KNOWLEDGE, ATTITUDES, AND PRACTICES OF MEDICAL STUDENTS FROM MIDDLE-INCOME COUNTRIES REGARDING CLIMATE CHANGE: THE CASE OF REPUBLIC OF MOLDOVA

DOI: https://doi.org/10.26758/15.1.9

(1), (2), (3), (4) Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; e-mail: (1) catalina.croitoru@usmf.md (2) elena.ciobanu@usmf.md (3) greta.balan@usmf.md (4) alina.ferdohleb@usmf.md

Address correspondence to: Cătălina CROITORU, Hygiene Discipline, Department of Preventive Medicine, Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD 2025, no. 26/2, Nicolae Testemitanu str., Chisinau, Republic of Moldova; Phone: (373) 68716501; E-mail: catalina.croitoru@usmf.md

Author’s contributions: CC and EC conceived the research idea. GB and AF developed the theory. CC and EC analyzed similar methodologies and designed the questionnaire. CC, EC, GB, and AF conducted the research and processed the data. CC and EC performed the calculations and wrote the manuscript with support from GB and AF. CC, EC, GB, and AF contributed to the final manuscript. AF supervised the project

Abstract

Objectives. Assessment of knowledge, attitudes, and practices regarding climate change, its causes and consequences, and its impact on health among medical students in the Republic of Moldova.

Material and methods. A quantitative study was conducted from September to March 2022. The study sample consisted of 606 medical students with an average age of 22.5 years, of whom 59.1% were women, in their 5th to 6th year of studies at Nicolae Testemițanu State University of Medicine and Pharmacy. A KAP (knowledge, attitudes, and practices) questionnaire with 30 questions was developed to assess the medical student’s perspective on the mechanism, consequences, causes, and awareness of climate change.

Results. The research revealed that most respondents are aware of the causes of climate change. Medical students are less informed about the effects of climate change on health and the need to consult a doctor to adjust therapeutic plans in response to heat waves. Their attitude towards the need for mitigation measures to reduce the impact of climate change triggers and the need for behavioral changes is positive. They have more trust in information received from experts in the scientific field, and a smaller portion of respondents trust environmental organizations and media sources. Although many students know about the phenomenon and its impact, their practices do not align with the needs and guidelines.

Conclusions. Training programs for medical students are necessary to increase their awareness of climate change, which can enhance their knowledge and shift their attitudes and practices.

Keywords: climate change, KAP survey, medical students.

Suggested citation (APA)

Croitoru, C., Ciobanu, E., Balan, G., & Ferdohleb, A. (2025). Knowledge, attitudes, and practices of medical students from middle-income countries regarding climate change: The case of Republic of Moldova. Anthropological Researches and Studies, 15, 140-153. https://doi.org/10.26758/15.1.9

Introduction

Humanity is constantly struggling with nature, and every day raises its level of knowledge to become a winner in this battle. Since the Industrial Revolution, many types of energy have been used, and the ecological balance has been degraded due to energy consumption. The deterioration of the ecological balance has brought many environmental problems. The most significant of these environmental issues is global warming and the resulting climate change (Deveci, Kurt, Pirinçci, & Oğuzöncül, 2019; The Royal Society, 2020).

Climate change has begun to influence various extreme weather and climatic phenomena in all regions of the world. This has led to widespread negative effects, resulting in losses and damages to both nature and humans (IPCC, 2023).

In low- and middle-income countries, such as the Republic of Moldova, climate change, on a global scale, affects the health of the population.

The impact of climate change on health is a critical global concern that requires robust scientific evidence and a comprehensive viewpoint, incorporating the perspectives of One Health, EcoHealth, and Planetary Health (Chambaud et al., 2023).

As a result of climate change, the estimated effects include: changes in the geographic distribution of ecosystems, increased forest fires, extreme rainfall following severe drought in some regions, rising sea levels, an increase in the intensity and frequency of tsunamis, the reduction of habitats for many animal species, the extinction of plants, insects, and birds due to difficulties adapting to new conditions, an increase in plant diseases, the spread of infectious diseases (such as increased viral mutations leading to malaria-like diseases and the proliferation of cholera-type diseases resulting in reduced water resources), social and economic changes in social life as a consequence of climate change, increased hunger and malnutrition due to regional declines in production, adverse effects on tourism and other economic activities, etc. The causes of climate change and global warming also contribute to the thinning of the ozone layer, which weakens the human immune system by increasing ultraviolet radiation. This leads to higher rates of infections and cancers. Thus, climate change causes both environmental and health problems (Australian Red Cross, 2017; Deveci et al., 2019; Haustein et al., 2017; Tomczyk et al., 2019).

There are three main pathways through which climate change affects health: (i) direct impact (heat stress, drought, and heavy rainfall); (ii) effects mediated through natural systems (vector-borne diseases, waterborne diseases, air pollution, allergies); (iii) strongly mediated effects through human systems (occupational impact, malnutrition, mental stress).

Rising temperatures can also lead to increased foodborne illnesses due to refrigeration failures during transport/storage or changes in the distribution of biological pathogens, such as increased occurrences of Salmonella, Listeria, and Campylobacter. Two research studies were conducted at Tel Aviv University (Israel) on food-related infectious diseases’ spatial and temporal distribution patterns. The relationship between Campylobacter and Salmonella with temperature was examined. It was found that higher year-round temperatures affect morbidity from Campylobacter, especially in younger children (World Health Organization [WHO], 2022, p. 19) Heatwaves are considered one of the deadliest natural hazards, causing high mortality rates in both developed and developing countries (Mazdiyasni, Sadegh, Chiang, & AghaKouchak, 2019).

Numerous published epidemiological studies have found an increase in mortality from various causes during summer, particularly during extremely high temperatures, known as heatwaves. Heatwave-related mortality has been intensively studied over the past two decades following well-known disasters such as the Chicago heatwave in July 1995 and the European heatwave in August 2003. The summer of 2003 was considered the hottest in Europe since 1500. In that year, an estimated 22,000 to 70,000 excess deaths were recorded. Reports from France concluded that the majority of these additional deaths occurred among the elderly, with 80% of those who died being over the age of 75. In the next century, heatwaves are expected to become more frequent, more intense, and last longer (Percic, Kukec, Cegnar, & Hojs, 2018). The 2010 heatwave in Russia claimed the lives of over 56,000 people (Steul, Schade, & Heudorf, 2018).

Specific studies should be conducted to prevent such outcomes. It would benefit the community to be aware of the damages caused by climate change and its potential consequences. Medical personnel are seen as role models by the community. They are expected to know about climate change, global warming, and other health-related aspects, particularly when it comes to informing and raising society’s awareness in the future (Australian Red Cross, 2017; Deveci et al., 2019; Haustein et al., 2017; Tomczyk et al., 2019).

An adequate attempt to minimize the impact of climate change should be addressed through mitigation and adaptation. The inadequate knowledge about climate change within society affects its capacity to engage in mitigation and adaptation efforts. As part of society, adolescents are expected to face the consequences of climate change in the future. On the other hand, adolescents are excellent agents of change for conveying messages about climate change. Understanding and identifying the gaps in adolescents’ knowledge regarding climate change is essential to ensure their proper engagement. There is a growing belief that knowledge is one of the critical factors in developing a community’s adaptive capacity, making it necessary to measure knowledge levels (Moonen, 2020).

Alongside young people, medical students worldwide are actively involved in climate change-related actions, from raising awareness to implementing initiatives for adapting to and mitigating the effects of climate change. They need to enrich their knowledge about climate change, its impact on health, and the vulnerable population groups affected. A key and familiar place where such knowledge is typically shared is the university (Akrofi, Antwi, & Gumbo, 2019; Damian-Timoşenco, 2021).

At the 26^th Conference of the Parties (COP 26), governments were urged to provide citizens comprehensive and global climate change education. Young people and medical students involved in these actions can offer innovative solutions to climate change and should be included in decision-making processes.

The current study aims to identify medical students’ knowledge, attitudes and practices, and training needs regarding the human health impacts of climate change to initiate climate education and training of future and current medical workers to increase climate change awareness, adjust their attitudes towards the correctness of their practices concerning both healthy and sick people in the face of climate change.

Materials and methods

General objective – Assessment of medical students’ knowledge, attitudes, and practices in middle-income countries, with a particular focus on the Republic of Moldova, regarding climate change.

Design of research – A qualitative study utilized descriptive, statistical, and analytical research methods. To initiate a study of high validity, a representative sample was planned. The sample size was designed to allow for the identification of correlations. It was representative of the entire population of medical students at the Nicolae Testemițanu State University of Medicine and Pharmacy in the Republic of Moldova. The estimation of the optimal number of respondents required for the study was based on the following conditions: (i) selecting research units to avoid repetition; (ii) ensuring the sample’s representativeness so that the research results could be generalized to the entire population. Inclusion criteria for the study included: medical students at the Nicolae Testemițanu State University of Medicine and Pharmacy in the Republic of Moldova, in their 5th or 6th year of study, and providing informed consent for participation in the study.

Participants – Considering that the population of medical students is a finite number (the number of medical students in the 2021-2022 academic year at the Nicolae Testemițanu State University of Medicine and Pharmacy were 2,934 local students in the Medicine study program), the sample size was calculated using the formula for descriptive studies of finite populations. An additional 10% was added to the calculated number of respondents—551—to account for non-responses. The study sample consisted of 606 medical students, with an average age of 22.5 years (SD = 2.72), and the age range included young people from 18 to 35 years. Of the respondents, 59.1% (358) were female, and 40.9% (248) were male. The gender distribution was nearly equal between women and men. All respondents were students in the Medicine study program, in their 5th and 6th years, at the Nicolae Testemițanu State University of Medicine and Pharmacy, Republic of Moldova.

Instrument – For the study, a questionnaire consisting of 28 KAP (Knowledge, Attitudes, and Practices) questions was developed using the KAP assessment questionnaire for the population, designed by Croitoru and co-authors, as a model (Ferdohleb, Croitoru, & Ciobanu, 2023, p.140). The questionnaire, – developed in Romanian, – included dichotomous, open-ended, and closed-ended questions to evaluate the medical students’ perspectives on the mechanisms, consequences, causes, and awareness of climate change. The instrument was preliminarily tested and adapted based on the pretesting results before the final data collection.

The questionnaire was structured into five sections: sociodemographic data (2 questions), knowledge about climate change (8 questions), attitudes towards climate change (4 questions), activities conducted during heatwaves (10 questions), and information aspects (4 questions).

Procedures – The self-administered questionnaire was distributed to all students through the Institutional University Information System (SIMU). All respondents had access to the questionnaire by following a link to the form on the Google Forms platform. Upon the first distribution, 416 medical students completed the questionnaire. During the study period, from September to March 2022, 606 questionnaires were completed. The following settings were applied to the form: restriction to one response per person, access to the questionnaire only during the valid research period, and the possibility to complete the questionnaire only by individuals with institutional accounts.

The ethical aspects of research – In the introductory section of the questionnaire, the study objectives, the data collection instrument, the risks and benefits of participation, and the data confidentiality were explained. Informed consent to participate in the study was obtained from each respondent before the data collection by answering “Yes” to the first question in the questionnaire: “Do you agree to participate in this study?”

Data and statistical analysis – The data were collected and analyzed using Excel spreadsheets and a statistical package for social sciences (IBM SPSS Version 26.0). In the current research, inferential statistics were used (Spearman’s rho, Kendall’s tau_b, Chi-square), and “p” was used as the significance level.

Results

Knowledge of medical students about the phenomenon of climate change

The research began by assessing the level of awareness among medical students regarding the existence of the phenomenon of climate change. It was found that only one-third of respondents view climate change as a threat to humans.

The majority of respondents, 72.9% (95% CI: 69.32-78.57), selected the answer confirming their knowledge that both natural factors and human activity are equally involved in climate change, indicating that respondents have a relatively significant level of knowledge. Among of some medical students, 20.0% (95% CI: 16.87-24.23) believe in the anthropogenic cause and a small percentage, 4.0% (95% CI: 1.17-9.13), think that natural factors cause climate change. Three respondents did not believe in the phenomenon’s existence, and four students mentioned that they were not sufficiently informed to give a clear answer.

In the analysis of medical students’ perceptions regarding the causes of climate change, it was found that the greenhouse effect is the most well-known cause, cited by 67.7% (95% CI: 56.67-74.28) of respondents, both among women – 68.2% (95% CI: 62.22-74.13) but also among the men – 66.9% (95% CI: 59.07-84.99), with the majority selecting this answer. Few medical students were aware that wildfires can be a cause (Figure 1).

Figure 1

Structure of respondents’ perceptions regarding the causes of climate change, (%) (to see Figure 1, please click here)

Among the effects known to many medical students are circulatory system diseases, and from the infectious diseases category, waterborne diseases, and vector-borne diseases. Few respondents are aware that diseases of the renal, endocrine, nervous and digestive systems, along with allergies, malnutrition, trauma and injuries, and forced migration, are also influenced by climate change. The least number of men are aware of trauma and injuries, while the least number of women are aware of malnutrition (Table 1).

Table 1

Knowledge of medical students about the major effects of climate change on health, (%) ( to see Table 1, please click here)

Just over half of the respondents know that climate change is a current and future problem, 39.4% and they responded that they do not know, and 5.8% do not consider it like being a problem now or in the future.

Only 36.5% of medical students are aware that individuals with certain chronic conditions should consult a doctor regarding the adaptation of their therapeutic regimen during heatwaves. Regarding the avoidance of strenuous physical activities during heatwaves, 41.7% (95% CI: 36.11-44.51) of medical students are informed, while 49.0% (95% CI: 36.01-64.13) are unaware that it is necessary in an intentionally way to increase the fluid intake during the extreme heat waves.

Attitudes of medical students toward the phenomenon of climate change

Regarding attitudes, the overall score is below average at 59.1% (95% CI: 45.47-67.23), suggesting that the respondents may not give sufficient importance to the phenomenon of climate change or may not be adequately motivated to take action in this regard.

A proportion of 59.1% (95% CI: 50.34-68.32) of respondents have noticed an increase in the frequency of heatwaves, but 3% didn’t notice any changes in the past ten years, and 18.0% (95% CI: 6.47-24.52) of medical students mentioned the opposite, perceiving a cooling trend, while the other respondents in the study did not report some specific observations concerning the weather changes or the evolution of the climate change phenomenon.

Analyzing the respondents’ attitudes towards global warming (a multiple-choice question was provided), it can be stated that more than half of the medical students (60.0%) were concerned about this issue, while 28.1% of respondents are involved in addressing the problem, and only 13% consider it like being a catastrophe. At the same time, 21.9% (95% CI: 16.49-25.31) of medical students view this phenomenon as being a positive trend.

Another question referred to the respondents’ attitudes toward events they consider as being important issues for them. From a predefined list, they were asked to select three situations. The largest number of respondents prioritized human overpopulation of the Earth (67.0%, 95% CI: 49.81-84.13), followed by poor waste management (59.1%, 95% CI: 46.53-67.01) and traffic congestion (52.0%, 95% CI: 40.80-71.98).

Regarding their attitudes, the medical students were asked about their trust in information concerning the climate change and its impact over their family members or friends, the scientific researchers, the government, the energy providers, environmental organizations, and the media. About 3/4 of medical students trust information coming from people working in the scientific field, 12.5% (95% CI: 6.27-19.25) trust information coming from environmental organizations, 6.6% (95% CI: 1.09-12.21) trust media sources (TV, radio, newspapers), and 4.6% of medical students have high trust in information heard from family members or friends, but only very few have high trust in the government.

Practices of medical students regarding climate change

The overall practice score of medical students is the lowest at 39.5% (95% CI: 10.60-54.73), indicating that, despite having knowledge and positive attitudes, the respondents do not always succeed in putting into practice what they know and believe about the phenomenon of climate change.

When respondents were asked if they calculate the amount of liquid they need daily according to their body weight, only 36.0% (95% CI: 10.01-50.02) answered affirmatively. Of those, only 7.9% provided the correct formula and explanation (30 ml/bodyweight); others chose from 0.03 liters of water /body weight to 40 ml/body weight.

The volume of liquid consumed is represented in Figure 2.

Analyzing the types of liquids frequently consumed by respondents, it was found that the top preference is for drinking plain water (32.0%), followed by respondents who frequently consume juice (15.0%), and then those who consume tea (13.0%) (Figure 3).

More than half of the respondents, 57.9% (95% CI: 41.72-24.29), consume cold liquids during heatwaves, which is not considered the most appropriate method, as cold liquids restrict digestion by causing blood vessel constriction and lead to a decrease function in immune system. When consuming cold liquids, the body exerts extra effort to bring the water to the body’s temperature, making it a thermal attempt, with the final result like being an increase in body heat rather than a cooling one. Water at a warmer temperature is recommended for the body, especially since hydration is faster and digestion is improved due to the natural stimulation of digestive enzymes. Drinking cold water can reduce the heart rhythm rate. Consuming water at room temperature can help purify the blood and naturally detoxify the body through the lymphatic system, skin, and kidneys.

Figure 2

The proportion of respondents on the subject of the volume of liquid consumed during the heatwaves, (%) (to see Figure 2, please click here)

A large number of medical students – 73.9% (95% CI: 66.87-84.56), practice proper habits concerning the daily consumption of fresh fruits and vegetables, which is especially beneficial during heatwaves. Additionally, 88.9% do not consume alcoholic beverages or drinks containing alcohol during heatwaves. The same respondents also mentioned avoiding sun exposure between 11:00 AM and 5:00 PM during heatwaves. However, if they need to go out, they take protective measures such as: (i) wearing protective gear (sunglasses, caps, hats, lightweight natural fabric clothing in light colors); (ii) applying sunscreen; (iii) staying hydrated; and (iv) walking in the shade.

Figure 3

Proportion of respondents by the type of water frequently consumed during periods of extremely high temperatures, (%) (to see Figure 3, please click here)

Respondents also mentioned less appropriate protective measures, such as: “consumption of cold carbonated drinks” and “traveling by car,” among the measures applied during periods of extremely high temperatures.

Many respondents (80.0%) stated that they ventilate their living spaces daily during heatwaves. However, the time for ventilation (which also involves cooling the spaces) is not always appropriate (Figure 4). To ensure adequate cooling of living spaces, the most suitable time for ventilation is at night, when the air temperature is the lowest, followed by the morning (after the night, when the air temperature is also low). Ventilating rooms during the day, in heatwave conditions, is not recommended, as the atmospheric air temperature is high, which increases the indoor air temperature.

Figure 4

Proportion of respondents ventilating rooms, (%) (to see Figure 4, please click here)

Another important practice during heatwaves is cooling the body by taking a shower. Two-thirds of the respondents correctly apply this practice, taking showers with moderately warm water. The explanation is similar to that of consuming room-temperature or warm water. However, 32.0% mentioned taking cold showers, which is not recommended, and 4% take showers with hot water, which is also not advised.

Informing medical students about the phenomenon of climate change and its impact

In addition to knowledge, attitudes, and practices regarding extreme weather events, the sources of information about climate change and its impact on health must also be examined to a better understanding and making informed decisions concerning the climate literacy. In this section, respondents provided multiple answers.

The questionnaire results showed that 56.9% of respondents used social media as their primary source of information about climate change and its impact. The internet ranked second with 39.9%, and television ranked third with 27.1%. Radio was the source of information with the lowest percentage. Energy providers were not selected as a source of information. Educational institutions were a source of information for only 18.0% of medical students. According to the sample, the media is a weak source of information (Figure 5).

Respondents were asked how they would prefer to receive information to guide their educational process, raise their awareness about the phenomenon of climate change and its impact on health, and foster the preventive behaviors on the researched topic. Most medical students mentioned that the university would be the most suitable place to obtain this information, with 62.0% (95% CI: 51.45-76.14) supporting this option. Additionally, 53.3% (95% CI: 39.37-69.29) believe it would be appropriate to receive information from the workers in the medical field with specialized training in the relevant health issue (for example, from an endocrinologist for those with diabetes, from a rheumatologist for those with arthritis, etc.) (Figure 6).

Figure 5

Structure of information sources about the climate change and their impact, (%) (to see Figure 5, please click here)

Figure 6

Structure of requested methods for obtaining information about climate change and their impact, (%) ( to see Figure 6, please click here)

The questionnaire conducted shows little doubt about the usefulness of learning about climate change as a subject for students. Over 70.0% referred to it as important for their informational needs, and nearly half of the sample stated that the topic is important for their career.

Correlation analysis

Table 2 presents a correlation analysis between medical students’ knowledge, attitudes, and practices and their socio-demographic data (age, biological gender).

Table 2

Statistical relationship between the level of knowledge, attitudes, practices, gender, age (to see Table 2, please click here)

A significant positive correlation was noticed between gender and the medical students’ knowledge (τ = “+0.173”, p < 0.01 and ρ = .179, p < 0.01) and attitudes (τ = “+0.109”, p < 0.05 and ρ = .107, p < 0.05) regarding the phenomenon of climate change, suggesting that women are more engaged and more knowledgeable than men.

The age of the respondents shows a significant correlation with knowledge (τ = .063, p < 0.05 and ρ = .051, p < 0.05), indicating that the older the respondents are, the more knowledge they have about the phenomenon of climate change.

Table 3 highlights the correlational links between the level of information among medical students regarding the impact of the climate change but also their knowledge, attitudes, and practices about this issue. The Pearson correlation coefficient (.031) suggests a weak positive correlation between the level of information and knowledge, with an insignificant p-value of 0.710. This indicates a lack of substantial association between the levels of knowledge and the level of information among the medical students. The Pearson correlation coefficient (.164**) reflects a statistically significant moderate positive correlation between the attitudes of medical students and the level of information, with a p-value < 0.01 (p = 0.001). This suggests that an increase in medical students’ attitudes is associated with an increase in their level of information. Similarly, the Pearson correlation coefficient (.122**) indicates a statistically significant moderate positive correlation at p < 0.01 (p = 0.010) between the respondents’ practices and the level of information, indicating that favorable practices are linked to an increase in the level of information.

Table 3

Correlation between the level of information and the knowledge, attitudes, and practices of medical students concerning the impact of the climate changes (to see Table 3, please click here)

Discussion

According to many researchers, there are generally two causes of climate change – natural and anthropogenic. Natural causes include solar activity, changes in the volcanic activity, ocean currents, and the movement of continents, while anthropogenic causes refer to the increased concentration of greenhouse gases (with carbon dioxide and water vapor being the most significant) that radiate heat back toward the ground and maintain the planet’s temperature. Other anthropogenic causes include the conversion of land from forests to agriculture, deforestation, the burning of fossil fuels (oil, gas, coal), which releases carbon dioxide into the air, and infrastructure or urbanization for economic reasons, which also increases carbon dioxide production (Luo Ching-Ruey, 2020; IPCC, 2022; IPCC, 2023).

Both in the present study (72.9%) and in the specialized literature (94.1%), most respondents believe that climate change is real and think that human and environmental factors cause climate change equally. In the current study, 20.0% of respondents, and 44.8-97.1% in the specialized literature, considered that the human factor is the primary cause of climate change (Arun Bharadwaj & Jannavada, 2023; Reddy et al., 2022).

Thus, students seem to have basic knowledge about climate change and the environmental decline, and they may be able to associate events from their timeline with the provided definition.

Climate change will lead to a continued increase in extreme temperatures, which have become a significant threat to the public health.

Most medical students know that circulatory system diseases, waterborne diseases, and vector-borne diseases are among the significant effects of high temperatures caused by climate change. Among the transmissible diseases, waterborne and vector-borne diseases are particularly highlighted. Current scientific research confirms this and even explains the mechanisms of influence.

According to published research, more young people are aware of cardiovascular, respiratory, infectious, and those vector-borne diseases, as well as the skin diseases. However, only a few respondents could identify that nearly every human body system could be affected by the indirect or direct effects of climate change. This should not be seen as a learning gap but highlights the need for climate change education in institutions. (Arun Bharadwaj & Jannavada, 2023; O’Malley, 2016, p.48; Reddy et al., 2022).

The body’s heat sensation is primarily mediated by the capsaicin receptor, a non-selective cation channel permeable to calcium, which is blocked by intense heat. Mitochondria play an important role in heat stress-induced myocardial injury in cardiac tissue. Mitochondrial dysfunction is a fundamental feature of heat stress. The opening of the mitochondrial permeability transition pore (MPTP) is a crucial event in triggering the cell death pathway. Heat stress causes the opening of the MPTP, leading to a series of cytological effects. (Wang et al., 2019).

The actual magnitude of cardiovascular mortality caused by heat may be higher than reported, as the heat may not be mentioned on death certificates as a cause or a contributing factor. There is unequivocal evidence that the exposure to high ambient temperatures increases cardiovascular mortality. Recent studies have suggested that individuals with pre-existing conditions, such as diabetes, neurological disorders, and cardiovascular diseases, are at a higher risk of mortality during episodes of extreme temperatures. (Bai et al., 2018; Thompson, Kovats, Hajat, Macintyre, & O’Connell, 2024; Vadzyuk & Huk, 2023; Wang et al., 2019).

It is not recommended to modify or initiate treatments during heat waves, especially for individuals in vulnerable population groups, nor is it advisable to engage in strenuous physical activities. Some respondents in the current study also knew this.

Scientific research indicates that individuals they were prescribed medications to treat heart failure and high blood pressure have a higher risk of death during heatwaves (>22°C) compared to days without intense heat (<17°C). There is also strong evidence that nonsteroidal anti-inflammatory drugs increase the risk of death during heatwaves. The evidence for an association with anticholinergic medications was weak, although the risk estimate is comparable to other similar drug classes that were investigated. (Thompson et al., 2024).

In the current study, the issue of climate change and its effects concerns 56% of medical students, 13% of respondents consider it like being a catastrophe, and 28% of respondents are involved in the process of addressing the problem.

A proportion of 71.8% of respondents from published research indicated that they are very concerned about this phenomenon. However, few individuals have taken definitive steps to address climate change by organizing events or influencing legislative action. Nearly 55.6% of respondents had been engaged in only household measures, such as turning off lights or conserving water, and 26.5% passively participated in climate rallies. Planetary health can be defined as the health of human civilization and the state of the natural systems upon which it depends. Planetary health encompasses the fields of global health and public health, and almost 72.65% of respondents agree that replacing global health with planetary health could be useful for raising awareness of climate change. (Arun Bharadwaj & Jannavada, 2023).

Regarding attitudes towards climate change, the scientific research results show a positive attitude among young people; for example, the majority (more than 90%) agree with replacing fossil fuels with renewable energy. In the future, many respondents would like to work for a company with an excellent environmental record and purchase an electric car to reduce greenhouse gas emissions. Half of the respondents support reducing subsidies for water and electricity. (O’Malley, 2016, p. 48; Salman, Al-Mannai, Abahussain, & Alalawi, 2023).

In scientific research, 26% of respondents always use eco-friendly products. Most respondents have never used public transportation or grown plants. Nearly all respondents always turn off the air conditioning and lights before leaving home and use water rationally. Students regularly participate in campaigns to combat climate change. The majority of respondents have occasionally shown interest in reading about climate change (Salman et al., 2023).

The specialized literature highlights that around two-thirds of respondents considered planetary health and climate change education like to be extremely important components of the medical curriculum. Additionally, only 21.37% of those surveyed were satisfied with the current national medical curriculum in terms of coverage, involvement, and encouragement of planetary health and climate change education. This indicates a need to restructure the curriculum to emphasize the importance of the environmental health. Respondents noted that the lack of quality training in planetary health and climate change education was attributed to several factors, with the most significant being perceived as the lack of faculty preparedness, the inadequate coverage of current subjects, or the disinterest of instructors in incorporating climate change into the curriculum. The majority of respondents suggested that climate change should be integrated into the curriculum through practical measures, including community awareness programs, discussions, and workshops (Arun Bharadwaj & Jannavada, 2023; O’Malley, 2016, p. 48).

Bibliographic studies report situations partially similar to those in the current research regarding information sources. While 40% of respondents in the current study use the internet as a source of information, other studies published in specialized literature indicate 74%. Television serves as an information source for 27% of respondents in the current study, compared to 68% in the specialized literature (Reddy et al., 2022).

Conclusions

Climate change is a serious concern, severely impacting both human health and the environment. Medical students need to be aware of climate change’s role in disease pathophysiology and to be determined to act as agents for disseminating climate education and planetary health.

The research findings suggest that training programs for medical students are necessary to increase their awareness of climate change. These programs can effectively enhance medical students’ knowledge and shift their attitudes and practices.

Acknowledgements

This study was conducted with the financial support of the European multinational project “Phage treatment and wetland technology as an intervention strategy to prevent dissemination of antibiotic resistance in surface waters (PhageLand)” with project number 22.80013.8007.1M. The authors are independent and take full responsibility for the integrity and accuracy of the data analysis.

Consent to participate

Informed written consent was obtained from each participant at the time of recruitment. The subjects were informed that they could withdraw from the study at any stage, and they were assured of confidentiality.

Competing interests

The authors declare no competing interests.

References

1. Akrofi, M., Antwi, S., & Gumbo, J. (2019). Students in climate action: a study of some influential factors and implications of knowledge gaps in Africa. Environments – MDPI, 6(12), 1-15. http://doi:10.3390/environments6020012
2. Arun Bharadwaj, P., & Jannavada, H. (2023). Assessment of knowledge, attitude and practice of medical students in a Metropolitan city on the role of planetary health in medicine and the impact of climate change on health through a survey. International Journal Of Community Medicine And Public Health, 10(10), 3756-3763. http://doi:10.18203/2394-6040.ijcmph20233112
3. Bai, L., Li, Q., Wang, J., Lavigne, E., Gasparrini, A., Copes, R., et al. (2018). Increased coronary heart disease and stroke hospitalisations from ambient temperatures in Ontario. Heart, 104(8), 673-679. http://doi:10.1136/heartjnl-2017-311821
4. Chambaud, L., Chen, T., Cadeddu, C., Pinho-Gomes, A.-C., Ádám, B., Middleton, J., et al (2023). ASPHER Statement for COP28. A Call for Action in Seven Points. Public Health Reviews, 44, 27-29. http://doi:10.3389/phrs.2023.1606889
5. Luo Ching-Ruey, L. (2020). Climate change – the causes, influence and conceptual management. International Journal of Applied Engineering and Technology, 10, 15-25. Retrieved July 10, 2024 from https://www.researchgate.net/publication/344802977_CLIMATE_CHANGE_-THE_CAUSES_INFLUENCE_AND_CONCEPTUAL_MANAGEMENT
6. Damian-Timoşenco, G. (2021). Rezilienţă climatică – factor determinant al dezvoltării durabile [Climate resilience – determining factor of sustainable development]. Revista Didactica Pro…, 1(125), 12-15. https://doi.org/10.5281/zenodo.4560565
7. Deveci, S. E., Kurt, O., Pirinçci, E., & Oğuzöncül, A. F. (2019). Knowledge and awareness of a medical faculty students in Turkey about global warming, climate change and their consequences. Journal of Human Sciences, 16(2), 679-689. http://doi:10.14687/jhs.v16i2.5587
8. Ferdohleb, A., Croitoru, C., & Ciobanu, E. (2023). Instrumente de cercetare în Sănătatea Publică (culegere de chestionare)[Research tools in Public Health (questionnaire collection)]. Chișinău: Print-Caro.
9. Haustein, K., Allen, M. R., Forster, P. M., Otto, F. E. L., Mitchell, D. M., Matthews, … Frame, D. J. (2017). A real-time Global Warming Index. Scientific Reports, 7(1), 1-6.  http://doi:10.1038/s41598-017-14828-5
10. Mazdiyasni, O., Sadegh, M., Chiang, F., & AghaKouchak, A. (2019). Heat wave intensity duration frequency curve: a multivariate approach for hazard and attribution analysis. Scientific Reports, 9(1), 1-8. http://doi:10.1038/s41598-019-50643-w
11. Moonen, G. (2020). Hydrogen – empowering Europe for a carbon-neutral future. Climate Change & Audit Journal, 2, 140-148. from https://medium.com/ecajournal/hydrogen-empowering-europe-for-a-carbon-neutral-future-aeed92deec4d
12. O’Malley, S. (2016). Knowledge, attitudes and practices (KAP) survey report. Results of climate change awareness survey. Saint Lucia, W.I. Retrieved May 5, 2024 from https://www.adaptation-undp.org/sites/default/files/resources/climate_change_kap_survey_report_grenada_0.pdf
13. Percic, S., Kukec, A., Cegnar, T., & Hojs, A. (2018). Number of heat wave deaths by diagnosis, sex, age groups, and area, in Slovenia. Int. J. Environ. Res. Public Health, 15(173), 1-16. http://doi:10.3390/ijerph15010173
14. Reddy, G. P., Rajamouli, J., Arora, K. D., Jothula, K. Y., & Amaravadi, S., & Boda, A. (2022). Knowledge, perceptions and practices of medical students towards climate change and global warming: A cross sectional study Gudelli. Journal of Family Medicine and Primary Care, 11(6), 2557-2564. http://doi:10.4103/jfmpc.jfmpc
15. Salman, N., Al-Mannai, M., Abahussain, A., & Alalawi, M. S. M. (2023). Young students’ knowledge, attitude and practice towards climate change. http://doi.org/10.5772/intechopen.1002528
16. Steul, K., Schade, M., & Heudorf, U. (2018). Mortality during heatwaves 2003 – 2015 in Frankfurt-Main – the 2003 heatwave and its implications. International Journal of Hygiene and Environmental Health, 221(1), 81-86. http://doi:10.1016/j.ijheh.2017.10.005
17. Thompson, R., Kovats, S., Hajat, S., Macintyre, H., & O’Connell, E. (2024). Identification of individual-level clinical factors associated with increased risk of death during heatwaves: a time-stratified case-crossover study using national primary care records in England. BMJ Public Health, 2, e000927. http://doi:10.1136/bmjph-2024-000927
18. Tomczyk, A. M., Bednorz, E., & Półrolniczak, M. (2019). The occurrence of heat waves in Europe and their circulation conditions. Geografie, 124(1), 1-17. https://doi.org/10.37040/geografie2019124010001
19. Vadzyuk, S. N., & Huk, V. O. (2023). Cardiovascular diseases in Ukraine under conditions of global warming. Вісник Соціальної Гігієни Та Організації Охорони Здоров’Я України [Visnyk social’noyi hihiyeny ta orhanizaciyi oxorony zdorov ya Ukrayiny], 1(95), 32-39. http://doi:10.11603/1681-2786.2023.1.13859
20. Wang, X., Wang, S., Liu, W., Wang, T., Wang, J., Gao, X., … Chen, Z. (2019). Epigenetic upregulation of miR-126 induced by heat stress contributes to apoptosis of rat cardiomyocytes by promoting Tomm40 transcription. Journal of Molecular and Cellular Cardiology, 129, 39-48. http://doi:10.1016/j.yjmcc.2018.10.005
21. ***Australian Red Cross. (2017). Climate-ready communities. A guide to getting started. Retrieved July 19, 2024 from https://www.redcross.org.au/globalassets/cms-assets/documents/emergency-services/climate-ready-communities-a-guide-to-getting-started.pdf
22. ***IPCC. (2022). Climate change 2022. Impacts, adaptation and vulnerability. Retrieved July 19, 2024 from https://www.ipcc.ch/report/ar6/wg2/
23. ***IPCC. (2023). Climate change 2023: Synthesis report contribution of working groups I, II and III to the sixth assessment. Retrieved July 19, 2024 from https://www.ipcc.ch/report/sixth-assessment-report-cycle/
24. ***Organisation Mondiale de la Santé. [World Health Organization] (2022). Health and climate change: country profile 2022: Israel. Genève, Organisation Mondiale de la Santé: Editions de l’Organisation Mondiale de la Santé. Retrieved July 21, 2024 from https://www.who.int/publications/i/item/WHO-HEP-ECH-CCH-22.01.06
25. ***The Royal Society. (2020). A short guide to climate science. London: The Royal Society. Retrieved July 21, 2024 from https://royalsociety.org/-/media/policy/projects/climate-evidence-causes/climate-change-q-and-a.pdf