Objectives:This study aimed to examine the use of HTPs among medical students and the effects on their smoking behavior which the relocation of the smoking area can cause. Methods: Two survey studies were conducted using questionnaires with 713 medical students. The first survey included questions regarding baseline smoking status of cigarettes and HTPs. The second survey consisted of questions concerning smoking status and frequency before and after the assigned smoking area was relocated far from the main lecture hall. Results: In the first survey, 630 responses were received (response rate: 88.4%) and 38 out of 553 valid respondents were smokers. Twenty smokers (52.6%) used HTPs, the principal reason being “less harmful than cigarettes”. When the smoking area was moved far away, the smoking rate of cigarettes or HTPs significantly declined from 8.9% to 7.2%. The median frequency going to the smoking area also significantly decreased from 4.25 to 2.00 times per day. Discussion: Education must be provided to medical students about HTPs since some of them need more accurate understanding. Furthermore, this study indicates that inconvenience caused by the relocation leads to less smoking frequency and lower smoking rate. Conclusion: This study shows that the percentage of HTP users among all smoking medical students was roughly equal to the number reported in a nationwide study. Our research indicates that the change in the location of the smoking place can motivate students to quit smoking.
A 52-year-old woman visited our department with headache and nausea. Brain magnetic resonance imaging showed cerebral venous sinus thrombosis (CVST), but an investigation of thrombotic predisposition was negative. The patient was a nonsmoker, but the patient’s urinary cotinine level was found to be increased. The patient's husband was a current smoker, thus, we diagnosed the patient as CVST due to second-hand smoke. We advised her husband to quit smoking, and the patient has shown no recurrence to date. CVST is a central neurological disorder that occurs based on thrombotic tendency and may accompany serious symptoms such as cerebral hemorrhage, cerebral infarction, and convulsions. However, smoking has not been demonstrated to be a risk factor for CVST, although meta-analyses have shown that smoking tends to increase the risk of CVST. To our knowledge, this is the first report to associate CVST with second-hand smoke. Further studies are necessary to accumulate similar cases.