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(Misjavicene et al., 1988). Across the entire group of physicians studied, the surgeons smoked six times more frequently than the outpatient general practitioners (48 vs. 8 percent), which can be explained by the gender differences between the two groups (Misjavicene et al., 1988). Smoking was also found to be highly prevalent among Russian medical students: Agranovsky and colleagues (1990) report that among sixth-year medical students, 54 percent of males and 19 percent of females smoked cigarettes. More important, only 33 percent of the sixth-year medical students believed that smoking is unacceptable for a health care provider (Agranovsky et al., 1990). In addition, medical professionals in the NIS are not held in high esteem by the general population. In Russia, for example, the popular image of a poorly compensated doctor in an outpatient clinic whose tasks rarely reach beyond writing sick-notes is quite unlikely to bring success to an anti-smoking campaign.
Thus in contrast with Western countries, one cannot just assume that physicians or other health care providers in the republics of the former Soviet Union will make the best candidates for leading an anti-smoking campaign. It is therefore appropriate to conduct sociological studies aimed at identifying the social/ professional groups in the NIS that are most capable of influencing the public in this regard (e.g., democratic politicians, church leaders, persons with high profiles) and thus serving as potential leaders of national anti-smoking campaigns.
It seems appropriate to conduct simultaneously a mass media campaign that would demonstrate the popularity of the nonsmoking lifestyle in the West. Such a campaign would counteract the massive tobacco advertising that targets primarily youth. Further, such a campaign would not require any substantial monetary investment since it could be based on existing Western anti-smoking infomercials.
School Health Education
Early smoking prevention through the school health education system is an extremely important priority for the NIS, especially in light of the increase in tobacco advertising. Some of the NIS countries have gained experience in implementing school-based smoking control programs. In Russia, for example, the first research-based school curriculum on smoking prevention was recently published (Alexandrov et al., 1993). This curriculum is based on experience from a 7-year randomized trial among Moscow students in grades 4 through 10 (Prokhorov and Alexandrov, 1994) and combines internationally accepted, theoretically sound approaches to smoking prevention. Although the preventive measures used in this trial failed to reduce experimentation with cigarettes, the age-specific increments of cigarette smoking (at least once in the past month) in the intervention group were lowered among boys by the third year (p < 0.001) and among girls by the fourth year (p < 0.05) of the study as compared with smokers in the control group. The observed significant difference in smoking rates was sustained until the end of the project (Prokhorov and