|Year : 2021 | Volume
| Issue : 4 | Page : 366-372
Smokers' perception, attitudes towards smoking cessation when visiting a smoker physician
Abdulaziz A Alodhayani, Abdulelah I Alhussain, Fahad M Alshughaithry, Saad A Aloqile, Saad A Alowaimer, Khaled A Showail, Salem Mohammed Basalem
Department of Family and Community Medicine, College of medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||25-Dec-2020|
|Date of Decision||14-Jul-2021|
|Date of Acceptance||25-Jul-2021|
|Date of Web Publication||06-Oct-2021|
Abdulelah I Alhussain
College of Medicine, King Saud University Medical City, King Saud University, P. O. Box 75830, Riyadh 11588
Source of Support: None, Conflict of Interest: None
Background: Smoking is one of the leading risk factors that raised mortalities and morbidities significantly. Smoking cessations programs were implemented to reduce the number of smokers. Many factors may influence the smoking cessation including factors related to the treating physician. Objective: To determine smokers' perception and attitude towards smoking cessation when knowing the physician is a smoker. Methods: This was an observational cross-sectional survey study that has been conducted among smokers' patients at King Khalid University Hospital in Riyadh, the estimated sample size was 200 participants. Results: The participants who saw a smoking physician were 90% and 8.8% of them were supported by physicians to quit smoking. The remaining 10% participants reported that they did not see a smoking physician and 15.8% of them were supported by physicians to quit smoking. There was significant correlation between attitude toward smoking cessation and the smoking status and the highest score was found among current smokers and lowest score among ex-smokers (P-value= 0.012). Moreover, the score was highest among those who have history of failed attempt to quit smoking. Lastly, there was no statistically significant difference in scores based on perception and attitude towards smoking cessations when knowing the physician is a smoker. Conclusion: The present study assessed the level of perception and attitude among smokers and the results suggest a different impact of smoker physicians and compared it according to characteristics of smoking. Also, this study showed variations in the behaviors of smoking and cessation, smoking-related barriers that prevent patients from stopping smoking based on physician smoking status.
Keywords: Attitude, cessation, perception, physician, smoker
|How to cite this article:|
Alodhayani AA, Alhussain AI, Alshughaithry FM, Aloqile SA, Alowaimer SA, Showail KA, Basalem SM. Smokers' perception, attitudes towards smoking cessation when visiting a smoker physician. J Nat Sci Med 2021;4:366-72
|How to cite this URL:|
Alodhayani AA, Alhussain AI, Alshughaithry FM, Aloqile SA, Alowaimer SA, Showail KA, Basalem SM. Smokers' perception, attitudes towards smoking cessation when visiting a smoker physician. J Nat Sci Med [serial online] 2021 [cited 2021 Dec 1];4:366-72. Available from: https://www.jnsmonline.org/text.asp?2021/4/4/366/327594
| Introduction|| |
There are over 1.1 billion people smoked tobacco worldwide according to the WHO. Smoking is currently common in most populations and has been linked to morbidity and mortality in developed and developing countries, the age-standardized prevalence for men was 25% and 5.4% for women. According to the Ministry of health, 12.1% of Saudi Arabia's population were smokers. Smoking cigarettes are the world's major cause of preventable death. Smoking cessation is not only associated with reducing the risk of smoking-related diseases and mortality but it has also been linked to enhancing the quality of life. It has also been found that quitting smoking dramatically reduces direct and indirect costs that can help payers, employers, workers, and society as a whole. While most smokers show a willingness to stop smoking, it is difficult to resolve the addiction and may require both pharmacological and behavioral treatments. Smoking cessation intervention by various health providers has proven cost-effective in increasing the quit rate.,, Smoking cessation is the biggest challenge faced by smokers, that required necessary medical assistance and advice must be provided by physicians. Smoking among physicians is an obstacle that reduces the acceptance of smoker patients toward smoking cessation. Physicians play an essential role in the identification, assessment, and treatment of smokers and the physician has close contact with the public; therefore, they are seen as good role model, decision-makers, and healthy lifestyle inﬂuencers in public health. Hence, doctors are expected to be nonsmokers to reach the highest levels of care and assistance. Many smokers visit a physician for various health-related illnesses, and these clinical visits provide some chance for treatments and guidance on smoking cessation. Health care professionals who advise a patient to quit and follow-up on them regularly may increase the success rate of the patient by more than 30%. Health professionals who are nonsmokers are more willing to assist the smoker patients and are likely than smoker physicians to provide cessation interventions. Some studies have been shown that one of the reasons why doctors who are smokers themselves give fewer medical cessation activities might be because they lack an impact on their ability to advise patients. The finding of another study leads to developed questions about specific approaches and strategies that must be developed to support healthcare professionals who smoke with cessation aid since their smoking actions can impede their medical efforts and interventions to assist smokers to quit. The current study aims to assess Smokers' perception and attitude about smoking cessation counseling by smoker physicians at King Khalid University Hospital (KKUH) to determine the impact on the behaviors of smoking cessation.
| Methods|| |
This was an observational cross-sectional study that has been conducted among smokers at KKUH in Riyadh during the period from September 2019 to April 2020. The estimated sample size for the current study was calculated based on smoking prevalence which is 12.2% according to the ministry of health, using the Cochran formula (n∞ = z2p(1−p)/e2). The precision used was 95% (z = 1.96), prevalence of (0.122), and margin of error of (5%). The calculated sample size was 165, by adding 20% to cover nonresponding participants and missing data, the final sample size was 200.
Out of the 200 targeted smokers, 190 had agreed to participate in the study and filled self-administered questionnaire with the overall response rate of 95%. The inclusion criteria for the current study were subjects aged 18 or older, smokers (current-smokers, ex-smokers), and both genders. The data collection tool for the current study was a structured questionnaire consisting of three sections; the first section sought the sociodemographic characteristics including age, gender, social status, education level, occupation status, and history of chronic diseases (diabetes mellitus, hypertension, stroke, heart diseases, and asthma). The second section sought information about smoking history, including smoking status, age when started smoking, duration of smoking, the number of cigarettes per day, another smoker in the family, desire to quit smoking, previous attempts to quit smoking, the previous failure at attempting in quitting smoking, supporting factors in quitting smoking, the negative factors in quitting smoking and seeing smoker physician. The third section has statements that reflect the perception and attitude of participants, where the participants had to answer according to a five-point Likert scale: (strongly agree, agree, neutral, disagree, strongly disagree). Items in this section included the following: Smoker physician reduces the awareness of the benefits of smoking cessation, smoker physician reduces the awareness of the harmful effects of smoking, Smoker physician reduces the desire to stop smoking, smoker physician reduces the desire to go to smoking cessations centers, the advice of a smoker physician about smoking cessation is unacceptable, The smoker physician is not trustworthy, Preference to consult with a nonsmoker physician rather than smoker physician, the physician should not be a smoker. A pilot test has been carried out to test the questionnaire, to estimate the average time required to administer it, and to test participants' comprehension of it.
Statistical Analysis: Data were analyzed using Statistical Package for Social Studies (SPSS 26; IBM Corp., New York, NY, USA). Continuous variables were expressed as the median and interquartile range (IQR), and categorical variables were expressed as percentages. The Mann–Whitney and Kruskal–Wallis were used for continuous variables. Chi-square test and Fisher exact test were used for categorical variables. Cronbach's alpha was used to assess the reliability and internal consistency of the items in the questionnaire. A P < 0.05 was considered statistically significant.
The study had been conducted after taking the ethical approval from the institutional review board at the faculty of medicine, King Saud University. The IRB project number (CMED305-B4). Date of approval 07-11-2019. Informed written consent was taken from all participants in the study. The informed consent was clear and indicates the purpose of the study and the right of the participant to withdraw at any time without any obligation towards the study team. Participants' anonymity had been assured by assigning each participant with a code number for analysis only. No incentives or rewards had been given to participants.
| Results|| |
The Cronbach's alpha for the study questionnaire was scored at 0.875 for overall items which reflects good reliability and internal consistency of the items in the questionnaire. A total of 190 smoking subjects agreed to participate in the study and completed a self-administered questionnaire and filled a self-administered questionnaire, giving an overall response rate of 90%.
Characteristics of smokers when seeing smoker physicians
The total number of participants who saw a smoking physician was 171 (90%), while only 19 (10%) participants reported that they did not. Most of the participants 72.1% were in the age group of 18–40 years. The majority of participants was male at 97.9% and married at 65.8%. Of the total, 50.5% had a college degree, and 74.7% were employed. For the past medical history, 12.1% were diabetics, 7.9% have hypertensive, 5.3% have heart disease, and 1.6% have stroke. For smoking history, the majority 76.8% were current smokers while 23.2% were ex-smokers. Almost half 49.5% of the respondents started smoking at the age of 12–18 years, and 41% have smoked for 5–15 years. Furthermore, about 46.8% consumed 10–20 cigarettes per day. Those who found to be negatively affected by smoker friends were 40%, while only 5.8% of them were negatively affected by smoker physicians. The characteristics of smokers are shown in [Table 1].
Relation between attempts of quitting and seeing smoker physicians
Among the participants who have seen smoker physicians 90%, 86% had the desire to quit smoking, 79.5% had previous attempts to quit smoking, 69.6% had failed to quit smoking and only 8.8% was supported by physicians to quit smoking. While for participants who have not seen smoker physicians 10%, 89.5% of them had the desire to quit smoking, 84.2% had previous attempts to quit smoking, 68.4% had failed to quit smoking and only 15.8% were supported by physicians to quit smoking. The relation between previous attempt of quitting and seeing a smoker physician are shown in [Table 2].
|Table 2: Relation between attempts of quitting and seeing smoker physicians|
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Median and interquartile range of perception and attitude towards smoking cessation
A total score representing the participant's perception and attitude toward smoking physicians was calculated. The minimum score was (8/40), while the maximum was (40/40). High scores represent negative perception and attitude toward smoking physician. The median score was 23 (IQR = 17–30). There was no statistically significant difference in participant's perception and attitude scores by age, gender, social status, education level, occupational status, past medical history, age when starting smoking, duration of smoking, the number of cigarettes, and desire to quit smoking. However, the scores differed significantly according to smoking status, where the highest score was from the current smoker and the lowest score was from ex-smokers (P = 0.012). While not statistically different, the score according to quitting smoking was highest among those who have failed. Participants who have not supported by the family showed a nonstatistically higher score. Finally, the scores differed significantly according to the point “health diseases lead to quitting smoking,” where the score was the highest from those who had health diseases and lowest from participants with no health diseases. There was no statistically significant difference in participants' perception and attitude scores according to stress in family and work, smoking friends, lack of knowledge, and smoker physicians that negatively affect quit smoking. Non-parametric tests comparing perception and attitude are shown in [Table 3].
|Table 3: Median and interquartile range for the total score of perception and attitude towards smoking cessation when knowing that the physician is a smoker|
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Smoker's perception and attitude towards smoking cessation when knowing that the physician is a smoker
There were no statistically significant differences in the scores between those who have seen a smoker physician and those who have not. However, the non-parametric tests of smokers' perception and attitude when seeing a smoker physician are shown in [Table 4].
|Table 4: Smokers' perception and attitude towards smoking cessation when knowing that the physician is a smoker|
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| Discussion|| |
We set out this cross-sectional survey study to assess smokers' perceptions and attitudes towards smoking cessation when they know that the physician is a smoker. The outcomes of the current study showed that, overall, there is no statistically significant correlation between attempts of quitting smoking and seeing a smoking physician. Current smokers showed a significantly negative perception and attitude score that smoking cessation is affected by seeing a smoking physician. In addition, smokers in the current study have a negative perception and attitude toward that health diseases lead to smoking cessation.
As expected, physicians play a vital and significant role in helping people stop smoking. It has been reported that primary care physicians are one of the strongest groups in reducing the public acceptance of smoking in different social settings. In our findings, most (>94%) of the participated smokers who saw smoker physicians disagree that their attempt to quit smoking negatively affected. In line with this finding, a study in Armenia about the patterns of smoking behavior among physicians reported that physicians smoke in front of patients because they believed that their attitudes will not affect others or lack of awareness about their professional role and the negative consequences of their behavior. Many smokers in the current study were found to be negatively affected by family stress toward smoking cessation regardless of whether they see smoker physicians or not. In the US, a study among middle-aged adults showed that high stress was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, past-year family problems, and a summary score. This finding is also consistent with many cross-sectional studies showing that psychosocial stress is associated with smoking behavior, and expands on small prospective literature showing that stressful life events are associated with continued smoking. Unfortunately, in a literature review study of data between “1987–2010,” it was concluded that in some countries smoking at work or in front of patients was commonly practiced by physicians and asking about smoking status or advising patients to quit smoking was not a common practice among the physicians. The results of the current study revealed that the desire and previous attempts to quit smoking were higher among smokers who do not see smoking physicians. In addition, despite being statistically nonsignificant, a higher percentage of smokers who did not see a smoking physician reported that physicians support smoking cessation. In this regard, a study on primary care providers delivering smoking cessation reported that smoking physicians will be offered fewer medical cessation activities as their ability to counsel patients is doubtful. In addition, smoking among physicians has insinuations for the general population since continued role modeling of smoking by physicians undermines the messages that smoking is harmful, and that quitting is important, as per the literature, nonsmoking physicians are more successful in getting their patients to attempt to quit than smoking physicians. Furthermore, smoking physicians may increase public skepticism about quitting, with people motivated to ask why they should stop smoking when their doctor continues to smoke. Moreover, it has been well documented that physicians' perceptions of the effectiveness of and recommendation of cessation counseling may be negatively affected by their smoking status. Therefore, strengthening the implementation of smoke-free hospital policies together with providing smoking cessation training and support for smoking health care providers could help in smoking cessation among patients and within hospitals. Having a supportive environment could help a smoker quit smoking and prevent smoking relapse., Soulakova et al. in their study found that social support from family and friends is associated with higher intentions to quit smoking among attempters who relapsed and thus, may support future smoking cessation. The suggested mechanisms through which family support can influence smokers' intentions to quit and quitting behaviors. These mechanisms include support persons could help smokers recognize quitting importance, encourage smokers to take responsibility for their actions and behaviors, promote more advantageous replacements for unhealthy behaviors, and support smokers during relapses and hindrances., In the current study, a higher proportion of smokers agreed that family support help in quitting smoking, especially among those who did not see smoking physicians. Preliminary research in the area of chronic illness and smoking cessation has suggested that being diagnosed with a chronic disease or experiencing a medical event like a heart attack increases the odds of smoking cessation. However, inconsistent results were obtained by Patel et al., where diabetic participants were more likely to report being former smokers while having hypertension or high cholesterol was not associated significantly with smoking status, and the likelihood of being a former smoker did not increase as the number of diagnosed chronic diseases increased. Our study showed insignificant results in this regard when comparing subjects who saw smoking physicians and those who did not. While when the total score for perception and attitude was calculated, our results were more or less consistent with Patel et al. study. Like any study, the present study has some limitations. It is limited in terms of the small sample size which is unrepresentative of the general smokers' population. The participants were also recruited from one region and cannot represent all smokers in Saudi Arabia. Another limitation of the study is that the questionnaire used might have created a bias because of the compliance and misinterpretation of the questions. However, these findings might be providing information that may be useful in increasing the awareness of smoking physicians and how can influence smokers.
| Conclusions|| |
In conclusion, the present study assessed the level of perception and attitude among smokers and the results suggest a different impact of smoker physicians and compared it according to characteristics of smoking, also this study shows variations in behaviors of smoking and cessation, smoking-related barriers that prevent patients from stopping smoking based on physician smoking status. It would be rational to conclude that smoker physicians would profit from practical help to quit themselves and additional inspiration to provide enhanced cessation services and acceptance to their patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]