Prevalence of Tobacco Use in Health Care Workers Worldwide: A Systematic Review and Meta-Analysis

Abstract

Background: The World Health Organisation Framework Convention on Tobacco Control Article 14 guidelines stress that health care workers (HCW) should set an example by not using tobacco, however the overall prevalence among HCW worldwide is unknown. We present prevalence estimates of tobacco use among HCW by country income level, gender and occupation. Methods: We searched five electronic databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 1 January 2000 and 14 March 2016 that included HCW and tobacco use data from 2000 onward. We performed random effect meta-analyses to obtain estimates by World Bank income level, occupation, and gender (Prospero number CRD42016041231) Findings 282 studies met our inclusion criteria, including 157 studies from high-income countries (HIC), 92 from upper- middle- income countries (UMIC), and 33 from Lower Middle and low Income countries (LMLIC). The overall prevalence of tobacco use was 22% (95% CI 21-23). Smoking prevalence was highest in the UMIC 25% (95% CI 22-28%), higher in males compared to females (31% vs 17%) and highest in nurses, 25% (22-27%). Heterogeneity was high (I2 > 90%) in all sub-group analyses. There was borderline significant reduction in the overall tobacco use prevalence between 2000 and 2014 (p=0·06). Interpretation: HCW continue to use tobacco at high rates. Tackling tobacco use in these groups requires urgent action as they are at the front line for tackling tobacco use in their patients. Funding: UK Centre for Tobacco and Alcohol Studies. Declaration of interests: We declare no competing interests.