Bibliografie verslaving bij artsen M/V

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1 Bibliografie verslaving bij artsen M/V Roken Periode (23 juni) * Inleiding Het doel van deze bibliografie is om meer inzicht te krijgen in de rookverslaving bij vrouwelijke en mannelijke artsen. Er werd een zoekactie uitgevoerd in de volgende databanken: PubMed, Embase, Web of Science, PsycINFO en Sociological Abstracts. Aanvankelijk was als tijdsperiode gekozen 1990 juni De zoekactie leverde ruim 1800, veelal irrelevante, referenties (tijdschriftartikelen) op. Daarom werden de selectiecriteria als volgt aangescherpt: 1. alleen uitgaan van de arts als patiënt; 2. tijdsperiode: 1995 juni 2010; 3. de keuze van de talen: Nederlands, Duits, Engels en Frans; 4. geografisch: Noord- Amerika, Europa en Australië; 5. geen studenten of artsen in opleiding opnemen; 6. uitsplitsen naar alcohol en/of drugs algemeen en behandelingsprogramma s; en 7. roken als aparte bibliografie. Dat leverde drie sets op die tesamen ongeveer zeventig referenties bevatten. Conclusies De verschillen zijn groot in Europa voor wat betreft het roken onder artsen. In Finland wordt het minst gerookt (7% van de mannelijke artsen en 4% van de vrouwelijke artsen). In Griekenland wordt het meest gerookt (40% van de mannelijke artsen en 37% van de vrouwelijke artsen). Vrouwelijke artsen roken overigens overal minder dan de mannelijke artsen. Uit een studie onder Finse artsen bleek dat in % van de mannelijke artsen dagelijks rookte en 4% van de vrouwelijke artsen. Dagelijks roken kwam het meest (8-12%) voor bij mannelijke artsen in de hoogste leeftijdsgroep. Af en toe roken kwam meer voor bij jongere artsen (22-24% bij mannen en 7-10% bij vrouwen). Er wordt relatief weinig gerookt onder Finse artsen en dat is niet veranderd sinds Een verdere reductie van het dagelijks en af en toe roken vereisen een verschillende, speciaal aangepast en op de arts gerichte benadering (Barengo). Een vergelijkende studie tussen Estse en Finse artsen toonde aan dat dagelijks roken meer voorkwam bij zowel mannelijke (18,6% en 6,7%) als vrouwelijke (6,6% en 3,6%) Estse artsen dan onder hun Finse tegenhangers. In vergelijking met Estland, zijn Finse artsen vaker van mening dat roken zeer schadelijk is voor hun gezondheid (Parna et al (2005)). Een andere studie (Parna, Rahu en Rahu (2005)) onder Estse artsen liet zien dat 24,9% van de mannelijke artsen rookte en 10,8% van de vrouwelijke artsen. Het percentage ex-rokers was 32,9% voor de mannen en 16,8% voor de vrouwen. Niet-rokende artsen hadden ongunstiger opvattingen over roken dan degenen die rookten. De conclusie was dat er onder artsen minder gerookt werd dan onder de doorsnee bevolking, en toonde de impact aan van het roken van de arts op diens houding / opvattingen ten aanzien van roken. Ook in België roken er meer mannelijke dan vrouwelijke artsen (19,4% versus 11,3%), blijkt uit onderzoek in Er werden geen grote verschillen aangetroffen in rookgedrag tussen huisartsen, specialisten, specialisten in opleiding en overige artsen. Er wordt onder artsen (18,1%) beduidend minder gerookt dan onder de doorsnee bevolking (30%) (Prignot). * Aanwezig in VALUE Databank. Bibliografie afgerond op 22 september

2 Een onderzoek onder Franse huisartsen uit 1998 liet zien dat 33,9% van de mannelijke artsen rookte tegen 25,4% van de vrouwelijke artsen. Mannen waren ook vaker ex-rokers (49,1%) dan vrouwen (31,7%). De gegevens laten zien dat er een grotere beroepsmatige participatie nodig is om het roken onder Franse huisartsen terug te dringen (Josseran (2005)). Uit een eerdere studie van Josseran (2000) bleek dat 36,1% van de mannelijke Franse huisartsen rookte, tegen 24,9% van de vrouwen en dat de mannen ook meer sigaretten per dag rookten (11,2 tegen 8 sigaretten per dag). In Tsjechië zijn de cijfers vergelijkbaar met Frankrijk. 38,1% van de mannelijke artsen aan de Tsjechische medische faculteiten rookt dagelijks of af en toe; bij de vrouwen is dat 25,6% (Kralikova). Griekse artsen zijn fervente rokers: 38,6% van hen rookt (40% mannelijke artsen; 37% vrouwelijke artsen). De prevalentie van het roken onder Griekse artsen is uitzonderlijk hoog en vergelijkbaar met die van de doorsnee bevolking (Sotiropoulos). Voor meer details over artsen en hun rookverslaving: raadpleeg de bibliografie. 1. Barengo, N. C. et al., "Changes in smoking prevalence among Finnish physicians ," European Journal of Public Health 14 (2): (2004). Background: The aim of the study was to investigate the changes in smoking habits among physicians in Finland between 1990 and Methods: Three independent cross-sectional surveys using a self-administered questionnaire regarding smoking behaviour as well as knowledge, skills and attitudes in smoking were carried out by mail among physicians in Finland in 1990, 1995 and Results: The prevalence of daily smoking decreased in both men and women between 1990 and 1995, but did not decrease any further between 1995 and In 2001, 7% of male and 4% of female physicians reported smoking daily. Daily smoking was highest (8-12%) among male physicians in the oldest age group. Occasional smoking was more prevalent at a younger age (22-24% in males and 7-10% in females). Conclusion: Smoking prevalence among physicians in Finland is relatively low and has not changed since A further reduction in daily and occasional smoking requires a different, specially adjusted and physician-targeted approach. 2. Dubois, M., M. Frydman, and O. Frydman, "Psychodynamic aspects of smoking cessation among physicians," Journal of environmental pathology vol. 15 (no. 1): 1996 (1996). After approximately 10 years of research on smoking habits with an emphasis on prevention and dishabituation, we focused on the training of teachers and general practitioners. A fairly wideranging inquiry within the Communautà franã aise de Belgique was conducted among nearly 2000 doctors. The study showed that the proportion of smokers, although lower than the average in the general population, was higher among the doctors than other socio-professional categories. A comparison of the results registered in 1983 and 1991 revealed a decrease in the number of smokers and an increase in the number of non-smokers (those who have never smoked). This change stemmed largely from a sharply lower smoking rate among young doctors. These findings impelled us to study the resistance to dishabituation among doctors who smoked. The inquiry was comprised of non-authoritative, Rogerian-style talks that enabled us to isolate a number of motivating factors and some rather typical defense mechanisms that, until recently, went partly unnoticed. The denial, indeed the placation, of anxieties in the medical profession fostered by the constant confrontation with illness and the challenge of and victory over death apparently plays a crucial role, albeit on the unconscious plane. 2

3 3. Hay, D. R., "Cigarette smoking by New Zealand doctors and nurses: results from the 1996 population census," New Zealand Medical Journal 111 (1062): (1998). Aim. To determine the prevalence of cigarette smoking among New Zealand doctors and nurses and to examine intercensal trends in smoking behaviour. Methods. The 1996 New Zealand population census included two questions on cigarette smoking. The data for doctors and nurses have been analysed and compared with results from the 1976 and 1981 censuses. Results. There were 7335 doctor respondents and nurses. Five percent of male and female doctors smoke cigarettes regularly compared with 15% in 1981, 20% in 1976 and 35% in Almost 90% of doctors aged less than 30 years have never smoked and reductions in smoking have occurred in all specialties. Eighteen percent of nurses (18% females, 27% males) are smokers compared with 31% of females and 39% of males in The highest prevalence is among psychiatric nurses (31%) while only 10% of midwives and Plunket nurses are smokers. Conclusions. Doctors continue to lead the New Zealand community in non-smoking and the goal of a smokefree medical profession by the year 2000 may be achievable. In contrast to 1981, the prevalence of smoking by female nurses (18%) is now less than women in the general New Zealand population (23%). Substantial reductions in smoking have occurred in all categories of the nursing profession. 4. John, U. and M. Hanke, "Tobacco-smoking prevalence among physicians and nurses in countries with different tobacco-control activities," European Journal of Cancer Prevention 12 (3): (2003). The aim of the study was to compare rates of smokers among physicians and nurses in the USA, a country with relatively high levels of activity in tobacco control, with those in a country with low levels of tobacco-control efforts. Analysis of interview data in three cross-sectional population studies was carried out. The tobacco-smoking rate of the physicians in the country with low prevention activity dropped to 18%, which is still much higher than the smoking rate in the US and other European countries. In conclusion, prevention activity on a national level might contribute to reducing the rate of current smokers among physicians to a large extent, less so in nurses. 5. Jormanainen, V. J., M. T. Myllykangas, and A. Nissinen, "Decreasing the prevalence of smoking among Finnish physicians," European Journal of Public Health 7 (3): (1997). A postal survey of smoking habits was conducted in a population of Finnish physicians between October and December Among the 1,623 surveyed (1,231 responses, a 75.8% response rate) the prevalence of daily smoking among mate physicians was 10% while in females it was 6%. Another 15% (6% of females) smoked occasionally. Smoking was more prevalent among elderly physicians. Daily smoking among physicians has decreased since 1969, when the daily smoking prevalence was 24% among male respondents and 17% among females. In addition, according to the survey, Finnish physicians often advice their patients to stop smoking if they have a disease, disorder or complaint for which the prognosis has already been reported to be associated with smoking. 3

4 6. Josseran, L. et al., "Smoking by French general practitioners: behaviour, attitudes and practice," European Journal of Public Health 15 (1): (2005). Introduction: This paper examines smoking prevalence, sociodemographic factors and the medical practice of French general practitioners. Method: Data from the 1998 cross-sectional national survey of 2,073 GPs. The questionnaire was administered by telephone. A response rate of 67% was attained. Instrumentation included questions about medical practice, sociodemographic characteristics, and health behaviour. Bivariate and multiple logistic regression (MLR) analyses were conducted. Results: Almost one-third (32.1%) of physicians were current smokers. A significantly higher proportion of male (33.9%) were smokers compared to women (25.4%, p < 0.001) and men were more likely to be former smokers (49.1% versus 31.7%). Two-thirds of physicians reported recommending nicotine replacement therapy to their patients. MLR shown that former smokers were more likely (OR = 1.51, 95% CI, ) to indicate that their help in getting patients to quit was not effective compared to smokers. Also, physicians who were 'dissatisfied' with the profession were more likely (OR = 0.75, 95% CI, ) to report their help as not effective than those who were 'satisfied'. Conclusion: These data support the need for greater professional participation in reducing smoking among general practitioners in France and greater education concerning the vital role of physicians in promoting cessation among the general population. 7. Josseran, L. et al., "Smoking behavior and opinions of French general practitioners," Journal of the National Medical Association 92 (8): (2000). This report examines smoking prevalence, sociodemographic factors, and the opinions of French general practitioners (GPs) about tobacco control policies. Data From the CFES (Comite Francais d'education pour la Sante) national survey on general practitioners included 1013 respondents. The questionnaire was administered by telephone and a response rate of 65% was attained. instrumentation included variables related to medical practice, sociodemographic characteristics, and opinions about health behavior. Thirty-four percent of physicians were current smokers. A higher proportion of males smoked compared to women (36.1% vs. 24.9%, p < 0.01), and they consumed on average more cigarettes per day (11.2 vs. 8 cigarettes/day, p < 0.05). Slightly more than 52% of physicians regarded their role in reducing nicotine addiction to be important. Doctors who believed that the physician's role was limited were less likely to advise pregnant women to stop smoking (odds ratio = 0.39, p < 0.001), and nonsmokers were more supportive of bans on smoking in public places. Despite the high prevalence of smoking among French physicians, they can still play an important role in reducing smoking among their patients. Medical school curriculum and continuing medical education programs focusing on prevention and cessation in France should be strengthened to help reduce smoking rates among physicians and the general population. 8. Kossler, W., M. Lanzenberger, and H. Zwick, "Smoking habits of office-based general practitioners and internists in Austria and their smoking cessation efforts," Wiener Klinische Wochenschrift 114 (17-18): (2002). Tobacco smoking is the major cause of lung disease. This study aimed to determine: 1) the prevalence of tobacco smoking among office-based physicians; 2) their readiness to inquire about their patients' smoking habits and, if need be, to motivate them to stop smoking; 3) whether non-smoking doctors advise their patients more frequently to stop smoking than their smoker colleagues do. A self-designed questionnaire on a post card was sent to 7674 officebased general practitioners (GPs) and internists (18.2%) questionnaires were returned. Independent telephone interviews with 91 doctors were also carried out to minimize the bias of 4

5 self-presentation. Just under 11% of doctors were smokers. About 50% of all doctors who responded described themselves as ex-smokers. 38% of the smokers would accept outside help to stop smoking. About 50% of GPs and 90% of internists inquire about the smoking habits of their patients during history taking. Of these, 85% of GPs and 92% of internists recommend their patients to stop smoking. Doctors who themselves are smokers do so less than their nonsmoker colleagues, For this reason, a further reduction In the smoking prevalence among doctors would be of special importance. Inquiry about smoking habits in the initial history taking should be stressed more to identify any smoker who can be subsequently encouraged to stop smoking. 9. Kralikova, E. et al., "Czech medical faculties and smoking," Central european journal of public health no. 2 (pp ) (1995). At the Medical Faculty of Charles University in Prague the prevalence of smoking was investigated among the faculty, staff, students and among health professionals in the country. We found 38.1% smokers (current and occasional) among malephysicians (N = 625), 25.6% smokers among women physicians (N = 394), 48.7% smoking nurses (N = 729) and 42.3% smokers among paramedical staff (N = 298). We have also followed up smoking up smoking habits among our students since 1989 (N = 1235). The number of smokers among them rose from 7% in 1989 to 18% in Students were also asked about their opinion on smoking as a risk factor for coronary heart disease which has a rising trend. Trying to coordinate the antismoking activity at all seven medical faculties in the Czech Republic, in collaboration with the Faculty of Medicine of Masaryk University in Brno, the National Centre for Health Promotion and the Czech Commission of EMASH, present the main points of the anti-smooking strategy at Czech medical faculties. 10. Naji, N. et al., "Smoking profile of non-consultant hospital doctors," Irish Journal of Medical Science 175 (1): (2006). Background In 1994 Doll and colleagues published smoking mortality figures for British doctors over 40 years. Aims To assess smoking prevalence among junior doctors in a major Dublin teaching hospital. Methods One hundred and fourteen non-consultant doctors (NCHDs) at St James's Hospital received a confidential smoking questionnaire. Results One hundred and six NCHDs responded (93%). Three refused, five were not available. Ninety per cent were aged years. Twenty-six per cent of the doctors had smoked for 10 to 15 years. Seventy-five per cent were smoking more than 10 cigarettes daily. Ninety-seven per cent (20) of smokers wanted to stop smoking. Seventy-four per cent (17) had unsuccessfully attempted to quit. The smoking cessation method most commonly used was 'cold turkey' in 60%. Others included nicotine replacement, bupropion and hypnotherapy. Conclusion A significant per centage of NCHDs (22%) continue to smoke, despite overwhelming evidence that this causes health problems. The prevalence in our study is lower than the national figure of 29%. 11. Parna, K. et al., "Comparison of knowledge, attitudes and behaviour rearding smoking among Estonian and Finnish physicians," Sozial-und Praventivmedizin 50 (6): (2005). Objectives: To compare smoking behaviour, attitudes and opinions towards smoking and smoking cessation among Estonian and Finnish physicians. Methods: A cross-sectional postal survey using a self-administered questionnaire was carried out among 2480 Estonian and 2075 Finnish physicians. Results: Daily smoking prevalence was higher among Estonian physicians 5

6 than among their Finnish counterparts in both male (18.6% and 6.7%) and female (6.6% and 3.6%). Compared to Estonia, physicians in Finland more often agreed that smoking is very harmful to their health, that trying to convince people to stop smoking is their responsibility and that smoking prevention should be part of the normal and special training of health professionals. In both countries, non-smoking physicians held more unfavourable attitudes towards smoking than those who were smoking. Conclusions: Physicians' own smoking patterns and quitting behaviour are important because physicians serve as models for their patients and play a key role in the reinforcement of smoke-free health facilities. These results remain a challenge to medical educators, especially in Estonia. Estonia needs to improve medical education in terms of motivating physicians to ask about the smoking patterns of their patients and of training medical students and resident physicians to counsel their patients to stop smoking. 12. Parna, K., K. Rahu, and M. Rahu, "Smoking habits and attitudes towards smoking among Estonian physicians," Public Health 119 (5): (2005). Objectives. This study examined the smoking habits and attitudes towards smoking among Estonian physicians. Study design and methods. Cross-sectional data for 2668 physicians were gathered by a self-administered postal survey. Results. The current smoking prevalence was 24.9% for male physicians and 10.8% for female physicians. The percentages of ex-smokers were 32.9 and 16.8%, respectively. Smoking prevalence among physicians was below the levels reported for the highest educational bracket of the total population in Estonia. Non-smoking physicians had more unfavourable views towards smoking than those who smoked. The majority of physicians were aware of the association between smoking and various diseases, with significant differences between smokers and non-smokers. Non-smoking physicians were more active in asking patients about smoking habits than those who smoked. Most Estonian physicians, especially those who smoked, failed to perceive themselves as positive role models. Conclusions. This study found a lower prevalence of smoking among physicians compared with the general population, and demonstrated the impact of personal smoking on physicians ' attitudes towards smoking. The results provide an important challenge to medical education in Estonia. 13. Prignot, J. et al., "Time-trends ( ) in smoking habits among Belgian physicians," Archives of public health no. 3 (pp ) (2000). A cross-sectional survey was conducted by the Belgian Lung and Tuberculosis Association (BELTA) in 1998 in a randomly selected sample of 4643 Belgian physicians and the results were compared with those of a similar survey conducted in 1983 among 3205 physicians. Both studies were founded on self-completed questionnaires with no biological validation of the smoking status. In 1998, the response rate was 64.8% for questions about the smoking and personal status, but 35.9% only for the other items. Among the responders 17.3% were current, 28.7% former and 54.0% never smokers. With age, the rate of never smokers decreased and that of former smokers increased, whereas the rate of current smokers showed a symmetrical distribution forage. More male than female physicians were smoking: 19.4% versus 11.3% (p < 0.001). No major differences in smoking rates were noted between GP's, certified specialists, specialists in training and other physicians. Among smokers, 61.6% were smoking daily and 38.4% occasionally; 62.0% smoked cigarettes and 44.4% other tobacco products. The median cigarette consumption was 12 per day for daily smokers; the Fagerstrà m nicotine dependence test (FNDT) of smokers was very low (median value = 1). Of former smokers 92.5% had quitted by personal decision only, but 52.7% reported unsuccessful earlier quit attempts. Since the large number of non-responders could cause a selection bias, a correction model was used, 6

7 yielding a total smoking prevalence rate of 18. 1%, which is notably lower than that in the general population of Belgium (30%). The smoking rate among physicians markedly decreased since 1983, when it amounted to 32%. This is due to the increase of never smokers in the numerous young physicians' group rather than to the increase of former smokers in the less numerous older physicians. The smokers' rate of belgian physicians remains still higher than that among physicians in several other countries (< 10%). 14. Samuels, N., "Smoking among hospital doctors in Israel and their attitudes regarding antismoking legislation," Public Health 111 (5): (1997). Anti-smoking legislation has been implemented in several countries. In order to study the attitudes of Israeli doctors to such legislation, 260 hospital doctors were questioned regarding their smoking habits and attitudes towards antismoking legislation. It was discovered that 15.8% are current smokers [40% of radiologists, 25% of surgeons and anesthetists, and 8% of internists and pediatricians (P = )], of which 76% began smoking before the age of 20, and 54% tried to quit at least once. 24.2% of the current non-smokers are prior smokers who stopped, 92% of nonsmokers and 83% of smokers tell their patients to quit (P = 0.10). 69% feel that cigarette sales should be limited to those of 18 y and older, 77% that advertisements for cigarettes should be prohibited, and 74% that nicotine should be recognized as an addictive substance. Doctors who smoke may have difficulty promoting healthy behavior among their patients. They must be offered help in order to quit, and emphasis should be placed on prevention among medical students. 15. Sotiropoulos, A. et al., "Smoking habits and associated factors among Greek physicians," Public Health 121 (5): (2007). Objective: To investigate the smoking habits and associated risk factors among Greek physicians. Study design: Cross-sectional survey of a randomly selected sample of Greek physicians. Methods: A national sample of 1284 physicians (718 men, 566 women) participated in the study, which was conducted between September 2003 and June Data were collected through an anonymous self-completed questionnaire. Logistic regression was used to analyse the influence of different factors on the probability of a physician being a current or former smoker. Results: Overall, 38.6% of the physicians (40% of men; 37% of women) currently smoked, 13.8% were former smokers, and 47.6% had never smoked. Eighty-three per cent of smokers reported starting smoking before the age of 25 years, with half of them during medical school (aged years). Multivariate analyses revealed that physicians who were mate, unmarried, divorced or widowed, surgeons or anaesthetists, and residents were more likely to be current smokers. Former smokers were more likely to be older, mate and born in a rural area. Moreover, the odds of being a current or former smoker were significantly higher among physicians with a history of parents who smoked. The proportion of physicians who reported counselling patients (often or always) to stop smoking was lower among current smokers compared with those who never smoked or those who were former smokers (74.4% vs. 85.3% vs. 84.7%, P < ). Conclusions: The prevalence of smoking among Greek physicians is exceedingly high and similar to that of the general population. More effective interventions that reduce smoking in the medical community should be implemented immediately so that physicians will be better able to fulfil their function as role models for the general population. 7

8 16. Stuyt, E. B. et al., "Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring," American Journal on Addictions 18 (2): (2009). The use of tobacco by physicians with substance abuse histories is drastically understudied. A chart review of 1319 physicians enrolled in a physician health program found tobacco use highest for those referred for substance abuse problems (58.1%). Among a subset of currently monitored substance abusers, all those who relapsed during monitoring were using tobacco and had more difficulty maintaining sobriety following initial treatment (p = ) than non tobacco users. Because tobacco was a risk factor for relapse, reasons why physician health programs should address its use and treatment facilities should establish tobacco-free environments to provide optimum learning and recovery are explored. 8