Attitudes of healthcare professionals towards tobacco use and anti-tobacco counseling practices in Georgia

Tengiz Verulava

Journal number 2 ∘ Tengiz Verulava ∘
Attitudes of healthcare professionals towards tobacco use and anti-tobacco counseling practices in Georgia

journal N2 2025

DOI: 10.52340/ekonomisti.2025.02.06

Expanded Summary

Introduction

Doctors play a significant role in supporting patients to quit tobacco use. The formation of patient attitudes and the implementation of preventive measures often depend on doctors’ knowledge and perspectives regarding the harmful effects of tobacco. The aim of this study is to analyze physicians’ attitudes toward tobacco use and their practices in providing anti-tobacco counseling to patients.

Methodology

A quantitative, cross-sectional study was conducted from October to December 2024. A total of 275 physicians were randomly selected from five major hospitals in Tbilisi, out of which 242 completed a pre-structured electronic questionnaire using an online platform (Google Forms).

Results

The study showed that the prevalence of tobacco use was 39.4% among male physicians and 13.63% among female physicians. The average tobacco use rate in the general population significantly exceeds that among physicians. The highest smoking rate was observed among surgeons (n=12; 24%). Men tend to start smoking at an earlier age (before 16) compared to women (between ages 16–20). The majority of respondents (84%; n=204) believe that doctors should not smoke, as they serve as role models for their patients. According to 74% of respondents, a doctor’s advice aimed at preventing tobacco use motivates patients to quit smoking.

Physicians’ attitudes toward smoking patients are primarily influenced by their smoking status. Doctors who smoke tend to have a more tolerant attitude toward smoking patients compared to non-smoking doctors. Moreover, the majority of smoking physicians believe that anti-tobacco counseling has little effect on reducing smoking among patients.

Discussion

The study confirmed that doctors play a crucial role in reducing tobacco use among patients. Physicians' attitudes toward smoking directly influence how actively they provide anti-tobacco counseling and how frequently they offer advice on quitting. A high smoking prevalence among doctors and their attitudes affect patient behavior, especially regarding the delivery of counseling and health recommendations. Similar results have been reported in other studies.

The findings suggest that doctors have limited knowledge about the harmful effects of tobacco and lack confidence in the effectiveness of anti-smoking counseling. According to the study, 11% of physicians disagree with the statement that a doctor's advice significantly increases a patient's chances of quitting.

The research also confirms that a decline in anti-smoking counseling (from 11% to 6%) and a reduction in advice on quitting smoking (from 38.2% to 19.8%) lead to fewer attempts by patients to quit tobacco (from 25.3% to 23.1%). This again highlights the key role physicians play in reducing tobacco consumption.

The study confirms a high rate of tobacco use among physicians. Nearly one-fifth of them are smokers, although the rate is lower than in the general population (20.7% among physicians vs. 30.7% in the general population). Differences by gender, age, and specialty were also found. The proportion of female physician-smokers (13.6%) is higher than that of female smokers in the general population (7.8%), while the rate among male physicians (39.4%) is lower than in the general male population (55.5%).

Long-term tobacco dependence is more pronounced among women. In terms of frequency, physicians typically consume 11 or more cigarettes per day (p=0.026), matching the national average. Most respondents (44%) began smoking between the ages of 16 and 20 (p=0.00), which coincides with the period after high school and during early university years—times characterized by increased stress (p=0.002). Similar findings were observed in other studies.

When comparing the smoking cessation rate of physicians with that of the general population, a significant difference emerges: only 23.1% of the general population have attempted to quit smoking, while this figure is 60% among doctors (p=0.000). The gender difference is also notable. This may be due to doctors’ greater awareness of tobacco’s harmful effects and their daily exposure to the consequences in patients, which motivates them to quit.

Tobacco use is most prevalent among urologists, oncologists, and neurologists, while the lowest rate was observed among family doctors (20%) compared to hospital-based physicians (80%). This may be explained by the nature of their work—hospital physicians face higher stress levels due to night shifts, long working hours, lack of vacations, and a heavy load of critical patients. These trends are also noted in other studies. Physicians’ attitudes toward smoking patients are influenced by their personal smoking status—smoking doctors are more lenient toward smoking patients than non-smokers and often do not believe that anti-tobacco counseling has any effect.

It is noteworthy that family physicians rarely inquire about patients' tobacco use habits, take limited preventive measures, and are less likely to promote healthy lifestyles. Health promotion and anti-tobacco counseling should be implemented at the primary care level to reduce the impact of one of the major health risk factors—tobacco—on the population.

There are several reasons why doctors do not regularly provide tobacco-related counseling: limited consultation time, patient skepticism regarding lifestyle advice, and the physician's lack of belief that their advice will have a real impact. Studies show that a patient's health condition partially determines whether they receive advice on quitting smoking. Patients with asthma, cardiovascular, or chronic respiratory diseases are more likely to be counseled than healthy individuals.

The study revealed that while doctors recognize their role in tobacco control, they are not sufficiently engaged in exploring all motivational aspects with patients. This suggests a lack of knowledge of modern counseling and motivational techniques—which go beyond simply delivering information and include effective communication and dialogue skills. Additionally, it confirms that doctors often lack the time to engage in deeper, more meaningful conversations with their patients.

Conclusion

Doctors play a critical role in helping patients quit tobacco. Despite having adequate knowledge about the health consequences of smoking, many physicians themselves are dependent on tobacco. It is essential to motivate physicians to change their own behaviors and serve as role models for their patients. Increasing physician education on effective smoking cessation methods is advisable. Integrating tobacco control education into medical university curricula will significantly enhance physician involvement in anti-tobacco counseling.

EKONOMISTI The international scientific and analytical, reviewed, printing and electronic journal of Paata Gugushvili Institute of Economics of Ivane Javakhishvili Tbilisi State University

DOI: 10.36172/EKONOMISTI DOI: 10.52340/EKONOMISTI E ISSN 2346-8432 Print ISSN 1987-6890	Journal number 2 ∘ Tengiz Verulava ∘ Attitudes of healthcare professionals towards tobacco use and anti-tobacco counseling practices in Georgia journal N2 2025 DOI: 10.52340/ekonomisti.2025.02.06 Expanded Summary Introduction Doctors play a significant role in supporting patients to quit tobacco use. The formation of patient attitudes and the implementation of preventive measures often depend on doctors’ knowledge and perspectives regarding the harmful effects of tobacco. The aim of this study is to analyze physicians’ attitudes toward tobacco use and their practices in providing anti-tobacco counseling to patients. Methodology A quantitative, cross-sectional study was conducted from October to December 2024. A total of 275 physicians were randomly selected from five major hospitals in Tbilisi, out of which 242 completed a pre-structured electronic questionnaire using an online platform (Google Forms). Results The study showed that the prevalence of tobacco use was 39.4% among male physicians and 13.63% among female physicians. The average tobacco use rate in the general population significantly exceeds that among physicians. The highest smoking rate was observed among surgeons (n=12; 24%). Men tend to start smoking at an earlier age (before 16) compared to women (between ages 16–20). The majority of respondents (84%; n=204) believe that doctors should not smoke, as they serve as role models for their patients. According to 74% of respondents, a doctor’s advice aimed at preventing tobacco use motivates patients to quit smoking. Physicians’ attitudes toward smoking patients are primarily influenced by their smoking status. Doctors who smoke tend to have a more tolerant attitude toward smoking patients compared to non-smoking doctors. Moreover, the majority of smoking physicians believe that anti-tobacco counseling has little effect on reducing smoking among patients. Discussion The study confirmed that doctors play a crucial role in reducing tobacco use among patients. Physicians' attitudes toward smoking directly influence how actively they provide anti-tobacco counseling and how frequently they offer advice on quitting. A high smoking prevalence among doctors and their attitudes affect patient behavior, especially regarding the delivery of counseling and health recommendations. Similar results have been reported in other studies. The findings suggest that doctors have limited knowledge about the harmful effects of tobacco and lack confidence in the effectiveness of anti-smoking counseling. According to the study, 11% of physicians disagree with the statement that a doctor's advice significantly increases a patient's chances of quitting. The research also confirms that a decline in anti-smoking counseling (from 11% to 6%) and a reduction in advice on quitting smoking (from 38.2% to 19.8%) lead to fewer attempts by patients to quit tobacco (from 25.3% to 23.1%). This again highlights the key role physicians play in reducing tobacco consumption. The study confirms a high rate of tobacco use among physicians. Nearly one-fifth of them are smokers, although the rate is lower than in the general population (20.7% among physicians vs. 30.7% in the general population). Differences by gender, age, and specialty were also found. The proportion of female physician-smokers (13.6%) is higher than that of female smokers in the general population (7.8%), while the rate among male physicians (39.4%) is lower than in the general male population (55.5%). Long-term tobacco dependence is more pronounced among women. In terms of frequency, physicians typically consume 11 or more cigarettes per day (p=0.026), matching the national average. Most respondents (44%) began smoking between the ages of 16 and 20 (p=0.00), which coincides with the period after high school and during early university years—times characterized by increased stress (p=0.002). Similar findings were observed in other studies. When comparing the smoking cessation rate of physicians with that of the general population, a significant difference emerges: only 23.1% of the general population have attempted to quit smoking, while this figure is 60% among doctors (p=0.000). The gender difference is also notable. This may be due to doctors’ greater awareness of tobacco’s harmful effects and their daily exposure to the consequences in patients, which motivates them to quit. Tobacco use is most prevalent among urologists, oncologists, and neurologists, while the lowest rate was observed among family doctors (20%) compared to hospital-based physicians (80%). This may be explained by the nature of their work—hospital physicians face higher stress levels due to night shifts, long working hours, lack of vacations, and a heavy load of critical patients. These trends are also noted in other studies. Physicians’ attitudes toward smoking patients are influenced by their personal smoking status—smoking doctors are more lenient toward smoking patients than non-smokers and often do not believe that anti-tobacco counseling has any effect. It is noteworthy that family physicians rarely inquire about patients' tobacco use habits, take limited preventive measures, and are less likely to promote healthy lifestyles. Health promotion and anti-tobacco counseling should be implemented at the primary care level to reduce the impact of one of the major health risk factors—tobacco—on the population. There are several reasons why doctors do not regularly provide tobacco-related counseling: limited consultation time, patient skepticism regarding lifestyle advice, and the physician's lack of belief that their advice will have a real impact. Studies show that a patient's health condition partially determines whether they receive advice on quitting smoking. Patients with asthma, cardiovascular, or chronic respiratory diseases are more likely to be counseled than healthy individuals. The study revealed that while doctors recognize their role in tobacco control, they are not sufficiently engaged in exploring all motivational aspects with patients. This suggests a lack of knowledge of modern counseling and motivational techniques—which go beyond simply delivering information and include effective communication and dialogue skills. Additionally, it confirms that doctors often lack the time to engage in deeper, more meaningful conversations with their patients. Conclusion Doctors play a critical role in helping patients quit tobacco. Despite having adequate knowledge about the health consequences of smoking, many physicians themselves are dependent on tobacco. It is essential to motivate physicians to change their own behaviors and serve as role models for their patients. Increasing physician education on effective smoking cessation methods is advisable. Integrating tobacco control education into medical university curricula will significantly enhance physician involvement in anti-tobacco counseling.