IRONY….  Some doctors and dentists are smokers  they are supposed to be a role model on healthy behavior.  They are well known to have good understanding on the adverse effects of smoking on human health.  They should be the leading role on tobacco control and prevention. They have a key role on health policy including tobacco control.

Prevalence of smokers among medical staff in selected countries CountriesYearTypes of medical stuffPrevelence (%) Turkey2004Doctors45,0 China (6 cities) Beijing & Honhot Doctors Paramedics 22,9 55,0 & 44,0 Tiongkok2004Male Doctors41,0 India: Karnataka2007Doctors, dentists and Nurses56,92 Bosnia & Herzegovina2004Doctors40,0 Finland2001Doctors (Male and Female)36,0 & 25,0 Japan2007Anesthesiologists and surgeon11,0 & 13,0 USA2003Medical practitioners7,0 Australia (Queensland) 2005Dentists3,9 Indonesia2008Doctors who work at community health centres (public) and doctors who work at private clinic 16,4 11,0

 Indonesia:  2008:  Sample: Doctors who works at community health centre (16,4%), Private practitioners (11%) Nurses (13,5%).  2009:  Male doctors 22% Female doctors (1%).

Are there any association between, attitude to their patients, types of working environment, readiness to smoking cessation and smoking behaviour among doctors and dentists in Makassar?

 Perception to smoking among doctors  How do doctors or dentists perceive toward smoking, social impact of smoking among doctors, their opinion about tobacco control policy.  Attitude to their patient who smoked  What do doctors or dentist attitude when patients visited them and wanted to discuss their health in related to their smoking behavior, whether doctors or dentist suggested their patient to stop smoking and doctors and dentists smoking behavior close to their patients.  Working place  whether their working place have a regulation on smoking at workplace, their attitude to that policy, smoking behavior among workers, stress and their behavior when their friends offered a cigarette.

 Study design Case control study  Study setting This study drew samples (Doctors or Dentists) from 15 health institutions (public) in Makassar (hospitals, clinics, Community health centres)  Population and Sample Male doctors and dentists at hospitals, clinics and community health centres in Makassar

Sample size A total of 172 doctors and dentists were included using exhausted sampling methods. Definitions Cases: Doctors or dentists who actively smoke; smoke at least one piece per day. Controls: doctors or dentists who do not smoke. Place of work and number of working hours per day were matched. Statistical analysis: Logistics regression was used to determine the association between dependent and independent variables.

Figure 1 Smoking Behaviours and Age Group

Figure 2 Smoking Behaviours and Educational Levels

Personality Smoking Status OR 95%CI (p=0,000) CasesControlTotal n%n%n% Negative Positive Total Table 1 Personality and Smoking Behaviours Doctors or dentists who have negative personality are 11 times more likely to smoke than doctors or dentists who have positive personality.

Attitude to their patients Smoking Status OR 95%CI (p=0,000) CasesControlTotal n%n%n% Negative Positive Total Table 2 Attitude to Their Patients and Smoking Behaviours Doctors or dentists who have negative attitude are four times more likely to smoke than those who have positive attitude.

Working place Smoking Status OR 95%CI (p=0,000) CasesControlTotal n%n%n% Negative Positive Total Table 3 Working Place and Smoking Behaviours Doctors or dentists who work at negative working place on smoking are 2.7 times more likely to smoke than those who works on positive working environment.

Level of knowledge Smoking status OR 95%CI (p=0,000) CasesControlTotal n%n%n% low High Total Table 4 Level of Knowledge and Smoking Behaviours There is no association between knowledge on smoking and smoking behaviours

Readiness to stop smoking Smoking status OR 95%CI (p=0,000) CasesControlTotal n%n%n% Not ready Ready Total Table 5 Readiness to Stop Smoking and Smoking Status Those who ready to stop smoking are 3.1 times more likely to keep smoking than those who are not ready.

VariablesCoefWaldOR 95% CI P LLUL Personality Attitude to their patient Readiness to stop smoking Constant Table 6Logistics Regression of Determinant of Smoking Behaviors Among Doctors and Dentists MULTIVARIATE ANALYSIS Personality is the most significant contributors to smoking behaviours among dentists and doctors

1.Doctors or dentists who have a negative personality are 11 times more likely to keep smoking than doctors or dentists who have a positive personality. 2.Doctors or dentists who have a negative attitude are 4.1 times more likely to keep smoking than doctors or dentists who have a positive attitude. 3.Doctors or dentists who worked at a negative working place are 2.7 times more likely to keep smoking than doctors or dentists who have positive working environment on smoking 4.There is no association between doctors or dentists knowledge on smoking adverse effect on health and smoking status. 5.Doctors or dentists who are not ready to smoke are 3.1 tie more likely to keep smoking than doctors or dentists who are ready to stop smoking.

Doctors and Dentists should actively involve on anti tobacco campaign, support non smoking area, initiate no smoking campaign to their patients. The Indonesia Medical Association (IDI) and The Indonesian Dentists Associations (PDGI) should regulate smoking rules among doctors or dentists. Health institutions in Makassar should implement non smoking area in theirs sites. The Indonesian Government should ban tobacco advertisement in the health institutions as a non smoking campaign in public places.