|Year : 2021 | Volume
| Issue : 3 | Page : 443-448
Patterns of smoking among oncologists of Eastern India: A questionnaire-based survey
Koushik Chatterjee1, Amitabh Ray2, Arup Chakraborty3
1 Department of Radiotherapy, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
2 Ruby Cancer Centre and HCG Hospitals, Kolkata, West Bengal, India
3 Department of Community Medicine, Medical College, Kolkata, West Bengal, India
|Date of Submission||05-Jun-2021|
|Date of Decision||17-Jun-2021|
|Date of Acceptance||01-Aug-2021|
|Date of Web Publication||08-Oct-2021|
Department of Community Medicine, MCH Building, Fourth Floor, Medical College, 88, College Street, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Oncologists deal with smoking-related cancers in their daily practice, and eastern India is known to be the smoking capital of India.
Objective: This study was aimed at evaluating the pattern and practice of smoking among oncologists of eastern India.
Materials and Methods: This was a questionnaire-based observational study conducted from April 2017 to May 2017 at the Institute of Postgraduate Medical Education and Research in Kolkata, India. Oncologists from West Bengal were eligible to participate through a predesigned questionnaire. The questionnaire was administered to the participants through e-mail to assess the smoking pattern. The responses were received by an independent reviewer and forwarded to the investigators in a de-identified form. The data were analyzed by the investigators using simple descriptive statistical methods.
Results: Out of 262 oncologists who were e-mailed the questionnaire, valid responses were received from a total of 132 (50.4%) oncologists, of which 130 (98.4%) were male and 2 (1.6%) were female. The median age of the respondents was 48 years (range, 28-72). Of these, 50 (38%) respondents were ever-smokers and 82 (62%) were never-smokers. Out of the ever-smokers (n = 50), 23 (46%) were moderate to heavy smokers; 14 (28%) were heavy smokers; 42 (84%) were current smokers; and 31 (74%) smoked daily. The median age of smoking onset was 19 years (range, 12–29), and the median duration of smoking was 78 months (range, 2-480). Peer pressure was the most common reason for smoking initiation, reported by 55% of the respondents, followed by adventure in 33%. Out of the total 76 smokers in the ever- and never-smoker groups, 43 (56.5%) attempted to quit for a median of 2 times (range, 1-6). There were 30 (69.7%) successful quitters in the group. Health concern was the most common reason to quit, whereas mental stress was the most common cause of relapse.
Conclusion: Our study suggests that an alarmingly large number of oncologists from West Bengal are smokers, with the majority of them smoking daily at moderate to heavy levels.
Keywords: Smoking, pattern, oncologists, India, survey
|How to cite this article:|
Chatterjee K, Ray A, Chakraborty A. Patterns of smoking among oncologists of Eastern India: A questionnaire-based survey. Cancer Res Stat Treat 2021;4:443-8
|How to cite this URL:|
Chatterjee K, Ray A, Chakraborty A. Patterns of smoking among oncologists of Eastern India: A questionnaire-based survey. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:443-8. Available from: https://www.crstonline.com/text.asp?2021/4/3/443/327757
| Introduction|| |
Smoking is a public health issue contributing significantly to morbidity and mortality worldwide. Medical professionals, particularly oncologists, are aware of the negative impact of smoking on health, as they routinely deal with smoking-related cancers in their daily practice. Smoking is a social illness, and doctors, like the general population, may be smokers.
Smoking rates among medical professionals are reported to be considerably high. This could be because of the persistently tension-filled nature of the medical profession, with stakes as high as life and death at all times. Moreover, with the mounting pressure of prolonged academic learning and long working hours, the stress probably progressively increases from medical school through internship to the practicing life as a professional.
Several studies allude to the smoking practices among Indian doctors and medical students, while others harp on the rate of rise of the smoking menace, with each passing year of training and hostile living conditions, until it finally peaks during internship.,,,, However, to the best of our knowledge, no study from India has evaluated the patterns of smoking among oncologists in particular. Therefore, we envisaged this study to evaluate the pattern and practice of smoking among oncologists from or practicing in West Bengal, an Indian state known for its smoking habits.
| Materials and Methods|| |
General study details
This cross-sectional, observational, questionnaire-based study was conducted in the Department of Radiotherapy of the Institute of Postgraduate Medical Education and Research in Kolkata, India between April and May 2017. As this study was survey-based and the questionnaire was sent to the oncologists who voluntarily responded, approval from the institutional ethics committee was not sought. As this was an e-mail-based survey, a response from the participants was considered as consent for participation in the study. The study was conducted according to the ethical guidelines outlined in the Declaration of Helsinki, Good Clinical Practice guidelines, and the Indian Council of Medical Research guidelines. There was no funding utilized for conducting the study.
Radiation, medical, and surgical oncologists from or practicing in West Bengal whose e-mail addresses were available were identified for participation in this study. The oncologists whose e-mail addresses were not available with their professional organizations, like the Association of Radiation, Surgical or Medical Oncologists were excluded from the study.
The age, sex, smoking history, duration of smoking, type of tobacco product used, current status of smoking, frequency of smoking, attempt to quit, and the reason for quitting were recorded for each participant.
A predesigned, pretested questionnaire was used to assess the pattern of smoking among the oncologists. The questionnaire comprised a total of 13 questions, and except for the age and sex, no personal identifiers were asked for [Table 1]. The questionnaire was sent through e-mail (Microsoft Word format) to all the eligible participants, and they were asked to send their responses to an independent reviewer with an independent e-mail address. The reviewer then emailed the response files to the investigators after assigning a coded serial number. At least two reminders were sent to those who did not respond, at biweekly intervals, following which the non-responders were categorized as “reminded non-responders” and the survey was closed.
The questionnaire was pretested before the initiation of the study by introducing it to a panel of five senior experts during a conference held in Kolkata. The experts were provided space for suggestions and inputs, and their suggestions were incorporated before the questionnaire was finalized.
The definitions of the various terms as adopted from the United States Centers for Disease Control and Prevention and the World Health Organization (WHO) used in the study are given in [Table 2].,,
A formal sample size calculation was not performed for this study, as it was a questionnaire-based survey to gauge the practices and smoking patterns. The responses were documented and the data were entered in Microsoft Excel version 2007. The baseline data were represented as absolute numbers and frequency. The Chi-square test was used to assess the association between variables. P < 0.05 was considered significant.
| Results|| |
The questionnaire was emailed to 262 eligible oncologists. E-mail delivery to 36 (13.7%) oncologists failed. Valid and complete responses were received from a total of 132 (50.4%) oncologists and included in the final analysis [Figure 1].
The median age of the respondents was 48 years (range, 8–72). A total of 130 (98%) respondents were male and 2 (2%) were female.
A total of 50 (38%) respondents were ever-smokers, and 82 (62%) were never-smokers. Of the 82 never-smokers, 26 (31.7%) had smoked less than 100 cigarettes in their lifetime and 56 (68.3%) had never smoked. Both the female respondents in our cohort were never-smokers; one had smoked six cigarettes and the other four cigarettes in her lifetime. The median age of initiation of smoking was 19 years (range, 12-29 years). The median duration of smoking was 78 months (range, 2–480 months).
Out of the ever-smokers and 26 never-smokers, who smoked less than 100 cigarettes, combined, 63 (82.9%) respondents smoked filtered cigarettes, while 13 (17.1%) used unfiltered tobacco smoking products. The respondents who smoked filtered cigarettes could be grouped into two major categories– those who smoked large/king-sized (length ≥84 mm) cigarettes and those who smoked normal-sized (length = 70 mm) cigarettes. Out of the total 63 respondents who had smoked filtered cigarettes, 22 (29%) had smoked king-sized cigarettes, while 41 (54%) had smoked normal-sized cigarettes. Of the 13 respondents who smoked unfiltered tobacco products, 3 (4%) smoked bidis, and 10 (13%) smoked mini cigarettes (length < 70 mm). Of the 50 ever-smokers, 42 (84%) were current smokers, 6 (12%) were former smokers (not currently smoking), and 2 (4%) had formerly quit smoking (quit smoking over 2 years earlier). Of the 42 current smokers, 31 (74%) were daily smokers and 11 (26%) were non-daily smokers.
Among the ever-smokers, a total of 14 (28%) respondents were heavy smokers (more than 20 cigarettes per day) (including all those who had formerly attempted to quit and 2 former) smokers, 23 (46%) were moderate to heavy smokers (10–20 cigarettes per day), and 13 (26%) (including 4 former smokers) were light smokers (less than 10 cigarettes per day).
Out of the total 76 smokers, 42 (55.3%) had started smoking due to peer pressure. Other reasons to start smoking were adventure in 25 (32.9%) respondents and stress in 6 (7.9%); 3 (3.9%) respondents had started smoking casually. Out of the total 76 smokers, 43 (56.5%) had attempted to quit smoking; of these, 21 (48.8%) respondents, including 8 (38.1%) former smokers, were ever-smokers and 22 (51.2%) were never-smokers. The median number of attempts required to quit smoking was 2 (range, 1–6). Out of the 43 smokers who attempted quitting, 30 (69.7%) were successful, of which 8 were former ever-smokers and 22 were never-smokers. The reasons for quitting reported by the respondents who had successfully quit smoking were health concerns in 13 (43.3%), family pressure in 8 (26.6%), peer pressure in 6 (20%), and graphical warnings in 3 (10%) respondents. However, of the 21 ever-smokers who attempted to quit smoking, 13 (62%) restarted smoking, 8 (38%) due to mental stress, and 5 (24%) due to peer pressure.
Respondents who had smoked less than 100 cigarettes in their lifetime had a 7.59 times higher probability of quitting than the ever-smokers who smoked more than 100 cigarettes in total. This difference was statistically significant (χ2 = 10.9695, P = 0.0009) [Figure 2]. Moreover, among respondents who attempted to quit, those who had smoked less than 100 cigarettes in their lifetime were 6.18 times more successful than ever-smokers who had smoked more than 100 cigarettes in total. This difference was also found to be statistically significant (χ2 = 5.2086, P = 0.02) [Figure 3].
|Figure 2: Association between the type of smoker and quitting attempt (n = 76)|
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|Figure 3: Association between the type of smoker and status of quitting (n = 43)|
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| Discussion|| |
In our study on 132 oncologists in West Bengal, we observed that 38% were ever-smokers and 62% were never-smokers. Peer pressure was the most commonly reported reason for smoking initiation. About 56.5% of the oncologists attempted to quit smoking and 69.7% of them were successful. These findings are highly relevant as oncologists are supposed to be the main torch bearers of the anti-tobacco campaigns and are ideally suited to advise patients to quit smoking. Our findings illustrate the fact that oncologists are not immune to the illnesses in the society they originate from.
One of the principal difficulties encountered when we envisaged this study was to set the definitions to be used for this survey. Because self-reported smoking patterns might vary as per the perception of the respondents, we adopted the definitions from the US Centers for Disease Control and Prevention and the WHO.,, However, given the nature of the smoking habits in India like bidis, smokeless tobacco, etc., whether these definitions are completely applicable in the Indian scenario is unclear. Additionally, these factors were incorporated in the questionnaire to make sure none of the aspects were missed.
From the WHO Global Health Repository data for India the percentage of male smokers above 15 years of age was 20.4% (14.5-27.3%) back in 2015, when it was last updated. Their projected rate for the year 2020 was 17.2%. The prevalence of smoking among school going adolescents in India ranges between 5.9% to 49%, as per a recent meta-analysis. The current study involving the oncologists, found a smoking rate of 38% (ever-smokers) among the respondents. Current smoker status was found in 84%; 74% of them smoked daily and 28% smoked at a heavy rate. These findings were alarmingly beyond the projected average for the country.
However, if we look toward the eastern part of India, the age-standardized prevalence of smoking in West Bengal in the year 2016-17 was 33.5% in the general population (based on the Global Adult Tobacco Survey Fact sheet India 2016-2017). Another study conducted by oncologists of the Medical College and Hospital in Kolkata, West Bengal, that involved medical professionals from all fields, reported that 44.4% of them were regular smokers. Yet, another study conducted at the conducted at the R.G.Kar Medical College in Kolkata compared the prevalence of smoking among medical students and those from other streams. It was reported that 15% of the medical students were regular smokers as opposed to 41% of those from other streams. Thus, the findings of our study reiterate that eastern India is the smoking capital, with a high proportion of smokers among all fraternities of medical professionals, including oncologists.
Regarding studies that described the rates of quitting smoking, the study on the doctors and medical students from Sher-i-Kashmir Institute of Medical Sciences Srinagar, Kashmir, found that 78% of the participants had no intention of quitting in the next 6 months. In a study from the Sree Chitra Tirunal Institute of Medical Sciences, Kerala, although only 15% of the male medical school faculties and 13% of the physicians were smokers, only one-third of them had tried to quit smoking for an average of 4 times. Conversely, a study from east India reported that 30% of all medical professionals of the Medical College, Kolkata, could quit smoking. In our current study, we observed that a much higher proportion (56.5%) of oncologists made a median of 2 attempts to quit smoking, and 70% of them finally succeeded. A recent review and meta-analysis reported that current smokers are 17% less likely to advise smoking cessation to their patients; however, larger studies in this regard are warranted to assess if this holds true for the oncologists in West Bengal. The prevalence of smoking in this population was high, but so was their determination to quit. Therefore, the assumption that oncologists in West Bengal might not be able to help their patients quit the habit may not be justified. An interesting observation from our study was that 10% of the respondents attempted to quit smoking because of the graphical warnings on the cigarette packages, something that was unexpected from professionals who see these images every day in their routine clinical practice.
The study from Sher-i-Kashmir Institute of Medical Sciences Srinagar, Kashmir, is the only other Indian study to have reported the age and reasons for initiation of smoking. This study reported that 70% of the participants had started smoking between the ages of 11 and 20 years, and 80% of them took it up due to peer pressure. In our study, the median age of smoking initiation was 19 years; peer pressure was reported to be the reason for smoking initiation by 55%, followed by a sense of adventure reported by 25% of the respondents. Our study also found that mental stress was the primary reason for relapse in 38% of the respondents.
To the best of our knowledge, ours is the first study to assess the smoking pattern among oncologists in eastern India. However, it was not without its limitations. The results appear to be skewed because of the higher prevalence of smoking in the eastern part of India in general and therefore may not be representative of the smoking pattern in other regions of the country. Moreover, as our study involved an e-mail-based survey, the number of respondents was small. Additionally, there were only two female respondents in our cohort. Lastly, a vast majority of the targeted participants in our study were radiation oncologists, and we were blinded to the number of medical and surgical oncologists who participated in our survey. Therefore, our results cannot be extrapolated to the entire population of oncologists in West Bengal with conviction. Thus, future studies could be aimed at determining the reasons for smoking among oncologists, considering the fact that they are well aware of the ill effects of smoking.
| Conclusion|| |
The findings from our study suggest that 38% of oncologists from the east Indian state of West Bengal in India are smokers, and the majority of them smoke daily at moderate to heavy levels. Therefore, consistent health counseling and other means of stress relief are of utmost importance to change the smoking behavior among oncologists.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]