Attitudes and behaviours towards tobacco cessation among general practice doctors: a cross-sectional study.

Problem

Waterpipe tobacco smoking (WTS), smokeless tobacco (ST) use, and electronic cigarettes (EC) are becoming increasingly common. While WTS and ST are associated with adverse health outcomes such as cardiorespiratory disease and oral cancers, EC are significantly less harmful and are recommended as a cessation aid. Little is known around how general practice doctors approach tobacco products beyond traditional cigarettes, and thus we aimed to examine the attitudes and behaviours of such clinicians towards these products and tobacco cessation.

Approach

A 13-item piloted self-completed anonymous electronic questionnaire was distributed throughout the United Kingdom to general practitioners (GP) and GP trainees via the Royal College of General Practitioners (RCGP), Health Education England, Vocational Training Schemes, and Clinical Commissioning Groups between January and May 2016. Social media was also utilised in dissemination. The questionnaire gathered sociodemographic characteristics of participants, clinician awareness of tobacco products, perceived consultation barriers, and clinician attitudes and behaviours. Likert scale responses were dichotomised, frequency counts described, and chi squared adopted to compare between product harm perception and clinician cessation behaviour. Logistic regression modelling was undertaken for cigarettes, WTS, ST, and EC, to determine the correlates of giving cessation advice in a consultation. A questionnaire approach enabled a diverse range of responses to several types of questions.

Findings

This cross-sectional study of 312 GPs and GP trainees in England highlighted that two thirds were aware of WTS and that a lack of information, knowledge, confidence, and time were all significant barriers to the enquiry of WTS in a consultation. ST awareness was poor (32% knew of Paan). It is concerning that GPs and GP trainees had lower harm perception, gave less cessation advice, and made less referrals, for WTS and ST users compared to cigarettes. A third endorsed EC as an appropriate cessation aid. Clinicians of ethnic minorities and more experienced GPs have higher odds of providing cessation advice for WTS and ST users. The possible explanation of these findings will be presented.

Consequences

The findings strengthen the need for an educational package for general practice on WTS, ST, and EC. The RCGP GP Curriculum must include objectives for trainees to be competent on these products. Practices should revisit their new patient registration template to ensure tobacco status is asked and recorded, allowing for opportunistic screening and management of tobacco users. Finally, further high-quality research exploring clinician attitudes in depth, and gaining the perspectives of patients is crucial.