An International Review of Tobacco Smoking in the Medical Profession

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.

Results in details

A total of 81 published studies met the inclusion criteria, as shown in Table. Most (n = 48) had been conducted as postal surveys, 14 were hand delivered, 4 were telephone surveys, 4 had utilised census data, 3 were conducted by personal interview, and two had been conducted at conferences. A further 4 used both postal surveys and follow-up telephone interviews, while two used postal and hand delivery, mainly to increase response rates following the postal phase. The latter technique appears to have been quite successful in some cases, with one Malaysian study achieving a 100% response rate in this regard. Response rates of the published studies ranged from 27% to 100%, with most above 60%. Only four manuscripts had response rates below 50%, and three investigations did not list their response rate. One study from Iran appeared to have 100% participation, although a response rate was not clearly stated and the authors were unable to be contacted to clarify their result, despite repeated attempts. A similar situation was encountered with a Greek study, where no response rate was listed and the authors were unable to be contacted. Among all manuscripts included in the current review, sample sizes ranged from 45 to 10 807, with an encouraging proportion having over 1000 respondents. Particularly large surveys of physicians' tobacco smoking habits were published from the Doctor's Health Study in the United Kingdom, the Physicians Health Study in the United States, and also from New Zealand census data; one of the few countries in the world which includes tobacco smoking questions on their census form.






International Comparison of Tobacco Smoking Surveys Conducted among Physicians between 1974 and 2004
One confounding factor across many investigations however, was a lack of standardisation regarding the definition of 'current smoker'. Although most authors referred to their subjects as simply being either smokers or non-smokers, some used recall periods ranging from one week to one month in their definition of the term 'current'. Others listed no recall period. This may have arisen due to the inherent difficulties in assessing smoking habits over time, and the fact that most investigations simply described the point-prevalence of tobacco smoking among the surveyed group. Not all physicians smoked cigarettes either, with a study of Hispanic physicians in the United States finding that 7% of their subjects smoked cigars, and none smoked cigarettes. In 1990 Doll et al also revealed that a large proportion of their British physicians only smoked pipes or cigars, similar to Fowler et al's earlier finding in the same country. Another confounding factor was that some studies appeared to use convenience samples, rather than true random sampling. Furthermore, a certain proportion of manuscripts did not clearly describe their sample group or their entire research methodology in detail. Nevertheless, such investigations were in the minority, with a large proportion of all manuscripts located during this review having reasonable sample sizes in the hundreds, and sufficiently high response rates to allow confidence in the published data.

Source