Chinese physicians and their smoking knowledge, attitudes, and practices

Background: China has the most smokers among the world's nations. Physicians play a key role in smoking cessation, but little is known about Chinese physicians and smoking. Methods: This 2004 clustered randomized survey of 3552 hospital-based physicians from six Chinese cities measured smoking attitudes, knowledge, personal behavior, and cessation practices for patients. Descriptive statistics and multivariate analysis of factors associated with asking about or advising against smoking were conducted in 2005 and 2006. Results: Smoking prevalence was 23% among all Chinese physicians, 41% for men and 1% for women. Only 30% report good implementation of smoke-free workplace policies and -37% of current smokers have smoked in front of their patients. Although 64% usually advise smokers to quit, only 48% usually ask about smoking status, and 29% believe most smokers will follow their cessation advice. Less than 7% set quit dates or use phartnacotherapy, when helping smokers quit. Although 95% and 89%, respectively, know that active or passive smoking causes lung cancer, only 66% and 53%, respectively, know that active or passive smoking causes heart disease. Physicians were significantly more likely to ask about or advise against smoking if they believed that counseling about health harms helps smokers quit and that most smokers would follow smoking-cessation advice. Conclusions: Physician smoking cessation, smoke-free workplaces, and education on smoking-cessation techniques need to be increased among Chinese physicians. Strengthening counseling skills may result in more Chinese physicians helping smoking patients to quit. These improvements can help reduce the Chinese and worldwide health burden from smoking.