Impact of marginalization on tobacco use in individuals diagnosed with head and neck Cancer.

BACKGROUND: Considerable evidence now indicates that individuals living in underprivileged neighbourhoods have higher rates of mortality and morbidity independent of individual-level characteristics. This study explored the impact of geographical marginalization on smoking cessation in a population of individuals with a diagnosis of head and neck cancer. The aims of this study were twofold: (1) assess the prevalence of smoking cessation in those with a previous diagnosis of head and neck cancer, (2) analyze the determinants of smoking alongside area-based measures of socioeconomic status. METHODS: This was a cross-sectional study. We administered a self-reported nicotine dependence package to participants between the ages of 20-90 with a previous mucosal head and neck cancer diagnosis and with a history of tobacco use. Using the Canadian Marginalization (CAN-Marg) Index tool based on 2006 Canada Census data we compared the degree of marginalization to the smoking status. For those individuals who were currently smoking, nicotine dependence and readiness to quit were assessed. A summative score of marginalization was compared to smoking status of individuals. RESULTS: The results from this study indicate that the summative level of marginalization developed from the combined factors of residential instability, material deprivation, ethnic concentration and dependency may be important factors in smoking cessation. CONCLUSIONS: This analysis of determinants of smoking alongside area-based measures of socioeconomic status may implicate the need for targeted population-based smoking cessation interventions.

Otolaryngology exposure in a longitudinal integrated clerkship setting.

BACKGROUND: Although 20-40% of primary care complaints are Otolaryngology-Head and Neck Surgery (OtoHNS) related, little emphasis is placed on OtoHNS instruction at the undergraduate medical education level. An OtoHNS clerkship rotation is not required at most Canadian medical schools. Furthermore, at institutions offering an OtoHNS rotation, less than 20% of students are able to complete a placement. Given that a large percentage of medical students in Canada will pursue primary care as a career, there remains a gap in providing OtoHNS clinical training. During the longitudinal integrated clerkship at the Northern Ontario School of Medicine (NOSM), students are assigned to one of 14 sites, and not all have access to an otolaryngologist. This study looks to quantify the level of exposure students are receiving in OtoHNS at NOSM and to assess their comfort level with diagnosing and treating common otolaryngologic conditions. METHODS: A structured 13-item survey was administered to second, third and fourth year medical students at NOSM. RESULTS: A majority (67.9%) of medical students surveyed had not observed an otolaryngologist. Furthermore, most students (90.6%) reported receiving very little OtoHNS classroom based and clinical instruction during medical school. CONCLUSIONS: A discrepancy exists between the quantity and breadth of OtoHNS training received in undergraduate medical education and the volume of OtoHNS encounters in primary care practice. Although geographic dissemination of students in the distributed learning model may be a challenge, strategies such as standardized objectives and supplemental electronic resources may serve to solidify clinical knowledge.