Knowledge, behavior and ethical responsibility of health professionals with regard to smoking

This is the first study after the implementation of a more restrictive Tobacco Law in Portugal, carried out in collaboration with the Program for Prevention and Treatment of Smoking of the Northern Region Health Authority. The aim of the study was to characterize the attitudes and practices of health professionals with regard to tobacco consumption, given their importance in smoking reduction. The high prevalence of risk factors associated with circulatory diseases, particularly smoking, highlights the need for preventive measures.

This was a cross-sectional study assessing knowledge of the harmful effects of tobacco consumption and exposure to environmental tobacco smoke, ethical and professional behavior, and agreement with tobacco control measures. Participants were 101 physicians and 524 nurses from the primary health centers (PHCs) and Hospital S. João in the city of Porto.

Smoking rates of 23.1% and 13.0% were found among nurses and physicians, respectively. There was a lower proportion of smokers in PHCs (14.5% vs. 23.9%, p = 0.014). Most participants agreed with prohibition of smoking inside and outside the building (70.7% vs. 53.3%), but smokers were more skeptical regarding the benefits, especially nurses. Knowledge of the consequences of tobacco consumption and environmental tobacco smoke was reasonable, but 40.0% of physicians and only 26.5% of nurses did not agree that ventilation systems can eliminate tobacco smoke (p = 0.009). Most participants acknowledged the inappropriateness of smoking in the presence of patients. In PHCs there was a higher percentage of health professionals who saw themselves as role models (80.6% vs. 66.7%, p = 0.001), and of nurses who agreed with the inappropriateness of smoking in the presence of the public (61.9% vs. 42.3%, p = 0.001). Health care professionals supported tobacco control programs, although smokers were less supportive. In PHCs there was a higher percentage of professionals who received training on tobacco, and this appears to have had some impact on nurses' belief that they are seen as role models (OR = 2.431, p = 0.024).

These findings support the need for new campaigns to reduce smoking among health care professionals. The reasons for their skepticism concerning their ethical responsibility must be clarified. Greater investment is required in training on tobacco for pre- and post-graduate health professionals, in order to increase their awareness of the importance of their role in reducing tobacco consumption in society.