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Tabacco Use Among Argentine Physicians 100Revista Argentina de Medicina Respiratoria ARTICULORevista Argentina ORIGINAL de Medicina Respiratoria Año 6 Nº 3 - Diciembre 2006 2006 - Nº 3: 100-105 Correspondencia E-mail gezabert@speedycomar Tobacco Use among Argentine Physicians: Personal Behavior and Attitudes Autores MC Minervini1, GE Zabert2, MPP Rondelli3, M Gómez4, C Castaños5, AS Buist6, JM Samet7, CM Patiño8 1Universidad Católica de Córdoba, Argentina; 2Universidad Nacional del Comahue, Argentina; 3Universidad Nacional de Rosario, Argentina; 4Hospital Materno-Infantil de Salta, Argentina; 5Hospital Garrahan, Buenos Aires, Argentina; 6Oregon Health & Science University, Portland; 7The Johns Hopkins University, Baltimore; 8Universidad Nacional de Córdoba, Argentina Abstract A cross-sectional study evaluate the prevalence of smoking, knowledge, and tobacco intervention among Argentine physicians A self-administered questionnaire was given to 1771 physicians, with a response rate of 82% Respondents mean age was 42±10 years, with 58% males The overall prevalence of ever smokers was 47%, with the prevalence significantly higher in males (52%) than females (40%) (p< 0001) The prevalence of current smokers was 25%, with no differences by gender Sixty-three percent of current smokers stated that they had no intention to quit in the next five years Most of the physicians recognized harmful health effects of tobacco, and most were familiar with the minimal intervention strategies Fewer than 15% arranged follow-up visits or assisted smokers in cessation, however only 33% of the respondents had ever received formal training in tobacco control, and 92% required it to improve their skills Responders considered their main barriers for tobacco intervention to be inadequate training (38%), the time-consuming nature of intervention (30%), and patients lack of desire to receive such advice (28%) Strategies to reduce the prevalence of smoking among Argentine physicians and improve their intervention skills would help them become effective anti-tobacco agents Key words > smoking, prevalence, epidemiology, health workers, knowledge, intervention, medical education, cardiologist, pediatrician, allergist, pulmonologist Resumen Consumo de tabaco en médicos argentinos: conductas y actitudes personales Se realizó un estudio de corte transversal para evaluar la prevalencia de fumar, conocimiento e intervención en tabaquismo de médicos Argentinos Se encuestaron 1771 médicos con una tasa de respuesta de 82% La edad media de los respondedores fue de 42±10 años y el 58% eran hombres La prevalencia de fumador alguna vez fue del 47%, con mayor prevalencia en hombres (52%) que en mujeres (40%) (p< 0001) El 25% eran fumadores actuales sin diferencia por sexo de los cuales el 63% afirmaron que no tenían intención de dejar de fumar en los próximos 5 años La mayoría de los médicos reconoció los efectos dañinos del cigarrillo y muchos estaban familiarizados con las estrategias de intervención mínima Sin embargo menos del 15% pactaba una visita de seguimiento o ayudaba a sus pacientes para cesación tabáquica, y solo el 33% reconoció haber recibido entrenamiento formal en control del tabaco a pesar que el 92% requería mejorar sus habilidades en el tema Los encuestados considera- ban como principales barreras de la intervención en tabaquismo: adecuado entrenamiento (38%), consumo de mayor tiempo de consulta (30%) y percepción que los pacientes no espe- raban estos consejos (28% Son necesarias estrategias para disminuir la prevalencia de consumo entre los médicos y mejorar sus habilidades de intervención en tabaquismo para que se conviertan en efectivos agentes contra el tabaquismo Palabras claves > fumar, prevalencia, epidemiología, agentes de salud, conocimiento, intervención, educación médica, cardiólogo, pediatra, alergista, neumólogo Tobacco Use among Argentine Physicians: Personal Behavior and Attitudes 101 Introduction Participants were asked to fill in an anonymous, self-administered survey based on questionnaires Physicians occupy a key position in reducing rates recommended by WHO13-16, IUATLD (17), and the of tobacco use through their roles as health care US Department of Commerce (CPS-695)18 The providers, advisors, and policy makers1 If phy- validated survey asked questions about demo- sicians themselves smoke, therefore, the strength graphics, smoking patterns, and four domains re- and reliability of their health-promoting messages lated to attitudes about tobacco use, intervention may be lost In countries where physician smok- skills, knowledge of adverse effects and health ing rates have declined, the overall prevalence of consequences, and smoking restriction policies All tobacco use has subsequently decreased as well2, questions were translated to Spanish, adapted to suggesting that physicians smoking patterns may the spoken expressions, and then translated back influence use of tobacco in the general popu-lation to English The original questionnaire in Spanish The prevalence of tobacco use (which is prima- was used in a pilot study of 88 allergists attending rily cigarette smoking) among physicians varies a meeting in November 1996 Based on feedback worldwide, from 33% in the US3 to almost 50% about ethno-cultural appropriateness, minor in Greece4 The prevalence among physicians in changes were made to the survey Latin America is unclear Studies to date suggest rates of up to 50%5-7, but methodology limitations Sampling scheme (including small study populations) limit inference from these data8-12 The prevalence of tobacco use Four hundred physicians were approached for in the general adult population of Argentina has participation in our study, representing about 20 to been about 38% over the last 30 years3, 5 The ob- 33% of attendees at the four meetings There were jective of this study was to assess the prevalence approximately an equal number of men and women of cigarette smoking in a large physician popula- at each event The sample size was calculated to tion in Argentina obtain a 90% confidence interval of (+/- 5%), assuming a prevalence of smoking of 40% An Methods additional 20% were approached for recruitment in case of refusal to participate This cross-sectional study surveyed physicians at Frequencies and descriptive statistics were com- their main national specialty meeting in 1997 This puted to characterize smoking status and tobacco- sampling approach was chosen because it was not related knowledge and intervention The chi sta- feasible to randomly sample all Argentine physi- tistic and one-way analysis of variance were used cians, since an updated database was unavailable to compare respondents and non-respondents on Physicians attending the following meetings categorical and continuous measures, respectively were approached to participate: XVI Congreso Data were analyzed using EPI-info 604 software Nacional de Cardiología (June 6-9, 1997), XXVI (CDC-WHO 1996) The operational definitions of Congreso de Tisiología y Neumonología, Argen- the main outcomes followed WHO recommenda- tina (October 11-14, 1997), XX Jornadas Anuales tions13: Progreso en Alergia e Inmunología, Argentina (August 3-6, 1997), and XXXI Congreso Argentino Ever smoker: someone who reported smok- de Pediatría (September, 26-29, 1997) Therefore, ing at least 100 cigarettes in his/her life the sample population included mostly cardiolo- Current smoker: an ever smoker who smoked gists, chest physicians, allergists, and pediatri- at the time of the survey cians Only physicians enrolled in more than one Occasional smoker: a current smoker who meeting, physicians not attending patients in Ar- smoked less than one cigarette per day at the time gentina, and those surveyed for the pilot study of the survey were excluded All responses from physicians sur- Daily smoker: a current smoker of at least 1 veyed at these meetings and who assisted patients cigarette per day at the time of the survey in Argentina at the time of the meeting were in- Former smoker: an ever smoker who had quit cluded in our analysis at the time of the survey 102 Revista Argentina de Medicina Respiratoria Año 6 Nº 3 - Diciembre 2006 Results Table 1: Demographics During the four meetings, 1,771 physicians were % approached, and 1,452 answered the survey, for Gender (n=1434) an overall response rate of 82% Eighteen were Female 42 ineligible because they did not assist patients as Male 58 part of their work; therefore, the final analysis Age (yrs) included 1,434 physicians < 35 26 Participants were more likely to be male than 35-44 41 female (58% vs 42%), without difference in re- 45-54 22 sponse rate The mean age was 42±10 years (range > 54 11 22-78), with males significantly older than females Specialties (n=1433) (435 years vs 388 years; t-test= 8,9; p<0,0001) Cardiologists 20 The four specialties were adequately represented, Pulmonologists 20 and most of the participants had graduated at least Pediatricians 32 Allergists 17 five years earlier Nearly all responders (91%) had Others 11 attended at least three meetings in the previous Yrs since graduation (n=1426) five years (Table 1) < 5 17 Ever-smokers represented 47% of the sample, 5-10 17 with this rate significantly higher among males 11-20 37 (Table 2) Current-smoker prevalence overall was >20 29 25%, with no difference by gender or specialties In Professional status (n=1411) the subsets 35-44 and 45-54 years of age, however, In training 30 current-smoker prevalence for females was higher Staff 50 than for males A larger proportion of males than Chair 20 females had quit for all age
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