Changes in Smoking Prevalences Among Health Care Professionals From 2003 to 2010-2011

Smoking by health care professionals is a barrier to tobacco interventions with patients.¹ From 2003 to 2006-2007,² smoking prevalences among health care professionals demonstrated no significant declines, with the highest prevalence among licensed practical nurses (20.55%) and the lowest prevalence among physicians (2.31%). With the release of 2010-2011 data, we updated these findings to assess changes in smoking status.

We obtained publicly available data from self-respondents to the Tobacco Use Supplement (response rate, 63%) to the Current Population Survey (response rate, 93% for self-respondents and proxies) to compare smoking prevalences among health care professionals from 2003 to 2010-2011.³ Questions about smoking status were the same for each survey. Stratified probability sampling provided representative estimates of the population by occupation, including physicians, registered nurses, licensed practical nurses, pharmacists, respiratory therapists, and dental hygienists. We excluded dentists and physician assistants from analysis because the sample sizes for current smokers were too small.

Smoking status was defined as never smokers (smoked < 100 cigarettes lifetime), former smokers (smoked ≥ 100 cigarettes lifetime but answered “not at all” to the question “Do you now smoke cigarettes everyday, some days, or not at all?”), and current smokers (smoked ≥ 100 cigarettes lifetime and responded “everyday” or “some days” to the above question).

Statistical analyses were performed using SAS (SAS Institute), version 9.3, and SUDAAN (Windows Network SAS-Callable), version 9.1. Estimates of smoking prevalence were calculated using self-response weights. Associated standard errors were calculated using replicate weights to account for the complex sampling design and to construct 95% CIs. All tests were 2-sided, P values less than .05 were considered significant. A weighted Cochran-Mantel-Haenszel test controlling for survey years was used to test for differences in smoking status among professionals across surveys. To determine the overall proportion of those who ever smoked and quit by profession, we calculated the following using weighted estimates: (former smokers) / (current smokers + former smokers). Differences in smoking status and quitting for each period by group were evaluated using weighted χ² tests.

The 2010-2011 survey data from 2975 health care professionals indicated that 8.34% (95% CI, 7.26%-9.58%) were current smokers (Table 1). Current smoking ranged from 1.95% (95% CI, 1.04%-3.62%) among physicians to 24.99% (95% CI, 20.51%-30.08%) among licensed practical nurses. There was a decline in prevalence of current smoking among these health care professionals from 2003 to 2010-2011, but the only group with a significant decline from 2006-2007 to 2010-2011 and from 2003 to 2010-2011 was registered nurses (from 11.14% to 7.09%; 36.36% decline [95% CI, 20.23%-52.48%], P < .001).

There were significant changes in prevalences of former and never smokers (Table 2). The only significant changes in proportions of those who quit by profession from 2006-2007 to 2010-2011 were among registered nurses (from 62.10% to 70.29%; 13.17% increase [95% CI, 0.52% to 25.83%], P = .04), and among licensed practical nurses (from 46.35% to 32.48%; 29.92% decrease [95% CI, 11.27% to 48.57% ], P = .02).

The majority of health care professionals continued as never smokers. In 2010-2011, current smoking among these health care professionals, excepting licensed practical nurses, was lower than the general population (16.08%). Recent declines in smoking among health care professionals may reflect the impact of national tobacco control policies^4,5 and efforts focused on reducing smoking among registered nurses.⁶ After little change in prevalence from 2003 to 2006-2007,¹ the drop in smoking among registered nurses was more than twice that of the 13% decrease in the population, and the proportion who have quit was higher than the general population estimate (53.62%). Continued smoking and diminished quitting among licensed practical nurses remains a serious concern. Health care professionals are expected to be well-informed about health issues, but nicotine is highly addictive.

Although a nationally representative sample, the Current Population Survey³ may not be representative of each health care professional group. Although the weighted samples were large, the sample size of some cells was small. Smoking status was not biochemically verified, and time since quitting was not available for these cross-sectional data.

Corresponding Author: Linda Sarna, PhD, RN, School of Nursing, University of California, Los Angeles, 700 Tiverton Ave, PO Box 956918, Los Angeles, CA 90095-6918 (lsarna@sonnet.ucla.edu).

Author Contributions: Dr Nandy and Ms Antonio had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Sarna, Bialous, Nandy.

Acquisition of data: Sarna, Nandy, Yang.

Analysis and interpretation of data: Sarna, Bialous, Nandy, Antonio, Yang.

Drafting of the manuscript: Sarna, Bialous, Nandy.

Critical revision of the manuscript for important intellectual content: Sarna, Bialous, Nandy, Antonio, Yang.

Statistical analysis: Nandy, Yang, Antonio.

Administrative, technical or material support: Sarna, Nandy.

Obtained funding: Sarna.

Supervision: Sarna, Bialous.

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Sarna reports consulting for the International Society for Nurses in Cancer Care and receiving grant funding from Pfizer Independent Grants for Learning and Change. No other disclosures were reported.

Funding/Support: This study was funded in part by the University of California, Los Angeles (UCLA) School of Nursing endowment to the lead author.

Role of the Sponsor: The University of California, Los Angeles had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Marjorie Wells, PhD (UCLA School of Nursing), assisted with manuscript preparation but did not receive compensation.