Smoking habits among Norwegian doctors 1974

Beliefs about harms of cigarette smoking among Norwegian adults born from 1899 to 1969. Do variations across education, smoking status and sex mirror the decline in smoking?

Background and aim

Smoking is one of the most important causes of socioeconomic disparities in morbidity and mortality. The aim of this study was to examine if beliefs about harms of smoking differed across gender, smoking status and education among Norwegian adults born between 1899 and 1969.

Methods

Using data from a nationally representative survey of smoking habits and a multinomial logit/negative binomial two-stage hurdle model design, we examined (first hurdle) the associations between birth cohort, gender, education and smoking status and four beliefs about cigarette smoking: i) smoking is not harmful, ii) do not know if smoking is harmful, iii) any number of cigarettes per day (CPD) is harmful and iv) smoking more than a given nonzero number of CPD is harmful, and (second hurdle) the predicted number of CPD that could be smoked without causing harm (from outcome iv).

Results

The probability of believing that smoking was not harmful was close to zero, regardless of birth cohort, sex, education and smoking status. The probability of not knowing if smoking was harmful decreased from around 0.7 to almost zero across cohorts. The probability of believing that smoking more than zero CPD was harmful increased from less than 0.1 to around 0.7, while the probability of believing that there is some safe level of smoking increased with cohorts born from 1900 to 1930 before declining. Respondents with primary/secondary education consistently believed smoking to be less harmful compared to respondents with tertiary education, but cohort trajectories were similar.

Discussion

The similar birth cohort trajectories in beliefs about the harms of smoking do not support the idea that Norwegian adults with lower education has had qualitatively different beliefs about the harmfulness of smoking compared to those with higher education. The persistent and large socioeconomic gradient is likely a result of other factors.

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.

Level of education and multiple sclerosis risk over a 50-year period: Registry-based sibling study

BACKGROUND

The conflicting results from studies on socioeconomic status (SES) and multiple sclerosis (MS) risk might be due to a change in the distribution of environmental exposures over time or to methodological limitations in previous research.

OBJECTIVE

To examine the association between SES and MS risk during 50 years.

METHODS

We included patients registered in Norwegian MS registries and prevalence studies born between 1930 and 1979, and identified their siblings and parents using the Norwegian Population Registry. Information on education was retrieved from the National Education Registry, categorized into four levels (primary, secondary, undergraduate and graduate) and compared in patients and siblings using conditional logistic regression.

RESULTS

A total of 4494 MS patients and 9193 of their siblings were included in the analyses. Level of education was inversely associated with MS risk ( p trend < 0.001) with an odds ratio (OR) of 0.73 (95% confidence interval (CI): 0.59-0.90) when comparing the highest and lowest levels. The effect estimates did not vary markedly between participants born before or after the median year of birth (1958), but we observed a significant effect modification by parental education ( p = 0.047).

CONCLUSION

Level of education was inversely associated with MS risk, and the estimates were similar in the earliest and latest birth cohorts.

[Tobacco consumption among men and women 1927-2007]

BACKGROUND

After 100 years of mass consumption of cigarettes, the smoking epidemic is on the verge of a historic decline in Norway. The article shows the number of smokers and tobacco consumption among men and women from 1927 to 2007.

MATERIAL AND METHODS

The total consumption of tobacco was estimated by adding up registered and unregistered sales. Data were collected from the Directorate of Customs and Excise and the tobacco industry. Sex-specific consumption was calculated from information on proportion of smokers and daily consumption (self-reported), excerpted from time series of representative cross-sectional surveys.

RESULTS

About 800,000 men - more men than women - smoked in the early 1960s, but the annual consumption of cigarettes per adult male reached its peak (2.8 kg) in the mid-1970s. The number of smokers among men has been halved since then and consumption reduced to 1.5 kg per adult male in 2007. Consumption peaked among women in about 1990, but stopped at 1.8 kg. The number of female smokers has only been reduced by about 150 000 individuals since it culminated at around 600,000 in the early 1970s. Men smoked more than 70 % of the cigarettes consumed from 1927 to 2007.

INTERPRETATION

The tobacco epidemic has affected men more than women. After 1995 a sex convergence has been observed.

The historical decline of tobacco smoking among United States physicians: 1949-1984

Background

Tobacco use became an ingrained habit in the United States (US) following the First World War and a large proportion of physicians, similar to the general population, were smokers. The period from 1949 to 1984 was a pivotal era of change however, as the medical profession, like the society it served, became increasingly aware of the dangers that tobacco incurred for health.

Methods

An extensive review targeted all manuscripts published in academic journals between 1949 and 1984 that related to tobacco smoking among US physicians. The study was undertaken in 2007–08 with an internet search of relevant medical databases, after which time the reference lists of manuscripts were also examined to find additional articles.

Results

A total of 57 manuscripts met the inclusion criteria. From a research perspective, the methodology and coverage of smoking surveys ranged from detailed national investigations, to local medical association surveys, and journal readership questionnaires. From a historical perspective, it can be seen that by the 1950s many US physicians had begun questioning the safety of tobacco products, and by the 1960s and 1970s, this had resulted in a continuous decline in tobacco use. By the 1980s, few US physicians were still smoking, and many of their younger demographic had probably never smoked at all.

Conclusion

Although the quality and coverage of historical surveys varied over time, a review of their main results indicates a clear and consistent decline in tobacco use among US physicians between 1949 and 1984. Much can be learned from this pivotal era of public health, where the importance of scientific knowledge, professional leadership and social responsibility helped set positive examples in the fight against tobacco.

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.

Smoking by physicians in Scandinavia: 1952-1989

The purpose is to describe smoking behaviour of physicians and of the general population in the Scandinavian countries. Data on smoking behaviour in physicians and in the population at large were collected from 14 surveys. The smoking prevalence dropped among male and female physicians in the period under study. Changes for the general male population were similar, but smoking among the general female population changed little. If the present changes continue, physicians could be a smokefree profession by the year 2000.

Smoking behaviour of Dutch general practitioners in the period 1977-1983

Between 1977 and 1983 roughly half of the Dutch general practitioners were smokers. The percentage of smokers was decreasing, both among general practitioners and in the general Dutch population. The number of smoking male general practitioners was higher than for men in general and considerably higher than in the highest socioeconomic bracket. Among general practitioners the daily consumption of manufactured and handrolled cigarettes was lower while the cigar consumption was higher. In most countries physician smoking behaviour antedates that of the general population but in Holland general practitioners' smoking habits are about four years behind that of the general population. It seems that Dutch general practitioners attribute little value to the role of setting an example in health behaviour, especially where it concerns their own smoking habits.

Fish tapeworm, a disappearing health problem in Finland

The occurrence of the tapeworm (Diphyllobothrium latum) in eastern Finland in 1975-81 was studied and findings were compared with previous results. The fish tapeworm has previously been shown to be a common health problem, especially in these parts of Finland. The prevalence rates of fish tapeworm eggs in large consecutive routine series of hospital laboratories have decreased to a level of 1-4% among the population. The results also indicate some possible differences in the rates and trends between different provinces in eastern Finland. The reasons for the occurrence and changing trends of the fish tapeworm in eastern Finland are discussed.

Smoking among schoolteachers in Estonia 1980

In the autumn 1980 schoolteachers in the Estonian SSR received a questionnaire concerning smoking habits and attitudes to health risks related to smoking. Responses were received from 8 347 teachers (82% response rate). Of the 1 336 men studied, 40% were current smokers and 15% ex-smokers. Of the 7 011 women, 11% were current smokers and 4% ex-smokers. Among men in the age groups below 30, 30-39, 40-49, 50-59 and above 59 years the percentages of current smokers were 44, 44, 36, 38 and 45, respectively. For female schoolteachers the corresponding figures were 20, 15, 7, 6 and 2. There were no differences in the rates of smoking between Estonian (40% current smokers) and Russian (40%) men. Among Estonian females there were more current smokers (13%) than among Russian females (5%) studied. Of male schoolteachers who were current smokers, 92 smoked cigarettes only; among females this percentage was 99. Two percent of male and 15% of female cigarette smokers smoked a few cigarettes per month; the proportions of heavy smokers (20 or more cigarettes per day) were 10% and 1%, respectively. The belief that smoking is associated with coronary heart disease, lung cancer, chronic bronchitis and lung emphysema was more widespread among ex-smokers and non-smokers as compared with current smokers.