Tobacco smoking among doctors in mainland China: a study from Shandong province and review of the literature
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School of Health Sciences, Faculty of Health, University of Newcastle, Ourimbah, New South Wales, Australia
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
Department of Medicine, Longkou Chinese Medicine Hospital, Longkou, Shandong, China
Submission date: 2012-04-05
Acceptance date: 2012-09-14
Publication date: 2012-09-24
Corresponding author
Derek R. Smith   

School of Health Sciences, Faculty of Health, University of Newcastle, Ourimbah, New South Wales, Australia
Tobacco Induced Diseases 2012;10(September):14
Tobacco control represents a key area in which doctors can make a significant positive impact on their patients’ lives. Despite this fact, however, doctors in certain regions of China are known to smoke tobacco at rates similar to or even exceeding those seen within the general population.

This study sought to investigate the smoking habits of doctors at a teaching hospital in Shandong province, as well as providing a brief review of smoking research that has been conducted among doctors elsewhere in China.

An anonymous questionnaire survey was distributed to doctors working at a university teaching hospital in 2008, as part of a larger study of occupational health issues in the healthcare profession.

The overall smoking prevalence rate of doctors in this study was 36.3% with significant differences observed between the genders (males: 46.7% and females: 5.3%). Age and total career length were also correlated with smoking habit, although no significant associations were found with department of employment.

Overall, our study suggests that smoking rates among doctors in Shandong province are higher than those documented in many other countries, a finding which is consistent with previous research conducted in some other Chinese provinces. Addressing this issue from an intrinsic cultural perspective will clearly need to form the cornerstone of tobacco control efforts within the Chinese medical community in future years.

World Health Organization (WHO) Website: Why is tobacco a public health priority?.
Smith DR, L'Abbate N, Lorusso A: Tobacco smoking among Italian physicians and the role of occupational medicine. La Medicina del lavoro. 2008, 99 (1): 3-7.
Smith DR, Leggat PA: Smoking among Healthcare Professionals. 2011, Sydney: Darlington Press.
Davis RM: When doctors smoke. Tob Control. 1993, 2: 187-188. 10.1136/tc.2.3.187.
World Health Organization (WHO): Global Adult Tobacco Survey (GATS). Fact Sheet China:. 2010,
Abdullah AS, Qiming F, Pun V, Stillman FA, Samet JM: A review of tobacco smoking and smoking cessation practices among physicians in China: 1987-2010. Tob Control. 2011, 10.1136/tobaccocontrol-2011-050135.
Lee S: Beyond the cloud: smoking Chinese doctors. J Thorac Dis. 2011, 3 (3): 211-212.
Smith DR, Leggat PA: An international review of tobacco smoking in the medical profession: 1974-2004. BMC Publ Health. 2007, 7 (1): 115-10.1186/1471-2458-7-115.
US National Library of Medicine (NLM): PubMed website.
Li HZ, Rosenblood L: Chinese physicians' cigarette smoking habits and their anti-smoking counselling practices. Health Promot Int. 1996, 11 (2): 89-94. 10.1093/heapro/11.2.89.
Li HZ, Fish D, Zhou X: Increase in cigarette smoking and decline of anti-smoking counselling among Chinese physicians: 1987–1996. Health Prom Int. 1999, 14 (2): 123-131. 10.1093/heapro/14.2.123.
Abdullah ASM, Rahman ASMM, Suen CW, Wing LS, Ling LW, Mei LY, Tat LC, Tai MN, Wing TN, Yuen WT: Investigation of Hong Kong doctors' current knowledge, beliefs, attitudes, confidence and practices: implications for the treatment of tobacco dependency. J Chin Med Assoc. 2006, 69 (10): 461-471. 10.1016/S1726-4901(09)70310-7.
Yan J, Xiao S, Ouyang D, Jiang D, He C, Yi S: Smoking behavior, knowledge, attitudes and practice among health care providers in Changsha city, China. Nicotine Tob Res. 2008, 10 (4): 737-744. 10.1080/14622200801901930.
Yao T, Ong M, Lee A, Jiang Y, Mao Z: Smoking knowledge, attitudes, behavior, and associated factors among Chinese male surgeons. World J Surg. 2009, 33 (5): 910-917. 10.1007/s00268-009-9938-0.
Smith DR, Wei N, Zhang YJ, Wang RS: Tobacco smoking habits among a cross-section of rural physicians in China. Aust J Rural Health. 2006, 14 (2): 66-71. 10.1111/j.1440-1584.2006.00766.x.
Jiang Y, Ong MK, Tong EK, Yang Y, Nan Y, Gan Q, Hu TW: Chinese physicians and their smoking knowledge, attitudes, and practices. Am J Prev Med. 2007, 33 (1): 15-22. 10.1016/j.amepre.2007.02.037.
Li HZ, Sun WX, Cheng FM, Wang XR, Liu WP, Wang AS: Cigarette smoking status and smoking cessation counseling of Chinese physicians in Wuhan, Hubei province. Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health. 2008, 20 (3): 183-192. 10.1177/1010539508317821.
Ceraso M, McElroy JA, Kuang X, Vila PM, Du X, Lu L, Ren H, Qian N, Jorenby DE, Fiore MC: Smoking, barriers to quitting, and smoking-related knowledge, attitudes, and patient practices among male physicians in China. Prev Chronic Dis. 2009, 6 (1): A06.
Lam TH, Jiang CQ, Chan YF, Chan SSC: Smoking cessation intervention practices in Chinese physicians: do gender and smoking status matter?. Health Soc Care Comm. 2011, 19 (2): 126-137.
Zhou J, Abdullah AS, Pun VC, Huang D, Lu S, Luo S: Smoking status and cessation counseling practices among physicians, Guangxi, China, 2007. Prev Chronic Dis. 2010, 7 (1): 1-10.
Wu SY, Li HY, Wang XR, Yang SJ, Qiu H: A comparison of the effect of work stress on burnout and quality of life between female nurses and female doctors. Arch Environ Occup Health. 2011, 66 (4): 193-200. 10.1080/19338244.2010.539639.
Shi Y, Yu C, Luo A, Huang Y, Warner DO: Perioperative tobacco interventions by Chinese anesthesiologists: practices and attitudes. Anesthesiology. 2010, 112 (2): 338-346. 10.1097/ALN.0b013e3181c91ee7.
Shin SS, Xiao D, Cao M, Wang C, Li Q, Chai WX, Lindsay RP, Usita P, Novotny TE: Patient and doctor perspectives on incorporating smoking cessation into tuberculosis care in Beijing, China. Int J Tuberc Lung Dis. 2012, 16 (1): 126-131. 10.5588/ijtld.11.0044.
Zhang CM, Xiao D, West R, Michie S, Troughton R, Hajek P, Wang C: Evaluation of 3-day smoking cessation training course for doctors from 38 cities in China. Chin Med J (Engl). 2012, 125 (7): 1338-1340.
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 (1): 118-123. 10.1016/j.pec.2008.07.042.
Xiang H, Wang Z, Stallones L, Yu S, Gimbel HW, Yang P: Cigarette smoking among medical college students in Wuhan, People's Republic of China. Prev Med. 1999, 29 (3): 210-215. 10.1006/pmed.1999.0525.
Smith DR, Leggat PA: An international review of tobacco smoking among medical students. J Postgrad Med. 2007, 53 (1): 55-62. 10.4103/0022-3859.30333.
Wong XZ, Hong ZG, Chen DY: National Smoking Survey Group. Results of a national survey of smoking. National Medical Journal of China. 1987, 67 (4): 229-232. [in Chinese].
Yu JM, Hu DY, Jiang QW, Zhang LJ, Dong Y, Li SC: Smoking status in Chinese cardiovascular physicians in 2008. Zhonghua Yi Xue Za Zhi. 2009, 89 (34): 2400-2403. [in Chinese].
Smith DR, Wei N, Wang RS: Tobacco smoking habits among Chinese medical students and their need for health promotion initiatives. Health Promot J Austr. 2005, 16 (3): 233-235.
Smith DR, Wei N, Wang RS: Contemporary smoking habits among nurses in Mainland China. Contemp Nurse. 2005, 20 (2): 258-266. 10.5172/conu.20.2.258.
Hu M, Rich ZC, Luo D, Xiao S: Cigarette sharing and gifting in rural China: a focus group study. Nicotine Tob Res. 2012, 14 (3): 361-367. 10.1093/ntr/ntr262.
Kaetsu A, Fukushima T, Moriyama M, Shigematsu T: Smoking behavior and related lifestyle variables among physicians in Fukuoka, Japan: A cross sectional study. J Epidemiol. 2002, 12: 199-207. 10.2188/jea.12.199.
Smith DR: The historical decline of tobacco smoking among United States physicians: 1949–1984. Tob Induc Dis. 2008, 4 (1): 9-10.1186/1617-9625-4-9.
Smith DR, Leggat PA: The historical decline of tobacco smoking among Australian physicians: 1964–1997. Tob Induc Dis. 2008, 4: 13-10.1186/1617-9625-4-13.
Doll R, Peto R, Boreham J, Sutherland I: Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ (Clinical research ed). 2004, 328: 1519-1528. 10.1136/bmj.38142.554479.AE.
Smith DR, Leggat PA: Tobacco smoking was dramatically reduced among New Zealand health care workers between 1963 and 1996, but what happened after that?. N Z Med J. 2007, 120 (1263): U2758.
Edwards R, Peace J, Stanley J, Atkinson J, Wilson N, Thomson G: Setting a good example? Changes in smoking prevalence among key occupational groups in New Zealand: evidence from the 1981 and 2006 censuses. Nicotine Tob Res. 2012, 14 (3): 329-337. 10.1093/ntr/ntr218.
Smith DR: Longitudinal trends of alcohol and tobacco consumption among Australian physicians and nurses, 1989–2005. Journal of Substance Use. 2007, 12 (4): 267-280. 10.1080/14659890601157679.
Smith DR, Wada K: Declining rates of tobacco use in the Japanese medical profession, 1965–2009. J Epidemiol. 2012, 10.2188/jea.JE20120121.
Yang G, Ma J, Chen A, Zhang Y, Samet JM, Taylor CE, Becker K: Smoking cessation in China: findings from the 1996 national prevalence survey. Tob Control. 2001, 10 (2): 170-174. 10.1136/tc.10.2.170.
Kim SS, Chen W, Kolodziej M, Wang X, Wang VJ, Ziedonis D: A systematic review of smoking cessation intervention studies in China. Nicotine Tob Res. 2012, 14 (8): 891-899. 10.1093/ntr/ntr289.
Klink K, Lin S, Elkin Z, Strigenz D, Liu S: Smoking cessation knowledge, attitudes, and practice among community health providers in China. Fam Med. 2011, 43 (3): 198-200.
Liu Y, Chen L: New medical data and leadership on tobacco control in China. Lancet. 2011, 377 (9773): 1218-1220. 10.1016/S0140-6736(10)61391-8.
Kohrman M: Smoking among doctors: Governmentality, embodiment, and the diversion of blame in contemporary China. Medical Anthropology. 2008, 27 (1): 9-42. 10.1080/01459740701831401.
Rich ZC, Xiao S: Tobacco as a social currency: cigarette gifting and sharing in China. Nicotine Tob Res. 2012, 14 (3): 258-263. 10.1093/ntr/ntr156.
Lin Y, Fraser T: A review of smoke-free health care in mainland China. Int J Tuberc Lung Dis. 2011, 15 (4): 453-458. 10.5588/ijtld.10.0049.
Ma GX, Lan YJ, Toubbeh MI, Zhai CK: Tobacco use in China: prevalence, consequences and control. Californian J Health Promot. 2004, 2 (1): 107-119.
Bland B: China tells doctors to quit smoking to set example to patients. BMJ. 2009, 338: b993-10.1136/bmj.b993.
Smith DR, Takahashi K: Too many Japanese university students are still smoking tobacco. Tob Induc Dis. 2008, 4 (1): 10-10.1186/1617-9625-4-10.
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