Physicians

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• Physicians Tobacco Use
• Eva Kralikova

American Cancer Society University Romania 2003
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• In those nations where the tobacco epidemic
  appears to have peaked and begun to ease, a
  retrospective view reveals that it was, in nearly
  all cases, physicians who led the way by changing
  their behavior from being one of the groups with
  the highest smoking prevalence to being one of,
  if not the, lowest.
• - Getting Doctors to Quit and Lead
  2002

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Evolution of the Physicians Role in Smoking
Cessation
1950-1975 Consciousness-raising Development of
the idea that physicians can improve their
patients health by helping them to stop smoking
1975-1985 Establishing a data base
Well-conducted clinical trials demonstrate that
the physician is in a unique and powerful agent
in smoking cessation
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1985-1990 Development of brief, structured
smoking interventions for physician use Training
and office-based programs are being developed for
physician and staff use in promoting and aiding
smoking cessation 1990-Present Widespread
physician activity in smoking cessation Means
for large-scale implementation of training and
intervention programs for physician use and
expanded physician roles in smoking cessation
will be developed
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Physicians Tobacco Use
Although data collection methods for worldwide
physician smoking rates are not universal,
evidence collected from many countries indicate a
wide range of physician smoking rates compared to
population smoking rates. For example

• In countries with the highest smoking rates,
  doctors smoking rates are sometimes higher than
  those among the general public. For example, in
  Latvia 59 of male physicians smoke, while 53 of
  adult males smoke.

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• At 63, male physicians from the Philippines lead
  the world in the highest smoking prevalence
  rates, while 75 of adult males from the
  Philippines rank fourth in the world in the
  highest smoking prevalence rates.
• In contrast, there are virtually no smokers among
  among female physicians from Lao Peoples
  Democratic Republic, Malaysia, and Tonga.

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Physicians Smoking
Bulgaria 52 of Physicians Smoke Czech
Republic 26 of Physicians Smoke Estonia 42
of Male Physicians Smoke Hungary 41 of
Surgical Physicians Smoke Lithuania 38 of
Physicians Male Moldova 44 of Male Physicians
Smoke 6 of Female Physicians
Smoke Russian Federation 41 of Male Physicians
of Smoke
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In the United States

• for example, 50 years ago physicians smoked at
  rates equal to or greater than the general
  population.
• As information on the relationship between
  smoking and lung cancer became widespread,
  physician smoking rates dropped sharply,
  especially after 1964, and now only 3 of U.S.
  physicians smoke (compared to 23 of the general
  population).

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Why Target Physicians?

• Physicians relationship with patients and the
  public is unique and powerful - nonsmoking
  physicians are good role models.
• In U.S., e.g., 70 of smokers see their physician
  at least once a year.
• Clinical trials have demonstrated that physicians
  can be successful in helping their patients stop
  smoking.
• Great potential for public health impact, e.g.,
  if only 10 of physicians gave brief advice to
  their smoking patients and were successful with
  only 5 of them, there would be nevertheless be
  X million new nonsmokers in the Russian
  Federation each year and more than X million over
  a decade.

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Potential Roles for Physicians

• Role Models for Not Smoking, or Quitting
• Counseling Patients Not to Smoke
• Providing Smoking Cessation Treatment
• Organizing and Speaking Out Publicly and
  Advocating for Comprehensive Public Policies to
  Control Tobacco Use
• In some countries, physicians also serve as
  parliamentarians, who are highly influential on
  matters of medical science, such as tobacco
  control

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Reaching Physicians

• Medical Societies
• Medical Schools
• Health Ministries
• Voluntary Health Non-Governmental Organizations
  (NGOs)

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Medical Societies

• Conduct surveys
• Organize plenary speakers and panel discussions
• Adopt resolutions and issue ethical opinions
• Publish stories in journals and newsletters
• Advocate for health care system reimbursement for
  cessation services
• Issue press statements and hold press conferences

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An Example

• The Slovak Medical Association tobacco
  control activities have included
• Lobbying for the implementation of a
  comprehensive tobacco control law
• Instituting a national plan of tobacco control
  activities
• Holding meetings to lobby workplaces to safeguard
  health
• Encouraging Quit and Win competitions
• Promoting smoking cessation through sponsorship,
  educational programs, school health lessons, and
  epidemiological research

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Medical Schools

• Medical school deans and professors may
• Offer courses in tobacco control treatment
• Offer orientation lectures and brochures for
  incoming students
• Recruit medical school students for diverse
  tobacco projects
• Use their status to speak out about the important
  of tobacco control to the media,
  parliamentarians, and medical forums
• Organize peer educator groups

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An Example
In the Czech Republic

• Every medical school student must take a course
  in tobacco control.
• Student conferences on tobacco control are
  organized.
• Teams of students work with local health clinics
  during their vacations to survey medical staff
  smoking behavior.

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Health Ministries

• Initiate surveys of smoking habits among doctors
  and other health care providers
• Advocate or provide money for cessation treatment
• Advocate for national tobacco control legislation
• Circulate pronouncements about the roles of
  doctors in tobacco control
• Organize a network of smoke-free hospitals and
  doctors

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Voluntary Health NGOs

• Develop and maintain a list of doctors who are
  active in tobacco control
• Issue brochures and guidelines in local languages
• Petition medical societies to encourage member
  involvement
• Hold workshops for doctors
• Offer national, regional, or international
  resolutions on tobacco control
• Help organize talk show debates about physician
  responsibilities

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More NGO Activities

• Encourage medical leaders to write letters and
  opinion articles in newspapers
• Endorse scientific articles on the effectiveness
  of doctor interventions
• Provide physician profiles to mass media of
  physicians who save lives
• Promote newspaper editorials about medical ethics
  and tobacco control
• Publicly recognize physicians who take time to
  reduce tobacco use
• Organize media events featuring public health
  leaders

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In Summary

• Physicians can be powerful role models in tobacco
  control efforts
• Physicians can be effective advocates in tobacco
  control efforts
• Physicians should be at the forefront of tobacco
  control efforts

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Thank you