RESEARCH PAPER
Physicians’ views on the role of smoking in smoking-related diseases: findings from cross-sectional studies from 1982–2014 in Estonia
Kersti Pärna 1  
,  
 
 
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Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
CORRESPONDING AUTHOR
Kersti Pärna   

Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
Publish date: 2017-07-19
 
Tob. Induc. Dis. 2017;15(July):31
KEYWORDS
ABSTRACT
Background:
Previous reports have shown that physicians who smoke underestimate the effects of smoking on health and this influences their practice. This study was designed to investigate the views of Estonian physicians on the role of smoking in smoking-related diseases.

Methods:
Cross-sectional postal surveys were sent to all practising physicians in Estonia in 1982, 2002 and 2014 providing data from 3504, 2694, and 2865 physicians respectively. Data analysis involved calculation of the prevalence of smoking with 95% confidence intervals and calculation of the prevalence of agreement with a causal role of smoking in ischaemic heart disease (IHD), lung cancer and chronic bronchitis. Logistic regression was used to analyse associations between agreement with the statements that smoking is a cause of IHD, lung cancer, chronic bronchitis and study year, smoking status, age group and ethnicity. Fully adjusted odds ratios with 95% confidence intervals were calculated.

Results:
The age-standardized prevalence of current smoking among men decreased from 39.6% in 1982 to 14.2% in 2014, and among women from 12.4 to 5.1%, respectively. Compared with 1982, the proportion of physicians agreeing with statements that smoking is a major cause or one of the causes of IHD, lung cancer, or chronic bronchitis was significantly higher in 2002 and 2014. Past and never smokers were more likely to admit a causal role of smoking in lung cancer than smokers. Agreement with a causal role of smoking in IHD and chronic bronchitis was significantly higher among never and past smoking women only. Compared with non-Estonians, the odds ratio indicating agreement with all three statements was significantly higher among Estonians.

Conclusions:
From 1982 to 2014, physicians’ attitudes towards the health risks of smoking improved in Estonia. However, their assessment of a causal role of smoking in smoking-related diseases was related to their own smoking habits and ethnicity. A further decline in smoking among Estonian physicians would require special efforts targeted at physicians. Societal pressure from a national policy could support a further decline in the social acceptability of smoking in Estonia and developments in medical education could provide continuing evidence-based information about the health effects of smoking to Estonian physicians.

 
REFERENCES (29)
1.
World Health Organization. WHO global report: mortality attributable to tobacco. World health Organization. 2012. http://www.who.int/tobacco/pub.... Accessed 16 Mar 2017.
 
2.
Centers for Disease Control and Prevention. Health effects of cigarette smoking. https://www.cdc.gov/tobacco/da.... Accessed 16 Mar 2017.
 
3.
Statistics Estonia. http://pub.stat.ee/px-web.2001.... Accessed 21 Mar 2017.
 
4.
Abdullah SA, Stillman FA, Yang L, Luo H, Zhang Z, Samet JM. Tobacco use and smoking cessation practices among physicians in developing countries: a literature review (1987–2010). Int J Environ Res Public Health. 2014;11:429–55.
 
5.
Pipe A, Sorensen M, Reid R. Physician smoking status, attitudes toward smoking, and cessation advice to patients: an international survey. Patient Educ Couns. 2009;74:118–23. 2.
 
6.
World Health Organization. The role of health professionals in tobacco control. World health Organization. 2005. http://www.who.int/tobacco/res.... Accessed 17 Mar 2017.
 
7.
Pärna K, Rahu K, Barengo NC, Rahu M, Sandström PH, Jormanainen VJ, et al. Comparison of knowledge, attitudes and behaviour regarding smoking among Estonian and Finnish physicians. Soz Praventivmed. 2005;50:378–88.
 
8.
Lohur L, Pärna K. Arstide suitsetamine, sellealased hinnangud ja tähelepanu pööramine patsientide suitsetamisele. [smoking habits, smoking related opinions and attitudes towards patients' smoking habits among physicians in Estonia]. Eesti Arst. 2016;95:285–93.
 
9.
Meshefedjian GA, Gervais A, Tremblay M, Villeneuve D, O'Loughlin J. Physician smoking status may influence cessation counseling practices. Can J Public Health. 2010;101:1–4.
 
10.
Pärna K, Rahu K, Rahu M. Smoking habits and attitudes towards smoking among Estonian physicians. Public Health. 2005;119:390–9.
 
11.
Waldron I, Lye D. Relationships of teenage smoking to educational aspirations and parents' education. J Subst Abus. 1990;2:201–15.
 
12.
Davis RM. When doctors smoke. Tob Control. 1993;2:187–8.
 
13.
Rahu M, Raudsepp J. Teine Eesti NSV arstkonna suitsetamislevimuse ankeetküsitlus 1982. Aastal. [second questionnaire survey of smoking prevalence among physicians in Estonian republic of soviet union]. Nõukogude Eesti Tervishoid. 1986;65:258–61.
 
14.
Innos K, Rahu K, Baburin A, Rahu M. Cancer incidence and cause-specific mortality in male and female physicians: a cohort study in Estonia. Scand J Public Health. 2002;30:133–40.
 
15.
Paapsi K, Pärna K. Uuringu "Epidemioloogiline ja geneetiline tõendus tervshoiutöötajate suitsetamiskäitumise ja nikotiinisõltuvuse kohta" andmed kogutud. [data collection of the survey 'Epidemiological and genetic evidence of smoking behaviour and nicotine dependence among Estonian physicians' is finished]. Eesti Arst. 2015;94:697.
 
16.
Ahmad OP, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. GPE Discussion Paper Series: No. 31. Geneva: World Health Organization; 2001.
 
17.
Stata 12. StataCorp. Stata statistical software: release 12. College Station, TX: StataCorp LP; 2011.
 
18.
Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res. 2009;9:160.
 
19.
Cummings S, Savitz L, Konrad T. Reported response rates to mailed physician questionnaires. Health Serv Res. 2001;35:1347–55.
 
20.
Smith DR, Leggat PA. An international review of tobacco smoking in the medical profession: 1974–2004. BMC Public Health. 2007;7:115.
 
21.
Smith DR, Leggat PA. The historical decline of tobacco smoking among Australian physicians: 1964–1997. Tob Induc Dis. 2008;4:13.
 
22.
Smith DR, Wada K. Declining rates of tobacco use in the Japanese medical profession, 1965–2009. J Epidemiol. 2013;23:4–11.
 
23.
Smith DR. The historical decline of tobacco smoking among United States physicians: 1949–1984. Tob Induc Dis. 2008;4:9.
 
24.
Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ. 1994;309:901–11.
 
25.
Barengo NC, Sandström PH, Jormanainen VJ, Myllykangas MT. Changes in smoking prevalence among Finnish physicians 1990–2001. Eur J Pub Health. 2004;4:201–3.
 
26.
Kasmel A, Lipand A, Markina A. Eesti täiskasvanud eanikkonna tervisekäitumise uuring, kevad 2002. health behaviour among Estonian adult population, spring 2002. Eesti Tervisekasvatuse Keskus: Tallinn; 2003.
 
27.
Tekkel M, Veideman T. Eesti täiskasvanud rahvastiku tervisekäitumise uuring, 2014. In: Health behaviour among Estonian adult population, 2014. Tallinn: Tervise Arengu Instituut. p. 2015.
 
28.
Ministry of Social Affairs. Green paper on tobacco policy. 2014.
 
29.
Willaing I, Jorgensen T, Iversen L. How does individual smoking behaviour among hospital staff influence their knowledge of the health consequences of smoking? Scand J Public Health. 2003;31:149–55.
 
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