Tobacco Use, Exposure to Secondhand Smoke ... - Semantic Scholar

International Dental Education

Tobacco Use, Exposure to Secondhand Smoke, and Cessation Counseling Training of Dental Students Around the World Charles W. Warren, Ph.D.; Dhirendra N. Sinha, M.D.; Juliette Lee, M.P.H.; Veronica Lea, M.P.H.; Nathan Jones, Ph.D.; Samira Asma, D.D.S. Abstract: The Global Health Professions Student Survey (GHPSS) has been conducted among third-year dental students in schools in forty-four countries, the Gaza Strip/West Bank, and three cities (Baghdad, Rio de Janeiro, and Havana) (all called “sites” in this article). In more than half the sites, over 20 percent of the students currently smoked cigarettes, with males having higher rates than females in thirty sites. Over 60 percent of students reported having been exposed to secondhand smoke in public places in thirty-seven of forty-eight sites. The majority of students recognized that they are role models in society and believed they should receive training on counseling patients to quit using tobacco, but few reported receiving formal training. Tobacco control efforts must discourage tobacco use among dentists, promote smoke-free workplaces, and implement programs that train dentists in effective cessation-counseling techniques. Dr. Warren is a Statistician-Demographer, Office on Smoking and Health, Global Tobacco Control, Centers for Disease Control and Prevention; Dr. Sinha is Tobacco Focal Point, Southeast Asia Regional Office, Tobacco-Free Initiative, World Health Organization; Dr. Lee is an Epidemiologist, Office on Smoking and Health, Global Tobacco Control, Centers for Disease Control and Prevention; Dr. Lea is an Epidemiologist, Office on Smoking and Health, Global Tobacco Control, Centers for Disease Control and Prevention; Dr. Jones is a Scientist, Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin; and Dr. Asma is Branch Chief, Office on Smoking and Health, Global Tobacco Control, Centers for Disease Control and Prevention. Direct correspondence and requests for reprints to Dr. Charles W. Warren, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-50, Atlanta, GA 30341; [email protected]. Charles W. Warren, Juliette Lee, Veronica Lea, and Samira Asma are obligated by their institution to have the following statement printed with this report: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Keywords: tobacco use, health professionals, dental students, counseling training Submitted for publication 7/2/10; accepted 9/23/10

T

obacco use is a serious health problem around the world. The World Health Organization (WHO) estimates globally over one billion people currently smoke tobacco; with approximately five million deaths a year attributed to tobacco.1 If current trends continue, WHO estimates tobaccoattributable mortality will exceed eight million per year by 2030. A disproportionate share of the global tobacco burden falls on developing countries, where 84 percent of current smokers reside. Tobacco use is a significant risk factor for oral cancer and periodontal disease.2,3 It has been estimated that 80 percent of oral cancers are attributable to tobacco use.4,5 Oral cancers are largely preventable, but if diagnosed late, the prognosis is poor. Health professionals play an important role in educating their

March 2011 ■ Journal of Dental Education

patients about the health risks of tobacco use and in promoting cessation.6 Studies have found that smoking cessation rates increase after even brief or simple counseling by health professionals.7 Consequently, dentists have a very important role to play in tobacco control and should be trained to conduct cessation counseling with their patients. Previous studies have shown that patients who smoke are receptive to cessation counseling from a dentist; however, no international cross-country study has collected information on whether dental students have received training on cessation counseling while in school. The WHO, U.S. Centers for Disease Control and Prevention, and Canadian Public Health Association have attempted to fill this void by developing and implementing the Global Health Professions Student Survey (GHPSS).8

385

The GHPSS project includes surveys of dental, medical, nursing, and pharmacy students. The data reported in this study come from GHPSS conducted among third-year dental students in forty-four countries, the Gaza Strip/West Bank, and three cities (Baghdad, Rio de Janeiro, and Havana) (all called “sites” in this article) from 2005 to 2009. All sites were nominated by their Ministries of Health in conjunction with their respective WHO regional offices. In most sites, national surveys are conducted, but in areas where this is not feasible, city-level surveys are conducted. This study includes data on tobacco use, exposure to secondhand smoke (SHS), and training to provide cessation counseling among dental students. Table 1 lists the sites that completed the Dental GHPSS by year, WHO region, and site.

Materials and Methods Design The Dental GHPSS is part of the Global Tobacco Surveillance System, which collects data through four surveys: the Global Youth Tobacco Survey, the Global School Personnel Survey, the Global Adult Tobacco Survey, and GHPSS.9 The GHPSS is a school-based survey of third-year students pursuing advanced degrees in dentistry, medicine, nursing, and pharmacy. GHPSS uses a core questionnaire on demographics, prevalence of cigarette smoking and use of other tobacco products, exposure to SHS, desire to quit smoking, and training received to provide patient counseling on cessation techniques. GHPSS has a

Table 1. Response rates by region and country, Dental Global Health Professions Student Survey, 2005–09 Country (Site)

Year

School Response Rate (%)

Class Response Rate (%)

Student Response Rate (%)

Overall Response Rate (%)

Number of Third-Year Students

100.0 100.0

100.0 100.0

76.7 74.0

76.7 74.0

225 36

100.0 93.3 100.0 100.0 50.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

87.6 62.9 100.0 64.0 78.1 56.3 86.2 62.4 84.0

87.6 58.7 100.0 64.0 39.1 56.3 86.2 62.4 84.0

91 303 258 71 162 135 475 123 389

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 80.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

79.2 62.7 94.4 93.8 96.3 94.2 81.9 80.0 64.3 55.3 86.9 100.0 73.7 100.0 100.0

79.2 62.7 94.4 93.8 96.3 94.2 81.9 80.0 64.3 55.3 86.9 80.0 73.7 100.0 100.0

53 149 170 193 153 113 148 32 72 83 43 583 212 42 39 (continued)

AFRICAN REGION (AFR) Algeria Senegal

2007 2009

EASTERN MEDITERRANEAN REGION (EMR) Gaza Strip/West Bank Iran Iraq (Baghdad) Lebanon Libyan Arab Sudan Syrian Arab Republic Tunisia Yemen

2007 2007 2009 2006 2006 2007 2006 2007 2009

EUROPEAN REGION (EUR) Albania Armenia Bosnia & Herzegovina Bulgaria Czech Republic Greece Kyrgyzstan Latvia Lithuania Macedonia Republic of Moldova Russian Federation Serbia Slovakia Slovenia

386

2005 2006 2006 2009 2006 2009 2008 2009 2006 2009 2008 2006 2006 2006 2007

Journal of Dental Education ■ Volume 75, Number 3

standardized methodology for selecting participating schools and uniform data-processing procedures. The Dental GHPSS included a census of both students and schools in all sites where all eligible schools and students were surveyed—except in Mexico and India, where a sample of schools was selected with probability proportional to size from all dental schools in the country and a census of students in the selected schools were surveyed (Table 2). The Dental GHPSS was conducted in schools during regular lectures and class sessions. Anonymous, selfadministered data collection procedures were used. Where appropriate, the final country questionnaires were translated into local languages and back-translated to check for accuracy. SUDAAN, a software package for statistical analysis of complex survey data, was used to calculate weighted prevalence estimates and standard errors (SE) of the estimates (95 percent confidence intervals [CI] were calculated from the SEs).10 For all sites excluding India and

Mexico, a finite population correction factor was applied to take into account non-response and used in the variance of the estimates. T-tests were used to determine differences between subpopulations.11,12 In this article, differences in proportions are considered statistically significant if the t-test p-value was less than 0.05. For sites conducting the Dental GHPSS, the school response rate was 100 percent in forty of the forty-eight sites (lowest was 50.0 percent in Libya); the student response rate ranged from 55.3 percent (Macedonia) to 100 percent (Fiji, Guyana, Iraq [Baghdad], Russian Federation, Slovakia, Slovenia, and Mongolia); and the overall response rate ranged from 39.1 percent (Libya) to 100 percent (Fiji, Guyana, Iraq [Baghdad], Slovakia, Slovenia, and Mongolia) (Table 1). The number of students who participated in each survey varied due to the number of schools and student enrollment for each country in each sample design.

Table 1. Response rates by region and country, Dental Global Health Professions Student Survey, 2005–09 (continued) Country (Site)

Year

School Response Rate (%)

Class Response Rate (%)

Student Response Rate (%)

Overall Response Rate (%)

Number of Third-Year Students

2007 2007 2007 2008 2008 2008 2009 2006 2008 2008 2008

100.0 94.1 100.0 90.9 100.0 100.0 100.0 86.7 100.0 71.4 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

95.7 97.5 84.2 79.4 78.3 86.4 100.0 85.5 86.1 92.0 94.3

95.7 91.8 84.2 72.2 78.3 86.4 100.0 74.1 86.1 65.7 94.3

237 1,658 304 792 146 99 13 1,301 57 147 95

2009 2009 2007 2009 2005 2006

100.0 93.3 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0

86.0 83.6 89.5 75.7 85.3 96.1

86.0 78.1 89.5 75.7 85.3 96.1

337 711 753 260 88 411

100.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0

85.5 100.0 98.5 100.0 91.7

85.5 100.0 98.5 100.0 91.7

47 14 64 139 11

REGION OF THE AMERICAS (AMR) Argentina Bolivia Brazil (Rio de Janeiro) Chile Cuba (Havana) Guatemala Guyana Mexico Panama Paraguay Uruguay SOUTH-EAST ASIA REGION (SEAR) Bangladesh India Indonesia Myanmar Nepal Thailand

WESTERN PACIFIC REGION (WPR) Cambodia Fiji Lao People’s Democratic Republic Mongolia Papua New Guinea

2005 2009 2009 2007 2009


387

Measurement

Region (EUR), the Region of the Americas (AMR), the South-East Asian Region (SEAR), and the Western Pacific Region (WPR). Data presented here are an expansion on previously published data.

This report includes information on current cigarette smoking, current use of tobacco products other than cigarettes (adapted by each country), exposure to SHS at home and in public places, the extent to which schools have official policies banning smoking in school buildings and clinics, and whether the policies are enforced. In addition, attitude questions were asked regarding health professionals as role models for their patients, whether health professionals think they should get training in patient cessation techniques, and if they have ever received formal training on such cessation counseling techniques. Results in this report are presented by WHO region with participating countries identified. The six WHO regions are the African Region (AFR), the Eastern Mediterranean Region (EMR), the European

Results The percentage of dental students who were females ranged from 5.0 percent in Moldova to over 70 percent in twelve countries (Fiji, Guatemala, Indonesia, Libya, Lithuania, Macedonia, Mongolia, Nepal, Paraguay, Slovenia, Tunisia, and Uruguay) (Table 2). Over 90 percent of the students were less than twenty-four years of age in every site except Argentina, Bolivia, Brazil, Cuba, Czech Republic, Fiji, Guatemala, Guyana, Laos, Papua New Guinea, Senegal, and Uruguay.

Table 2. Population characteristics by region and country, Dental Global Health Professions Student Survey, 2005–09

Country (Site)

Year

Census or Sample?

Female (%)

Age 24 and Under (%)

Age 25–29 (%)

Age 30+ (%)

AFRICAN REGION (AFR) Algeria

Senegal

2007 2009

Census Census

62.5 52.8

96.4 83.3

2.9 16.7

0.7 0.0

EASTERN MEDITERRANEAN REGION (EMR) Gaza Strip/West Bank Iran Iraq (Baghdad) Lebanon Libyan Arab Sudan Syrian Arab Republic Tunisia

Yemen

2007 2007 2009 2006 2006 2007 2006 2007 2009

Census Census Census Census Census Census Census Census Census

57.5 53.7 67.3 67.2 71.8 61.3 38.2 79.5 64.3

95.7 92.9 99.2 100.0 95.3 NA 96.8 99.1 97.2

0.0 3.8 0.4 0.0 4.7 NA 2.6 0.8 2.5

4.3 3.4 0.4 0.0 0.0 NA 0.7 0.0 0.3

EUROPEAN REGION (EUR) Albania

Armenia Bosnia & Herzegovina Bulgaria Czech Republic Greece Kyrgyzstan Latvia Lithuania Macedonia Republic of Moldova Russian Federation Serbia Slovakia Slovenia

388

2005 2006 2006 2009 2006 2009 2008 2009 2006 2009 2008 2006 2006 2006 2007

Census Census Census Census Census Census Census Census Census Census Census Census Census Census Census

66.1 58.7 66.9 59.4 68.6 62.8 50.2 56.9 82.6 74.7 5.0 63.2 41.5 66.7 87.2

93.3 93.0 97.0 91.0 88.9 90.2 97.9 100.0 98.5 97.6 95.0 97.9 95.2 92.8 97.4

6.7 7.0 3.0 5.4 9.7 8.9 1.4 0.0 1.5 2.4 2.6 2.1 3.8 7.1 2.6

0.0 0.0 0.0 3.6 1.4 0.9 0.7 0.0 0.0 0.0 2.4 0.0 1.0 0.0 0.0 (continued)


Tobacco Use Smoking rates among third-year dental students varied widely across the sites. Six sites had current smoking rates above 40 percent (Kyrgyzstan, Macedonia, Moldova, Russian Federation, Chile, and Mexico), and three sites had rates less than 5 percent (Libya, Thailand, and Cambodia) (Table 3). From the AFR, 10.2 percent currently smoked cigarettes in Algeria, and 16.7 percent currently smoked cigarettes in Senegal, with males significantly more likely to smoke than females in both sites. In EMR, current cigarette smoking ranged from 33.4 percent in Gaza Strip/West Bank to 2.3 percent in Libya, with two other sites (Lebanon [31.6 percent] and Syria [23.6 percent]) reporting rates over 20 percent. Males were significantly more likely than females to smoke in all EMR sites, except Lebanon (no gender difference). In EUR, current cigarette smoking was over 20 per-

cent in all sites except for Slovenia (17.9 percent) and Latvia (19.6 percent); five sites reported current cigarette smoking rates over 40 percent (Bulgaria [52.2 percent], Kyrgyzstan [44.0 percent], Macedonia [52.5 percent], Moldova [65.2 percent], and Russian Federation [43.7 percent]). Males were significantly more likely to smoke than females in every site, except Czech Republic, Bulgaria, and Slovakia (females significantly higher than males) and Albania, Bosnia & Herzegovina, Macedonia, and Serbia (no gender difference). In AMR, current cigarette smoking was at least 20 percent in all sites, except Guatemala, Guyana, Panama, and Paraguay, and over 40 percent in Chile and Mexico. Males were significantly more likely than females to smoke in every site with the exception of Chile and Uruguay, where females had significantly higher rates than males, and Argentina and Panama with no gender difference. In the SEAR sites, current cigarette smoking was over 20

Table 2. Population characteristics by region and country, Dental Global Health Professions Student Survey, 2005–09 (continued)

Country (Site)

Year

Census or Sample?

Female (%)

Age 24 and Under (%)

Age 25–29 (%)

Age 30+ (%)

REGION OF THE AMERICAS (AMR) Argentina Bolivia

Brazil (Rio de Janeiro) Chile Cuba (Havana) Guatemala Guyana Mexico Panama Paraguay Uruguay

2007 2007 2007 2008 2008 2008 2009 2006 2008 2008 2008

Census Census Census Census Census Census Census Sample Census Census Census

67.2 59.8 68.3 55.3 68.5 76.1 69.2 68.3 68.3 75.6 73.7

75.3 82.4 84.0 91.5 88.4 71.6 58.3 94.0 96.5 90.8 81.0

21.3 13.0 9.6 6.1 11.6 24.2 33.3 4.8 3.6 7.1 13.7

3.4 4.6 6.4 2.4 0.0 4.1 8.3 1.1 0.0 2.0 5.3

SOUTH-EAST ASIA REGION (SEAR) Bangladesh India Indonesia Myanmar Nepal Thailand

2009 2009 2007 2009 2005 2006

Census Sample Census Census Census Census

59.8 67.6 82.3 22.7 72.0 67.9

100.0 98.5 99.1 99.6 92.8 98.3

0.0 1.3 0.7 0.4 7.2 1.6

0.0 0.2 0.1 0.0 0.0 0.0

WESTERN PACIFIC REGION (WPR) Cambodia Fiji

Lao People’s Democratic Republic Mongolia Papua New Guinea

2005 2009 2009 2007 2009

Census Census Census Census Census

43.5 71.4 49.2 75.0 45.5

93.6 85.7 89.1 93.5 81.8

6.4 7.1 6.3 5.8 18.2

0.0 7.1 4.7 0.7 0.0

NA=data not available


389

390


2006

2007

2006

2007

2009

Libyan Arab

Sudan

Syrian Arab Republic

Tunisia

Yemen

2009

Iraq (Baghdad)

2006

2007

Iran

Lebanon

2007

Gaza Strip/West Bank

14.4 (12.9–16.1) [384]

12.6 (9.3–16.9) [119]

23.6 (22.2–25.2) [472]

11.4 (7.6–16.7) [131]

2.3 (0.9–5.5) [158]

31.6 (24.4–39.7) [69]

17.1 (16.2–18.1) [251]

10.3 (7.9–13.2) [298]

34.8 (31.1–38.7) [130]

30.4 (19.9–43.5) [23]

33.2 (31.1–35.4) [289]

26.9 (17.8–38.5) [45]

8.4 (3.5–19.1) [45]

34.8 (23.2–48.7) [25]

41.3 (39.0–43.6) [80]

14.8 (10.5–20.5) [99]

48.8 (42.7–54.9) [36]

16.7 (10.9–24.6) [36] EASTERN MEDITERRANEAN REGION (EMR) 33.4 (29.9–37.2) [87]

29.4 (18.9–42.7) [17]

2009

20.1 (15.7–25.5) [72]

Senegal

10.2 (8.2–12.6) [198]

2.5 (1.8–3.5) [238]

8.3 (5.4–12.6) [96]

8.1 (6.6–9.8) [181]

2.4 (0.8–6.9) [86]

[111]

0.0

30.0 (21.4–40.3) [44]

5.3 (4.6–6.1) [170]

5.9 (3.9–8.9) [197]

19.9 (16.1–24.4) [49]

5.3 (1.8–14.5) [19]

4.6 (3.1–6.8) [126]

Current Cigarette Smokers Male % Female % (95% CI) (95% CI) [n] [n]

2007

Year

Total % (95% CI) [n]

Algeria

AFRICAN REGION (AFR)

Country (Site)

0.0000

0.0011

0.0000

0.0000

0.0244

0.5518

0.0000

0.0017

0.0000

0.0007

0.0000

P-Value

15.0 (13.5–16.7) [389]

17.1 (13.3–21.7) [123]

29.2 (27.6–30.8) [475]

4.9 (2.7–8.7) [134]

5.5 (3.0–9.9) [162]

37.3 (30.1–45.1) [71]

21.3 (20.3–22.4) [258]

15.2 (12.2–18.8) [301]

30.9 (27.5–34.5) [91]

5.6 (2.6–11.5) [36]

5.1 (3.8–6.8) [215]


25.4 (22.2–29.0) [134]

48.0 (35.9–60.3) [25]

38.5 (36.4–40.7) [292]

9.5 (4.7–18.0) [48]

15.7 (8.1–28.3) [47]

30.6 (21.0–42.4) [26]

52.4 (50.1–54.6) [84]

18.8 (13.7–25.3) [102]

55.0 (49.1–60.8) [39]

11.8 (5.5–23.2) [17]

10.6 (7.7–14.4) [85]

9.0 (7.5–10.9) [239]

8.2 (5.4–12.5) [97]

13.8 (11.9–15.9) [181]

2.2 (0.7–6.3) [86]

1.6 (0.5–5.7) [113]

40.5 (31.2–50.6) [45]

6.4 (5.6–7.2) [173]

11.6 (8.6–15.4) [197]

12.2 (9.2–16.1) [50]

0.0 [19]

1.6 (0.8–3.2) [130]

Currently Use Other Tobacco Products Male % Female % (95% CI) (95% CI) [n] [n]

Table 3. Prevalence of current tobacco use, by gender, region, and country, Dental Global Health Professions Student Survey, 2005–09

0.0000

0.0000

0.0000

0.0353

0.0084

0.1929

0.0000

0.0356

0.0000

0.0082

0.0000

P-Value


391

2005

2006

2006

2009

2006

2009

2008

2009

2006

2009

2008

2006

2006

2006

Albania

Armenia

Bosnia & Herzegovina

Bulgaria

Czech Republic

Greece

Kyrgyzstan

Latvia

Lithuania

Macedonia

Republic of Moldova

Russian Federation

Serbia

Slovakia

EUROPEAN REGION (EUR)

29.3 (27.1–31.5) [41]

28.5 (25.3–31.9) [211]

43.7 (42.1–45.3) [574]

65.2 (51.1–77.1) [38]

52.5 (45.0–59.9) [80]

29.6 (23.6–36.5) [72]

19.6 (13.6–27.3) [30]

44.0 (40.4–47.6) [141]

39.1 (36.9–41.3) [110]

33.3 (31.4–35.2) [152]

52.2 (50.3–54.1) [192]

36.1 (34.4–37.8) [169]

28.4 (23.2–34.3) [145]

30.1 (23.2–38.1) [41]

23.1 (19.6–26.9) [13]

24.7 (20.8–29.1) [120]

53.3 (50.6–55.9) [212]

69.1 (54.7–80.6) [36]

52.4 (38.0–66.4) [21]

61.7 (44.7–76.3) [13]

32.1 (21.0–45.7) [12]

60.9 (55.8–65.8) [69]

31.7 (28.3–35.3) [41]

29.4 (26.2–32.7) [47]

49.3 (46.3–52.3) [78]

34.1 (31.2–37.1) [56]

60.2 (50.5–69.1) [57]

38.0 (24.9–53.1) [12]

32.1 (29.5–35.0) [28]

31.0 (26.1–36.5) [88]

37.9 (35.9–39.9) [359]

* [2]

52.5 (43.9–61.1) [59]

22.9 (17.0–30.1) [59]

11.4 (6.0–20.8) [18]

27.8 (23.5–32.6) [72]

43.5 (40.6–46.4) [69]

34.4 (32.2–36.8) [104]

54.7 (52.1–57.1) [113]

37.1 (35.0–39.2) [113]

7.8 (4.5–13.1) [86]

27.1 (19.4–36.6) [29]

0.0003

0.0615

0.0000

NA

0.9850

0.0002

0.0067

0.0000

0.0000

0.0129

0.0077

0.1069

0.0000

0.2016

7.1 (6.0–8.5) [42]

17.8 (15.1–20.7) [210]

11.8 (10.8–12.9) [583]

9.4 (4.0–20.3) [42]

14.5 (10.0–20.4) [83]

21.9 (16.6–28.3) [72]

24.4 (18.0–32.1) [32]

14.5 (12.2–17.2) [147]

22.5 (20.7–24.5) [111]

12.3 (11.0–13.6) [153]

20.8 (19.3–22.4) [192]

2.5 (2.0–3.2) [162]

4.1 (2.3–7.2) [148]

2.2 (0.8–6.0) [51]

7.1 (5.3–9.6) [14]

16.8 (13.5–20.8) [119]

22.5 (20.4–24.8) [213]

9.9 (4.3–21.3) [40]

9.5 (3.7–22.2) [21]

70.3 (53.3–83.1) [13]

18.2 (10.8–29.0) [14]

23.7 (19.6–28.2) [73]

19.5 (16.7–22.7) [41]

20.8 (18.0–23.8) [48]

32.9 (30.1–35.8) [77]

2.1 (1.3–3.3) [48]

8.9 (4.7–16.1) [60]

7.0 (2.5–18.0) [16]

7.1 (5.8–8.8) [28]

17.3 (13.4–21.9) [88]

5.7 (4.9–6.8) [366]

* [2]

16.1 (10.8–23.4) [62]

11.7 (7.5–17.7) [59]

29.0 (20.0–40.1) [18]

5.6 (3.7–8.5) [74]

24.3 (21.9–26.8) [70]

7.6 (6.4–9.0) [104]

12.8 (11.2–14.6) [114]

2.7 (2.0–3.5) [114]

0.7 (0.2–2.9) [86]

[35]

0.0

(continued)

1.0000

0.8741

0.0000

NA

0.2188

0.0000

0.1156

0.0000

0.0159

0.0000

0.0000

0.3477

0.0047

0.0528

392


2007

Slovenia

2007

2007

2007

2008

2008

2008

2009

2006

2008

2008

2008

Argentina

Bolivia

Brazil (Rio de Janeiro)

Chile

Cuba (Havana)

Guatemala

Guyana

Mexico

Panama

Paraguay

Uruguay

REGION OF THE AMERICAS (AMR)

Year

Country (Site)

38.9 (35.9–42.0) [95]

16.6 (14.7–18.7) [147]

15.8 (11.8–20.8) [57]

42.8 (37.8–47.9) [1,291]

15.4 (10.2–22.5) [13]

18.7 (14.9–23.3) [98]

26.4 (23.1–30.0) [144]

44.4 (42.4–46.4) [782]

20.0 (17.7–22.5) [303]

38.7 (38.0–39.3) [1,584]

38.3 (35.9–40.8) [233]

17.9 (14.8–21.6) [39]


32.0 (26.5–38.0) [25]

25.3 (20.9–30.4) [33]

16.5 (9.9–26.2) [18]

48.0 (41.9–54.3) [395]

* [4]

37.6 (27.5–48.9) [23]

38.6 (32.0–45.8) [44]

41.7 (38.8–44.7) [357]

24.4 (20.2–29.2) [94]

51.3 (50.2–52.4) [630]

38.7 (34.5–43.2) [75]

* [5]

41.4 (37.8–45.1) [70]

13.7 (11.8–16.0) [114]

15.5 (10.8–21.6) [39]

40.5 (35.2–46.0) [879]

* [9]

13.0 (9.4–17.8) [75]

21.0 (17.4–25.1) [100]

46.5 (43.8–49.3) [425]

18.3 (15.7–21.3) [205]

30.2 (29.4–31.0) 951]

38.0 (35.0–41.0) [156]

17.6 (14.3–21.5) [34]

Current Cigarette Smokers Male % Female % (95% CI) (95% CI) [n] [n]

0.0075

0.0000

0.8257

0.0256

NA

0.0001

0.0000

0.0195

0.0245

0.0000

0.7807

NA

P-Value

7.4 (5.9–9.2) [95]

6.7 (5.5–8.1) [147]

5.3 (3.1–8.9) [56]

3.9 (3.3–4.7) [1,298]

[13]

0.0

9.9 (7.1–13.6) [99]

4.8 (3.4–6.8) [146]

7.1 (6.2–8.2) [792]

10.5 (8.8–12.5) [304]

11.6 (11.2–12.0) [1,653]

5.5 (4.5–6.8) [237]

[39]

0.0


12.0 (8.6–16.6) [25]

7.4 (4.8–11.2) [33]

5.6 (2.2–13.3) [18]

8.6 (7.0–10.5) [401]

* [4]

24.4 (16.2–35.0) [24]

8.7 (5.5–13.5) [46]

9.4 (7.9–11.1) [361]

18.1 (14.4–22.7) [94]

16.4 (15.6–17.1) [663]

13.1 (10.4–16.4) [77]

* [5]

5.7 (4.2–7.7) [70]

6.4 (5.1–8.0) [114]

5.2 (2.7–9.7) [38]

1.7 (1.0–3.2) [880]

* [9]

5.4 (3.1–9.0) [75]

3.0 (1.7–5.1) [100]

5.3 (4.2–6.7) [431]

7.2 (5.6–9.3) [206]

8.4 (7.9–8.8) [987]

1.9 (1.2–2.9) [158]

[34]

0.0

Currently Use Other Tobacco Products Male % Female % (95% CI) (95% CI) [n] [n]

Table 3. Prevalence of current tobacco use, by gender, region, and country, Dental Global Health Professions Student Survey, 2005–09 (continued)

0.0051

0.5668

0.8913

0.0012

NA

0.0003

0.0092

0.0001

0.0000

0.0000

0.0000

NA

P-Value


393

2009

2007

2009

2005

2006

India

Indonesia

Myanmar

Nepal

Thailand

2009

2009

2007

2009

Fiji

Lao People’s Democratic Republic

Mongolia

Papua New Guinea

9.1 (4.7–16.9) [11]

33.3 [138]

7.9 (7.1–8.8) [63]

14.3 (8.3–23.4) [14]

2.1 (1.0–4.5) [47]

3.9 (3.5–4.3) [411]

17.3 (14.0–21.2) [84]

34.4 (31.5–37.4) [258]

10.6 (9.6–11.7) [748]

6.5 (3.8–10.8) [689]

20.9 (19.2–22.6) [316]

*Cell size