Smoking among future doctors in a "no-smoking" university campus in Karachi, Pakistan: issues of tobacco control.

Objective: To determine the level of tobacco-related attitudes and practices among medical students who study in a designated 'No-Smoking University' in Pakistan's largest city, Karachi. It further highlighted some challenges for tobacco control at the university. Methods: The study design adopted mixed methods. It commenced with an initial qualitative phase using indepth interviews with medical students and university staff to refine and expand areas of enquiry for the development of a structured cross-sectional survey among second and fifth (final) year students. Thematic analysis was used to analyse qualitative data, while descriptive statistics and various statistical tests were applied to investigate differences along a number of parameters in the survey data. Results: Overall smoking prevalence across both years was 14.5%; however, there was a sharp disparity along sex lines, with 32% of males and just 1% of females self-identifying as current or occasional smokers. Importantly, the majority of smokers initiated smoking after starting their medical education. Despite students' expressed expectations that they can and should be future non-smoking role models and advocates, their actual knowledge and practices - for males at least - were disappointing. Significantly fewer second year than final year students knew that Hamdard had been designated a 'No-Smoking University', and about half of the participants believed the university had 'effectively' controlled tobacco use on campus. A large majority supported stronger tobacco control measures at the university and in the wider society. Conclusion: This study highlights weaknesses in the measures taken for tobacco control on the university campus through the picture it provides of the presence of tobacco use, the on-campus initiation of smoking and the increase in smoking rates among final year students by comparison to those in the initial years of medical studies .