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DEDICATED
TO
OUR BELOVED
PARENTS AND
TEACHERS
ACKNOWLEDGMENTS
First of all I would like to acknowledge the
hard work of my group fellows who spent
their time and attention into obtaining of the
data in the form of questionnaires from
Doctors and other health care workers at
Wapda Teaching Hospital Complex Lahore.
The much appreciated friendly and
professional supervision of our supervisor Dr
SYED Khurram Raza was a true source of
guidance during the preparation of this
report .
ThE moral support and encouragement of our
head of community medicine department Dr
Shaheena Manzoor was a beacon of light and
a true source of support for our batch and
our entire class .
STUDY ABOUT PREVALENCE OF SMOKING IN HEALTH
CARE PROVIDERS AT WAPDA TEACHING HOSPITAL
COMPLEX LAHORE
DEPARTMENT OF COMMUNITY MEDICINE
CENTRAL PARK MEDICAL COLLEGE, LAHORE.
4TH
YEAR MBBS SESSION 2011-2012
NAME: _________________________________________________
COLLEGE ROLL NO: ___________________________________
UNIVERSITY ROLL NO: ________________________________
CLASS: _________________________________________________
HEAD OF DEPARTMENT: PROF. DR SHAHEENA MANZOOR
STUDY ABOUT PREVALENCE OF SMOKING IN HEALTH
CARE PROVIDERS AT WAPDA TEACHING HOSPITAL
COMPLEX LAHORE
Submitted By: ___________________________________________
Signature of Supervisor: ___________________________________
Signature of Head of Department: __________________________
Signature of External Examiner: ___________________________
RESEARCH STUDY GROUP
No ROLL
NO
NAME
1. 13014 ATIFAH ZAFAR
2. 13015 AZAZ-UL-HAQ
3. 13016 BAZGHA MUSHTAQ
4. 13019 FAIZA ASHRAF
5. 13020 FATIMA ABBAS
6. 13021 FATIMA BINT-E-SHAHID
7. 13023 FIZZAH IQBAL
8. 13025 HABIBA TARIQ
9. 13026 HAFIZ ASAD ABDULLAH BABAR
GROUP LEADER: HAFIZ ASAD ABDULLAH BABAR
SUPERVISOR: DR. SYED KHURRAM RAZA
1
Abstract
Objective:
To study the prevalence of smoking among health care providers at Wapda
Teaching Hospital Complex Lahore .
Method:
In this cross-sectional study, 90 questionnaires were administered to participants
between June – July 2012 to collect data from Health care providers at different
departments of Wapda Teaching Hospital Complex Lahore on smoking.
Study Sample:
The study population included all doctors, pharmacists and pharmacy assistants,
laboratory technologists and laboratory technicians, professional nurses, enrolled
nursing assistants, staff nurses, radiographers, paramedics. Some allied medical
personnel and non-medical administrative staff (Receptionists and Cafeteria) were
excluded.
Sampling Size
90 Health Care Workers
Sampling Techniques
Non-probability, convenience sampling.
Sampling Frame
All health care providers of Wapda Teaching Hospital Complex, Lahore.
Inclusion/Exclusion Criteria
Doctors and other health care providers who had time to answer the questions were
included in the study while those who were busy or unwilling were excluded.
Bias and limitations
Incomplete entries and non-return of questionnaires may have affected the validity
of some of the analysis during this research. One doctor decided not to disclose his
name .
Research Methodology
i. Qualitative Variables
Name of subject
Smoker or non-smoker
Reason for started smoking
Do friends also smoke
Any other smoker at home
Smoking at home by study subject
Non-smoking policy in institution
Restart smoking after quitting
Knowledge about hazards of smoking
Any respiratory problems of smokers
Does subject want to quit smoking
Have study subject influenced others
Room sharing with Non-Smokers
Drugs used for quitting smoking
Knowledge of Rehabilitation centers for quitting smoking
ii. Quantitative Variables
Age
Class
Number of Cigarettes per day
Age of starting smoking
Time since started smoking
Money spent on smoking
Time since quitted smoking
Study Design:
Cross-Sectional Study
Place of Study:
Wapda Teaching Hospital Complex Ferozepur Road Lahore.
Data Collection Plan:
A. Time Frame
March 2012 to July 2012
B. Data Collection Tool
Questionnaire
Response Rate
Response rate was 100% for all those Health Care Workers who gave the informed
consent to participate.
Data Analysis:
Data entry and Analysis was done in SPSS IBM 20 (Statistical Product and Service
Solutions-International Business Machine Version 20).
Calculations
Descriptive statistics were calculated and presented in forms of frequency.
Figures
Bar and pie charts are made to present data.
Results:
Out of 90 health care personnel included in the sample of study, 32 (35.6%)
were found to be smokers of variable magnitude and the remaining (58 i.e.
64.4%) were found to be nonsmokers.
Out of the 32 smokers, 7 started smoking due to peer pressure, 1 smoker
started due to inspiration from Television and movies and 24 smokers had
their personal reasons which mostly included personal pleasure.
45.6% subjects also had smoker friends while the remaining (54.4%) did
not.
12.2% smoked only inside homes and 24.4% smoked only among friends.
Their daily expenditure on smoking is variable and most smokers spend
between 50-100 Rupees on smoking on a daily basis.
16% restarted smoking after quitting and 6.7% have influenced others to
start smoking.
93% subjects consider smoking injurious to health and 95% are not suffering
from any respiratory problems.
26% smokers are willing to quit smoking.
69% subjects are aware of non-smoking policy in their institution.
30-35% subjects have knowledge of drugs that help quit smoking and
rehabilitation centers.
Conclusion:
Smoking by Health Care Professionals undermines their moral high ground in the
fight against the tobacco epidemic. There is also a very high exposure of non-
smokers to second-hand smoke, especially at home. The high exposure to second-
hand smoke in public places, including the hospital premises, suggests that the
smoking ban in public places is not effectively enforced. The authorities should
ensure that the smoking bans in public places are strictly enforced. Health Care
Workers need to be educated on harmful effects of smoking. This study showed
that 35.6% of Health care providers of Wapda Teaching Hospital Complex Lahore
indulged in smoking of variable magnitude. Main cause was said to be gaining of
personal pleasure.
Keywords:
Health care, Smoking
Introduction:
Tobacco use has been described as the single greatest preventable cause of
death in the world, and up to half of all cigarette smokers may be killed by their
addiction. Medical evidence of the harmful effects of tobacco use has been
available for about 200 years. However, this evidence was generally ignored.
Tobacco use has been shown to be associated with many different cancers and a
major risk factor for six of the eight leading causes of death worldwide. More than
one billion people worldwide currently smoke tobacco and it is estimated that more
than five million people worldwide die each year as a result of tobacco use. Based
on the current trends, the World Health Organization has predicted that by 2030
more than eight million people will die of tobacco-related illnesses each year.
Many studies have shown that when Health Care Workers smoke, this
inadvertently undermines their roles in advising or assisting smokers to quit.
Intensive counseling has been shown to increase the chance of quitting, and
follow-up support further increases the quit rate. Strategies used effectively to
assist smokers to quit their addiction include the use of pharmacological products
such as nicotine replacement therapy (NRT), bupropion and varenicline;
behavioral interventions, such as financial incentives; and the use of support
groups to help quit smoking.
LITERATURE REVIEW
A review of Cigarette smoking in health care shows the results that a large
proportion of doctors are involved in smoking habit (1). Review of researches
performed on an international scope shows Asian doctors to be more
involved in smoking (2-3). Only a third of medical students did counselling, and
assessed the patients' willingness to quit. Majority of the students agreed
about doctors' role in tobacco control as being role models, competence in
smoking cessation methods, counseling, and the need for training about
tobacco cessation in medical schools (3).Another research shows that dentists
can help prevent smoking by warning doctors and general public about
hazards of smoking on dental health (4). Research done on doctors in Karachi
shows very high prevalence of smoking i.e 82% as well as other minor form of
drugs in form of chewable items (5-6) Review of researches also shows that in
Pakistan ,government hospital personnel specially lower staff and nurses are
involved in smoking more as compared to senior doctors ad professors in a
developing country like pakistan(7-8) Doctors are, however quite interested in
cessation guidelines regarding tobacco smoking for fellow doctors as well as
smoking patients(6,9)student doctors are aware of all the deleterious effects of
smoking on their health and health of their patients i.e upto 80% (10) . A large
number of students and senior doctors i.e upto 90% were involved in
antismoking campaigns and smoking cessation guidelines provision (11-12)
Nurses and para-medics smoked more as compared to doctors by a large ratio
(1: 3)General attitude of medical students towards smoking is normally
against it and are non-supportive of the concept of smoking but smoking
attitude among medical students is declining due to many reasons specially
peer pressure and gaining of personal pleasure (14-17) Males are more involved
in smoking as compared to females (18-20) .
RESULTS:
Table 1 : Age distribution among participant HCWs at WTHC
Frequency Percent
<25 10 11.1
26-35 34 37.8
36-45 17 18.9
>45 29 32.2
Total 90 100.0
The frequency table of age groups of our participants shows variable age groups
involvement . Most participants are between age 36-45 .
Pie Chart 1 : Showing age distribution percentages
Table 2 : Number of smoking HCWs at WTHC Lahore.
Frequency Percent
Smoker 32 35.6
Nonsmoker 58 64.4
Total 90 100.0
The table shows number of smoking population among the health care personnel at
WTHC . According to this table , non-smokers are more in percentage i.e. 64% .
Bar graph 1 : Showing number of smokers at WTHC
Table 3 : Number of cigarettes on a daily basis
Frequency Percent
1-5 15 16.7
6-10 15 16.7
16-20 2 2.2
Total 32 35.6
Non smokers 58 64.4
Total 90 100.0
The variation in the number of cigarettes smoked per day by the smokers is below
the dangerous level as shown in the frequency table because 46% smokers are
smoking less than 10 cigarettes per day.
Bar Graph 2 : Showing frequency of number of ciggeretes per day
Table 4 : Age variation for initiation of smoking
Frequency Percent
<15 3 3.3
16-20 16 17.8
21-25 7 7.8
26-30 5 5.6
>30 1 1.1
Total 32 35.6
Non smokers 58 64.4
Total 90 100.0
The frequency table above shows that 50% smokers started in their late teens. Only 3% smokers
started after 30 years of age.
Bar Graph 3 : Showing ages at which participants started smoking
Table 5 : Duration of smoking
Frequency Percent
<1 Year 9 10.0
1 Year 11 12.2
5 Years 4 4.4
10 Years 8 8.9
Total 32 35.6
Non smokers 58 64.4
Total 90 100.0
According to the frequency table above most smokers have been smoking for 1
year or less .
Bar Graph 4 : Showing duration of smoking
Table 6 : Reasons involved in starting smoking
Frequency Percent
Peer Pressure 7 7.8
Inspired By TV Films 1 1.1
Other 24 26.7
Total 32 35.6
Non smokers 58 64.4
Total 90 100.0
The table shows that most documented reason for initiation of smoking
among smokers was personal reasons including personal pleasure.
Bar Graph 5 : Showing reasons to start smoking
Table 7 : Number of participants having smoking friends
Frequency Percent
Yes 41 45.6
No 49 54.4
Total 90 100.0
Greater percentage of smokers does not have smoker friends . Clearly having smoking friends
has a great influence on smoking habit and this is depicted in the above table .
Pie Chart 2 : Showing percentages Number of participants having friends who smoke
Table 8 : Number of participants having smokers at home
Frequency Percent
Yes 16 17.8
No 74 82.2
Total 90 100.0
According to the frequency table shown above, a large percentage of
smokers also have other smocking people at home, this also has an
influence on smoking on a regular basis.
Bar Graph 6 : Showing participants having other smokers at home
Table 9 : Number of participants who smoke inside home
Frequency Percent
Yes 11 12.2
No 21 23.3
Total 32 35.6
Non smokers 58 64.4
Total 90 100.0
65% smokers do not smoke inside their home which has an influence on passive smoking hence
this is not a very alarming figure because most of the public places have non-smoking policies
hence smoking habits can easily be suppressed through this.
Bar Graph 7 : Participants who smoke inside home
Table 10 : Number of participants who smoke only among friends
Frequency Percent
Yes 22 24.4
No 10 11.1
Total 32 35.6
Non smokers 58 64.4
Total 90 100.0
Passive smoking is easily affected when somebody smokes amongst their friends, 68% smokers
smoke among friends only so this is also an alarming figure.
Bar Graph 8 : Participants who only smoke among frioends
Table 11 : Daily expenditure on smoking
Frequency Percent
0-50 6 6.7
51-100 15 16.7
101-150 5 5.6
151-200 2 2.2
Total 28 31.1
Non smokers 62 68.9
Total 90 100.0
According to the frequency table shown above, a large number of smokers i.e. 54% spend
between 50-100 Rupees on smoking on a daily basis as compared to the other figures. Hence this
is not an alarming figure because most of the health care workers are doctors in this research and
they can easily afford. However, the figure is still alarming when it comes to a national basis.
Bar Graph 9 : Daily expenditure of the smoking participants
Table 12 : Knowledge of non-smoking policy
Frequency Percent
Yes 62 68.9
No 28 31.1
Total 90 100.0
Majority of the participants of this research did have knowledge of a non-smoking policy in their
institutions according to the frequency table shown above so this is clearly a positive result.
Pie Chart 3 : Showing percentages of participants who had knowledge of non-smoking policy
Table 13 : Restarted smoking after quitting
Frequency Percent
Yes 15 16.7
No 17 18.9
Total 32 35.6
Non smokers 58 64.4
Total 90 100.0
It is alarming to note that as observed in this research, more than 50% of the smokers are those
that have restarted smoking after leaving it for some time. Due however to their personal reasons
which were not included in the questionnaire. This is still an alarming figure because this has a
lot of influence on the smoking habits of the people nationwide.
Bar Graph 10 : Participants who restarted smoking aftrer quitt
Table 14 : Considers smoking injurious to health
Frequency Percent
Yes 84 93.3
No 6 6.7
Total 90 100.0
According to the frequency table shown above since most of our participants were health care
professionals. They were highly aware of the deleterious effects of smoking on normal health i.e.
93% respectively.
Bar Graph 11 : Participants who consider smoking injurious to health
Table 15 : Suffering from respiratory problems
Frequency Percent
Yes 3 3.3
No 87 96.7
Total 90 100.0
According to the frequency table shown above, a large number of participants were not suffering
from any type of respiratory problems which may or may not be associated with smoking. Still,
however this figure is not alarming in any way. But, since respiratory problems can occur as a
result of passive smoking so this is a variable figure that has to be monitored on a regular basis.
According to the frequency table shown above, WTHC health care providers are mostly not
suffering from any type of respiratory problems which is obviously because of non0-smoking
policy that is present in WTHC.
Pie Chart 4 : Percentage of participants suffering from any respiratory problenms
Table 16 : Willing to quit smoking
Frequency Percent
Yes 24 26.7
No 7 7.8
Total 31 34.4
Non smoker 59 65.6
Total 90 100.0
According to the frequency table shown above a large percentage of people are in favor of
wanting to quit smoking which is a very positive attitude among the smokers of WTHC. The
percentage of such smokers is 77% respectively.
Bar Graph 12 : Participants willing to quit smoking
Table 17 : Influencing others to start smoking
Frequency Percent
Yes 6 6.7
No 25 27.8
Total 31 34.4
Non Smokers 59 65.6
Total 90 100.0
The quality of a smoker of influencing other people to start smoking is quite a dangerous thing
and the figure above do not indicate this quality being so common in the smoking population of
WTHC. Those influencing other people are only 20% smokers.
Bar Graph 13 : Smoking participants who have influenced others to start smoking
Table 19 : Share room with non-smokers
Frequency Percent
Yes 25 27.8
No 60 66.7
Total 85 94.4
Non smokers 5 5.6
Total 90 100.0
According to the table above, 30% smokers share rooms with non-smoking people and are a
source of passive smoking for the non-smoking roommate. Hence this is still an alarming figure.
Bar graph 14 : Smoking participants sharing rooms with non-smokers
Table 20 : Knowledge of drugs to help quit smoking
Frequency Percent
Know 29 32.2
Dont Know 61 67.8
Total 90 100.0
Since most of the participants of this study are health care providers, it is expected of them to
have knowledge of drugs that help quit smoking hence the percentage of people not knowing is
quite alarming and shows negligence i.e. 66%.
Pie Chart 5 : Participants havimg knowledge of drugs that help quit smoking
Table 21 : Knowledge about Rehab centers
Frequency Percent
Know 32 35.6
Dont Know 58 64.4
Total 90 100.0
According to the frequency table shown above, only 36% of the participants of this research
were aware of rehabilitation centers in the city.
Pie Chart 6 : Participants ( Smokers + Non-Smokers ) having knowledge of Rehab centres
DISCUSSION:
The result of our investigation indicated that health care workers, though aware of
risks and hazards of smoking, had a quite prevalent smoking habit. Yet, only few
studies have examined this issue. Non-Smoker physicians are reported to be more
efficient in patients’ advice, attitudes, and counseling practices on smoking
cessation. In general, most of the studies agree that Pakistani smokers start as
early as first years of the teenage and continue thereafter . Our study documented
the next common smoking starting age was late childhood and the least was above
35 years. This may highlight the importance of a planned age-dependent
intervention and education.
Our results have also ascertained earlier findings pertaining to the influence of
friend on the decision to begin smoking. This is properly due to lack of experience
along with psychological and mental changes and preference of leisure. It is, thus,
the most appropriate age to install programs on tobacco-related issues at schools,
mosques & areas of gatherings by experts and authorities. Other reasons are
unrestricted tobacco sales, low cost of cigarettes, receptivity to cigarette
promotions and seeing tobacco use in films among adolescence. In consistent with
other research, high percentage of the sample was aware of smoking hazards and
considered quitting but failed . Failure to quit tobacco smoking was mainly due to
lack of will power and influence of the family. In our sample, a less proportion of
the participants smoke at home, decreasing the risk for passive smoking which is a
good sign.
The majority of the sample was light smokers consuming 1-10 cigarettes/day. This
may point out the relatively low smoking prevalence and consumption of our
sample when compared to universal prevalence and figures obtained from different
populations. Consequently, there is a reasonable opportunity for smoking
intervention. More health awareness is required among health professionals and
our general population. Programs and activities should be implemented as early as
in the elementary school.
The impact of films and cigarettes advertising should be acknowledged and used in
the proper direction. Tobacco control laws and policies should be implemented.
Tobacco cessation clinics should advertise it more widely and expand its service to
reach schools. In the view of the scarcity of such researches, we recommend
further national survey to study the prevalence, determinant factors and the impact
of smoking cessation and education on prevalence and incidence.
CONCLUSION:
This study showed that 35.6% of Health care personnel of WTHC Lahore indulged
in smoking of variable magnitude. Main cause was said to be gaining of personal
pleasure. In conclusion, smoking prevalence was relatively high among our
hospital workers. Most of them were males and technicians. Smoking usually had
started at an early age. This may highlight the importance of policies,
implementation of early age health education. Tutoring should also explain the
risks for both the smokers and passive smokers.
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Prevalence of Smoking in Health Care Workers
of Wapda Hospital Complex, Lahore
Questionnaire
Name : ______________ Age : ____________
Department : ____________ Designation : ______________
1. Do you smoke cigarettes? Yes___________ No______________
2. If yes, how many cigarettes per day? ____________
3. At what age did you start smoking?______________
4. Since how long you are smoking?________________
5. Why did you start smoking?
For personal pleasure__________
Due to peer pressure___________
Inspired by TV and films________
6. Do your friends also smoke? Yes_______________ No________________
7. A) Is there any smoker at home? Yes_____________No________________
B) If yes, Father______________ Mother________________
Brothers_____________Sisters________________
Uncle_______________Others
8. Do you smoke inside your home? Yes ___________ No_____________
9. Do you smoke only when amongst friends? Yes___________No___________
10. How much do you spend on smoking per day?____________________
11. Is there a non-smoking policy in your institution?
Yes___________No___________
12. Have you restarted smoking after leaving it for some time?
Yes _________No__________
13. For how long did you leave smoking? ______________
14. Why did you restart smoking after quitting? Give reasons
_____________________________________________________________
_____________________________________________________________
15. Do you think smoking is injurious to health?
Yes_______________ No________________
16. Do you suffer from respiratory problems e.g. Asthma, Bronchitis etc.
Yes_____________________ No_____________________
17. Do you really want to quit smoking? Yes_______________
No_______________
18. Have you influenced your friends, companions, relatives by your smoking
habit?
Yes_______________ No _________________
19. Do you know of any drug used for quitting smoking ?
Yes __________No ____________
20. Do you know of any centres which help in rehabilitation after smoking ? Yes
___________ No ________________
