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BMC Health Services Research BioMed Central

Research article Open Access

Consumption of alcohol, cigarettes and illegal substances among
physicians and medical students in Brandenburg and Saxony
(Germany)
Karen Voigt*1, Sabine Twork2, Dirk Mittag1, Anne Göbel1, Roger Voigt1,
Jörg Klewer3, Joachim Kugler2, Stefan R Bornstein4 and Antje Bergmann1

Address: 1Department of General Medicine/Medical Clinic III, Dresden Medical School, Dresden University of Technology, Dresden, Germany,
2Department of Public Health, Dresden Medical School, Dresden University of Technology, Dresden, Germany, 3Department of Public Health and

Health Care Management, University of Applied Sciences Zwickau, Zwickau, Germany and 4Medical Clinic III, University Hospital Carl Gustav
Carus of the Dresden University of Technology, Dresden, Germany
Email: Karen Voigt* - Karen.Voigt@uniklinikum-dresden.de; Sabine Twork - sabine_twork@hotmail.com; Dirk Mittag - dirk.mittag@hausarzt-
hlp.de; Anne Göbel - la.pluie@web.de; Roger Voigt - praxis.drvoigt@web.de; Jörg Klewer - joklewer@aol.com;
Joachim Kugler - jokugler@aol.com; Stefan R Bornstein - stefan.bornstein@uniklinikum-dresden.de;
Antje Bergmann - Antje.Bergmann@uniklinikum-dresden.de
* Corresponding author

Published: 3 December 2009 Received: 29 June 2009

Accepted: 3 December 2009
BMC Health Services Research 2009, 9:219 doi:10.1186/1472-6963-9-219
This article is available from: http://www.biomedcentral.com/1472-6963/9/219
© 2009 Voigt et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Background: Patients regard health care professionals as role models for leading a healthy lifestyle. Health care
professionals' own behaviour and attitudes concerning healthy lifestyle have an influence in counselling patients. The aim
of this study was to assess consumption of alcohol, cigarettes and illegal substances among physicians and medical
students in two German states: Brandenburg and Saxony.
Methods: Socio-demographic data and individual risk behaviour was collected by an anonymous self-administered
questionnaire. Physicians were approached via mail and students were recruited during tutorials or lectures.
Results: 41.6% of physicians and 60.9% of medical students responded to the questionnaire; more than 50% of the
respondents in both groups were females. The majority of respondents consumed alcohol at least once per week; median
daily alcohol consumption ranged from 3.88 g/d (female medical students) to 12.6 g/d (male physicians). A significantly
higher percentage of men (p < 0.05) reported hazardous or harmful drinking compared to women. A quarter of all
participating physicians and one third of all students indicated unhealthy alcohol-drinking behaviour. The majority of
physicians (85.7%) and medical students (78.5%) were non-smokers. Both groups contained significantly more female
non-smokers (p < 0.05). Use of illegal substances was considerably lower in physicians (5.1%) than medical students
(33.0%). Male students indicated a significantly (p < 0.001) higher level of illegal drug-use compared to female students.
Conclusion: More than one third of the medical students and health care professionals showed problematic alcohol-
drinking behaviour. Although the proportion of non-smokers in the investigated sample was higher than in the general
population, when compared to the general population, medical students between 18-24 reported higher consumption of
illegal substances.
These results indicate that methods for educating and promoting healthy lifestyle, particularly with respect to excessive
alcohol consumption, tobacco use and abuse of illegal drugs should be considered.

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Background hol, and; 3) spirits: 4 cl was considered as 11 g of alcohol

Alcohol consumption, smoking and illegal drug use are [12].
important health indicators in accordance with the results
of European Community Health Indicators project All participants were asked to describe their current smok-
(ECHI) within the European Commissions Health Moni- ing behaviour and the number of cigarettes smoked daily
toring Programme [1]. According to the German Report of as well as previous consumption of illegal substances.
Drugs and Addiction [2], approximately 16 million Ger- There was no specific definition of illegal substances in
man adults (34%) are smokers and more than 9 million the questionnaire. Data was analysed using SPSS 15.0.
German adults (31% male and 16% female) consume Descriptive analysis and nonparametric statistics (χ2-
inappropriate levels of alcohol. Five percent of German tests) were performed, and the level of significance was
adults reported use of illegal drugs in the previous 12 defined at p < 0.05. In comparing different groups, miss-
months [3]. ing values were pairwise deleted.

This indicates a need to educate the German population Samples

about the potential negative consequences of alcohol, cig- The total number of responses was 940 with 642 regis-
arette smoking and abuse of illegal substances. Physicians tered physicians and 298 medical students participating.
play an important role in health education and are often The response rate was 41.6% for the physicians and
expected to serve as role models for a healthy lifestyle [4- 60.9% for the students.
6]. Physicians who lead an unhealthy lifestyle themselves
might provide their patients with less effective advice on The majority of medical students were under the age of 30
this topic than their more health-conscious colleagues years, while the majority of physicians were older than 30
[7,8]. This study attempts to assess the prevalence of ciga- years. The proportion of females was higher in both
rette smoking and level of consumption of alcohol and groups (58.8% and 58.4%, respectively, see Table 1). The
illegal substances among physicians and medical stu- number of students was evenly distributed among each of
dents. the three academic years (33.0%).

Methods Results
Between April 2004 and May 2006 a voluntary survey was Alcohol consumption
conducted by the Department of General Medicine at the More than 75% of the participants reported consumption
Dresden Medical School. Anonymous questionnaires of alcohol one or more times during an average week. The
together with a letter of motivation and prepaid envelope majority of the respondents (82.5% physicians, 62.8%
were mailed to all private practice physicians (i.e. general medical students) drank wine every week, whereas 40% in
practitioners and surgeons) registered at the National both groups consumed beer. As the questioning only
Association of Statuary Health Insurance of Brandenburg addressed weekly consumption, it was not possible to
and Saxony. Medical students in the 1st, 3rd and 5th aca- identify the phenomenon of binge drinking [2].
demic years at the Dresden Medical School (one of the
two public Medical Schools in Saxony) were asked to The average amount of alcohol consumed among the
complete similar questionnaires during tutorials or lec- medical students was significantly higher than among
tures. physicians (25.77 vs. 10.88 g/d, respectively). A compari-
son of the median values (50th percentile) in both groups
Questionnaire and statistics showed that more students than physicians consumed
The questionnaire was based on several former surveys [9] only few or no amounts of alcohol (5.9 vs. 7.54 g/d,
and collected information on socio-demographic data, respectively). Nevertheless, a sub-group of students con-
health status (e.g. body mass index, subjective experi- suming high quantities of alcohol was identified (see
enced individual health status), occupational stress and Table 2).
reported health behaviour (e.g. consumption of alcohol,
cigarettes and illegal substances, received vaccinations The age and the daily amount of alcohol consumed only
[10]). Participants were asked the quantity and type of correlated significantly in the group of medical students
alcohol consumed in litres per average week. To standard- (Kendall-Tau-b, r = 0.104/p = 0.05).
ize the data for comparison, litres were converted to grams
of alcohol consumed per day (g/d) in calculating daily 24.8% of the male physicians and 36.5% of the male
ingestions. Reference values used for these calculations medical students reported higher ingestions than the rec-
[11] were: 1) wine: 0.125 l of wine was considered as 11 g ommended daily allowance by the German Nutrition
of alcohol; 2) beer and mixed drinks: 0.33 l of beer and Society on maximal alcohol ingestion (MAAI for men: >
0.275 l of mixed drinks were considered as 13 g of alco- 20 g/d). Among the female participants, 25.3% of the

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Table 1: Socio-demographic sample data

Medical students (Saxony) Physicians (Saxony and Brandenburg)

GP Surgeon

1425 117
Total 489 1542

41.8% 40.2%
response rate 60.9% 41.6%

595 47
Sample included in analysis 298 642

Age
<= 30 years 98.3% 7.2%
> 30 years 1.7% 92.8%

Gender
male: female 41.2% : 58.8% 41.6% : 58.4%

physicians and 30.4% of the medical students reported harmful (13.8% vs. 1.9%) quantities of alcohol (χ2 =
higher ingestions of alcohol than the recommended daily 33.531/p < 0.001).
allowance (MAAI for women > 10 g/d) [11].
Cigarette smoking
The European Community Health Indicators-Project The majority of physicians (85.7%) and medical students
(ECHI) and the World Health Organisation (WHO) have (78.5%) were non-smokers. In both groups fewer females
made distinctions between hazardous and harmful drink- than males reported cigarette smoking (see Figure 2).
ing. Hazardous drinking (more than 40 g/d for males and
more than 20 g/d for females) is defined as a level of alco- No significant correlation between age and non-smoking
hol consumption that may result in physical or psycho- status was found. No significant gender-related differ-
logical damage [13]. Harmful alcohol consumption ences in smoking were found between physicians and
(more than 60 g/d for males and 40 g/d for females) is medical students.
defined as a drinking behaviour leading to harming of
physical or psychological health [14,15]. According to Among smokers (n = 125), 66.4% reported smoking fewer
these reference values, 17.5% of the male physicians and than ten cigarettes per day, while 27.2% reported smoking
9% of the male medical students ingested hazardous more than ten but fewer than 20 cigarettes per day. 6.4%
quantities of alcohol. More than 30% of the male students of all smokers mentioned a daily smoking rate of more
but less than 10% of the male physicians indicated harm- than 20 cigarettes. No relation between age and the
ful drinking behaviour (see Figure 1, χ2 = 31.933/p < number of cigarettes smoked was found.
0.001).
Consumption of illegal substances
More female medical students than female physicians The majority of physicians (94.9%) and two-thirds of the
consumed significantly hazardous (9.2% vs. 5.8%) and medical students (66.0%) denied any consumption of
Table 2: Daily alcohol consumption in g/d among medical students and physicians

Medical students (n = 298) Physicians

(n = 642)

Mean +/- standard deviation 30.84 +/- 56.70 11.58 +/- 15.81

Mode 0 0

25 0 2.51
Quartile 50 5.89 7.54
75 25.45 14.16

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Discussion
hazardous drinking harmful drinking
Sampling and methods
40 Within the initial distribution group, 61% of the medical
students and 42% of the physicians responded to the
30 questionnaire. Among other possibilities, such as method
percent

of delivery and time constraints, an intensive political dis-

20
cussion at the time broaching the issues of the survey
10
might have influenced the response behaviour.

0 The difference in the response rate between the groups

may have been affected by the distribution methods
m

fe

fe
m

m
al

al
e

al

al
(direct distribution during classes vs. distribution by
st

ph

e
ud

st

ph
ys

ud
en

ys
ic

post).
en
ia

ic
ts

ns

ia
ts
(n

ns
(n

(n
=

(n
12

=
17

=
25
2)

36
4)

Respondents are proportionally comparable in gender

7)

1)
and age to those of physicians in Brandenburg and Saxony
[16-18] and of medical students at Dresden Medical
Figure
proportions
cal students
1 andof hazardous
physiciansand
depending
harmful on
drinking
genderamong medi- School. Therefore, study findings appear to be representa-
proportions of hazardous and harmful drinking tive for physicians in private practice and medical students
among medical students and physicians depending on
in the eastern states of Germany.
gender.
Participation in the study was voluntary and anonymous.
It remains unclear whether the response rate was associ-
illegal substances. Among medical students, fewer female ated with consumption rate of alcohol, cigarettes and ille-
than male students reported consuming illegal sub- gal substances.
stances. Additionally, the one-time or repeated consump-
tion of these substances was significantly lower in female Alcohol consumption
than in male students (χ2 = 24,937/p < 0.001, see Table 3) The proportion of current abstinence in the investigated
medical students corresponds to a similar study in medi-
No statistical difference in relation to year of matricula- cal students from Poland and Germany [19]. Compared
tion was found in the group of medical students. to findings related to attitudes towards alcohol drinking
behaviour in the European Union, the percentage of phy-
sicians reporting abstinence was lower than the average

percent

100 Ȥ² = 9.1
p < 0.01 Ȥ² = 3.4
p < 0.05
80

60
male
91.6 86.7 female
40 83.7
77.8

20

0
physicians (n=629) medical students (n=283)

Figure 2 of female and male non-smokers among medical students and physicians
Proportions
Proportions of female and male non-smokers among medical students and physicians.

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Table 3: Proportions of students and physicians related to consumption of illegal substances

Amount of consumption Medical students (n = 291) Physicians (only Brandenburg, n = 486)

Gender male female male female

Never 49.6 77.8 92.5 96.5

Once 10.9 7.0 3.3 2.3
Several times 39.5 15.2 4.2 1.2

percentages in European males (16%) and females (32%) population: 32%; general German population: 30%)
[20]. [27]. The proportion of non-smokers in this study is
higher than in a comparable German population in which
Male physicians report consuming significantly higher 30-45% of males and 45-55% of females age 18-29 years,
amounts of alcohol than female physicians, which corre- and 45-70% of males and 55-85% of females age 30-59
sponds to findings in the general German population years were non-smokers [22]. These significant gender-
[11,21]. Furthermore, in comparison to results from a specific differences correspond to results from different
national German health survey [22], the proportion of the surveys in the general German population [28] as well as
investigated male medical students reporting harmful the general European population [27], and correspond to
alcohol consumption (20 g/d) was higher than in male previous studies on the health behaviour of medical stu-
Germans 18 to 29 years of age (33% vs. 20%), and the dents [25,29].
proportion of male physicians reporting harmful alcohol
consumption (25%) was lower than in male Germans 30 Medical education about the risks of smoking does not
to 59 years of age (26-32%) respectively. The proportion seem to be enough to lead to non-smoking behaviour.
of investigated female medical students (30.4%) and Health care professionals should be assisted in stopping
female physicians (25.3%) reporting harmful consump- smoking, for example by increasing the number of smoke-
tion of alcohol (> 10 g/d) was remarkably higher than in free health care facilities (e.g. smoke-free hospitals) [30].
females in the general German population (7.2% in the
group 18-29 years of age, and 15% in the group 30-59 Consumption of illegal substances
years of age respectively) [22]. Additional German [2,12] The proportion of investigated physicians reporting con-
and European [20] studies presented findings of harmful sumption of illegal substances at least once is equal to the
alcohol consumption in approximately 25% of the proportion in the general population reporting the same
younger population. Consequently, harmful or hazard- experience (5% versus less than 3% in the general popula-
ous consumption of alcohol appears to be a problem in tion), and not lower [22]. In contrast, a French study
the general German population as well as in health care showed that approximately 20% of general practitioners
professionals, especially medical students. had smoked cannabis at least once [31]. The difference
might derive from the fact that the majority of investi-
Preventive strategies need to be developed to identify and gated physicians grew up in the German Democratic
support health care professionals at risk from high alcohol Republic, where illegal substances were not available or
consumption [12,23]. Moreover, future studies are difficult to obtain [32].
required to analyse underlying general tendencies, and to
determine whether special conditions during medical On the other hand, the proportion of medical students
training (e.g. psychological strains) lead a higher propor- reporting consumption of illegal substances was higher
tion of medical students reporting harmful alcohol con- than in the general German population 18-29 years of age
sumption. The relationship between alcohol (15-25%) [22]. A Croatian study revealed similar results
consumption and intake of meals, the time of consump- with 35% of medical students reporting consumption of
tion, and binge drinking should also be studied. illegal substances at least once [33]. The observed gender-
specific differences in the group of medical students corre-
Smoking spond to findings in the general German population:
The proportion of cigarette smokers among the investi- males reported to have consumed illegal substances three
gated group of medical students and physicians is similar times more often than females [22]. Consequently, medi-
to that reported in former studies of health care profes- cal students require more information about the prob-
sionals [24-26]. The percentage in the investigated groups lems related to the consumption of illegal substances
(approximately 25%) is lower than the percentage of which can result in medical and psychiatric problems as
smokers in the general European population (European well as legal problems. It can be assumed that most of the

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