Research articleChinese Physicians and Their Smoking Knowledge, Attitudes, and Practices
Introduction
China consumes more cigarettes than any other country in the world and is home to 360 million current smokers.1 China has a smoking prevalence of 31%; 57% of men and 3% of women smoke.1 Additionally, 52% of nonsmokers in China are exposed to secondhand smoke at home or at work.1 Smoking in China has tremendous health consequences, with 514,000 premature deaths due to smoking-related illnesses in 1998,2 and smoking is responsible for over 7% of all deaths.3 These mortality numbers are under-estimated because they do not account for secondhand smoke-related deaths.
Physicians can play a key role in smoking cessation.4, 5, 6 Simple interventions, such as advising a smoker to quit, and more intensive interventions, such as counseling or pharmacologic therapy, increase the odds of a smoker quitting.4, 5 Physicians can also serve as role models for healthy behaviors by not smoking. Smoke-free hospitals are important for the health of patients and healthcare workers, and can help with smoking cessation.7
Little is known about Chinese physicians’ smoking behavior and their smoking-cessation attitudes and practices.8 One study of 500 physicians in the city of Wuhan showed a smoking prevalence of 61% for men and 12% for women.9 This study also found that 58% of physicians usually advise smokers to quit, and that 85% thought that physicians should be nonsmoking examples and should help smokers quit.9 A second study of 361 physicians working in a rural teaching hospital in Hebei province demonstrated a smoking prevalence of 31.9% for males only, and that among all physicians, those aged 50 to 54 years (31.6%) had the highest smoking prevalence.10
This is a report on the first geographically diverse survey of physicians from six cities in China on physician smoking behavior and their smoking knowledge, attitudes, and practices.
Section snippets
Population
The survey of physicians was conducted between July 2004 and October 2004 in six cities: Chengdu, Guangzhou, Harbin, Lanzhou, Tianjin, and Wuhan (Figure 1). These cities were selected, as they were representative of different regions throughout China. In each city, hospitals were stratified by catchment size into provincial, city, and district-level hospitals. Nonhospital-based physicians were included by considering two community health centers as the equivalent of one district-level hospital.
Results
Men comprised over half of the sample, and subjects were evenly distributed throughout the six cities. Over 60% of all surveyed physicians were aged <40 years, while <3% were aged >60 (the state-mandated retirement age). Most physicians were working in internal medicine, surgical, or gynecologic specialties (Table 1).
Discussion
This is the first geographically diverse survey of Chinese physicians’ smoking behavior and their smoking-cessation attitudes and practices. Male physician smoking prevalence is high with few former smokers, in contrast to the low female physician smoking prevalence. This pattern is reflective of China’s general population, although overall physician rates are lower. Chinese physicians have a substantially higher smoking prevalence than United States (3.3%)14 or United Kingdom (6.8%)15
References (38)
- et al.
Investigation of Hong Kong doctors’ current knowledge, beliefs, attitudes, confidence and practices: implications for the treatment of tobacco dependency
J Chin Med Assoc
(2006) - et al.
Is serum cotinine a better measure of cigarette smoking than self-report?
Prev Med
(1995) - et al.
Smoking and passive smoking in China, 2002
Zhonghua Liu Xing Bing Xue Za Zhi
(2005) - et al.
Emerging tobacco hazards in China. 1. Retrospective proportional mortality study of one million deaths
BMJ
(1998) - et al.
Major causes of death among men and women in China
N Engl J Med
(2005) Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence: a US Public Health Service report
JAMA
(2000)What to do with a patient who smokes
JAMA
(2005)ABC of smoking cessationUse of simple advice and behavioural support
BMJ
(2004)- et al.
Ending smoking at the Johns Hopkins medical institutionsAn evaluation of smoking prevalence and indoor air pollution
JAMA
(1990) - et al.
Research on tobacco in China: an annotated bibliography of research on tobacco use, health effects, policies, farming, and industry
(2004)
Increase in cigarette smoking and decline of anti-smoking counselling among Chinese physicians: 1987–1996
Health Promot Int
Tobacco smoking habits among a cross-section of rural physicians in China
Aust J Rural Health
Smoking in China: findings of the 1996 National Prevalence Survey
JAMA
Tobacco use and cessation counseling—global health professionals survey pilot study, 10 countries, 2005
MMWR Morb Mortal Wkly Rep
Guidelines for the Conduct of Tobacco Smoking Surveys for the General Population
Trends in cigarette smoking among US physicians and nurses
JAMA
Tobacco use among adults—United States, 2005
MMWR Morb Mortal Wkly Rep
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