We should empower GPs to lead by example and quit tobacco
Smoking rates among GPs in Australia are lower than that of the general adult population, but a concerning percentage still smoke. Image: vchalup - stock.adobe.com
Tobacco continues to be a significant health concern, killing more than eight million people globally each year despite public health campaigns having highlighted the dangers of smoking and other tobacco products for decades.
The World Health Organization (WHO) created World No Tobacco Day in 1987 to draw global attention to the tobacco epidemic and the preventable death and disease it causes. With this year's World No Tobacco Day on May 31, it's a timely reminder to consider all opportunities around smoking cessation support as part of global tobacco control efforts.
As public health concerns about smoking continue to grow, smoking prevalence has declined, including among health professionals like doctors. Historically, many doctors smoked, and tobacco companies even featured them in cigarette ads.
Studies indicate that advice from health professionals significantly aids patients in quitting smoking, reinforcing the WHO's stance that these professionals should lead by example.
Our project studied the smoking behaviours of General Practitioners (GPs) in Australia and their influence on patient support for quitting. Research on their smoking behaviour is limited, and our recent scoping review assessed the smoking trends among Australia's health professionals.
We focused on GPs who are the cornerstone of Australia's healthcare system and examined their smoking habits with a cross-sectional online survey conducted from September 2020 to January 2021.
It included 178 GPs across Australia, revealing a daily smoking prevalence of 7 per cent, compared to 10.6 per cent of the adult population. While cigarettes were the most common form of smoking, some GPs also used vapes and water pipes. Many GPs viewed smoking as a personal choice, citing it provided relief from anxiety and social pressure.
From this group, only 15 per cent had attempted to quit in the past year, and more than half could remain abstinent for over six months. Current smokers expressed desire but lacked the intention to quit, with older male GPs more likely to be smokers. Overall, the study highlighted that while smoking rates among GPs were lower than in the general population, targeted smoking cessation interventions are needed to enhance motivation and self-efficacy in this group.
In healthcare settings, a variety of professionals provide smoking cessation support. The smoking habits of health professionals can undermine public trust and affect their health promotion roles. Despite this, public health initiatives have largely focused on smoking cessation for the general population, often overlooking the influence of health professionals' smoking behaviours on their patients.
In a follow-up study using the same population, we examined the use of the 5As smoking cessation tool (Ask, Advise, Assess, Assist, Arrange) recommended by the Royal Australian College of General Practitioners (RACGP). We found that current smokers were less likely than never-smokers to advise patients to quit. They were also less likely to view GPs as role models or believe that GP advice increases patients' chances of quitting.
Current smokers were less familiar with the 5As guideline and spent less than two minutes on consultations. Four out of five GPs received no training in smoking cessation counselling. Significant perceived barriers included patient resistance, time constraints, and lack of reimbursement.
This study suggests that GPs need capacity-building training for adequate smoking cessation support, and their smoking status should be considered in training program design.
In our study, 92 per cent of Australian GPs identified as migrants, reflecting the unique makeup of the Australian healthcare workforce, where one-third of doctors are overseas trained. Due to a local supply shortage, many migrant GPs work across various states and territories. However, there is a lack of data on smoking behaviour among this population, particularly among GPs.
To address this gap, we conducted a scoping review on the smoking patterns of migrant healthcare professionals but found only two relevant studies from the early 1980s in the US. This highlights the limited evidence in both Australia and globally, despite the significant role of migrant health professionals in healthcare. Our research also examined differences in smoking behaviour and cessation support between migrant and non-migrant GPs in Australia. We discovered that smoking prevalence was higher among migrant GPs (6 per cent) compared to non-migrants (1 per cent), however, our sample size might have an impact on this.
Recent studies indicate that although the daily smoking rate among GPs in Australia is lower than that of the general adult population, a concerning percentage still smokes. This is troubling, given their crucial role in promoting smoking cessation within the community. There is a need for tailored smoking cessation interventions for GP smokers, particularly those from multicultural backgrounds who often lack the motivation and self-efficacy to quit.
Additionally, GPs must learn to separate their habits from their professional responsibilities as health promoters. While no significant link was found between the migration status of GPs and their smoking habits, developing a responsive 5As implementation policy that includes overseas-born GPs is necessary, especially as they adapt to the Australian healthcare system.
Understanding the cultural factors influencing smoking among migrant GPs is vital, as the Australian GP workforce increasingly relies on overseas-trained doctors.
Professor Dr Muhammad Aziz Rahman is the Head of Public Health and Research Adviser at the Institute of Health and Wellbeing. Dr Masudus Salehin is a final-year PhD student. Both are medical doctors and public health professionals.