This document discusses physician attitudes and practices related to smoking cessation. It finds that while guidelines recommend doctors help all patients quit smoking, many doctors find cessation activities too time-consuming or lack knowledge to assist. Several studies also show doctors miss opportunities to provide smoking cessation advice. The potential public health impact of physician intervention is enormous, but increased efforts are needed to improve physician assistance and increase their familiarity with cessation resources.

1. Physician attitude and practice
pattern related to smoking cessation
Dr. Essam Elmoghazy

2. Health Hazards of smoking
• Tobacco is the leading preventable cause of death in
the world today. It currently leads to the death of one
in ten adults. The number of annual deaths is expected
to increase to 8 million by 2030.
• Smoking causes a wide range of health conditions and
fatal diseases, including cancer, respiratory disease and
heart disease.
• It is the most important risk factor for chronic
obstructive pulmonary disease and lung cancer.
• Exposure to second-hand tobacco smoke harms health
and worsens existing health problems, including
respiratory conditions. It causes diseases such as lung
cancer, coronary heart disease and cardiac death

7. Smoking burden
Globally
• The tobacco epidemic is one of the biggest public
health threats the world has ever faced, killing
around 6 million people a year. More than 5
million of those deaths are the result of direct
tobacco use while more than 600 000 are the
result of non-smokers being exposed to second-
hand smoke.
Nearly 80% of the more than 1 billion smokers
worldwide live in low- and middle-income
countries, where the burden of tobacco-related
illness and death is heaviest.

8. Smoking burden
Egypt:
• It is estimated that approximately 20% of the
population uses tobacco products daily.
• Cigarettes are the most common form of
tobacco consumption in Egypt, with an
estimated 20 billion cigarettes smoked
annually in the country.
• After cigarettes shisha are the most common
form of tobacco consumption.

10. Smoking cessation
• Smoking cessation significantly reduces morbidity
and mortality.
• Brief tobacco cessation counseling interventions,
including screening, brief counseling (3 min or
less), and/or pharmacotherapy; have proven to
increase tobacco abstinence rates.
• It’s recommended that clinicians screen all adults
for tobacco use and provide tobacco cessation
interventions for those who use tobacco products

11. Golden standards for initiating
smoking cessation is the 5 As
Asking about tobacco use,
Advising tobacco users to quit,
Assessing readiness to make a quit attempt,
Assisting with the quit attempt,
Arranging follow-up care.

12. Cessation Options
• Counseling. . Intensive counseling is associated
with a 22% rate of quitting, and even minimal
(<3 minutes) counseling is associated with a
13% quit rate.
Pharmacotherapy. Two general classes of drugs
are approved by FDA for cessation:
1-Nicotine replacements products (NRTs)
2-Psychotropic drugs.
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13. Smoking Cessation Interventions
There are 5 basic ways to help smoking quit: increase the
price of a pack of cigarettes by increasing taxes; pass
clean indoor air legislation that bans smoking in public
places; create and disseminate effective counter-
marketing messages about smoking-in the media or as
graphic package displays; ban tobacco advertising and
promotion; and provide cessation aids.
25 November 2015 Moustapha Mounib 13

14. Role of physicians
• While guidelines recommend all doctors to ask their patients
about their smoking habits and, in case they smoke, offer
cessation advice, limited data are available about doctors'
attitudes toward these recommendations
• Physicians can contribute largely to efforts to reduce smoking
and remain one of the most important sources of information
on health risks for patients and their families.
• Many smokers will visit a physician each year , and physician
advice and encouragement have been shown to increase the
number of patients who will attempt and succeed in quitting
smoking.
• Recent studies suggest that physician interventions have the
potential to increase abstinence rates to 30% from only 7%
among adult smokers attempting to quit on their own

16. Norwegian hospital doctors
• 23% of the doctors found it too time consuming to ask if
the patient smoked, and approximately 35% found it too
time consuming to inform or offer help on smoking
cessation.
• About 25% of the doctors felt that they did not possess
enough knowledge to help the patient to stop smoking, and
65% of the doctors preferred to refer to a specialist for this.
• 28% of the doctors did not see it as their task to help the
patient to stop smoking, while 32% did not think it is worth
the effort to offer the patient help to stop smoking.
• In conclusion, about one-quarter to one-third of Norwegian
hospital doctors seem to disagree with current guidelines
that all doctors should address their patients' smoking
habits

17. University of Washington School of Medicine
• A sample of 8229 smokers aged 18 years and
older who made at least one visit to a physician in
the past year.
CONCLUSIONS:
• Physicians continue to miss opportunities to
provide smoking cessation advice, a potentially
lifesaving intervention. Given the adverse health
consequences of tobacco use and the
demonstrated benefit of advice to quit,
physicians need to improve their cessation
counseling efforts.

18. A study by the Cancer Control Science Program,
National Cancer Institute, Maryland
The potential public health impact of physician
intervention with smoking patients is enormous.
Even with very modest expectations of cessation
rates, 100,000 physicians using effective
intervention can produce over 3 million new ex-
smokers in the United States each year. In
conjunction with other community-based
tobacco control efforts, this physician-lead effort
will result in a marked reduction in the morbidity
and mortality caused by smoking and, thus,
control of "the most important public health
issue of our time."

19. KAP Family Physicians Regarding Smoking
Cessation Counseling in Suez Canal University
• The present study showed limited knowledge
and practice of family physicians regarding
smoking cessation counseling.
• Training and lack of time were among the
barriers that call for organization support.
• Further, interventional researches are needed
to improve and re-evaluate quality of smoking
cessation counseling using direct observation
of practice.

20. Conclusions
Decreasing tobacco use will require greater activity on the part
of the physicians in cessation activities. This will require
increased familiarity with available resources as well as
sustained efforts to improve these resources. Specifically,
several areas for improvement exist, including:
Increase the availability and use of tobacco control tools
• Increase the number of smoking cessation services
• Promote physician familiarity with tobacco control
resources as well as how patients can access these services
• Provide physicians with additional information on quitlines
and web based resources Increase physician assistance to
patients who smoke to reduce their use of tobacco

21. Conclusions
Increase physician assistance to patients who
smoke to reduce their use of tobacco
• Encourage medical practices to require
documentation of activities undertaken to help
patients quit smoking, e.g., documentation of
treatment strategies discussed with patients
• Improve physician-patient communication
around tobacco use
Improve coverage for tobacco control treatment,
services, and physician time
• Expand insurance coverage to include additional
cessation treatment and support services

22. Conclusions
Increase physician knowledge of tobacco control
interventions
• Improve effectiveness of medical school curricula on
tobacco control as part of assisting patients with
behavioral changes
• Increase the availability of CME related to smoking
cessation and behavioral change
Support investment in tobacco control
• Improve linkages between physician associations and
other tobacco control stakeholders to promote
collaboration in efforts in to promote the health of
citizens in communities

23. Thank you