Tabaquismo en médicos de la República Argentina II. Estudio TAMARA II

Abstract

Introducción: El tabaquismo es la principal causa de morbimortalidad evitable, por lo que es importante conocer las características del tabaquismo en los médicos y su actitud con los pacientes fumadores. Objetivo: Investigar la prevalencia de tabaquismo en médicos de la Argentina, los factores asociados con su consumo y la conducta frente a sus pacientes fumadores. Material y métodos: Estudio observacional y transversal de médicos de distintas especialidades de la Argentina, realizado entre junio y diciembre de 2013. Mediante una encuesta estructurada, se analizaron factores de riesgo cardiovascular asociados, las características del consumo de tabaco, el entrenamiento en tabaquismo y la actitud frente al paciente fumador. Resultados: Se encuestaron 3.033 médicos, 57% varones, edad promedio 41,3 ± 12 años, con una proporción de fumadores del 19,7% y de exfumadores del 21,7%. Ejercer una especialidad quirúrgica (OR 1,29) o trabajar en urgencias (OR 1,41) aumentó la probabilidad de ser fumador. El 36,6% y el 40,8% recibieron entrenamiento antitabaco en pregrado y posgrado, respectivamente. Ser joven, tener una especialidad clínica o trabajar en un medio privado se asoció con mayor adiestramiento. Aquellos con capacitación tenían mayor posibilidad de brindar siempre consejo de cesación y lo daban menos los fumadores o los que ejercían especialidades quirúrgicas. Los exfumadores presentaron una prevalencia mayor de factores de riesgo y de eventos vasculares. Estos y los fumadores tenían más antecedentes familiares de tabaquismo. Conclusiones: La prevalencia de tabaquismo en médicos argentinos es elevada. Distintos factores repercuten en la probabilidad de ser fumador, en el entrenamiento en tabaquismo o en la posibilidad de dar consejo médico. Se debe brindar mayor entrenamiento antitabaco.

Use of Smoking Cessation Interventions by Physicians in Argentina

“…The smoking rate reported in this study is lower than that reported in previous studies of 20% to 35% prevalence among physicians in Argentina (Gigliotti et al, 2013; Minervini et al, 2006; Tambussi et al, 2003; Zabert et al, 2005; Zylbersztejn et al, 2007). Our finding of a lower prevalence may be explained by selection bias of the sample studied because physicians had to sign an informed consent to participate in research that included randomization to a follow-up educational intervention.…”

“…Physicians have an important potential role in the implementation of smoking cessation interventions even though the prevalence of tobacco use among physicians and medical students in Argentina has been similar to that of the general population in previous surveys (Gigliotti et al, 2013; Mejia, Martinez, Gregorich, & Perez-Stable, 2010; Tambussi, Schoj, Perel, Zabert, & Ortiz, 2003; G. Zabert, Chatkin, & Ponciano-Rodriguez, 2010; G Zabert&Verra,2004; G Zabert, Videla, & Verra, 2005; Zylbersztejn et al, 2007). …”

“…Studies from Argentina have shown low rates of smoking cessation counselling by physicians and that smoking cessation training is insufficient (Noble et al, 1996; Tambussi et al, 2003; Zabert & Verra, 2004; Zabert et al, 2005; Zylbersztejn et al, 2007). Several Argentinean studies have identified previous tobacco training as a positive predictor of smoking cessation interventions among physicians from different specialties (Gigliotti et al, 2013; Mejia et al, 2010; Zylbersztejn et al, 2007), and two of them found an association between tobacco use in physicians and lower rates of implementing tobacco cessation interventions (Mejia et al, 2010; Zylbersztejn et al, 2007).…”

“…Several Argentinean studies have identified previous tobacco training as a positive predictor of smoking cessation interventions among physicians from different specialties (Gigliotti et al, 2013; Mejia et al, 2010; Zylbersztejn et al, 2007), and two of them found an association between tobacco use in physicians and lower rates of implementing tobacco cessation interventions (Mejia et al, 2010; Zylbersztejn et al, 2007). However, most of these studies were conducted several years ago, before the implementation of the National Tobacco Control Law in 2013 which among other public health components includes the dissemination of educational interventions targeting physicians and medical students in the clinical practice guidelines launched by the Ministry of Health in 2005 (Ministerio de Salud de la Nacion, 2005).…”

Tobacco smoking among pediatric residents in Argentina. Current prevalence and trend over the past 10 years

“…However, such prevalence is lower than that reported for Argentine medicine students and medical practitioners. The F.U.M.Ar study, 13 conducted in 2004 in 12 schools of medicine in Argentina, estimated a smoking prevalence of 35.2% among students, while the TAMARA study 14 reported a prevalence of 30.2% in a sample of almost 6500 Argentine physicians.…”