Abstract
Tobacco use is increasing globally, particularly in low and middle-income countries like the Dominican Republic (DR) where data have been lacking. Health care worker (HCW) interventions improve quit rates; asking patients about tobacco use at each visit is an evidence-based first step. This study provides the first quantitative examination of knowledge, attitudes and practices of DR HCWs regarding tobacco use. All HCWs (N = 153) in 7 economically disadvantaged DR communities were targeted with anonymous surveys. Approximately 70% (N = 107) completed the primary outcome item, asking about tobacco use at each encounter. Despite >85% strongly agreeing that they should ask about tobacco use at each encounter, only 48.6% reported doing so. While most (94.39%) strongly agreed that smoking is harmful, knowledge of specific health consequences varied from 98.13% for lung cancer to 41.12% for otitis media. Few received training in tobacco intervention (38.32%). Exploratory analyses revealed that always asking even if patients are healthy, strongly agreeing that tobacco causes cardiac disease, and always advising smoke-free homes were associated with always asking. Overall, results demonstrate a disconnect between HCW belief and practice. Though most agreed that always asking about tobacco was important, fewer than half did so. Gaps in HCW knowledge and practices suggest a need for education and policy/infrastructure support. To our knowledge, this is the first reported survey of DR HCWs regarding tobacco, and provides a foundation for future tobacco control in the DR.
Highlights
As global tobacco use continues to increase, the worst of the associated morbidity and mortality is shifting from high-income countries to low- and middle-income countries (LMICs) [1]
Health care worker (HCW) in participating communities were surveyed at baseline (April–July 2011) for knowledge, attitudes, and practices regarding tobacco use
Each housed a Community Technology Center (CTC), directed, at the time, by the Office of the First Lady that served as bases for project operations
Summary
As global tobacco use continues to increase, the worst of the associated morbidity and mortality is shifting from high-income countries to low- and middle-income countries (LMICs) [1]. The estimated proportionate mortality from tobacco use is 12% globally [3], ranging from 0%–18% among females, and 1%–24% among males in the LAC. It is one of the five countries in the Americas (and one of the three in the LAC) that have not ratified the WHO Framework Convention on Tobacco Control, and the only one that has not even signed the FCTC (as of 25 March 2015) [4]. Overall tobacco and cigarette use prevalence in the DR ranges from
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