Tobacco smoking among health care workers

Smoking represents a critical international priority for public health. According to the World Health Organization, tobacco is the second major cause of death and the fourth most common risk factor for disease, worldwide. If current trends continue it will be causing around 10 million deaths each year by 2020, with approximately 650 million fatalities overall. Smoking also represents a key issue for health care workers, as they play a lead role in the prevention of tobacco use in the community. Health care workers are on the frontlines of primary health care, and in this role they are widely viewed as exemplars by the community, their patients and their colleagues. As early as 1976, it was suggested that health care workers could best persuade patients to quit if they themselves did not smoke. This thesis comprises five literature reviews and five research projects on the topic of tobacco smoking among health care workers. Research was conducted on groups of dentists, doctors, nurses, medical students and nursing students in Australia and China between 2004 and 2006. The review component targeted all published literature on the topic, from which a total of 289 English language manuscripts were examined. From an international perspective the prevalence of smoking among almost all health care workers appears to be declining in recent years, although in certain regions of Europe and Asia their smoking rate remains unacceptably high. Low rates of smoking among dentists and doctors were demonstrated in the United States, Australia and the United Kingdom. Tobacco smoking research ascertained the prevalence, distribution, habits and correlates for smoking among various groups of health care workers in Australia and China. By profession, dentists were shown to have uniformly low smoking rates in the current study, while nurses by contrast had relatively high rates. ln the research component, almost one-third of male Chinese doctors and one-half of male Chinese nurses were smokers. Only 6% of Chinese medical students and 4% of Queensland dentists smoked. Sixteen percent of Australian nursing students were smoking tobacco however, a habit which was correlated with age and year of study in the nursing course. Overall, the research described within this thesis suggests that while tobacco smoking is probably declining among health care workers in recent years, the trend has not been uniform across these professions, nor has it occurred equally from country to country. Nurses and nursing students in particular, remain a subpopulation where tobacco smoking is fairly common. A greater commitment of public health efforts and tobacco control activities will need to target these groups in future