| Background: The epidemic of tobacco and alcohol is a major public health issue in the world.According to the 2017 World Health Organization Tobacco fact sheet,more than 7 million people died of tobacco use each year in the world,of which more than 6 million were directly tobacco using and 890 thousand were exposed to secondhand smoke.Smoking is the second leading risk factor for premature death and disability worldwide.The World Health Organization released a global status report on alcohol and health in 2014,which shows that around 3.3 million people died from alcohol use each year globally,accounting for 5.9% of all deaths(AIDS 2.8%,violence 0.9%,Tuberculosis 1.7%),accounting for 5.1% of the global disease burden.Harmful use of alcohol is the fifth leading risk factor for premature death and disability worldwide.At present,the number of people who are smoking and drinking in China is numerous and the consequences are serious.Medical students,as the future medical personnel,play an exemplary role in the prevention and control of tobacco and alcohol epidemics.The study found that the smoking and drinking habits of medical personnel affect their own health and their ability to properly care for the patient.Foreign scholars have conducted in-depth studies on the smoking and drinking conditions of medical students.In China,there are few domestic studies and a lack of accurate assessment scales.The aim of this study was to use the Fagerstrom Test for Nicotine Dependence(FTND)and the Alcohol Use Disorders Identification Test(AUDIT)to develop an epidemiological survey about medical students with tobacco dependence and alcohol use disorders,analysis the medical students' status of tobacco dependence and alcohol use disorders and related factors and propose some pointed strategies and measures of tobacco control and alcohol control.Objectives: 1.To assess the reliability and validity of the Chinese version of FTND and AUDIT scales in Chinese medical students and to provide a scientific basis for the promotion and use of these scales in Chinese medical students.2.To carry out a cross-sectional study and a structural equation model study on the current status of tobacco dependence and alcohol use disorders in Chinese medical students,and to analyze the factors influencing the medical students' tobacco dependence and alcohol use disorders.3.To propose some pointed strategies and measures of tobacco control and alcohol control.Methods: 1.Reliability and validity study: The reliability of the Chinese version of the FTND scale and the AUDIT scale is evaluated by Cronbach alpha coefficient,split-half reliability.The validity is evaluated by content validity,construct validity,convergence validity and discriminant validity.2.Cross-sectional study: Using cluster sampling,medical students from 4 institutions in Jiangsu Province were selected as the survey subjects.According to a self-made questionnaire,the medical students' demographic characteristics,family smoking and drinking,peer smoking and alcohol consumption were investigated.3.Structural Equation Model Study: The structural equation model was used to model and analyze the influencing factors of medical students' alcohol use disorders,and the related influencing factors and theinterrelationships between various factors.Then provide the basis for further in-depth study.Results: 1.The overall Cronbach alpha of FTND was 0.638 and the split-half reliability was 0.659.The content validity index on the levels of items(I-CVI)were from 0.67 to 1.00,the content validity index of scale level(S-CVI/UA)was 0.67,content validity index of average scale level(S-CVI/Ave)was 0.89.The simplified version of FTND supported a presupposed three-factor structure which could explain 58.512% of the total variance revealed through exploratory factor analysis,and each item had a common factor loading >0.5.The confirmatory factor analysis showed that in addition to the PGFI,PNFI,PCFI,and RFI,others like ?2,GFI,AGFI,RMSEA,RMR,IFI,NFI,and CFI all met the adaptation criteria.Convergence validity and discriminant validity calibration test success rate was 100%.2.The overall Cronbach alpha of AUDIT was 0.890 and the split-half reliability was 0.790.The three dimensions of the Cronbach alpha coefficient were 0.835,0.852,and 0.826,the split-half reliability were 0.862,0.879,and 0.831.The content validity index on the levels of items(I-CVI)were from 0.83 to 1.00,the content validity index of scale level(S-CVI/UA)was 0.80,content validity index of average scale level(S-CVI/Ave)was 0.97.The simplified version of AUDIT supported a presupposed three-factor structure which could explain 78.454% of the total variance revealed through exploratory factor analysis.Except item 7 which the common factor loading was <0.4(0.387),all other items were >0.4.The confirmatory factor analysis showed that in addition to the ?2,others like,GFI,AGFI,RMSEA,RMR,IFI,NFI,and CFI all met the adaptation criteria.Convergence validity and discriminant validity calibration test success rate was 100%.3.In the cross-sectional survey,a total of 4,100 questionnaires were distributed,3,869 questionnaires were returned,and the questionnaire recovery rate was 94.37%.Among 142 smokers,the smoking rate was 3.67%,of which 112(88.87%)were mildly dependent on tobacco,26(18.31%)were moderately dependent on tobacco,and 4.8%(2.82%)were severely dependent on tobacco.Two-class Logistic regression analysis showed that male,alcoholic,senior,mother smoking,companion smoking,parents that agreed to smoking,thinking that smoking was necessary,always felt anxiety and depression,personality extroversion were risk factors for medical students smoking(P<0.05).Ordered multi-classified Logistic regression analysis showed that male and companion smoking were risk factors for tobacco dependence among medical students(P<0.05).There were 1,725 drinkers,the drinking rate was 44.59%,and 319 were alcohol use disorders,accounting for 8.25%.Orderly multi-classified Logistic regression analysis showed that male,smoking,senior,and family drinking,peer drinking,parents that approved drinking,thinking that drinking was necessary,and personality extroversion were risk factors for medical students' alcohol use disorders(P<0.05).4.Structural equation model results showed that general conditions and environmental drinking conditions had direct impacts on medical students' alcohol use disorders,and the general conditions had an indirectly impact by environmental drinking conditions.Their total effects were 0.471 and 0.205.Among all the influencing factors,gender,grade,and smoking had the most effect,followed by family drinking,peer drinking,and drinking attitudes,personality type had the least effect.Conclusions: 1.The structure validity,convergence validity,discriminant validity of Chinese version of FTND scale were good.However,the internal consistency and content validity were not good.Probably because of the different cultures between Chinese and Western,consideration should be given to amending some items of the scale.AUDIT showed good reliability and validity among medical students in China thus worth for promotion on its use.2.Male and companion smoking were risk factors for tobacco dependence among medical students.Male,smoking,senior,and family drinking,peer drinking,parents that approved drinking,thinking that drinking was necessary,and personality extroversion were risk factors for medical students' alcohol use disorders.3.The structural equation model was the first time used to analyze the influential factors of alcohol use disorders among medical students.This study still had certain flaws and may not include all the possible influencing factors.In the future,it needs to improve the deficiencies and study further. |
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