Health impact of smoking – an unforgiveable omission in a doctor’s repertoire

Dear editor

Rahman et al¹ should be thanked for their discussion-provoking paper investigating the smoking behavior of patients and staff in a hospital based in Melbourne, Australia. The authors hoped to gather epidemiological data surrounding smoking, information on dependence to nicotine, and attitudes toward both the health impact and quitting strategies of smokers.

The authors decided to use a cross-sectional study design, limiting knowledge of the temporal outcome. This was further limited by a 2-hour time frame for data collection, meaning cohort inclusion was representative of a time of day rather than whole population. Data would be ideally collected over a week or month, for 24 hours each day to ensure adequate recruitment. The study would have been further reinforced by grouping of study participants, giving the reader further insight into smoking characteristics. The authors acknowledge smokers are less likely to have taken part in the study than non-smokers, also impacting on result reliability. This bias may even be more pronounced in health professionals due to potential embarrassment.

Limitations aside, this paper is of interest, with hospital staff less likely to smoke (7% compared to 16% in general population).¹ The paper raises a serious concern regarding the fact that hospital staff are not aware of the extent of smoking side effects. While this may include both medical staff and non-medical staff due to methodological oversight, it is concerning enough to warrant further attention and study. It also highlights the need for undergraduate education on smoking and for rigorous research skills, as without either of these, the problem identified will only continue.² The authors should be thanked for raising this pertinent issue.