Faktori pušenja i prestanka pušenja među zdravstvenim radnicima u Srbiji: rezultati studije preseka
Sažetak
Uvod/Cilj. Zbog visoke prevalencije pušenja u Srbiji (34% odraslih; 38% muškarci, 30% žene) i vodeće uloge zdravstvenih radnika u prevenciji i odvikavanju od pušenja, sprovedena je studija preseka na reprezentativnom uzorku zdravstvenih radnika u Srbiji Cilj rada bio je utvrđivanje faktora pušenja i prestanka pušenja među zdravstvenim radnicima pre stupanja na snagu zakona koji je zabranio pušenjem na javnim i radnim mestima, 2010. godine. Metode. Za studiju je izabran reprezentativni uzorak od 3 084 lekara i medicinskih sestara iz 4 vrste zdravstvenih ustanova u Srbiji. U istraživanju je učestvovalo 2 282 zdravstvenih radnika (stopa odaziva 74,0%). Korišćen je struktuirani upitnik koji su ispitanici sami popunjavali. Korišćene su standardne statističke metode za računanje stopa prevalencije i multivarijantna logistička regresija za procenu nezavisnih prediktora pušenja i prestanka pušenja. Rizik je izračunat kao unakrsni odnos (UO) koji predstavlja približnu vrednost relativnog rizika izloženih osoba sa 95% intervalima poverenja (95% IP). Rezultati. Rezultati su pokazali visoku prevalenciju pušenja (38,0%), sličnu među muškarcima (37,6%) i ženama (37,8%) (p = 0,138), višu među medicinskim sestrama (41,7%) nego lekarima (29,1%) (p = 0,000), kod zaposlenih u opštim bolnicama (42,6%) i zavodima za javno zdravlje (43,8%) (p = 0,000). Rizik da se bude pušač bilo kad u životu ili trenutno značajno je bio povišen kod medicinskih sestara (UO = 1,75, 95% IP 1,42–2,14 i UO = 1,91, 95% IP = 1,52–2,40), kod zaposlenih u opštim bolnicama (UO = 1,37, 95% IP 1,09–1,73, i UO = 1,40, 95% IP 1,09–1,79) i kod ispitnika koji su lošije procenili svoje zdravlje (UO = 1,15, 95% IP 1,02–1,30; i UO = 1,17, 95% IP 1,02–1,34). Namera da se prekine s pušenjem ili da se smanji broj popušenih cigareta bili su češći kod žena (UO = 1,51, 95% IP 1,01–2,27) i kod ispitanika koji su lošije procenili svoje zdravlje (UO = 1,74, 95% IP 1,39–2,18). Zaključak. Visoka zastupljenost pušenja među zdravstvenim radnicima predstavlja prepreku za punu primenu zakona u zdravstvenim ustanovama u Srbiji. Potrebno je sprovoditi programe odvikavanja od pušenja na radnim mestima, metode odvikavanja od pušenja uključiti u program redovnih studija zdravstvene struke, a uprave zdravstvenih ustanova trebalo bi da efikasnije sprovode zakon.
Reference
Ministry of Health of the Republic of Serbia. National Health Survey Serbia, 2006 – Key Findings. Belgrade: Ministry of Health of the Republic of Serbia; 2007.
Denic Lj, Knezevic T, Radovic Lj, Kisin Dj, Separovic N. Smoking prevalence in the institutes of public health in Serbia. Glas Inst Zast Zdr Ser Yu 2007; 79(1−2): 15−9.
Hodgetts G, Broers T, Godwin M. Smoking behaviour, knowledge and attitudes among Family Medicine physicians and nurses in Bosnia and Herzegovina. BMC Fam Pract 2004; 5: 12.
Gokirmak M, Ozturk O, Bircan A, Akkaya A. The attitude to-ward tobacco dependence and barriers to discussing smoking cessation: a survey among Turkish general practitioners. Int J Public Health 2010; 55(3): 177−83.
Vardavas CI, Bouloukaki I, Linardakis MK, Tzilepi P, Tzanakis N, Kafatos AG. Smoke-free hospitals in Greece: Personnel percep-tions, compliance and smoking habit. Tob Induc Dis 2009; 5(1): 8.
Fakhfakh R, Khanchal F, Klouz A, Ben-Salah F, Lakhal M, Achour N. Determinants of tobacco use habits among hospital staff in Tunisia, 2005. Prev Med 2011; 52(6): 478−9.
Pipe A, Sorensen M, Reid R. Physician smoking status, attitude toward smoking, cessation advice to patients: An international survey. Patient Educ Couns 2009; 74(1): 118−23.
Virtanen M, Vahtera J, Batty GD, Tuisku K, Oksanen T, Elovainio M, et al. Health risk behaviors and morbidity among hospital staff - comparison across hospital ward medical specialties in a study of 21 Finnish hospitals. Scand Work Environ Health 2012; 38(3): 228−37.
Sebo P, Bouvier Gallacchi M, Goehring C, Kunzi B, Bovier PA. Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey. BMC Public Health 2007; 7: 5.
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 2004; 328(7455): 1519.
Tong EK, Strouse R, Hall J, Kovac M, Schroeder SA. National survey of U.S. health professionals' smoking prevalence, ces-sation practices, and beliefs. Nicotine Tob Res 2010; 12(7): 724−33.
Sarna L, Bialous SA, Sinha K, Yang Q, Wewers ME. Are health care providers still smoking? Data from the 2003 and 2006/2007 Tobacco Use Supplement-Current Population Sur-veys. Nicotine Tob Res 2010; 12(11): 1167−71.
Smith DR, Leggat PA. An international review of tobacco smoking in the medical profession: 1974-2004. BMC Public Health 2007; 7: 115.
Smith DR, Leggat PA. The historical decline of tobacco smok-ing among Australian physicians: 1964–1997. Tob Induc Dis 2008; 4: 13.
Edwards R, Bowler T, Atkinson J, Wilson N. Low and declining cigarette smoking rates among doctors and nurses: 2006 New Zealand Census data. N Z Med J 2008; 121(1284): 43−51.
Kaneita Y, Uchida T, Ohida T. Epidemiological study of smoking among Japanese physicians. Prev Med 2010; 51(2): 164−7.
Warren CW, Asma S, Lee J, Lea V, Mackay J. Global Tobacco Surveillance System. The GTSS Atlas. Atlanta: CDC Founda-tion; 2009.
World Health Organization. The role of health professionals in tobacco control. Geneva: World Health Organization; 2005.
Eriksen M, Mackay J, Ross H. The Tobacco Atlas, Fourth Edi-tion. Atlanta, Georgia: American Cancer Society and World Lung Foundation; 2012.
World Health Organization. Empower Women. Combating Tobacco Industry Marketing in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2010.
Ficarra MG, Gualano MR, Capizzi S, Siliquini R, Liguori G, Manzoli L, et al. Tobacco use prevalence, knowledge and attitudes among Italian hospital healthcare professionals. Eur J Pub Health 2011; 21(1): 29−34.
Martínez C, Garcia M, Méndez E, Peris M, Fernández E. Barriers and challenges for tobacco control in a smoke-free hospital. Cancer Nurs 2008; 31(2): 88−94.
Ravara SB, Calheiros JM, Aguiar P, Barata LT. Smoking beha-viour predicts tobacco control attitudes in a high smoking pre-valence hospital: A cross-sectional study in a Portuguese teach-ing hospital prior to the national smoking ban. BMC Public Health 2011;11: 720.
Djikanovic B, Marinkovic J, Jankovic J, Vujanac V, Simic S. Gender differences in smoking experience and cessation: do wealth and education matter equally for women and men in Serbia. J Public Health (Oxf) 2010; 33(1): 31−8.
Malik AK, Chaudhry A, Karamat A, Arif N, Cheema MA, Rauf A. Cigarette smoking and health care professionals at Mayo Hospital, Lahore, Pakistan. J Pak Med Assoc 2010; 60(6): 509−12.
Klink K, Lin S, Elkin Z, Stringenz D, Liu S. Smoking cessation knowledge, attitudes, and practice among community health providers in China. Fam Med 2011; 43(3): 198−200.
Han ZL, Weixing S, Fangmei C, Xiangrong W, Weiping L, Aisheng W. Cigarette smoking status and smoking cessation counseling of Chinese physicians in Wuhan, Hubei province. Asia Pac J Public Health 2008; 20(3): 183−92.
Shishani K, Nawafleh H, Jarrah S, Froelicher ES. Smoking patterns among Jordanian health professionals: a study about the impediments to tobacco control in Jordan. Eur J Cardiovasc Nurs 2011; 10(4): 221−7.
Sarna L, Bialous SA, Jun H, Wewers ME, Cooley ME, Feskanich D. Smoking trends in the Nurses' Health Study (1976-2003). Nurs Res 2008; 57(6): 374−82.
Echer IC, Correa APA, de Lucena AF, Ferreira SAL, Knorst MM. Prevalence of smoking among employees of a university hos-pital. Rev Latino-Am Enfermagem 2011; 19(1): 179−86.
Pärna K, Rahu K, Rahu M. Smoking habits and attitudes to-wards smoking among Estonian physicians. Public Health 2005; 119(5): 390−9.
John U, Hanke M. Tobacco-smoking prevalence among physi-cians and nurses in countries with different tobacco-control activities. Eur J Cancer Prev 2003; 12(3): 235−7.
Fathallah N, Maurel-Donnarel E, Baumstarck-Barrau K, Lehucher-Michel M. Three-year follow-up of attitudes and smoking beha-viour among hospital nurses following enactment of France's national smoke-free workplace law. Int J Nurs Stud 2012; 49(7): 803−10.
Twardella D, Brenner H. Lack of training as a central barrier to the promotion of smoking cessation: a survey among general practitioners in Germany. Eur J Pub Health 2005; 15(2): 140−5.
Gallus S, Muttarak R, Franchi M, Pacifici R, Colombo P, Boffetta P, et al. Why do smokers quit. Eur J Cancer Prev 2013; 22(1): 96−101.
Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Pub Health 1994; 84(7): 1086−93.
Etter JF, Due TV, Perneger TV. Saliva Cotinine Levels in Smokers and Nonsmokers. Am Epidemiol 2000; 151(3): 251−58.
Vartiainen E, Seppälä T, Lillsunde P, Puska P. Validation of self reported smoking by serum cotinine measurement in a com-munity-based study. J Epidemiol Community Health 2002; 56(3): 167−70.
Binnie V, McHugh S, Macpherson L, Borland B, Moir K, Malik K. The validation of self-reported smoking status by analysing cotinine levels in stimulated and unstimulated saliva, serum and urine. Oral Dis 2004; 10(5): 287−93.
Pérez-Stable EJ, Marín G, Marín BV, Benowitz NL. Misclassifica-tion of smoking status by self-reported cigarette consumption. Am Rev Respir Dis 1992; 145(1): 53−7.
Connor GS, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: A systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res 2009; 11(1): 12−24.
