American Review of Respiratory Medicine - Volumen 24, Número 4 - December 2024

Editorials

The Role of Healthcare Workers in Tobacco Control

El papel de los trabajadores de la salud en el control del tabaco

“Do as I say, not as I do”

Séneca

 

The recent study on the prevalence and attitudes toward tobacco use among healthcare workers at Hospital de Especialidades Axxis in Quito, Ecuador, presents relevant findings that justify a broader debate on the role of healthcare profes­sionals in tobacco control.

HEALTHCARE WORKERS AS ROLE MODELS

Healthcare professionals are regarded as role mod­els in promoting healthy lifestyles. Their behaviors and attitudes significantly influence their patients and society in general. The effectiveness of preven­tion policies partly depends on the commitment of healthcare workers, as well as their attitudes and behaviors regarding tobacco use. This makes them key social figures in the fight against tobacco and role models for healthy behavior.¹ However, the study revealed that nearly 20% of workers at Hospital Axxis are current or former smokers. Although this figure is lower than the national prevalence in Ecuador, estimated at 11.5%, the fact that those who play a crucial role in health promotion continue to engage in this harmful habit is still an issue of concern. Various studies have highlighted this situation over time and in differ­ent parts of the world.^2,3 Nevertheless, tobacco use among healthcare professionals continues to be a challenge in the fight against smoking.

THE PARADOX OF KNOWLEDGE AND BEHAVIOR

One of the most striking findings is the higher prevalence of smoking among physicians compared to administrative staff. This paradox highlights a crucial issue: knowledge alone is not enough to change behavior. Despite being trained in the risks of smoking, many doctors continue to smoke, largely due to high levels of stress and work pressure. While healthcare professionals understand the dangers of tobacco, they continue using it. This suggests that factors such as stress, workload, and social influences play a decisive role in this behavior. However, the biological factors inherent to smoking cannot be overlooked in this analysis. It is an addictive disease primarily driven by nicotine.⁴ This substance initiates and sustains the addictive behavior over time. Nicotine is one of the most addictive drugs known,⁵ comparable to cocaine and heroin. Reducing smoking to a mere “habit” or “vice” oversimplifies the complexity of the problem. Healthcare workers, like the rest of the population, are not exempt from this reality.

The link between knowledge and behavior is clearly evident in the general population. Most adult smokers are aware of the harmful effects of tobacco on their health, at least to some degree. However, many feel incapable of quitting or believe they can postpone it indefinitely.

Nicotine addiction is a complex phenomenon. Beyond its biological basis— which involves the activation of neural receptors and the release of psychoactive substances—other factors contribute to its persistence: ease of access, its legal status, low social condemnation, and the influence of the tobacco industry through advertising and product promotion.

Given this scenario, tobacco treatment must also address multiple dimensions. While physical absti­nence can and should be managed with drugs of proven efficacy, the social, cultural, and psychological aspects of dependence require equal attention. In this regard, cognitive-behavioral therapy and psycho­logical support should be considered as fundamental pillars of treatment.⁶  

THE IMPORTANCE OF SUPPORT SYSTEMS

The study also highlights the importance of having effective support systems for quitting smoking. A significant percentage of healthcare workers expressed a strong interest in quitting, with 60% planning to do so within the next six months and 53% within the next 15 days. In the general popu­lation, up to 70% of adult smokers wish to quit; however, without assistance, the success rate is very low (approximately 5%).⁷ The success of these attempts often depends on access to cessation programs and professional support. The approach and appropriate treatment for smokers have been described⁸ and updated over time, and all smokers should have access to these resources. The fact that most quit attempts were made without specialized help reveals a gap in the support system that has to be addressed. It is essential to develop psycho­logical support programs, individual and/or group therapy, and ensure access to pharmacological treatments that increase the chances of successful smoking cessation.

IMPLICATIONS FOR HEALTH POLICY

The findings of the study at Hospital Axxis un­derscore the need for healthcare institutions to implement stricter policies of tobacco control. This could include banning smoking across all hospital facilities, offering free smoking cessation programs for staff, regularly monitoring tobacco use among employees, and integrating educational modules on smoking into ongoing healthcare training. It could include monitoring tobacco use regularly among employees, access to specialized programs to quit smoking, and the creation of an environment that encourages tobacco cessation. Additionally, health­care professionals should receive training on how to counsel their patients in quitting smoking, as their personal experiences and attitudes can influ­ence their effectiveness as advisors.

CONCLUSION

The role of healthcare workers in tobacco control is fundamental. They are not only responsible for their own health but must also serve as role models for their patients and the community. However, like the rest of the population, many healthcare professionals also struggle with tobacco dependence.

For this reason, healthcare institutions should implement support systems at two levels: on one hand, monitoring smokers through periodic surveys or other mechanisms, and on the other, offer­ing assistance through counseling and personalized treatments.

Additionally, promoting smoke-free hospitals and healthcare centers encourages healthy behaviors among the staff and the patients. The study con­ducted at Hospital Axxis highlights the importance of having comprehensive strategies to support health­care professionals in quitting smoking and adopting a tobacco-free lifestyle. By doing so, they will not only strengthen their role as health advocates but also contribute to building a healthier society.

Conflict of interest

The author have no conflicts of interest to declare.

REFERENCES

1. Robledo de Dios T, Saiz Martínez-Acitores I, Gil López E. Los profesionales sanitarios y el tabaquismo. Trastornos adictivos. 1999;1:117-23. https://www.elsevier.es/es-revista-trastornos-adictivos-182-articulo-los-profesionales-sanitarios-el-tabaquismo-13010688

2. Fernández Ruiz ML, Sánchez Bayle M. Prevalencia de consumo de tabaco entre las medicas y enfermeras de la comunidad de Madrid. Rev Esp Salud Publica [on­line]. 1999;73:355-64. https://doi.org/10.1590/S1135-57271999000300004

3. Arenas Monreal L, Hernández Tezoquipa I, Rogelio Jasso V, Martínez PC, Menjivar Rubio A. Prevalencia de tabaqui­smo de médicos y enfermeras en los estados de Morelos y Guajanato. Rev Inst Nal Enf Resp Méx 2004;17:261-5.

4. Asociación Americana de Psiquiatría, Manual diagnóstico y estadístico de los trastornos mentales (DSM-5^®), 5ª Ed. Arlington, VA, Asociación Americana de Psiquiatría, 2014

5. American Addiction Centers. Most Addictive Drugs. Disponible en: http://americanaddictioncenters.org/adult-addiction-treatmentprograms/most-addictive/

6. Granda Orive Ji. Dependencia por el tabaco. El tabaqui­smo como enfermedad adictiva crónica. En: Jiménez-Ruiz CA y Solano Reina S (eds.). Tabaquismo. Monografías NEUMOMADRID; Vol VII. Madrid: Ediciones Ergon; 2004; p. 53-69.

7. Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quit­ting Smoking Among Adults - United States, 2000-2015. MMWR Morb Mortal Wkly Rep 2017;65:1457-64. https://doi.org/10.15585/mmwr.mm6552a1

8. Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and de­pendence: 2008 update. A U.S. Public Health Service report. Am J Prev Med 2008;35:158-76. https://doi.org/10.1016/j.amepre.2008.04.009