Research article
Chinese Physicians and Their Smoking Knowledge, Attitudes, and Practices

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Background

China has the most smokers among the world’s nations. Physicians play a key role in smoking cessation, but little is known about Chinese physicians and smoking.

Methods

This 2004 clustered randomized survey of 3552 hospital-based physicians from six Chinese cities measured smoking attitudes, knowledge, personal behavior, and cessation practices for patients. Descriptive statistics and multivariate analysis of factors associated with asking about or advising against smoking were conducted in 2005 and 2006.

Results

Smoking prevalence was 23% among all Chinese physicians, 41% for men and 1% for women. Only 30% report good implementation of smoke-free workplace policies and 37% of current smokers have smoked in front of their patients. Although 64% usually advise smokers to quit, only 48% usually ask about smoking status, and 29% believe most smokers will follow their cessation advice. Less than 7% set quit dates or use pharmacotherapy when helping smokers quit. Although 95% and 89%, respectively, know that active or passive smoking causes lung cancer, only 66% and 53%, respectively, know that active or passive smoking causes heart disease. Physicians were significantly more likely to ask about or advise against smoking if they believed that counseling about health harms helps smokers quit and that most smokers would follow smoking-cessation advice.

Conclusions

Physician smoking cessation, smoke-free workplaces, and education on smoking-cessation techniques need to be increased among Chinese physicians. Strengthening counseling skills may result in more Chinese physicians helping smoking patients to quit. These improvements can help reduce the Chinese and worldwide health burden from smoking.

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

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