Can smoke-free physicians lead the way to a tobacco-free China?

Background: Some western countries have witnessed an overall decrease in tobacco use after the elimination of smoking among physicians. Helping physicians quit might serve as a starting point to turn the tide on the high rates of tobacco use in China.

Methods: To better understand Chinese physicians' smoking-related knowledge, attitudes and practices, we conducted a baseline survey in a convenience sample of 416 healthcare providers in two Chinese research hospitals and four focus groups in the same two hospitals.

Result: Smoking rates remain high among male physicians (50%) and are linked to decreased awareness of smoking-related risks and a lower likelihood to believe that physicians should advise patients to quit. Both smoking and non-smoking physicians reported accepting cigarettes as gifts, and those who did were less likely to ask their patients to quit. Physicians reported receiving little or no support for their own cessation efforts and limited training on how to intervene with their patients who smoke. Focus group data supported these findings. Physicians furthermore described an environment in which smoking is socially acceptable even for health professionals and serves as an important relationship builder. Our data provided some clues for the development of effective intervention strategies.

Conclusion: A culturally appropriate intervention strategy that addresses the social function of smoking is urgently needed to help Chinese physicians quit. Enforcement of smoke-free policies in hospitals, training on appropriate patient practices, and utilization of social support mechanisms should also be part of the intervention strategy.