PubL Hlth, Lond. (1975) 89, 199-205
Tobacco-smoking in a University Community Charles N. Brown
Honorary Research Fe//ow, Hea/th Centre, Reading University and Alexander D. G. Gunn
Director, University Hea/th Service, Reading An investigation into the knowledge of, and attitudes towards, the hazard to health of tobacco smoking was undertaken in a university community, whose members should be well-informed on matters of public importance. An estimatewas made of the percentage of smokers in both academic staff and students and their smoking habits. The results suggest that those who responded to the questionnaire accept that smokers incur a risk to health and are almost all aware of the major risk of lung cancer. On the other risks, and particularly those that have been the subject of recent publicity, they are less well-informed. The proportion of smokers is below the national average and comparable with the rate in the medical profession.
Introduction The medical profession has often been accused of failing to communicate effectively with its patients on matters affecting their health. Yet it is difficult to believe that this accusation could be upheld on the subject of tobacco-smoking, where so much effort, information and publicity has been expended, provided, and directed towards informing the public on the concomitant risks of the habit. Other surveys (McKennel & Thomas, 1967; Brynner, 1969) have concentrated on nonspecific groups of the population but this investigation was undertaken to find out how wellinformed on the risks of smoking is a university community, and to assess thereby the effectiveness of the general public's health education on this special group of the population. Attitudes to the use of tobacco were also assessed. The University of Reading was considered particularly suitable for the study. It has no schools of medicine or pharmacy and, except for the doctors working at the health centre, only one member of the academic staff with a medical qualification who, for this reason, was excluded from those to whom the questionnaire was sent. The influences assessed, therefore, are those of the normal media of communication on any (assumedly) intelligent, perceptive and educated section of the population.
Method of Sampling (1) Academic staff Only about one in eight of the academic staff are women and the staffs of the Faculties of Science and Agriculture outnumber those of the Faculty of Letters (Arts) by about two to one. F r o m a list of 900 names provided by the Registrar, 600 were selected for the distribution of questionnaires, equally divided between "arts" and "science".
200
C. N. Brown and A. D. G. Gunn
(2) Students Again the terms of reference were to find an equal number of men and women reading science-based ("Science" group) and other subjects ("arts" group), and 550 questionnaires were so distributed. Form of questionnaire The form was divided into two parts (see Appendix) and for reasons of confidentiality no record of names was kept of those who received, or who replied to, the form. Part A, for completion by all, asked for sources of information on smoking and its risks to health. A list of diseases which the respondent thought might be due to smoking was asked for, an estimate of the increased risk of these diseases resulting from the regular smoking of 20 or more cigarettes daily, a note of relatives who had died from diseases which may be caused by smoking, and details of age, sex and academic status. Part B was for smokers only. It included questions about the form of tobacco-smoking, i.e. pipe, cigar or cigarette; quantity and type of cigarette--"filter tip", "low tar", or "plain"; age at starting; family smoking ~ habits and details of any attempts to give up. They were also invited to give their reasons for smoking from a choice of "positive pleasure", "relief of tension", habit", "social aid" and "other". ~ Results Academic staff A total of 405 (68 ~ ) forms were returned by the staff group. The number of smokers, and particularly of heavy cigarette smokers, in the group of 405 analysed is remarkably low; 63 (16 ~ ) use cigarettes and 52 (13 ~ ) cigars and pipes only, giving a total of 29 ~ for all smokers (Table 1). TABLE 1. Academic staff: distribution and age group of smokers and non-smokers Type of smoker Age group 20-30 3140 41-50 51-60 Over60 ? Total
Cig.
C/P
Non
Total
14 16 17 12 3 1 63
12 12 17 6 4 1 52
57 92 77 39 14 11 290
83 120 111 57 21 13 405
Cig., Cigarette smokers. C/P, smokers of cigars or pipes only.
Students The percentage of forms returned was also similar at 360 (64 ~). The results were similar to those from the staff, 69 (19 ~ ) use cigarettes and 10 (3 ~ ) cigars and pipes only, giving a total of 22 ~ for all smokers (Table 2). (1) Accuracy of i n formation o~ health hazards The question which asked for a list of diseases which may be caused by smoking was not multiple choice and no clues were given on the form. The replies are reported as they were described by the participants (Tables 3 and 4). Both academic staff and students listed either cancer or lung cancer as the commonest health hazard (99 ~ staff, 99 ~ students). Specific cancers other than lung, mostly of the mouth, lip and throat were mentioned by a few individuals from both groups.
Tobacco-smoking in a university community
201
TABLE 2. S t u d e n t s : d i s t r i b u t i o n o f s m o k e r s a n d n o n smokers Smoking category Non-smokers Cigarette smokers Cigar/pipe smokers Total
Males
Females
Total
155 40 10 205
124 29 -153
279 69 10 358
TABLE 3. A c a d e m i c s t a f f : d i s e a s e s w h i c h r e s p o n d e n t s caused or aggravated by smoking
Disease Group total
Nonsmokers 342
Cancer (general) or other than lung Lung cancer Respiratory diseases (general) Bronchitis Emphysema Asthma Pneumonia Tuberculosis Heart disease (general) Coronary artery disease Atberosclerosis Hypertension Cardio-vascular disease Circulatory and peripheral vascular disease Thromboangiitis Thrombosis Foetal/neonatal damage E.N.T. infections Digestive disorders Gastric ulcer Cerebral haemorrhage Liver disease Faulty metabolism Nicotine poisoning Blood diseases Leukaemia Amblyopia Nutritional diseases Drug addiction Immune deficiency Kidney disease Diabetes Mental diseases Headaches Suffocation Poverty Selfishness
thought
may be
Cigar/pipe smokers 52
Cigarette smokers 63
Total
106 207 61 168 3 8 2 2 130 20 5 7 6
18 39 10 23 4 ---20 9 2 1 1
19 46 13 33 3 ---33 9 1 2 2
143 293 84 224 10 8 2 2 183 38 8 10 9
9 1 1 16 5 6 2 1 1 1 .1 1 1 1 1 1 1 --1 -1 -1
--2 1 3 1 --------------1 -1 --
3 --3 2 -3 ----------1 1 ------
12 1 3 20 10 7 5 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
405
C. N. Brown and A. D. G. Gunn
202
Neither staff n o r students seem to be as aware of the risk of respiratory diseases other t h a n cancer. A p p r o x i m a t e l y 72 ~ of students a n d 78 ~ of staff listed bronchitis a n d other n o n m a l i g n a n t respiratory tract disorders. TABLE4. Students: diseases which respondents thought may be caused or aggravated by smoking Non-
Disease
Group total
Cancer (general) or other than Lung Lung cancer Respiratory diseases (general) Bronchitis Emphysema Asthma Pneumonia (including pleurisy) Tuberculosis Heart disease (general) Coronary artery disease (including angina and "hear t attack") Atherosclerosis Hypertension Thrombosis Peripheral vascular disease Foetal/neonatal damage (including miscarriage) Digestive (including peptic ulcer) E.N.T. infections Liver disease Nervous diseases (including anxiety and depression) Blood diseases/leukaemia Nicotine poisoning Metabolic dysfunction Hyperthermia Decreased virility Venereal disease Poverty Bad breath None
smokers 281
Smokers 79
Total 360
125 170 50 154 6 3 10 4 68
26 51 10 44 2 4 3 1 25
151 221 60 198 8 7 13 5 93
12 6 4 2 2
6 2 3 8 --
18 8 7 10 2
14 5 2 2
3 1 4 --
17 6 6 2
5 3 5 1 -1 ---2
----1 1 2 1 1 --
5 3 5 1 1 2 2 1 1 2
H e a r t diseases were even less often m e n t i o n e d , although more often by staff (60 ~ ) than by students (33 ~ ) . Specific reference to c o r o n a r y artery a n d ischaemic heart disease was rather rare, even in the staff cigarette smoker group, who might be expected to be more aware of it, because of their progressing age.
(2) Attitudes and habits of smoking (a) Risk acceptance. A n u m b e r of respondents accepted s m o k i n g as a factor c o n t r i b u t i n g to the diseases which they listed, b u t n o t as a possible cause. Only four staff m e m b e r s said they were not convinced of a risk to health from smoking, all of them heavy cigarette smokers from the older age groups. A m o n g the students, eight of them apparently r e m a i n u n convinced, four of w h o m smoke less t h a n 10 a n d four more t h a n 16 cigarettes daily. (b) Desire to stop. A little over half in the "staff cigarette" a n d " s t u d e n t s m o k e r " classes a n d rather more in the staff "cigar/pipe" group say that they do not want to stop smoking.
Tobacco-smoking in a university community
203
A few of them are included in the 27 (43 %) of the staff and 39 (56 %) of students who have tried to give up in the past. The staff were rather more successful than the students, where they had tried to, 20 abstaining for 3 months or more before returning to the habit; nine of the "cigar/pipe" smokers are individuals who have succeeded in abandoning cigarettes. (c) Reasons given for smoking. "Positive pleasure" was the commonest reason given for smoking, closely followed by "relief of tension". Cigarettes are used more as a "social aid" than pipes or cigars (Tables 5 and 6). Similar findings have been reported elsewhere with regard to motivation (Russell, 1971). TABLE 5. Academic staff: reasons given for smoking Reason
Total
Positive pleasure Relief of tension Habit Social aid Other--includes "sedation", "aid to concentration", "association--with coffee break" "eat less"
88 71 63 34 10
(Note: Most respondents gave more than one answer to this question) TABLE6. Students: reasons given for smoking Reason
Total
Positive pleasure Relief of tension Social aid Habit Other
49 45 35 28 9
"Other" includes: "pressure of work", "helps concentration", "to stop nail biting", "boredom", "No idea". (Note: Most respondents gave more than one answer to this question).
(d) Patterns of cigarette use. The number of cigarette smokers is slightly higher in the student than in the staff group. Smoking appears to be more common in women than in men who are members of the university staff, but about equally divided between the sexes in students. Half of the cigarette smokers smoke less than 10 per day and about 8 % are only occasional smokers. Low tar content cigarettes are used exclusively by only five of the staff and one student in these samples. The majority use filter tip brands. A total of 15 cigarette smokers, almost equally divided between staff and students and two from the "cigar/pipe" group came from non-smoking families. Deaths in relatives from causes possibly related to smoking seem to have had little influence. The age of starting showed that rather more than half of the smokers were smoking before the age of 18.
Discussion Although the percentage of non-responders does not justify a precise estimate of the incidence of smoking in the university staff and student community, the evidence suggests
204
C. N. Brown and A. D. G. Gunn
that it is lower than in the general population and comparable with that found in the medical profession. The purpose of the exercise was to assess the knowledge and the habits of a group of educated critical people, accustomed to the study and interpretation of data, and it seems that even in such a group, there are some surprising gaps in their awareness of the effects (or reported effects) of tobacco smoking. Concentration on cancer for example as a message in health education may have been successful in that the majority of the community suggested this as the first disease likely to accrue as a result of tobacco smoking. There was, nevertheless, some confusion as to where in the body this cancer might develop (Tables 3 and 4). Similarly, more respondents were aware of bronchitis as a concomitant than heart disease, and this latter--coronary artery disease--was significantly mentioned twice as often by the older age groups to whom it is a more immediate threat than it is to the young. That almost as many individuals should indicate that tobacco smoking causes tuberculosis as indicate that it causes atherosclerosis (Table 4) and that anyone should define it as a cause of venereal disease gives cause for serious concern about the ignorance of an educated community albeit one reflected in the outside population (Schofield, 1973). Surprisingly also, few references were made to the widely publicised effects of maternal smoking on the foetus, and many who did include it in their response were males. The smaller numbers who indicated diseases such as "anxiety and depression", "liver disease", "decreased virility" and "immune deficiency", etc. must be regarded as victims of half-knowledge in their incomprehension, whilst those who report "poverty", " b a d breath" and "selfishness" as consequences of tobacco smoking make justifiable conclusions even if they are not strictly defined as diseases. Finally, whilst it is reassuring to note the comparatively low incidence of tobacco usage in the academic community, it is disturbing to find that the public media of communication have inaccurately informed an educated group about the precise risks involved.
Conclusion At Reading University, the academic community, both staff and students, recognizes in the main, the health hazards of tobacco smoking and most of those who continue to smoke do so in moderation. However, some surprising gaps in awareness of all the risks which smokers take show that there is substantial room for improvement in this field of health education. If a perceptive and educated population are insufficiently aware of all the risks the general public must be presumed to be even less well-informed.
Acknowledgements We are grateful for the willing assistance of the secretarial staff of the Reading University Health Centre, particularly with the production of the questionnaire forms. It is also a pleasure to acknowledge the contribution of Mr H. E. Bell who provided the list of academic staff, the constructive criticisms and advice of certain members of that staff and the help of the volunteers who distributed forms to and collected them from their fellow students. Finally, we must thank all those, both staff and student, who took the time and trouble to answer the questions.
References McKennel, A. C. & Thomas, R. K. (1967). Adults' and Adolescents' Smoking Habits andAttitudes. Government Social Survey. London : H.M.S.O.
Tobacco-smoking in a university community
205
Brynner, J. M. (1969). The Young Smoker, A Study of Smoking Among Schoolboys. Government Social Survey. London: H.M.S.O. Russell, M. A. H. (1971). British Medical Journal, 2, 330, and 393. Schofield, M. (1973). The Sexual Behaviour of Young Adults. P. 67. Harmondsworth: Allen Lane.
A New Look at the Control of Children's Respiratory Diseases
A WHO working group on the management of respiratory diseases in children (Rotterdam, 3-7 March, 1975) has put forward the following recommendations: (1) an investigation should be carried out into the comparability of death certification and practices for coding respiratory causes of death in children: in its next version, the International Classification of Diseases should take into account the difficulties now experienced by doctors who follow current instructions on the certification of respiratory causes of death; (2) a meeting of specialists should be convened under WHO auspices to prepare a set of definitions of respiratory diseases; (3) the large number of unnecessary tonsillectomies practised in some countries should be reduced; (4) parents should receive instruction in the management and adequate follow-up of their children's diseases; (5) existing services for children with respiratory illnesses, as well as any changes that may be made in their organization, should be brought to the notice of parents, physicians and other persons involved in the care of these children. The working group also noted that many of the deficiencies in the management of respiratory illnesses result from inadequacies in medical education, at both the undergraduate and the postgraduate level. Provision should be made for training the primary care physician in the management of these illnesses. Courses should be organized to keep the specialists concerned informed about any new developments in the management of these diseases. In undergraduate medical teaching, greater emphasis should be placed upon the diagnosis and treatment of the common respiratory illnesses of childhood. Every attempt should be made to mitigate the adverse effects of poor socio-economic and domestic conditions, as well as of the general environment. Vaccines for the prevention of measles and influenza should be used more extensively to prevent recurrences of respiratory disease. Attempts to increase general, immunological resistance in children deserve further study. When parents smoke, the child is particularly at risk. Further respiratory disability evidently increases when children themselves start to smoke.
Tobacco-smoking in a University Community Charles N. Brown
Honorary Research Fe//ow, Hea/th Centre, Reading University and Alexander D. G. Gunn
Director, University Hea/th Service, Reading An investigation into the knowledge of, and attitudes towards, the hazard to health of tobacco smoking was undertaken in a university community, whose members should be well-informed on matters of public importance. An estimatewas made of the percentage of smokers in both academic staff and students and their smoking habits. The results suggest that those who responded to the questionnaire accept that smokers incur a risk to health and are almost all aware of the major risk of lung cancer. On the other risks, and particularly those that have been the subject of recent publicity, they are less well-informed. The proportion of smokers is below the national average and comparable with the rate in the medical profession.
Introduction The medical profession has often been accused of failing to communicate effectively with its patients on matters affecting their health. Yet it is difficult to believe that this accusation could be upheld on the subject of tobacco-smoking, where so much effort, information and publicity has been expended, provided, and directed towards informing the public on the concomitant risks of the habit. Other surveys (McKennel & Thomas, 1967; Brynner, 1969) have concentrated on nonspecific groups of the population but this investigation was undertaken to find out how wellinformed on the risks of smoking is a university community, and to assess thereby the effectiveness of the general public's health education on this special group of the population. Attitudes to the use of tobacco were also assessed. The University of Reading was considered particularly suitable for the study. It has no schools of medicine or pharmacy and, except for the doctors working at the health centre, only one member of the academic staff with a medical qualification who, for this reason, was excluded from those to whom the questionnaire was sent. The influences assessed, therefore, are those of the normal media of communication on any (assumedly) intelligent, perceptive and educated section of the population.
Method of Sampling (1) Academic staff Only about one in eight of the academic staff are women and the staffs of the Faculties of Science and Agriculture outnumber those of the Faculty of Letters (Arts) by about two to one. F r o m a list of 900 names provided by the Registrar, 600 were selected for the distribution of questionnaires, equally divided between "arts" and "science".
200
C. N. Brown and A. D. G. Gunn
(2) Students Again the terms of reference were to find an equal number of men and women reading science-based ("Science" group) and other subjects ("arts" group), and 550 questionnaires were so distributed. Form of questionnaire The form was divided into two parts (see Appendix) and for reasons of confidentiality no record of names was kept of those who received, or who replied to, the form. Part A, for completion by all, asked for sources of information on smoking and its risks to health. A list of diseases which the respondent thought might be due to smoking was asked for, an estimate of the increased risk of these diseases resulting from the regular smoking of 20 or more cigarettes daily, a note of relatives who had died from diseases which may be caused by smoking, and details of age, sex and academic status. Part B was for smokers only. It included questions about the form of tobacco-smoking, i.e. pipe, cigar or cigarette; quantity and type of cigarette--"filter tip", "low tar", or "plain"; age at starting; family smoking ~ habits and details of any attempts to give up. They were also invited to give their reasons for smoking from a choice of "positive pleasure", "relief of tension", habit", "social aid" and "other". ~ Results Academic staff A total of 405 (68 ~ ) forms were returned by the staff group. The number of smokers, and particularly of heavy cigarette smokers, in the group of 405 analysed is remarkably low; 63 (16 ~ ) use cigarettes and 52 (13 ~ ) cigars and pipes only, giving a total of 29 ~ for all smokers (Table 1). TABLE 1. Academic staff: distribution and age group of smokers and non-smokers Type of smoker Age group 20-30 3140 41-50 51-60 Over60 ? Total
Cig.
C/P
Non
Total
14 16 17 12 3 1 63
12 12 17 6 4 1 52
57 92 77 39 14 11 290
83 120 111 57 21 13 405
Cig., Cigarette smokers. C/P, smokers of cigars or pipes only.
Students The percentage of forms returned was also similar at 360 (64 ~). The results were similar to those from the staff, 69 (19 ~ ) use cigarettes and 10 (3 ~ ) cigars and pipes only, giving a total of 22 ~ for all smokers (Table 2). (1) Accuracy of i n formation o~ health hazards The question which asked for a list of diseases which may be caused by smoking was not multiple choice and no clues were given on the form. The replies are reported as they were described by the participants (Tables 3 and 4). Both academic staff and students listed either cancer or lung cancer as the commonest health hazard (99 ~ staff, 99 ~ students). Specific cancers other than lung, mostly of the mouth, lip and throat were mentioned by a few individuals from both groups.
Tobacco-smoking in a university community
201
TABLE 2. S t u d e n t s : d i s t r i b u t i o n o f s m o k e r s a n d n o n smokers Smoking category Non-smokers Cigarette smokers Cigar/pipe smokers Total
Males
Females
Total
155 40 10 205
124 29 -153
279 69 10 358
TABLE 3. A c a d e m i c s t a f f : d i s e a s e s w h i c h r e s p o n d e n t s caused or aggravated by smoking
Disease Group total
Nonsmokers 342
Cancer (general) or other than lung Lung cancer Respiratory diseases (general) Bronchitis Emphysema Asthma Pneumonia Tuberculosis Heart disease (general) Coronary artery disease Atberosclerosis Hypertension Cardio-vascular disease Circulatory and peripheral vascular disease Thromboangiitis Thrombosis Foetal/neonatal damage E.N.T. infections Digestive disorders Gastric ulcer Cerebral haemorrhage Liver disease Faulty metabolism Nicotine poisoning Blood diseases Leukaemia Amblyopia Nutritional diseases Drug addiction Immune deficiency Kidney disease Diabetes Mental diseases Headaches Suffocation Poverty Selfishness
thought
may be
Cigar/pipe smokers 52
Cigarette smokers 63
Total
106 207 61 168 3 8 2 2 130 20 5 7 6
18 39 10 23 4 ---20 9 2 1 1
19 46 13 33 3 ---33 9 1 2 2
143 293 84 224 10 8 2 2 183 38 8 10 9
9 1 1 16 5 6 2 1 1 1 .1 1 1 1 1 1 1 --1 -1 -1
--2 1 3 1 --------------1 -1 --
3 --3 2 -3 ----------1 1 ------
12 1 3 20 10 7 5 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
405
C. N. Brown and A. D. G. Gunn
202
Neither staff n o r students seem to be as aware of the risk of respiratory diseases other t h a n cancer. A p p r o x i m a t e l y 72 ~ of students a n d 78 ~ of staff listed bronchitis a n d other n o n m a l i g n a n t respiratory tract disorders. TABLE4. Students: diseases which respondents thought may be caused or aggravated by smoking Non-
Disease
Group total
Cancer (general) or other than Lung Lung cancer Respiratory diseases (general) Bronchitis Emphysema Asthma Pneumonia (including pleurisy) Tuberculosis Heart disease (general) Coronary artery disease (including angina and "hear t attack") Atherosclerosis Hypertension Thrombosis Peripheral vascular disease Foetal/neonatal damage (including miscarriage) Digestive (including peptic ulcer) E.N.T. infections Liver disease Nervous diseases (including anxiety and depression) Blood diseases/leukaemia Nicotine poisoning Metabolic dysfunction Hyperthermia Decreased virility Venereal disease Poverty Bad breath None
smokers 281
Smokers 79
Total 360
125 170 50 154 6 3 10 4 68
26 51 10 44 2 4 3 1 25
151 221 60 198 8 7 13 5 93
12 6 4 2 2
6 2 3 8 --
18 8 7 10 2
14 5 2 2
3 1 4 --
17 6 6 2
5 3 5 1 -1 ---2
----1 1 2 1 1 --
5 3 5 1 1 2 2 1 1 2
H e a r t diseases were even less often m e n t i o n e d , although more often by staff (60 ~ ) than by students (33 ~ ) . Specific reference to c o r o n a r y artery a n d ischaemic heart disease was rather rare, even in the staff cigarette smoker group, who might be expected to be more aware of it, because of their progressing age.
(2) Attitudes and habits of smoking (a) Risk acceptance. A n u m b e r of respondents accepted s m o k i n g as a factor c o n t r i b u t i n g to the diseases which they listed, b u t n o t as a possible cause. Only four staff m e m b e r s said they were not convinced of a risk to health from smoking, all of them heavy cigarette smokers from the older age groups. A m o n g the students, eight of them apparently r e m a i n u n convinced, four of w h o m smoke less t h a n 10 a n d four more t h a n 16 cigarettes daily. (b) Desire to stop. A little over half in the "staff cigarette" a n d " s t u d e n t s m o k e r " classes a n d rather more in the staff "cigar/pipe" group say that they do not want to stop smoking.
Tobacco-smoking in a university community
203
A few of them are included in the 27 (43 %) of the staff and 39 (56 %) of students who have tried to give up in the past. The staff were rather more successful than the students, where they had tried to, 20 abstaining for 3 months or more before returning to the habit; nine of the "cigar/pipe" smokers are individuals who have succeeded in abandoning cigarettes. (c) Reasons given for smoking. "Positive pleasure" was the commonest reason given for smoking, closely followed by "relief of tension". Cigarettes are used more as a "social aid" than pipes or cigars (Tables 5 and 6). Similar findings have been reported elsewhere with regard to motivation (Russell, 1971). TABLE 5. Academic staff: reasons given for smoking Reason
Total
Positive pleasure Relief of tension Habit Social aid Other--includes "sedation", "aid to concentration", "association--with coffee break" "eat less"
88 71 63 34 10
(Note: Most respondents gave more than one answer to this question) TABLE6. Students: reasons given for smoking Reason
Total
Positive pleasure Relief of tension Social aid Habit Other
49 45 35 28 9
"Other" includes: "pressure of work", "helps concentration", "to stop nail biting", "boredom", "No idea". (Note: Most respondents gave more than one answer to this question).
(d) Patterns of cigarette use. The number of cigarette smokers is slightly higher in the student than in the staff group. Smoking appears to be more common in women than in men who are members of the university staff, but about equally divided between the sexes in students. Half of the cigarette smokers smoke less than 10 per day and about 8 % are only occasional smokers. Low tar content cigarettes are used exclusively by only five of the staff and one student in these samples. The majority use filter tip brands. A total of 15 cigarette smokers, almost equally divided between staff and students and two from the "cigar/pipe" group came from non-smoking families. Deaths in relatives from causes possibly related to smoking seem to have had little influence. The age of starting showed that rather more than half of the smokers were smoking before the age of 18.
Discussion Although the percentage of non-responders does not justify a precise estimate of the incidence of smoking in the university staff and student community, the evidence suggests
204
C. N. Brown and A. D. G. Gunn
that it is lower than in the general population and comparable with that found in the medical profession. The purpose of the exercise was to assess the knowledge and the habits of a group of educated critical people, accustomed to the study and interpretation of data, and it seems that even in such a group, there are some surprising gaps in their awareness of the effects (or reported effects) of tobacco smoking. Concentration on cancer for example as a message in health education may have been successful in that the majority of the community suggested this as the first disease likely to accrue as a result of tobacco smoking. There was, nevertheless, some confusion as to where in the body this cancer might develop (Tables 3 and 4). Similarly, more respondents were aware of bronchitis as a concomitant than heart disease, and this latter--coronary artery disease--was significantly mentioned twice as often by the older age groups to whom it is a more immediate threat than it is to the young. That almost as many individuals should indicate that tobacco smoking causes tuberculosis as indicate that it causes atherosclerosis (Table 4) and that anyone should define it as a cause of venereal disease gives cause for serious concern about the ignorance of an educated community albeit one reflected in the outside population (Schofield, 1973). Surprisingly also, few references were made to the widely publicised effects of maternal smoking on the foetus, and many who did include it in their response were males. The smaller numbers who indicated diseases such as "anxiety and depression", "liver disease", "decreased virility" and "immune deficiency", etc. must be regarded as victims of half-knowledge in their incomprehension, whilst those who report "poverty", " b a d breath" and "selfishness" as consequences of tobacco smoking make justifiable conclusions even if they are not strictly defined as diseases. Finally, whilst it is reassuring to note the comparatively low incidence of tobacco usage in the academic community, it is disturbing to find that the public media of communication have inaccurately informed an educated group about the precise risks involved.
Conclusion At Reading University, the academic community, both staff and students, recognizes in the main, the health hazards of tobacco smoking and most of those who continue to smoke do so in moderation. However, some surprising gaps in awareness of all the risks which smokers take show that there is substantial room for improvement in this field of health education. If a perceptive and educated population are insufficiently aware of all the risks the general public must be presumed to be even less well-informed.
Acknowledgements We are grateful for the willing assistance of the secretarial staff of the Reading University Health Centre, particularly with the production of the questionnaire forms. It is also a pleasure to acknowledge the contribution of Mr H. E. Bell who provided the list of academic staff, the constructive criticisms and advice of certain members of that staff and the help of the volunteers who distributed forms to and collected them from their fellow students. Finally, we must thank all those, both staff and student, who took the time and trouble to answer the questions.
References McKennel, A. C. & Thomas, R. K. (1967). Adults' and Adolescents' Smoking Habits andAttitudes. Government Social Survey. London : H.M.S.O.
Tobacco-smoking in a university community
205
Brynner, J. M. (1969). The Young Smoker, A Study of Smoking Among Schoolboys. Government Social Survey. London: H.M.S.O. Russell, M. A. H. (1971). British Medical Journal, 2, 330, and 393. Schofield, M. (1973). The Sexual Behaviour of Young Adults. P. 67. Harmondsworth: Allen Lane.
A New Look at the Control of Children's Respiratory Diseases
A WHO working group on the management of respiratory diseases in children (Rotterdam, 3-7 March, 1975) has put forward the following recommendations: (1) an investigation should be carried out into the comparability of death certification and practices for coding respiratory causes of death in children: in its next version, the International Classification of Diseases should take into account the difficulties now experienced by doctors who follow current instructions on the certification of respiratory causes of death; (2) a meeting of specialists should be convened under WHO auspices to prepare a set of definitions of respiratory diseases; (3) the large number of unnecessary tonsillectomies practised in some countries should be reduced; (4) parents should receive instruction in the management and adequate follow-up of their children's diseases; (5) existing services for children with respiratory illnesses, as well as any changes that may be made in their organization, should be brought to the notice of parents, physicians and other persons involved in the care of these children. The working group also noted that many of the deficiencies in the management of respiratory illnesses result from inadequacies in medical education, at both the undergraduate and the postgraduate level. Provision should be made for training the primary care physician in the management of these illnesses. Courses should be organized to keep the specialists concerned informed about any new developments in the management of these diseases. In undergraduate medical teaching, greater emphasis should be placed upon the diagnosis and treatment of the common respiratory illnesses of childhood. Every attempt should be made to mitigate the adverse effects of poor socio-economic and domestic conditions, as well as of the general environment. Vaccines for the prevention of measles and influenza should be used more extensively to prevent recurrences of respiratory disease. Attempts to increase general, immunological resistance in children deserve further study. When parents smoke, the child is particularly at risk. Further respiratory disability evidently increases when children themselves start to smoke.
