In response to the questions raised by Neil about if do health workers have adequate knowledge to prevent and treat tobacco addiction among their patients? what matters to them? how can they be better informed?, I wish to focus on one obstacle: Tobacco smoking prevalence in Healthcare Professionals.
As Julie N. Reza pointed out in a previous comment, there is still a high prevalence of tobacco use among physicians. Worldwide, 21% of physicians are current smokers. (1), although there is a wide variation: In the United States it is close to 7%, in Europe it is 3.8% in Wales and reaches 22.1% in Germany. Among Asian countries smoking prevalence ranges from 2.1% (in Thailand) to 66.9% (China). (2)
Also, among medical students and students of other health professions, smoking prevalence remains high. According to the results from the Global Health Professions Students Survey the smoking prevalence was highest in European countries (20% medical and 40% dental students) and the Americas (13% pharmacy to 23% dental students).(3)
When considering all Healthcare Professionals, including non-physicians, we found that the smoking prevalence is still high. In a 2019 systematic review and meta-analysis on Prevalence of tobacco use in healthcare workers it showed an overall prevalence of 21% ( 31% in males and 17% in females). (4)
This high prevalence, especially among physicians, constitutes a major obstacle to increasing awareness among the general population and among smokers. Because if many doctors continue to smoke, how will people believe them about the health risk of smoking?
As a general rule, smoking cessation among physicians tends to precede the decline in tobacco use in the general population.
In my country (Uruguay), in 2000 the National Medical Association (Sindicato Médico del Uruguay) engaged in tobacco control policies and WHO-FCTC process, as well as educating physicians on smoking cessation. In 2001 the smoking prevalence among physicians was 27% while in general population was about 32%.
In 2005, Uruguay started its implementation of the WHO-FCTC. The smoking prevalence dropped to 17% among physicians in 2007 and to 25% in general population in 2008. In 2011, the smoking prevalence among physicians dropped to 9,8%. (5)
Another problem is that physicians who smoke tend to intervene less in their patients' smoking habits, as Julie also pointed out, citing the work of Cattaruzza & West. (6)
In some ways, physicians can also be considered a disadvantaged population due to their cumulative risk factors for smoking. They face a huge workload, working over 55 h a week, and some of them work on nightshifts disrupting the circadian rhythm that can heighten smoking behavior. (1)
In most developing countries, physicians and other HCPs are not trained in tobacco control or smoking cessation interventions. Nor do they receive help to quit smoking.
Associations of health professionals, as well as medical schools and other health professions, globally, and especially in developing countries, should prioritize these interventions.
Dr. Eduardo Bianco
References
1. Besson et al. Smoking Prevalence among Physicians: A Systematic Review and Meta Analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705497/
2. Pazdro-Zastawny K, Dorobisz K, Bobak-Sarnowska E, Zatoński T. Prevalence and Associated Factors of Cigarette Smoking Among Medical Students in Wroclaw, Poland. Risk Manag Healthc Policy. 2022;15:509-519 https://doi.org/10.2147/RMHP.S337529
3. Sreeramareddy CT, Ramakrishnareddy N, Rahman M, et alPrevalence of tobacco use and perceptions of student health professionals about cessation training: results from Global Health Professions Students Survey. BMJ Open 2018;8:e017477. doi:10.1136/bmjopen-2017-017477
4. Nilan K, McKeever TM, McNeill A, Raw M, Murray RL. Prevalence of tobacco use in healthcare workers: A systematic review and meta-analysis. PLoS One. 2019 Jul 25;14(7):e0220168. doi: 10.1371/journal.pone.0220168. PMID: 31344083; PMCID: PMC6657871.
5. BOADO, MARCELO, & BIANCO, EDUARDO. (2011). Tabaquismo en los médicos uruguayos (2011). Revista Uruguaya de Cardiología, 26(3), 214-224. Recuperado en 06 de marzo de 2023 http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-0420201....
6. Cattaruzza & West. Why do doctors and medical students smoke when they must know how harmful it is? https://academic.oup.com/eurpub/article/23/2/188/683606.
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master’s in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Bianco’s research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. He is a member of the HIFA working group on substance use disorders. https://www.hifa.org/support/members/eduardo Email: ebianco AT nextgenu.org
