Table 1.
Description of Tobacco use and cessation related surveys among physicians between 1986 and 2010 by regions.
| Author [ref.] | Country | Year of Publication | Study Population | Sample Size | Study Design | Response Rate | Def of Smoker | Total Prev. [avg # of cig/day] | Male Prev. | Female Prev. | Other Relevant Findings and Recommendations |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Africa Region | |||||||||||
| Nollen, et al. [16] | Nigeria | 2004 | Physicians in two teaching hospitals | 373 | Cross-sectional survey | 80% | - | 3% | - | - | Suggested to implement smoking bans in health facilities. |
| Tessier, et al. # [11] | Algeria | 1999 | Health Professionals | - | Secondary data analyses | - | - | 40% | - | - | |
| Morocco | 1999 | Health Professionals | - | Secondary: data analyses | - | - | 30% | - | - | ||
| Egypt | 1999 | Health Professionals | - | Secondary data | - | - | 40% | - | - | ||
| Ndayie, et al. * [28] | Senegal | 1999 | Physicians | 163 | Cross-sectional study | - | Current smoker | 28% | - | - | More male than female smokers. 56.4% were heavy smokers. 70% of physicians smoked at work. |
| Recommended to create special smoking cessation programs targeted at doctors. | |||||||||||
| Rady and Sabbour [15] | Egypt | 1997 | Physicians at Ain Shams University | 382 | Behavioral risk factor surveillance system | 62% | Current smoker | - | 27% | 3% | 51% of current smokers reported smoking in front of patients or in clinic. 2/3 of current smokers have tried to quit smoking during the past year. Smoking is more prevalent among young physicians. |
| Shafey, et al., (Eds.) [18] | Egypt | 1993 | Physicians | - | - | - | - | 34% | - | - | |
| WHO (1997) [1] | Mada-gascar | 1993 | Physicians | - | Survey | - | Current smoker | 29% | - | - | Surgeons had higher rate of smoking (44%) |
| Callander and Rocke [29] | South Africa | 1986 | Anesthetists in Durban | 102 | Survey | 78 % | Daily smoker | 19% | - | - | 80% of smokers had considered quitting. Most highly rated reason for not smoking was health protection. There was a significant difference between smokers/non-smokers regarding perception of smoking as a health hazard. |
| Suggested for physicians support on policy development, bans on smoking in health facilities, and health info on cigarette packets. | |||||||||||
| Ballal [30] | Sudan | 1984 | Medical Practitioners | 753 | Crosssectional survey | 72.4 % | Current smoker | - | 46% | <0.1% | More than half of smokers smoked 15 cigs/day or greater. Subjects who engage in heavy smoking (>14 cig/day) have more difficulty in quitting. |
| Shafey, et al. (Eds.) [18] | Ethiopia | 1983 | Health Professionals | - | - | - | - | 9% | 13% | 2% | |
| Asia Region | |||||||||||
| Vanphanom, et al. [31] | Laos | 2011 | physicians | 855 | Survey | 80.6 | Daily smoker | 9.2% | 17% | 0.4% | Older doctors smoked more than the younger doctors. Over 84% of current smokers wanted to quit, and 74.7% had made a recent serious attempt to do so. Only 24% had received cessation training; 8.8% considered themselves ‘well prepared to deliver counseling |
| Zhou, et al. [6] | China | 2010 | Physicians | 673 | Survey | 85% | Current smoker | 26% | 35% | 3% | 50% reported that no smoke-free policy was in place in their hospital;93% had not received any training on smoking cessation counseling, and 62% had not read any smoking cessation guidelines. |
| Malik, et al. [9] | Pakistan | 2010 | Physician | 234 | Survey | 88% | Current smoker | 37.2% | 50.3% | 7% | Doctors considered smoking as relaxing; Peer pressure was a triggering factor for smoking |
| Peykari, et al. [32] | Iran | 2010 | general practitioners | 5,140 | Cross sectional | - | Life time current | 15% (6.6 cig/d) | - | - | There was significant relationship between smoking pattern of GPs and their knowledge about harms from smoking, and attitude towards smoking. |
| Lam, et al. [33] | China | 2010 | Male physicians | 514 | Cross sectional | 60.8% | Current smoker | - | 24.9% | - | Non-smokers than smokers were more likely to advice on quitting. Factors significantly associated with ‘‘initiation and/or advice’’ were prior smoking cessation training, a non-smoking status, better knowledge of smoking cessation and organizational support. |
| Shi, et al. [34] | China | 2010 | Anesthesiologists | 467 | survey | 60.3% | Current smoker | 10% | 18.4% | 3.9% | Compared with nonsmokers, smokers were significantly less likely to advise about the health risks of smoking and quitting. |
| Ceraso, et al. [35] | China | 2009 | Male physicians | 103 | survey | 89% | Current smoking (Smoking in the last month or 100 cigarettes life time smoking) | 49.5% | 49.5% | - | More than one-fourth (29%) of non-smoking physicians accepted cigarettes as gifts, and these physicians were less likely to ask their patients about their smoking status than those who did not accept gift cigarettes. Only 19% reported receiving training in how to help their patients quit. |
| Fadhil., L., et al. [36] | Bahrain | 2009 | Primary care physicians | 120 | survey | 55% | Current smoker | 24% | - | - | Only 4% physicians received training about tobacco cessation interventions. |
| Han Zao, L., et al. [37] | China | 2008 | physicians | 347 | survey | 86.8% | Current smoker | 42% | 58% | 18% | The following five variables were significantly associated with physicians’ smoking cessation counseling frequency: their smoking status, perceived success in their past counseling, perceived influence,perceived exemplary role, and perceived responsibility |
| Merrill, R., et al. [26] | Jordan | 2008 | Physicians and nurses | 513(physician = 251) | Cross sectional | - | Daily smoker | 12% (16/d) | - | - | Besides daily smokers, 7% were occasional smoker and 17% were former smoker; 81% of physicians who currently or formerly smoked had smoked in front of patients. Smoking status and training were associated with counseling patients about smoking. |
| Yan, J., et al. [38] | China | 2007 | Physicians and nurses | 636 (physician = 358) | Cross sectional | 77.56% | Current Smoker | 20.8% (16/d) | 43% | 1.2% | 45% of physicians informed patients about methods of smoking cessation. Smoking behavior was negatively associated with giving cessation counseling. |
| Ng, N., et al. [39] | Indonesia | 2007 | Physicians | 447 | Cross sectional | 65% | Current smoker | - | 22% | 1% | 72% of physicians did not routinely ask about their patient’s smoking status. |
| Jiang et al [40] | China | 2007 | Hospital based physicians | 3,552 | Clustered randomized survey | - | Current smoker | 23% (less than a pack) | 41 | 1 | Prevalence of current smoking increased with age except in physicians aged >60; Former smoking rate 2.7% (male 4.7%, female 0.3%) |
| Smith, et al. [41] | China | 2006 | Physicians in Hebei Province | 361 | Self-reporting survey | 79% | Current smoker | 16 % (10 c.) | 32% (10 c.) | 0% | 51.4% were light smokers; only 9% heavy smokers. |
| Mohan, et al. [20] | India | 2006 | Physicians | 229 | Cross sectional survey | 86% | Current smoker | 16% | 13% | 0% | About 60% had made some effort to quit in last year (1/3 had tried 4+ times). Recommended inclusion of tobacco control education in medical curriculum with a focus on dangers of low-level smoking. |
| Shafey, et al. (Eds.) [18] |
Palau | 2001 | Health professionals (MOH) | - | Survey | - | Current smoker | - | 20 % | 15 % | |
| Li, et al. [42] | China | 1999 | Physicians | 493 | Survey | 82% | Current smoker | - | 61% | 12% | One third smoked 20 or more cigs per day. Argued that physicians should be educated about their role as a role model in the society. |
| Shafey, et al. (Eds.) [18] |
Laos | 1996 | Physicians | - | Survey | - | Current Smoker | 18% | - | - | |
| Shafey, et al. (Eds.) [18] |
Tonga | 1994 | Physicians | - | Questionnaire survey | - | Current smoker | - | 14% | 0% | |
| Yaacob, et al. [43] | Malaysia | 1993 | Physicians at a university hospital | 120 | Mailed survey | - | Current smoker | 18% | 25% | 0% | 2/3 of smokers had previously tried to quit. Majority of smokers smoked 11–20 cigs/day. |
| WHO (1997) [1] | Fiji | 1991 | Physicians | - | Cross-sectional survey | - | Regular smoker | 26% | - | - | |
| Mongolia | 1991 | Doctors at University Hospital | - | - | - | Current smoker | 12% | - | - | ||
| Papua New Guinea | 1990 | Physicians | - | - | - | Current smoker | - | 2% | - | ||
| Sarkar, et al. [44] | India | 1990 | Physicians and medical students | 218 | Cross-sectional survey | 98% | Current smoker | 32% | 48% | 3% | About 1/3 each of heavy, moderate, and light smokers. 2/3 made efforts to quit and 9/10 had considered quitting. Physicians who smoked counseled patients significantly less often than non-smokers. |
| WHO (1997) [1] | Philippines | 1987 | Physicians | - | Survey | - | - | - | 63% | 37% | 38% of all said they smoked in front of patients. Only 59% advised patients on harmful effects of smoking. |
| Thailand | 1987 | MOPH doctors and dentists | - | - | - | - | 17%(12.6 c.) | - | - | ||
| Mongolia | 1980 | Military doctors | - | - | - | Current smoker | 50% | - | - | ||
| Shafey, et al. (Eds.) [18] | Vietnam | - | Health workers | - | Cross-sectional survey | - | Tobacco product use | - | 42% | 1% | |
| Supramaniam [45] | Malaysia | 1980 | Military physicians | 103 | Postal questionnaire survey | 87% | Current smokers | - | 50% | - | Half are heavy smokers (smoked 20 or more cig/day). Only 20% are light smokers (less than 10/day). |
| East and Central Europe | |||||||||||
| Perrin, et al. [46] | Armenia | 2006 | Physicians in Yerevan | 240 | Self-administered anonymous survey | 70 % | Regular or occasional smoker | - | 55% | 17% | Male physicians started smoking at much younger ages (most <18) than women (most >25). 13% had smoked in front of patients. About 1/2 of men and 3/4 of women ready to quit now or in next 6 months. Smokers were less likely to counsel patients to quit. |
| Schnoll, et al. [13] |
Russia | 2006 | Oncologists | 63 | Brief survey | - | Current smoker | 27% | - | - | Almost 1/2 of physicians do not feel confident in providing counseling and more than 1/2 do not see counseling as being ineffective. |
| Squier, et al. [27] |
Ukraine | 2006 | General practitioners | 799 | Cross-sectional survey | - | Current smoker | 14% | 62% (ever smoked) | 21% (ever smoked) | Most smokers are light smokers (66%, less than 1/2 pack per day). Suggested to increase number of smoke-free places, starting in hospitals and healthcare facilities. |
| Poanta, et al. [47]. |
Romania | 2006 | Physicians in Cluj County | 112 | Cross-sectional survey | 95% | Tobacco use | 42% | 55% | 35% | |
| Parna, et al. [48] |
Estonia | 2005 | Physicians | 2,746 | Postal Survey | 68 % | Current smoker | - | 25% | 11% | Over half of the physicians tried to quit smoking. Physicians should be informed of the importance of their ability to be role models as non-smokers |
| Gunes, et al. [49] |
Turkey | 2005 | Physicians at Turgut Ozal Medical Center | 257 | Cross-sectional survey | 85 % | Current smoker | 38% | - | - | |
| Hodgetts, et al. [9] |
Bosnia and Herze-govina | 2004 | Physicians in 19 Family Medicine Teaching Centers | 112 | Cross-sectional survey | 73% | Current smoker | 40%(16 c.) * both nurses and phys. | -(2 cig) * both nurses and phys | 40%(15 c.) both nurses and phys | Population overwhelmingly (91%) female. Those who had tried to quit in the past smoked significantly less cigarettes per day (14 vs. 22). Rates for male physicians not given due to small numbers. |
| Arkvadar, et al. [50] |
Turkey | 2004 | Physicians | 153 | Cross-sectional survey | 51 % | Current smoker | 38%(12 c.) | - | - | |
| Zolnierczuk-Kieliszek, et al. [51] |
Poland | 2004 | Hospital Staff | 127 | Cross-sectional survey | - | Current smoking | 29% | - | - | 57.4% of smokers tried to cut down while on hospital premises. |
| Glavas, et al. [52] |
Croatia | 2003 | Health Professionals | 119 | 97% | Daily smoker | 37% | 37%(both phys and nurses) | 36%(both phys and nurses) | Gender specific prevalence were combined for physicians and nurses. 48.2% smoked 16–25 cigarettes daily. 67.5% have a strong desire to quit; 52 % had tried to quit. | |
| Didilescu and Muntueanu [53] | Romania | 2000 | Physicians | 1,136 | - | - | - | 43% | 50% | 39% | More than half of smokers smoke between 10–20 cig/day. |
| Shafey, et al., (Eds.) [18] | Georgia | 1998 | Health Professionals | - | - | - | Current smoker | - | 48% | 16% | |
| Russia | 1999 | Physicians in Moscow (30-70 years) | - | - | - | Current smoker | 27% | 41% | 13% | ||
| Wold, et al. [54] | Georgia | 1999 | Physicians and nurses | 107 | Cross-sectional survey | - | Tobacco product use | 32% | - | ||
| Shafey, et al., (Eds.) [18] | Czech Republic | 1998 | Physicians | - | Cross-sectional survey | Daily or occasional smoker | - | 26% | 21% | ||
| Shafey, et al., (Eds.) [18] | Moldova | 1998 | Physicians | - | Cross-sectional survey | - | Current smoker | - | 44% | 6% | |
| Ukraine | 1998 | Health Professionals | - | Secondary data | - | - | - | 43% | 19% | ||
| Bosnia | 1996 | Physicians | - | Survey | - | Regular daily smoker | - | 50% | 55% | ||
| Bulgaria | 1996 | Doctors | - | Survey. | - | Regular daily smoker | 52% | - | - | ||
| Slovenia | 1996 | Physicians | - | Survey | - | Regular daily smoker | - | 17% | 15% | ||
| Poland | 1995 | Physicians | - | Cross-sectional survey | - | Regular daily smoker | - | 24% | 16% | ||
| Kralikova, et al. [55]. |
Czech Republic | 1995 | Physicians | 2,046 | Survey | - | Current or occasional smoker | - | 38% | 26% | Almost half of physicians had not heard of NRT. 75% smoking physicians would like to stop smoking. |
| Shafey, et al., (Eds.) [18] | Croatia | 1993 | Health Workers | - | Survey | - | 35% | - | - | ||
| Latvia | 1993 | Physicians | - | - | - | Current smoker | 59% | - | - | ||
| Turkey | 1993 | Physicians | - | - | - | Daily smoker | - | 53% | 41% | ||
| Lithuania | 1992 | Physicians | - | Survey | - | Current smoker | - | 38% | 10% | ||
| Icli, et al. [56] | Turkey | 1992 | Residents and interns | 200 | Survey | 100% | Current smoker | 34% | 35% | 31% | About 62% had unsuccessfully tried to quit. Smoking residents are more likely to believe their influence on patient smoking is only minor, and less likely to offer counseling. |
| Gorecka, et al. [57] * |
Poland | 1991 | Pneumol-ogists | 850 | Self-reported questionnaire survey | - | - | - | 38% | 29% | |
| Fortic [58] * | Slovenia | 1989 | Physicians | - | - | - | Regular smoker | - | 30% | 20% | Recommended that tobacco control and smoking cessation teaching should be mandatory at the medical schools. |
| Misiavichene, et al. [14]* |
Russia | 1987 | Physicians | 275 | Interview | - | Regular smoker | - | 30% | 2% | Recommended to focus preventative measures on men, who have high rates of smoking. |
| Innos, et al. [17] |
Estonia | 1982(pub 2002) | Physicians | 3,791 | Survey | 81% | Current smoker | 21% | 41% | 15% | About 40% (60% of men, 1/4 of women) smoked 10 or more cigs/day |
| Central/South America | |||||||||||
| Mejia, R., et al. [59] | Argentina | 2010 | Gynecologist | 235 | Survey | 78.3 | Current smoking | 35% | - | - | Only 22% had received training in smoking cessation counseling and 48.5% reported insufficient knowledge to provide smoking cessation advice. |
| Viegas, et. al. [21] |
Brazil | 2007 | Physicians, Federal District | 830 | Mailed surveys | 12% | Regular or occasional smoker | 7% | 9% | 5% | 53% of smokers smoked 10 cig or less per day. 77% of smokers believed they could quit, and 68% intended to quit. |
| Balbani, et al. [22] |
Brazil | 2006 | Otorhino-laryngologists | 209 | Mailed surveys | 35% | Regular or occasional smoker | 7%(14 c.) | - | - | 73.3% of smokers have already tried to quit smoking. |
| Varona, et. al. [60] |
Cuba | 2005 | Family physicians | 121 | Cross-sectional survey | - | Current smoker | 18% | 21% | 16% | |
| Bello, et al. * [12] |
Chile | 2004 | Employees of Chilean MOH | 20,848 | Cross-sectional survey | - | Current smoker | 41%(7 c.) | 43% | 40% | 45 % of smokers are interested in quitting. |
| Sanchez and Lisanti [23] * | Ecuador | 2003 | Physicians in Azuay, Ecuador | 687 | Survey | 78% | - | 32% | - | - | Men smoked more cigs per day than women. |
| Barnoya and Glantz [61] | Guatemala | 2002 | Physicians | 174 | Self-administered questionnaire survey | 64% | Current smoker | 18%(2.5 c.) | 26% | 5% | 40% of residents who smoked said they did so at work. 76% of smokers said they would like to quit. |
| Salmeron-Castro [62] * | Mexico | 2002 | Physicians at the Mexican Institute of Social Security | 3,133 (all workers) | Self-administered questionnaire survey | - | Current smoker | - | 21% | 16% | |
| Shafey, et al., (Eds.) [18] |
Uruguay | 2001 | Medical doctors | - | National survey | - | Current smoker | 27% | - | - | |
| Grossman, et al. [63] |
Costa Rica | 1999 | Physicians | 217 | Cross-sectional survey | 76% | Current smoker | 19%(<10 cigs) | 59% (ever smoker) | 60% (ever smoker) | 2/3 of physicians had smoked in their office. |
| Sansores, et al. [19] |
Mexico | 1999 | Physicians at National Institute of Health | 4,422 (all health workers) | Survey | 31% | Current smoker | 22% | 22%(all health workers) | 39%(all health workers) | 29% of physician smokers want to quit and 44% have quit at some point in the past. Place more restrictions on smoking in the workplace (or enforce current ones). Provide smokers who want to quit with effective health promotion and health education programs. |
| Tapier-Conyer, et al. [24] |
Mexico | 1997 | Physicians | 3,488 | Survey | 98% | Current smoker | 27% | 30% | 21% | 60% of men and 77% of women smoked≤10 cigarettes/day. Recommended to ban smoking in workplace to force quitting behavior or at least reduce number smoked during office hours. |
| Shafey, et al. (Eds.) [18] | Argentina | 1997 | Physicians at 15 Hospitals in Buenos Aires | - | Cross-sectional survey | - | Current smoker | 30% | - | - | |
| Mirra and Rosemberg [25] * | Brazil | 1997 | Physicians | 11,909 | Cross-sectional survey | - | Regular smoker | 6% | - | - | Onset of smoking most frequently between 10 and 19 years. |
| Shafey, et al., (Eds.) [18] |
Cuba | 1995 | Physicians | - | Cross-sectional survey | - | Daily smoker | 25% | - | - | |
| Panama | 1993 | Health Professionals (30–44 years) | - | Cross-sectional survey | - | - | 10% | 16% | 5% | ||
| Peru | 1993 | Physicians (25 plus) | - | - | - | Current smoker | 26% | 27% | 19% | ||
| Cornejo, et al. [64] * |
Chile | 1992 | Physicians | 288 | Questionnaire survey | - | Daily smoker | 35%(9 Cig) | 40% | 24% | 50% of smokers would not not quit smoking. |
| Shafey, et al., (Eds.) [18] | Colombia | 1991 | - | - | - | - | Daily smoker | 21% | 21% | 22% | |
| Ramirez-Casanova, et al. [65] * |
Mexico | 1991 | Physicians | 284 | Questionnaire survey | - | Current or former smoker | 61% | 67% (among all health workers) | 58% [amg all health workers] | Physician rates are comparable to overall prevalence in hospital workers. Implement a smoke free policy at the hospital. |
| Shafey, et al., (Eds.) [18] | Paraguay | 1989 | Physicians (Age 20–80) | 837 | - | - | Current smoker | 32% | 35% | 33% | |
| Alonso and Diaz [66] * | Chile | 1989 | Physicians from Valparaiso area | 174 | Survey | - | Current smoker | 25% | - | - | |
| Shafey, et al., (Eds.) [18] | Bolivia | 1987 | Physicians | - | Survey | - | Daily smoker | 35% | - | - | |
| Dominican Republic | 1986 | Physicians | - | - | - | Current smoker | - | 43% | 17% | ||
* Indicates that only the abstract was available for review; # Same study covered three countries.