Determinants of smoking behaviour among doctors and dentists in Makassar, Indonesia

Andi Zulkifli, Alimin, Akbar & Muh Syafar

BackgroundIRONY…. Some doctors and dentists are

smokers they are supposed to be a role model on healthy behavior.

They are well known to have good understanding on the adverse effects of smoking on human health.

They should be the leading role on tobacco control and prevention. They have a key role on health policy including tobacco control.

Prevalence of smokers among medical staff in selected countries

Countries Year Types of medical stuff Prevelence (%)Turkey 2004 Doctors 45,0 China (6 cities)Beijing & Honhot

20062010

Doctors Paramedics

22,955,0 & 44,0

Tiongkok 2004 Male Doctors 41,0India: Karnataka 2007 Doctors, dentists and Nurses 56,92

Bosnia & Herzegovina 2004 Doctors 40,0 Finland 2001 Doctors (Male and Female) 36 ,0 & 25,0Japan 2007 Anesthesiologists and surgeon 11 ,0 & 13,0USA 2003 Medical practitioners 7,0Australia (Queensland)

2005 Dentists 3,9

Indonesia 2008 Doctors who work at community health centres (public) and doctors who work at private clinic

16,411,0

Introduction

Indonesia: 2008: Sample: Doctors who

works at community health centre (16,4%), Private practitioners (11%) Nurses (13,5%).

2009: Male doctors 22% Female

doctors (1%).

Research question

Are there any association between, attitude to their patients, types of working environment, readiness to smoking cessation and smoking behaviour among doctors and dentists in Makassar?

Perception to smoking among doctors How do doctors or dentists perceive toward smoking, social impact of smoking among doctors, their opinion about tobacco control policy.

Attitude to their patient who smoked What do doctors or dentist attitude when patients visited them and wanted to discuss their health in related to their smoking behavior, whether doctors or dentist suggested their patient to stop smoking and doctors and dentists smoking behavior close to their patients.

Working place whether their working place have a regulation on smoking at workplace, their attitude to that policy, smoking behavior among workers, stress and their behavior when their friends offered a cigarette.

Definition

METHOD Study design

Case control study Study setting

This study drew samples (Doctors or Dentists) from 15 health institutions (public) in Makassar (hospitals, clinics, Community health centres)

Population and SampleMale doctors and dentists at hospitals, clinics and community health centres in Makassar

METHODSSample size

A total of 172 doctors and dentists were included using exhausted sampling methods.

• Definitions• Cases: Doctors or dentists who actively smoke; smoke at least

one piece per day.• Controls: doctors or dentists who do not smoke. Place of work

and number of working hours per day were matched. Statistical analysis: Logistics regression was used to determine

the association between dependent and independent variables.

<31 years 31-44 years 41-50 years > 50 years0

10

20

30

40

50

60

70

80

12.2

22.4

42.9

22.4

0

18.4

68.4

13.2

5.3

26.3

42.1

26.328.6

20.4

34.7

16.3

Non smokers

Previously smoke

smoke irregularly

actively smoke (daily)

%

RESULTS

Figure 1 Smoking Behaviours and Age Group

general prac-titioners

specialist sub specialist master degree

doctoral degree

0

10

20

30

40

50

60

35.7

54.1

1

8.2

1

47.4

36.8

0

15.8

0

52.9

39.7

1.5

5.9

0

non smokers

previusly smoked

actively smoke

%

RESULTS

Figure 2 Smoking Behaviours and Educational Levels

Personality

Smoking Status

OR 95%CI(p=0,000)

Cases Control Total

n % n % n %

Negative 58 85.3 47 34.6 100 51.5 10.983

5.144-23.449

Positive 10 14.7 89 65.4 99 48.5

Total 68 100.0 136 100.0 204 100.0

Table 1 Personality and Smoking Behaviours

Doctors or dentists who have negative personality are 11 times more likely to smoke than doctors or dentists who have positive personality.

Attitude to their patients

Smoking Status

OR 95%CI(p=0,000)

Cases Control Total

n % n % n %

Negative 55 80.9 69 50.7 124 60.84.108

2.057-8.204Positive 13 19.1 67 49.3 80 39.2

Total 68 100.0 136 100.0 204 100.0

Table 2 Attitude to Their Patients and Smoking Behaviours

Doctors or dentists who have negative attitude are four times more likely to smoke than those who have positive attitude.

Working place

Smoking Status

OR 95%CI(p=0,000)

Cases Control Total

n % n % n %

Negative 49 72.1 66 48.5 115 56.42.735

1.461-5.123Positive 19 27.9 70 51.5 89 43.6

Total 68 100.0 136 100.0 204 100.0

Table 3 Working Place and Smoking Behaviours

Doctors or dentists who work at negative working place on smoking are 2.7 times more likely to smoke than those who works on positive working environment.

Level of knowledge

Smoking status

OR 95%CI(p=0,000)

Cases Control Total

n % n % n %

low 27 39.7 47 34.6 74 36.31.247

0.684-2.274High 41 60.3 89 65.4 130 637

Total 68 100.0 136 100.0 204 100.0

Table 4 Level of Knowledge and Smoking Behaviours

There is no association between knowledge on smoking and smoking behaviours

Readiness to stop smoking

Smoking status

OR 95%CI(p=0,000)

Cases Control Total

n % n % n %

Not ready 44 64.7 50 36.8 94 46.13.153

1.718-3.246Ready 24 35.3 86 63.2 110 53.9

Total 68 100.0 136 100.0 204 100.0

Table 5 Readiness to Stop Smoking and Smoking Status

Those who ready to stop smoking are 3.1 times more likely to keep smoking than those who are not ready.

Variables Coef Wald OR95% CI

PLL UL

Personality 2.249 30.600 9.476 4.272 21.026 0.000

Attitude to their patient 0.954 5.695 2.596 1.186 5.688 0.017

Readiness to stop smoking 1.143 10.053 3.136 1.547 6.357 0.002

Constant -3.316 46.657 0.036 0.000

Table 6 Logistics Regression of Determinant of Smoking Behaviors Among Doctors and Dentists

MULTIVARIATE ANALYSIS

Personality is the most significant contributors to smoking behaviours among dentists and doctors

Conclusions1. Doctors or dentists who have a negative personality are 11 times

more likely to keep smoking than doctors or dentists who have a positive personality.

2. Doctors or dentists who have a negative attitude are 4.1 times more likely to keep smoking than doctors or dentists who have a positive attitude.

3. Doctors or dentists who worked at a negative working place are 2.7 times more likely to keep smoking than doctors or dentists who have positive working environment on smoking

4. There is no association between doctors or dentists knowledge on smoking adverse effect on health and smoking status.

5. Doctors or dentists who are not ready to smoke are 3.1 tie more likely to keep smoking than doctors or dentists who are ready to stop smoking.

Recommendations• Doctors and Dentists should actively involve on anti tobacco

campaign, support non smoking area, initiate no smoking campaign to their patients.

• The Indonesia Medical Association (IDI) and The Indonesian Dentists Associations (PDGI) should regulate smoking rules among doctors or dentists.

• Health institutions in Makassar should implement non smoking area in theirs sites.

• The Indonesian Government should ban tobacco advertisement in the health institutions as a non smoking campaign in public places.

Thank…

Wassalam…