement in smoking cessation.

TABLE OF CONTENTS

i. Acknowlegdments……………………………………………………………………..4
ii. Abstract………………………………………………………………………………..5
iii. List of tables………………………………………………………………………....10
I.Introduction…………………………………………………………………………...11
1.1 Background 12
1.2 Current smoking situation in Mongolia 13
1.3 Health professionals’ roles in tobacco control and smoking cessation. 14
1.4 Aim of the study 15
1.5 Study objectives 16
II. Literature review 17
2.1 Health consequences of tobacco use 17
2.2 Economic costs of tobacco burden 19
2.3.1 Brief introduction of Mongolia 19
2.3.2 Tobacco production trade and consumption 22
2.3.3 Tobacco control measures 23
2.3.4 Current cessation services in Mongolia 24
2.3.5 Previous studies on smoking among Mongolians 24
2.4 Global Health Professional Survey 26
2.5 Physicians role in smoking cessation 27
2.5.1 Health Professionals are role models in not smoking, or quitting smoking 27
2.5.2 Health professionals have role of providing smoking cessation treatment 29
2.5.3 Health professionals’ roles in public policies of tobacco control 31
2.6 Research questions 32
2.7 Research Hypotheses 32
III. Methodology 33
3.1 Survey 1: Knowledge, attitude and practice on smoking and smoking cessation among medical students. 33
3.1.1 Study setting and materials 33
3.1.2 Data collection 34
3.1.3 Questionnaire 35
3.2 Survey 2: Knowledge, attitude and practice on smoking and smoking cessation among family doctors. 36
3.2.1 Study setting and materials 36
3.1.2 Data collection 37
3.2.3 Questionnaire 38
3.3 Data analysis 39
VI. Results 40
4.1 SURVEY 1: Knowledge, attitude and practice on smoking and smoking cessation among third year health profession students. 40
4.1.1 Socio-demographics 40
4.1.2 Tobacco Use Prevalence 41
4.1.3 Attitudes and Attempts to quit 42
4.1.4 School policy on smoking 42
4.1.5 Exposure to secondhand smoke 43
4.1.6 Supporting ban on smoking in public, tobacco advertisement and sale to minors 44
4.1.7 Responsibility to counsel patients about smoking and cessation 45
4.1.8 Training in medical schools to support tobacco cessation 46
4.2 SURVEY 2: Knowledge, attitude and practice on smoking and smoking cessation among family doctors. 47
4.2.1 Response rate and socio demographics 47
4.2.2 Tobacco Use Prevalence 47
4.2.3 Exposure to secondhand smoke 48
4.2.4 Responsibility to counsel patients about smoking and cessation 48
4.2.5 Practice on smoking cessation activities 49
4.2.6 Difficulties and barriers to smoking cessation in primary health care 50
4.2.7. Knowledge about smoking consequences 51
V. Discussion 53
5.1 Study limitations 60
5.2 Further study 61
VI. Policy implication 62
VII. Conclusion 65
VIII. Reference 66
IX. Tables……………………………………………………………………………69-87
X. Appendix………………………………………………………………………….88-98
10.1 Questionnaire 1: Knowledge, attitude and practice on smoking and smoking cessation among health profession students……………………………………….…88-94
10.2 Questionnaire 2: Knowledge, attitude and practice on smoking and smoking cessation among family doctors……………………………………………………...94-98

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