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Smoking Control Among Health-Care Workers -- World No-Tobacco Day, 1993

In many countries, smoking prevalence among physicians has declined substantially since the 1950s (1). Preliminary data indicate that a maximum of 10% of physicians smoke in Australia, Canada, Norway, the United Kingdom, and the United States (2); in contrast, at least 40% of physicians in France, Italy, Japan, Spain, and Turkey are smokers (1). In the United States, smoking is generally less prevalent among physicians than among other health-care workers (HCWs) (3; CDC, unpublished data, 1993). Smoking by HCWs undermines the message to smokers that quitting is important, and HCWs who smoke are less likely to recognize their role as health educators and to counsel smokers about quitting (4). Because of their potential for preventing smoking among patients, HCWs may serve as role models by not smoking (4). Accordingly, the theme of the sixth World No-Tobacco Day to be held May 31, 1993, is "Health Services: Our Window to a Tobacco-Free World."

Each year, the objectives of World No-Tobacco Day are to encourage governments, communities, and groups worldwide to become aware of the hazards of tobacco use and to encourage all persons who use tobacco to quit for at least 24 hours. World No-Tobacco Day 1993 will emphasize the role health professionals play by not smoking and the need to ban smoking in all health-care facilities to provide smoke-free environments for patients and employees. Activities will include press releases, videotape presentations, and radio announcements by World Health Organization (WHO) experts on tobacco control.

The theme for World No-Tobacco Day 1992, "Tobacco-Free Workplaces: Safer and Healthier," emphasized the right of all persons to breathe smoke-free air (5). WHO's Tobacco or Health Program documented a variety of activities associated with World No-Tobacco Day 1992 in many countries, including a nationwide broadcast appealing to all workers to refrain from smoking at the workplace (Togo); a campaign by a Ministry of Health (Chile) to promote the active use of legislative measures against tobacco; a declaration by a government (Nepal) that government and semigovernment offices, public places, public transport, industries, and factories should be tobacco-free areas; prohibition of smoking in hotels and restaurants in one community during World No-Tobacco Day 1992 and quit-smoking competitions in local companies (Norway); and awarding of a WHO medal to a metropolitan government (Tokyo) for declaring a new municipal hall smoke-free (2).

Reported by: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Legislation has been used in at least 60 countries to restrict smoking in health-care facilities (2,5). For example, several countries (e.g., Belgium, Brazil, Nigeria, Oman, Singapore, and Thailand) have adopted smoke-free policies in health-care facilities. In addition to legislative approaches, during 1992, the Joint Commission on Accreditation of Healthcare Organizations began requiring accredited hospitals in the United States to disseminate and enforce hospitalwide no-smoking policies (6). Smoke-free policies in health-care facilities provide an environment for encouraging smoking cessation by patients, preventing exacerbation of respiratory symptoms among patients, and reducing the risk of fires (7). Moreover, approximately 80% of smokers and 90% of all persons support limiting smoking in hospitals and physicians' offices (8).

Smoking-cessation activities by HCWs and the enactment of clean indoor air legislation are key components of tobacco control worldwide (9). In the United States, the national health objectives for the year 2000 identify the importance of HCWs counseling patients about smoking cessation and the need for smoke-free policies in health-care facilities (10). The goal of one objective (3.16) is to increase to at least 75% the proportion of primary-care and oral HCWs who routinely advise cessation and provide assistance and follow-up for patients who use tobacco. Nonsmoking HCWs are more likely to provide such advice and assistance (4). Another objective (3.12) recommends that each state enact comprehensive laws on clean indoor air that prohibit or strictly limit smoking in health-care facilities, other workplaces, and enclosed public places.

Additional information about World No-Tobacco Day 1993 is available from Richard Leclair, Office of Information and Public Affairs, Pan American Health Organization, telephone (202) 861-3457; or CDC's Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, telephone (404) 488-5705.


  1. Adriaanse H, Van Reek J. Physicians' smoking and its exemplary effect. Scand J Prim Health Care 1989;7:193-6.

  2. World Health Organization. World No-Tobacco Day -- 31 May 1992 {Advisory kit}. Geneva: World Health Organization, 1993.

  3. Brackbill R, Frazier T, Shilling S. Smoking characteristics of U.S. workers, 1978-1980. Am J Ind Med 1988;13:5-41.

  4. Public Health Service. Smoking and health: a report of the Surgeon General. Rockville, Maryland: US Department of Health, Education, and Welfare, 1979; DHEW publication no. (PHS)79-50066.

  5. CDC. World No-Tobacco Day, 1992. MMWR 1992;41:349-51.

  6. American Hospital Association. Joint commission adopts smoking ban. Chicago: American Hospital Association, 1991.

  7. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989:259-644; DHHS publication no. (CDC)89-8411.

  8. CDC. Public attitudes regarding limits on public smoking and regulation of tobacco sales and advertising -- 10 U.S. communities, 1989. MMWR 1991;40:344-5,351-3.

  9. Pierce JP. Progress and problems in international public health efforts to reduce tobacco usage. Annu Rev Public Health 1991;12:383-400.

  10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

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