Smoking habits, exposure to passive smoking and attitudes to a non-smoking policy among hospital staff

Smoking Prevalence among Physicians: A Systematic Review and Meta-Analysis

BACKGROUND

Smoking is a major public health problem. Although physicians have a key role in the fight against smoking, some of them are still smoking. Thus, we aimed to conduct a systematic review and meta-analysis on the prevalence of smoking among physicians.

METHODS

PubMed, Cochrane, and Embase databases were searched. The prevalence of smoking among physicians was estimated and stratified, where possible, by specialties, continents, and periods of time. Then, meta-regressions were performed regarding putative influencing factors such as age and sex.

RESULTS

Among 246 studies and 497,081 physicians, the smoking prevalence among physicians was 21% (95CI 20 to 23%). Prevalence of smoking was 25% in medical students, 24% in family practitioners, 18% in surgical specialties, 17% in psychiatrists, 16% in medical specialties, 11% in anesthesiologists, 9% in radiologists, and 8% in pediatricians. Physicians in Europe and Asia had a higher smoking prevalence than in Oceania. The smoking prevalence among physicians has decreased over time. Male physicians had a higher smoking prevalence. Age did not influence smoking prevalence.

CONCLUSION

Prevalence of smoking among physicians is high, around 21%. Family practitioners and medical students have the highest percentage of smokers. All physicians should benefit from targeted preventive strategies.

Cigarette Smoking, Health-Related Behaviors, and Burnout Among Mental Health Professionals in China: A Nationwide Survey

OBJECTIVES

Mental health professionals (MHPs) play an important role in treating patients with nicotine addiction. However, data on MHPs' cigarette smoking habits are scarce. This survey aimed to collect such data and to examine the correlates of smoking among MHPs working in China.

METHODS

A cross-sectional survey was conducted in all 41 provincial, tertiary psychiatric hospitals, and MHPs from these hospitals were targeted. An anonymous questionnaire was designed to collect socio-demographic and occupational factors, and the Maslach Burnout Inventory-Human Service Survey was used to assess burnout. Data about smoking and other health behaviors were also collected.

RESULTS

In total, 13,614 MHPs were included in the analysis. The overall rate of current smoking was 8.6% (31.3% in males, and 1.1% in females). A substantial proportion (28.0%) of life-time smokers had abstained for more than 3 months. Those who were male (OR=37.73), older (OR=1.02), divorced or widowed (OR=1.72), working in West (OR=1.45), and Northeast China (OR=1.65), were nurses (OR=1.44), had a high income (OR=1.31), experienced burnout (OR=1.29), frequent insomnia (OR=1.39), and used alcohol (OR=2.76) were significantly more likely to be smokers, while those who had a higher level of education (OR=0.67, 0.47, and 0.43 for college, master, and doctorate degrees, respectively), and exercised regularly (OR=0.73) were significantly less likely to be smokers.

CONCLUSION

Although lower than that of the general population in China, smoking is still relatively high among MPHs. Efforts to lower smoking rates among MHPs in China should continue and should incorporate strategies that target burnout, sleep, alcohol use, exercise and other factors associated with smoking.

Trends in smoking behaviour among Estonian physicians in 1982-2014

Background

Smoking surveys among physicians have proved useful in highlighting the importance of physicians as healthy life style exemplars and role models in tobacco control and smoking cessation. The aim of this study was to give an overview of smoking behaviour among Estonian physicians from 1982 to 2014.

Methods

Three cross-sectional postal surveys using a self-administered questionnaire were carried out among all practising physicians in Estonia. The number of physicians participating in this study was 3786 in 1982, 2735 in 2002, and 2902 in 2014. Data analysis involved calculating the age-standardized prevalences of smoking, prevalences of smoking by age group and mean age of smoking initiation. A non-parametric test for trend was used to assess significant changes in smoking over time.

Results

Age-standardized prevalence of current smoking among men was 39.7% in 1982, 20.9% in 2002, and 14.3% in 2014 and among women 12.2%, 8.0%, and 5.2%, respectively (p < 0.0001 for trends). From 1982 to 2014, the biggest decline of current smoking among men and women was in age groups under 35 (from 55.2% to 16.7% and from 16.7% to 2.8%, respectively) and 35–44 (from 47.1% to 8.3% and from 19.5% to 5.1%, respectively) (p < 0.0001 for trends). Mean age of smoking initiation decreased from 20.4 to 19.3 among men and from 24.5 to 20.4 among women over the study period.

Conclusions

In 1982–2014, smoking prevalence among Estonian physicians declined substantially. This may influence the willingness of society to recognize the health consequences of smoking which could give a support to the decline of the smoking epidemic in the country. Differences between smoking among male and female physicians persisted over the study period, but mean age of smoking initiation decreased. A further decline in smoking among Estonian physicians should be encouraged by special efforts targeted at physicians.

Smoking prevalence and associated risk factors among healthcare professionals in Nicosia general hospital, Cyprus: a cross-sectional study

Background

In recent years, a significant progress has been achieved globally in reduction of smoking among physicians and nurses, however, in some countries the smoking prevalence of health professionals is maintained at very high levels, without significant difference from the general population. This study aims to investigate the prevalence of smoking among physicians and nurses working at Nicosia General Hospital, as well as their knowledge and attitudes towards smoking cessation strategies.

Methods

This is a cross-sectional questionnaire-based study. The study consisted of 119 doctors and 392 nurses currently working at Nicosia General Hospital in Cyprus. Study participants were recruited from all hospital wards between May and June 2008. Both physicians and nurses were asked to answer an anonymous questionnaire, which included questions regarding their smoking habits, knowledge and attitudes about smoking and smoking cessation strategies.

Results

Overall smoking prevalence among healthcare professionals was 28.2 % (28.6 % among physicians and 28.1 % among nurses). Multivariate analysis revealed that being male, younger than 34 years old, unmarried and with a family history of smoking were associated with increased likelihood of being a current smoker. An impressive 72 % of current smokers reported that they wished to quit smoking, however, only 5.6 % of physicians and 6.9 % of nurses, reported ever using any smoking cessation aids. Never- smokers counseled their patients to quit smoking more often (96.4 %) compared to former (84.6 %) and current smokers (72.7 %), (p < 0.001). In addition, those who felt more confident about their knowledge regarding smoking cessation, reported counseling their patients to quit smoking more often compared to those who did not (92 % vs 60 %, p < 0.001).

Conclusions

Smoking prevalence among physicians and nurses working at Nicosia General Hospital was similar to that of the general Cypriot population. Further training of healthcare professionals towards smoking cessation strategies is needed in order to improve their knowledge and consequently their efforts on counseling and support to their patients who wish to quit smoking.

The frequency of smoking and common factors leading to continuation of smoking among health care providers in tertiary care hospitals of Karachi

Background:

The primary objective of the study was to find out the frequency of tobacco smoking among health care providers in tertiary care hospitals of Karachi. The secondary objective was to identify the common factors responsible for the continuation of smoking.

Method:

This cross sectional study was conducted in the wards and out-patient departments of three selected tertiary hospitals of Karachi. A total of 180 health care providers were enrolled in the study using proportionate stratified sampling. Postgraduate students, house officers and trainees were excluded from the study. Data were collected from randomly selected health care providers using survey methodology. SPSS v. 20.0 was used to enter and analyze the data.

Results:

Fifty two participants out of 180 were smokers for past one year (28.9%). Among them, 21 (11.7%) smoked more than 5 cigarettes per day. Twenty smokers (11.1%) were found to smoke due to peer influence. It was found that those who were influenced by their peers were 8.33 times more prone to be addicted to smoking than those who were less influenced. Similarly, the likelihood of addiction increased up to 76.9% with the lack of incentives.

Conclusion:

Our results clearly indicate that a large number of health care providers smoke which should be a serious concern. Hence our health agencies should take immediate action in order to curtail the heaving burden of smoking and its related health consequences.

Smoking prevalence and attitudes regarding its control among health professional students in South-Western Nigeria

Background:

Tobacco use is one of the leading preventable causes of morbidity and mortality globally; about 70% of smokers see physicians each year. Health care professionals have a very unique role in motivating people to quit smoking.

Aim:

The aims of this study were to document the smoking prevalence and attitudes regarding its control among these set of students who will be tomorrow's health care providers.

Subjects and Methods:

A cross-sectional survey was conducted in two medical schools in South-Western Nigeria with their accompanied nursing and pharmacy students. All students in the selected schools were eligible to participate and student's participation was voluntary. The Global Health Professional Students Survey core questionnaire was used to collect data on smoking prevalence and attitudes regarding its control. The data were summarized using percentages and confidence interval (CI) was calculated using standard error of mean. Pearson's Chi-square and fisher's exact were employed to test the significance.

Results:

Life-time prevalence of cigarette smoking was 17.9% (121/675) with (95% confidence interval [CI] 15-20.8). Only 5.04% (34/675) with (95% CI 3.7-7.1) of the respondents were currently smoking. Ever smokers were significantly less likely than non-smokers to indicate that tobacco sales to adolescents should be banned (P < 0.01). Fewer smokers than non-smokers agreed that there should be a complete ban on advertising of tobacco products (P < 0.001). 93.3% of them said that they were taught about danger of smoking but only 48.6% ever heard of using anti-depressant in tobacco cessation program.

Conclusions:

Smoking prevalence among health professional students in South-West Nigeria is relatively low; however, majority believed that health-care providers serve as role models for their patients and the public.

Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: a cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban

BACKGROUND

Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008.

METHODS

Questionnaire-based cross-sectional study, including all eligible staff.

SAMPLE

52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes.

RESULTS

Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes.

CONCLUSIONS

Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.

The historical decline of tobacco smoking among Australian physicians: 1964-1997

BACKGROUND

Physicians occupy an important position as tobacco control exemplars and their own smoking habits are known to influence how effective they may be in such a role.

METHODS

A comprehensive review of all published manuscripts describing tobacco usage rates and tobacco control activities in the Australian medical profession between 1964 and 1997.

RESULTS

Some of the earliest surveys revealed that around one-quarter of Australian physicians were smoking in the mid twentieth century, a rate which rapidly declined in the 1970s and 1980s, with reductions beyond that achieved by the general population.

CONCLUSION

Overall, our review suggests that not only do contemporary Australian physicians smoke at very low rates when compared internationally, but that an active professional community can also make a real difference to the lifestyle choices of its own members.

Smoking prevalence and awareness among undergraduate and health care students

Approximately 10,000 undergraduates from 12 Texas colleges and universities and 350 health care students completed a Web-based survey assessing the prevalence and awareness of cigarette smoking. There were few differences between health care and undergraduate students on trying smoking or quitting smoking. Health care students reported lower rates of current smoking than undergraduate students, even though both groups demonstrated similar knowledge of tobacco-related health risks. Gender differences are discussed. Findings suggest that tobacco awareness programs should continue to target young adults as an at-risk population, and that health care training programs should place a greater emphasis on tobacco cessation.

An international review of tobacco smoking in the medical profession: 1974-2004

BACKGROUND

Tobacco smoking by physicians represents a contentious issue in public health, and regardless of what country it originates from, the need for accurate, historical data is paramount. As such, this article provides an international comparison of all modern literature describing the tobacco smoking habits of contemporary physicians.

METHODS

A keyword search of appropriate MeSH terms was initially undertaken to identify relevant material, after which the reference lists of manuscripts were also examined to locate further publications.

RESULTS

A total of 81 English-language studies published in the past 30 years met the inclusion criteria. Two distinct trends were evident. Firstly, most developed countries have shown a steady decline in physicians' smoking rates during recent years. On the other hand, physicians in some developed countries and newly-developing regions still appear to be smoking at high rates. The lowest smoking prevalence rates were consistently documented in the United States, Australia and the United Kingdom. Comparison with other health professionals suggests that fewer physicians smoke when compared to nurses, and sometimes less often than dentists.

CONCLUSION

Overall, this review suggests that while physicians' smoking habits appear to vary from region to region, they are not uniformly low when viewed from an international perspective. It is important that smoking in the medical profession declines in future years, so that physicians can remain at the forefront of anti-smoking programs and lead the way as public health exemplars in the 21st century.

'We will speak as the smoker': the tobacco industry's smokers' rights groups

INTRODUCTION

The tobacco industry usually keeps its commercial and political communications separate. However, the images of the smoker developed by the two types of communication may contradict one another. This study assesses industry attempts to organize 'smokers' rights groups,' (SRGs) and the image of the smoker that underlay these efforts.

METHODS

Searches of the Legacy Tobacco Documents Library, the British American Tobacco documents database, and Tobacco Documents Online.

RESULTS

1100 documents pertaining to SRGs were found, including groups from across Europe and in Australia, New Zealand, and Hong Kong. From the late 1970s through the late 1990s they were active in numerous policy arenas, particularly the defeat of smoke-free laws. Their strategies included asserting their right to smoke and positioning themselves as courteous victims of tobacco control advocates. However, most SRGs were short-lived and apparently failed to inspire smokers to join in any significant numbers.

CONCLUSION

SRGs conflated the legality of smoking with a right to smoke. SRGs succeeded by focusing debates about smoke-free policies on smokers rather than on smoke. However, SRGs' inability to attract members highlights the conflict between the image of the smoker in cigarette ads and that of the smokers' rights advocate. The changing social climate for smoking both compelled the industry's creation of SRGs, and created the contradictions that led to their failure. As tobacco control becomes stronger, the industry may revive this strategy in other countries. Advocates should be prepared to counter SRGs by exposing their origins and exploiting these contradictions.