Objective
To explore Indonesian physician''s smoking behaviours, their attitudes and clinical practices towards smoking cessation.
Design
Cross‐sectional survey.
Setting
Physicians working in Jogjakarta Province, Indonesia, between October and December 2003.
Subjects
447 of 690 (65%) physicians with clinical responsibilities responded to the survey (236 men, 211 women), of which 15% were medical faculty, 35% residents and 50% community physicians.
Results
22% of male (n = 50) and 1% of female (n = 2) physicians were current smokers. Approximately 72% of physicians did not routinely ask about their patient''s smoking status. A majority of physicians (80%) believed that smoking up to 10 cigarettes a day was not harmful for health. The predictors for asking patients about smoking were being male, a non‐smoker and a medical resident. The odds of advising patients to quit were significantly greater among physicians who perceived themselves as sufficiently trained in smoking cessation.
Conclusions
Lack of training in smoking cessation seems to be a major obstacle to physicians actively engaging in smoking cessation activities. Indonesian physicians need to be educated on the importance of routinely asking their patients about their tobacco use and offering practical advice on how to quit smoking.Tobacco use is one of the greatest causes of preventable deaths and disease in human history. According to the World Bank, four‐fifths of the world''s 1.1 billion smokers live in low‐income or middle‐income countries.
1 East Asian and Pacific countries currently account for about 38% of the world''s smokers and men, especially those aged 30–49 years, account for about 80% of these smokers.
2 In Indonesia, 59% of male, but only <5% of women, smoke.
3 Notably, the rates of tobacco use, especially among adolescents and young adults in East Asia, continue to rise.
1 Although reliable national data are unavailable for Indonesia, estimates in 2004 showed a high incidence rate of tobacco‐attributable mortality and morbidity.
4 For example, in 2002, the International Agency of Research on Cancer Globocan estimated that the age‐standardised mortality of respiratory tract cancer in Indonesia among men was 68.5 per 100 000 population, but that among women was only 21.5 per 100 000 population.
5Nations such as Indonesia continue to bear significant health and socioeconomic burdens associated with tobacco use, primarily due to aggressive tobacco industries marketing and the slow progress in tobacco control activities resulting from a strong dependency of the national economy on the tobacco trade.
6 To reduce the economic and health burden from cigarette smoking, effective measures for smoking cessation and tobacco control are clearly needed. Public health education, and governmental policies such as taxation on sales and restrictions on advertisement may serve as useful tools to limit the use of tobacco products.
7,8 Currently, such measures are lacking in Indonesia.Smoking behaviour and attitudes towards smoking cessation by healthcare providers in Western countries have been studied extensively.
9,10,11 Research findings suggest that asking about smoking and offering advice about cessation help smokers quit.
12,13,14,15,16 Of equal importance is the observation that the smoking status of healthcare providers may influence their willingness to offer smoking cessation advice to smokers.
16,17 Unfortunately, limited research is available on non‐Western countries in regard to behaviours, perceptions and attitudes towards smoking among physicians and other healthcare providers.
16,18,19,20Understanding the attitudes of health professionals towards cessation of tobacco use is an important early step in the development of a country''s comprehensive anti‐tobacco initiative. This step is especially important in countries like Indonesia, where there are few anti‐tobacco initiatives and physicians play a particularly important role as opinion leaders and role models. To understand physician''s attitudes towards tobacco, we conducted a survey of physicians to explore a range of issues including smoking behaviours, and their attitudes and clinical practices regarding smoking.
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