U.S. medical students' personal and clinical tobacco- and alcohol-related practices

Purpose: Medical students' tobacco- and alcohol-related practices particularly matter because practicing physicians' personal tobacco and alcohol use predicts their tobacco and alcohol counseling, but the point at which this relationship develops is unknown.Methods: Students at 16 nationally-representative U.S. medical schools completed questionnaires at freshman orientation (n=1,818), entrance to wards (n=1,601), and senior year (n=1,428) in 2003 (response rate 80%). Results: 6% of women and 8% of men currently regularly smoked cigarettes, 78% reported drinking alcohol in the past month, and 34% drank excessively; these proportions changed little during medical school. In multivariate models, more training in smoking cessation and strongly agreeing that physicians should promote prevention significantly predicted both higher perceived counseling relevance and reported frequency. Intention to practice primary care predicted perceived smoking counseling relevance (OR=3.5, 95% CI 2.5-4.9), and tobacco users were 77% (95% CI: 64%-94%) as likely as non-users to usually/always counsel on smoking cessation. Extensive training in alcohol counseling doubled the likelihood of seniors' reporting that alcohol counseling would be relevant to their practice, and reporting currently frequently counseling patients about alcohol. Conclusions: U.S. medical students are far less likely to smoke than other young adults (25% for all U.S. women and 29% for men), but their binge drinking prevalence is similar to previous studies of comparably-aged U.S. adults (32%). Consistent with prior literature in practicing physicians, students' personal habits were also associated with their frequency of patient counseling.