Pärna Kersti, Põld Mariliis, Ringmets Inge
Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia.
Tob Induc Dis. 2017 Jul 19;15:31. doi: 10.1186/s12971-017-0136-9. eCollection 2017.
Previous reports have shown that physicians who smoke underestimate the effects of smoking on health and this influences their practice. This study was designed to investigate the views of Estonian physicians on the role of smoking in smoking-related diseases.
Cross-sectional postal surveys were sent to all practising physicians in Estonia in 1982, 2002 and 2014 providing data from 3504, 2694, and 2865 physicians respectively. Data analysis involved calculation of the prevalence of smoking with 95% confidence intervals and calculation of the prevalence of agreement with a causal role of smoking in ischaemic heart disease (IHD), lung cancer and chronic bronchitis. Logistic regression was used to analyse associations between agreement with the statements that smoking is a cause of IHD, lung cancer, chronic bronchitis and study year, smoking status, age group and ethnicity. Fully adjusted odds ratios with 95% confidence intervals were calculated.
The age-standardized prevalence of current smoking among men decreased from 39.6% in 1982 to 14.2% in 2014, and among women from 12.4 to 5.1%, respectively. Compared with 1982, the proportion of physicians agreeing with statements that smoking is a major cause or one of the causes of IHD, lung cancer, or chronic bronchitis was significantly higher in 2002 and 2014. Past and never smokers were more likely to admit a causal role of smoking in lung cancer than smokers. Agreement with a causal role of smoking in IHD and chronic bronchitis was significantly higher among never and past smoking women only. Compared with non-Estonians, the odds ratio indicating agreement with all three statements was significantly higher among Estonians.
From 1982 to 2014, physicians' attitudes towards the health risks of smoking improved in Estonia. However, their assessment of a causal role of smoking in smoking-related diseases was related to their own smoking habits and ethnicity. A further decline in smoking among Estonian physicians would require special efforts targeted at physicians. Societal pressure from a national policy could support a further decline in the social acceptability of smoking in Estonia and developments in medical education could provide continuing evidence-based information about the effects of smoking to Estonian physicians.
既往报告显示，吸烟的医生低估了吸烟对健康的影响，这影响了他们的医疗行为。本研究旨在调查爱沙尼亚医生对吸烟在吸烟相关疾病中所起作用的看法。
1982年、2002年和2014年分别向爱沙尼亚所有执业医生发送了横断面邮政调查问卷，分别提供了3504名、2694名和2865名医生的数据。数据分析包括计算吸烟率及其95%置信区间，以及计算认同吸烟在缺血性心脏病（IHD）、肺癌和慢性支气管炎中起因果作用的比例。采用逻辑回归分析认同吸烟是IHD、肺癌、慢性支气管炎病因的观点与研究年份、吸烟状况、年龄组和种族之间的关联。计算了完全调整后的比值比及其95%置信区间。
男性当前吸烟的年龄标准化患病率从1982年的39.6%降至2014年的14.2%，女性则从12.4%降至5.1%。与1982年相比，2002年和2014年认同吸烟是IHD、肺癌或慢性支气管炎主要病因或病因之一的医生比例显著更高。既往吸烟者和从不吸烟者比吸烟者更有可能承认吸烟在肺癌中起因果作用。仅在从不吸烟和既往吸烟的女性中，认同吸烟在IHD和慢性支气管炎中起因果作用的比例显著更高。与非爱沙尼亚人相比，爱沙尼亚人认同所有三项陈述的比值比显著更高。
1982年至2014年期间，爱沙尼亚医生对吸烟健康风险的态度有所改善。然而，他们对吸烟在吸烟相关疾病中因果作用的评估与他们自己的吸烟习惯和种族有关。爱沙尼亚医生吸烟率的进一步下降需要针对医生采取特别措施。国家政策带来的社会压力有助于进一步降低爱沙尼亚吸烟的社会接受度，医学教育的发展可以为爱沙尼亚医生提供关于吸烟影响的持续循证信息。
