Editor—In some developed countries including Japan, smoking prevalence among nursing students tends to be the same or higher than that of the general female population of the same age group.1-6 In Japan, an increase in the prevalence of smoking among women in their 20s was recently reported,7and this trend is assumed to be reflected in the smoking prevalence of nursing students, where young women are over represented.

To obtain data on smoking prevalence of nursing students, a nationwide survey was conducted among the students of nursing (three year programme), public health nursing (PHN), and midwifery schools. Students of PHN and midwifery are qualified as nurses, and involved in one year training to acquire qualification as PHN and midwives, respectively. The survey was conducted in October 2000 using self reported questionnaires.

In 2000, there were 465 three year nursing schools (total number of students: 66 430,) 66 PHN schools (1697 students), and 73 midwifery schools (1420 students) in Japan. Among these, 27 nursing schools, 17 PHN schools, and 16 midwifery schools were selected at random, and the survey was carried out on all students in the selected schools. Between selected schools and non-selected schools, little difference was observed with respect to their geographical distribution and student volume size.

Each subject from the selected schools filled in the questionnaire, put it into an envelope, sealed and handed it to the person in charge. The questionnaire included the items of a previous survey on smoking behaviour among nurses,8 and eight items related to the nicotine dependency scale of Fagerstrom.9

The return rates were 93% (3866/4169) for the nursing schools, 91% (539/592) for the PHN schools, and 95% (325/343) for the midwifery schools. After excluding incompletely answered questionnaires, 3762, 530, and 303 responses were analysed, respectively.

The prevalence of smoking among women was 25% in the nursing schools, 13% in the PHN schools, and 22% in the midwifery schools. In the nursing schools, the prevalence of smoking increased as the grade advanced. In the third year, the prevalence of smoking was 31%, higher than that among the general population in their 20s (23%).7 As to male students in third year, the prevalence of smoking was nearly the same as that of the general male population in their 20s (60%).7 Furthermore, the nicotine dependency among female daily smokers in the nursing schools was higher than that in the PHN schools or midwifery schools. Therefore, anti-smoking education in nursing schools is urgently needed. In this survey, smoking prevalence was lower among students in the PHN and midwifery schools. The difference occurs because those who had already qualified as nurses and wished to continue studying to acquire another qualification were less likely to smoke than those who were not in the same career level. It is therefore suggested that the prevalence of smoking among less educationally motivated students is lower. Adriaanse and colleagues10 reported that nurses who were motivated in their jobs had a tendency not to smoke, which is consistent with our results although our subjects were nursing students.