American Review of Respiratory Medicine - Volumen 25, Número 2 - June 2025

Editorials

Smoking and Medical Education in Argentina: A Gap that Compromises Public Health

Tabaquismo y formación médica en Argentina: una brecha que compromete la salud pública

Smoking continues to be one of the leading causes of morbidity and mortality in Argentina, with more than 40,000 annual deaths attribut­able to tobacco use, according to the Ministry of Health. Despite its devastating impact, a con­cerning gap remains in medical training regarding the comprehensive management of smoking as an addictive, chronic, and recurrent disease. In a country where tobacco causes over 40,000 deaths annually, it is alarming that those responsible for respiratory care are not sufficiently prepared to fight it.

National studies such as TAMARA II (smoking among physicians in Argentina) have shown that less than 50% of surveyed doctors received specific training in smoking cessation. Spe­cifically, only 36.6% received undergraduate edu­cation and 40.8%, postgraduate training. Even so, the information remains fragmented and lacks a structured, systematic approach. This deficiency translates into ineffective clinical interventions, low professional confidence in addressing the issue, and underuse of available therapeutic tools such as brief interventions, pharmacological therapy, and behavioral support.

The paradox is troubling: while physicians are expected to play an active role in tobacco pre­vention, many professionals are unfamiliar with updated protocols, underestimate the complexity of addiction, or even continue to smoke themselves. In the TAMARA II study, 19.7% of physicians were active smokers, and 21.7% were former smokers.¹

However, we have the responsibility, as physi­cians, to address and treat smoking in all individu­als who use the healthcare system, and we have tools to do so.

The 5 A’s strategy is a brief intervention (3 to 10 minutes) that should be offered to all patients at any medical visit, regardless of the specialty. The 5 A’s are: Ask about the patient’s smoking status; Advise the patient to quit smoking in a clear and firm manner; Assess the patient’s level of motivation to quit; Assist the patient and offer them concrete help; and Arrange a follow-up plan.

It is a cost-effective intervention that can be applied in primary care visits, internal medicine or general practice consultations, and even in other health-related consultations such as dentistry or nursing, where it provides a clear framework to identify and encourage smoking cessation in pa­tients who smoke.

It is very common during general consulta­tions to ask patients about arterial hypertension, diabetes, obesity, eating habits, and/or physical activity, and even to prescribe treatment when there is a pathological finding. However, it is also common for patients to receive no warning about the impact of smoking on their diagnosed condi­tion. And many times, patients are not even asked about their smoking history. Omitting tobacco use in the medical history means omitting one of the most significant causes of respiratory deterioration and overall health decline.

International evidence supports the fact that a brief intervention carried out by a trained professional can significantly increase smoking cessation rates. The effect of offering support to quit smoking is substantial in absolute terms. Approximately 20% of patients receiving this intervention are likely to make a quit attempt within six months of the visit. If, in addition to advice, they are offered concrete help, up to 35% of patients will make the attempt. However, for this strategy to be effective, it is essential that physicians have solid, up-to-date, and cross-cutting training throughout all stages of their careers: from undergraduate education to hospital practice.

What are the barriers to achieving this?

- Limited inclusion in the undergraduate cur­riculum.

- Smoking cessation and prevention are not well integrated into medical school curriculum.

- Lack of time in the curriculum.

- Most medical schools do not require training in these areas, and the topic is often addressed only superficially.

- Insufficient experience among the teaching staff.

At present, there is no comprehensive survey on how smoking-related training is addressed in postgraduate education (internships, residencies, etc.). However, it can be assumed that it is just as fragmented and unsystematic as in undergraduate training, maybe even more so, as shown by the TAMARA II study.¹ The lack of systematic training perpetuates a clinical practice that ignores one of the most lethal yet treatable addictions.

It is also noteworthy that the population of physicians who smoke is only slightly lower than that of the general population. In the study pub­lished in this issue, 20.4% of surveyed physicians are current smokers. The fact that physicians themselves smoke influences their attitude toward the problem. As evidenced in various studies, smoking doctors are more permissive and show less commitment to community initiatives aimed at tobacco prevention.

The fight against smoking requires more than willpower: it demands knowledge, institutional commitment, and educational policies that pri­oritize prevention and treatment. In this context, medical education in Argentina has an unre­solved debt. Incorporating mandatory content on tobacco into the curricula, promoting continuous training, and fostering smoke-free environments in healthcare institutions are urgent and necessary steps. As respiratory health professionals, we can­not allow ignorance about smoking to remain the norm. Medical education must rise to the level of the public health challenge we face.

Because if physicians do not know enough about tobacco, who will lead the healthcare response to one of the deadliest epidemics of the century?

Conflict of interest

The author declares no conflict of interest related to this editorial.

REFERENCES

1. Zylbersztejn HM, Masson WM, Lobo LM, et al. Tabaquismo en médicos de la República Argentina II. Estudio TAMARA II. Rev Argent Cardiol 2013;83:222-31. Disponible en https://www.redalyc.org/pdf/3053/305339770011.pdf

2. Zylbersztejn HM, Lobo LM, Masson W, et Variación tem­poral del tabaquismo en médicos argentinos. Comparación entre los estudios TAMARA I (2004) y II (2013). Rev Argent Cardiol 2017;85:21-7. https://doi.org/10.7775/rac.es.v85.i1.9519

3. Aveyard P, Begh R, Parsons A, West R. Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction. 2012;107:1066-73. https://doi.org/10.1111/j.1360-0443.2011.03770.x.

4. Fiore MC, Epps RP, Manley MW. A missed opportunity. Teaching medical students to help their patients success­fully quit smoking. JAMA 1994;271:624-6. https://doi.org/10.1001/jama.271.8.624.

5. Nerín I. Los médicos y el tabaco: Un problema sin resolver. Prev Tab 2002;4:62-4. Disponible en: https://www.uata.org.ar/uata_2018/images/publicacines/ambiental/editorial3.pdf

6. Organización Panamericana de la Salud. Intervenciones breves contra el tabaco: capacitación para proveedores de atención primaria [Internet]. Washington, D.C.: OPS; 2021 [citado 17 sep 2025]. Disponible en: https://campus.paho.org/es/curso/intervenciones-breves-contra-tabaco

7. Lanao Martín A, Felices Peralta V, Zaragoza Buj Á, et al. Tabaquismo en atención primaria: revisión sistemática sobre intervenciones eficaces y retos asistenciales. Rev Sanitaria Invest. 2025;15:145-60. Disponible en: https://revistasanitariadeinvestigacion.com/tabaquismo-en-atencion-primaria-revision-sistematica-sobre-intervenciones-eficaces-y-retos-asistenciales/#google_vignette