Abstract
ObjectivesTo estimate tobacco use prevalence in healthcare workers (HCW) by country income level, occupation and sex, and compare the estimates with the prevalence in the general population.MethodsWe systematically searched five databases; Medline, EMBASE, CINHAL Plus, CAB s, and LILACS for original studies published between 2000 and March 2016 without language restriction. All primary studies that reported tobacco use in any category of HCW were included. Study extraction and quality assessment were conducted independently by three reviewers, using a standardised data extraction and quality appraisal form. We performed random effect meta-analyses to obtain prevalence estimates by World Bank (WB) country income level, sex, and occupation. Data on prevalence of tobacco use in the general population were obtained from the World Health Organisation (WHO) Global Health Observatory website. The review protocol registration number on PROSPERO is CRD42016041231.Results229 studies met our inclusion criteria, representing 457,415 HCW and 63 countries: 29 high-income countries (HIC), 21 upper-middle-income countries (UMIC), and 13 lower-middle-and-low-income countries (LMLIC). The overall pooled prevalence of tobacco use in HCW was 21%, 31% in males and 17% in females. Highest estimates were in male doctors in UMIC and LMLIC, 35% and 45%, and female nurses in HIC and UMIC, 21% and 25%. Heterogeneity was high (I2 > 90%). Country level comparison suggest that in HIC male HCW tend to have lower prevalence compared with males in the general population while in females the estimates were similar. Male and female HCW in UMIC and LMLIC tend to have similar or higher prevalence rates relative to their counterparts in the general population.ConclusionsHCW continue to use tobacco at high rates. Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients.
Highlights
As health experts and promoters, healthcare workers (HCW) have an important role to play in curbing the global tobacco epidemic [1]
Highest estimates were in male doctors in upper-middle-income countries (UMIC) and lower-middleand-low-income countries (LMLIC), 35% and 45%, and female nurses in highincome countries (HIC) and UMIC, 21% and 25%
Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients
Summary
As health experts and promoters, healthcare workers (HCW) have an important role to play in curbing the global tobacco epidemic [1]. A recent international review of nurses’attitudes to smoking and smoking cessation (2015) found female nurses’smoking rates to range from as low as 2% in China to as high as 25.8% in Northern Ireland, and above 30% in Italy, Serbia and Spain [13]. Another international review of physicians’ tobacco use and smoking cessation practices between 1987–2010, reported regional variation in smoking, with rates of 37% in Central and Eastern Europe, 29% in Africa, 25% in Central and South America, and 17.5% in Asia [14]
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