Tobacco use is the most preventable cause of death and disability in modern societies. Worldwide, there are 4 million tobacco-related deaths annually, and 30% of all cancer is linked to tobacco use [1, 2] . Available evidence suggests that the risk of disease increases with greater use of tobacco whereas quitting smoking can result in de-creasing that risk [3] . Tobacco is also a signifi cant risk factor for oral diseases such as periodontal disease, ulcers, cleft lip and palate, and coronal and root caries. Wound healing, dental implants, cosmetic treatments and cancer therapy all are compromised by patients’ tobacco con-sumption [4, 5] . Cigarette smoking was found to be nega-tively associated with oral health status (periodontal dis-ease, missing teeth, and decayed teeth) regardless of the dental health behavior of the patient [6] . Moreover, re-search showed that tobacco users brushed and fl ossed their teeth less frequently and had more oral health prob-lems than the nonusers
Alomari/Barrieshi-Nusair/SaidMed Princ Pract 2006;15:195–199 196Signs of smoking such as odor, tooth stain, poor oral hygiene, and the aforementioned oral diseases make to-bacco use very obvious to dentists. The typical dental ap-pointment is usually long, affording opportunity for den-tist-patient discussion of tobacco use and its conse-quences [8] . In the US, when dentists were asked if they thought that they should encourage their patients to stop smoking, over two thirds responded in the affi rmative [9] . Yet only one third of them believed that they were effec-tive in this area and only about one quarter of current smokers received advice from their dentists to quit using tobacco [10] . Fewer than 10% of US dentists reported that they had adequate knowledge of smoking cessation tech-niques [11, 12] . Indications from published studies are that health pro-fessionals who smoke may not be as effective in counsel-ing patients to quit smoking as health professionals who do not smoke [13, 14] . The help and advice of health pro-fessionals in smoking cessation are very important, yet many oral health professionals continue to smoke. Den-tists must set an example as a role model for their patients, families and friends by not smoking. Despite acquiring an increased knowledge about risk factors and the pathogenesis of tobacco-related diseases during their healthcare professional education, students begin or continue to smoke during their studies at univer-sity. The purpose of this study was to examine the preva-lence of smoking among dental students in Jordan and document the effects of smoking on students’ dental health attitudes and behavior
Results
Of a total of 375 dental students, 314 (83.7%) com-pleted the questionnaire. The distribution of the partici-pating students by academic year and gender is presented in table 2 . The participation rate was not different be-tween the academic years, ranging from 81 to 88%. As shown in table 3 , the percentage of male student smokers was 31% while it was only 4.3% for females. Of the smokers, only 11.4% smoke 10 cigarettes or more per day. About 15% have been smoking for more than a year from the date of the questionnaire.
This study used the general approach in attitudes/be-havior measurements to compare dental student smok-ers’ and nonsmokers’ dental health attitudes and behav-ior. All items of the survey had a dichotomous response format (yes/no). This questionnaire was recently used to compare oral health attitudes and behaviors among den-tal and dental hygiene students throughout the world [17–20] . In a sample of Japanese university students, the HU-DBI had good test-retest reliability over a 4-week period [21] . The English version has also shown good test-retest
eliability and translation validity in a sample of 26 bi-lingual individuals [22] . Translation of HU-DBI survey from English to Arabic was not needed as students start-ed their English early in elementary school and because English is the language of instruction at the dental school. Translation might indirectly infl uence the results, which would prevent comparing our study to other studies. The questionnaire was modifi ed to be more suitable to our students and culture. Participation in the survey was voluntary. While some of the students were absent on the day of the survey dis-tribution, very few chose not to participate. The partici-pation rate (83.7%) was considered good for the purpose of the survey. Haddad and Malak [23] reported that the prevalence of smoking among the general student population at Jor-dan University of Science and Technology was approxi-mately 30; 50 and 7% for males and females, respective-ly. Our study showed that the prevalence of smoking among dental students was lower than that among other students at Jordan University of Science and Technology. This may be due to the fact that dental students are ex-pected to be more knowledgeable about the health risk associated with tobacco use. A study by Burgan [24] in 2003 found that 35% of Jor-danian dentists were tobacco users; 83% were daily smok-ers and about 20% smoked 20 or more cigarettes per day. Two thirds were men younger than 40 years of age who worked in private practice. In comparison to our study, it is clear that smoking is less prevalent among dental stu-dents than dentists. It is probable that dentists have more expendable income. The prevalence of smoking among Jordanian dental students was much higher than that in the region [25] and in developed countries [26] . The probable explanation for the high rate of smoking among our students may be due to cultural behavior and people’s perception of smokers in society. Considerable effort needs to be made towards changing our dental students’ smoking habit so that they become role models for their society. Despite the fact that the students acquire knowledge about tobacco-related diseases, they continue to smoke during their studies at the university. Research showed smoking to be more frequent among male students com-pared to female students [27] and to rise progressively with age and level of education [28] . This is in agreement with the results of our study, as smoking was more prev-alent among male students than females. It was obvious that prevalence of smoking decreased with progression of the students in their academic studies: 33.3% fi rst-year students compared to 3.7% in the fourth year. However, smoking prevalence increased again among the fi nal-year students. The reason for this is diffi cult to explain, but one might suggest it is due to the different kinds of stress and tension that the students are exposed to during their fi nal year at the university. In general, the results of previous studies [29] showed that nonsmokers have more healthy dental behaviors than smokers. According to our results, except for the fre-quency of toothbrushing, there was no difference between smokers and nonsmokers in their dental health behavior. There was no difference in fl ossing or using mouthwash between the two groups. On the other hand, smokers showed worse dental health attitudes. They were less con-cerned about the health of their gums and the color of their teeth than nonsmokers. Also, they were not worried about having bad breath. Reviewing the dental school’s curriculum showed that smoking education was part of a preventive dentistry course which is taught to the students at the third year. We strongly recommend that the curriculum involve the-oretical and practical education about risks of smoking for oral health throughout the 5 years of dental education. Obligatory workshops should be held for all students to learn about smoking and smoking cessation within the framework of preventive courses. In addition, selected students should be encouraged to undertake studies on smoking and oral health as part of their research. Students can also practice their skills on tobacco counseling on each other. A class summarizing the topic of smoking and oral health could be added to the fi nal-year curriculum
References
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