- Open Access
The historical decline of tobacco smoking among Australian physicians: 1964–1997
© Smith and Leggat; licensee BioMed Central Ltd. 2008
- Received: 04 September 2008
- Accepted: 29 December 2008
- Published: 29 December 2008
Physicians occupy an important position as tobacco control exemplars and their own smoking habits are known to influence how effective they may be in such a role.
A comprehensive review of all published manuscripts describing tobacco usage rates and tobacco control activities in the Australian medical profession between 1964 and 1997.
Some of the earliest surveys revealed that around one-quarter of Australian physicians were smoking in the mid twentieth century, a rate which rapidly declined in the 1970s and 1980s, with reductions beyond that achieved by the general population.
Overall, our review suggests that not only do contemporary Australian physicians smoke at very low rates when compared internationally, but that an active professional community can also make a real difference to the lifestyle choices of its own members.
- Tobacco Smoking
- Tobacco Control
- Smoking Rate
- Tobacco Usage
- Japanese Physician
Tobacco control represents a key facet of public health. Worldwide, smoking is the second most common cause of death and the fourth most common risk factor for disease. If smoking trends continue at the current rate, tobacco will be causing approximately 10 million deaths per annum by the year 2020, with around 650 million fatalities overall . Global tobacco control is therefore very important, a realization which led to the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), an evidence-based treaty focusing on demand reduction and tobacco supply issues from a global perspective . At a local level, individual physicians and scientists have often been at the forefront of tobacco control, due to the now well-known links between smoking and ill-health, as well as the direct evidence of sick patients whom they treat in daily practice. Physicians themselves have also played a key role in tobacco research, with one of the earliest epidemiological studies linking tobacco smoking with adverse health outcomes being conducted among a group of British doctors . So groundbreaking was the original investigation by Doll and colleagues that it was republished 50 years later  and remains a cornerstone of preventive medicine literature [5–7]. Being on the frontlines of primary health care, physicians have always occupied a key position in tobacco control and are often viewed as healthy lifestyle role models by their patients, their colleagues and the communities in which they live. As early as thirty years ago, it had been suggested that physicians would be more effective at persuading patients to quit smoking, if they themselves did not smoke .
Despite these facts, medical professionals have not always set a good example for patients with regard to smoking [9, 10]. In the early to mid 20th century for example, some tobacco companies even used physicians to help advertise their products [11, 12]. The relative success of certain campaigns in the United States (US) and Japan was most likely due to the fact that smoking rates among local physicians were reasonably high at the time. In the US for example, some of the earliest epidemiological research found that around 40% of physicians were smoking in 1959 , although their smoking rate had dropped dramatically by the 1980s . A large study conducted in 1965  revealed that 68% of male physicians in Western Japan were current smokers. By the mid to late 20th century however, physicians in many countries had begun to heed a growing body of scientific evidence linking smoking with ill health, and many active smokers among them had begun to quit . As the medical profession was early to notice the dangers of tobacco use, the national smoking rate of physicians in the US, for example, fell dramatically during this time [16–18]. Tobacco use among their Japanese medical counterparts was also seen to decline last century , albeit at a less rapid rate than some of their Western counterparts. Regardless of what country they live in, the ongoing collection and interpretation of epidemiological data on smoking habits among physicians continues to serve at least two important functions relevant for tobacco control. Firstly, this kind of data can help predict how effective any potential anti-smoking campaigns in a given country may actually be . That is, it would be difficult to convince the general public not to smoke if physicians continued to do so. Secondly, it allows policy makers to determine how 'mature' a country's smoking epidemic currently is, and thus, how soon the overall community prevalence rate might decline .
As a nation, Australia has set many positive examples in the field of tobacco control. It was one of the first countries to test the tar and nicotine content of cigarettes, one of the first democracies to ban all forms of tobacco advertising, one of the first nations to introduce explicit health warnings on cigarette packets, and one of the first countries to run large scale anti-smoking campaigns for the public . Partly due to these restrictions, Australia has now become a relatively difficult region for tobacco industries to operate in, with a wide variety of anti-smoking laws and an aggressive and well-organized anti-smoking movement . Australia's community smoking rate has been steadily declining in recent years  and is currently one of the lowest in the developed world . Although part of the impetus for these changes can be attributed to the efforts of Australian physicians, few authors have systematically investigated tobacco smoking rates within this occupational subgroup . The aim of our current review therefore, was to undertake a comprehensive and systematic review of tobacco smoking habits within the Australian medical profession during the mid to late 20th century.
An extensive literature review was conducted which targeted all manuscripts published in peer-reviewed journals relating to the topic of tobacco smoking among Australian physicians. As the official language of Australia is English, and studies from this region could be expected to be published in such a format, only English-language manuscripts were included. The review itself began with a search of relevant Medical Subject Headings (MeSH) such as 'smoking', 'Australia', 'tobacco' and 'physician' on the PubMed database from the US National Library of Medicine . After identifying some initial studies, the search was repeated using keyword variations such as 'smoke' and 'doctor'. As there were relatively few older manuscripts on this topic listed in PubMed, the reference lists of journal papers located using our initial criteria were subsequently examined to find additional publications. Manuscripts were then arranged in descending order, depending on the year in which the smoking survey had actually been undertaken, rather than the year it was published. Where the year of study was not listed or was otherwise unclearly stated in the text, the manuscript's corresponding author was contacted for clarification, wherever possible. The publication year for all studies was eventually determined using either the manuscript itself or by direct contact with the authors. After sourcing the original article, all manuscripts were assigned a reference number based on the abovementioned criteria. For consistency, all smoking prevalence rates were rounded to the nearest whole number. Response rates for each study were also rounded to the nearest whole number for standardization purposes. To gain some perspective on physician's tobacco smoking habits over time, with respect to physicians in other countries and the general Australian population, smoking rates for these subgroups were also sourced from various scientific reports.
Historical research on tobacco use among Australian physicians
Participants and Recruitment Method
Young & Ward 
General practitioners who were on a commercial mailing list
Young & Ward 
General practitioners in Australia (selection method not specified)
McCall et al 
General practitioners registered with the Commonwealth Department of Human Services
Roche et al 
Physicians enrolled in a postgraduate family medicine training program
Roche et al 
Physicians enrolled in various postgraduate training programs
Readers of the journal: Australian Family Physician
Readers of the Australian Medical Association Gazette
Dodds et al 
Physicians registered with the Medical Board of Victoria
Rankin et al 
Physicians listed in the Medical Directory of Australia (1972 Edition)
Physicians who were registered as medical practitioners in Australia
Physicians who were registered as medical practitioners in Australia
Even so, it is important to consider our results within the limitations of collected data, namely the fact that all studies relied on self-reported measures of smoking. As such, the possibility of systematic under-reporting of smoking habits by physicians cannot be totally excluded, and may have occurred for at least two reasons. Firstly, underreporting is a known confounder in population surveys that deal with personal habits, about which people may feel embarrassed. Secondly, and perhaps more importantly, is the fact that throughout the latter half of last century the increasing weight of scientific evidence had made it clear that physicians should not be smoking. While the overall community data no doubt suggests that fewer Australians are smoking than ever before, exactly how many of the physicians who claim to be 'non smokers' never use tobacco at all, cannot be established. As such, it is reasonable to assume that at least some physicians who smoked might have been reluctant to admit the fact during a survey. While we cannot be sure exactly what proportion of smoking doctors would incorrectly report themselves to be non-smokers, we anticipate it should be a relatively low proportion of the total. Furthermore, as this unique bias would presumably be occurring whenever physicians were surveyed in any country, international comparisons between them remain valid.
Aside from changes to individual behavior, the Australian Medical Association (AMA) also became increasingly active in its opposition to tobacco usage throughout the 20th century. Although many different reasons can be proposed as to why physicians would choose to be involved in the anti-smoking movement, it is reasonable to assume that physicians were probably the first health care providers to graphically witness tobacco induced diseases among patients in their care. Immediately following the Second World War for example, Gallup polls suggested that around three-quarters of all Australian adult males were current smokers . This situation no doubt inspired physicians who were interested in preventive medicine, particularly as the scientific evidence against tobacco mounted. Changes of opinion in the Australian medical community were also reflected in the scientific evidence published in relevant Australian medical journals. In 1953 for example, the Medical Journal of Australia published its first article suggesting a tentative link between smoking and lung cancer . In 1962, the National Health and Medical Research Council (NHMRC) issued an official statement on the suspected relationship between cigarette smoking and lung cancer . Two years later in 1964, the first study on physicians' smoking habits was published in Modern Medicine of Australia , and three years after that, the AMA released their official policy on the topic . By 1970, it appears that most of the Australian medical community had accepted the dangers of tobacco use .
Tobacco smoking research also appears to have begun on a national scale around this time, with the first national data on Australia's smoking demographic being published in the MJA during 1975 . The Australian Bureau of Statistics (ABS) then conducted a national survey of alcohol and tobacco usage, publishing their results in a large report three years later, in 1978 . Around this time, some Australian physicians became actively opposed to smoking at an individual level. By 1983 for example, at least four had been charged after defacing cigarette billboards with anti-smoking messages . Australian health professions also adopted a more unified, national front, with nine of Australia's professional health bodies endorsing a national newspaper advertisement condemning cigarette promotion in 1987 . In 1988, an article in the Medical Journal of Australia went one step further to suggest that a smoke-free Australia could be a bicentennial resolution for the year 2000 . The introduction and approval of pharmaceutical products to help smokers quit their habit was instrumental in the fight against tobacco. In 1993, Nicotine patches were first approved for use in Australia, if prescribed by medical practitioners. From a policy perspective, the Australian medical profession became increasingly active in its opposition to smoking. In recent years for example, professional medical societies such as the Australian Medical Association , the Royal Australian College of General Practitioners  and the Royal Australasian College of Physicians  have all published their official policies on tobacco smoking and tobacco control. With regard to contemporary smoking interventions from a global perspective, the aforementioned WHO-FCTC  represents an important treaty and one to which Australia is a signatory.
Although few contemporary physicians appear to be smoking in Australia, it is interesting to compare the progression of their tobacco usage trends with physicians in other developed countries. Although the current paper is not intended as a systematic review of tobacco smoking in all countries, a few brief comparisons with other regions are appropriate. Some interesting contrasts can be seen when current tobacco smoking trends among physicians in four developed countries are juxtaposed with the five Australian studies during this time period [30–34]. Between 1990 and 2002 for example, at least five separate studies from the US [55–59] found that American physicians smoked tobacco at very low rates, similar to their Australian counterparts. From the publications we located, it appears that the prevalence rate of smoking among US physicians is currently between 2% and 4%, very similar to their Australian counterparts, where it ranges from 3% to 6%. Interestingly, three of the aforementioned US investigations also looked at smoking among dentists at the same time [55, 56, 59]. All three found that smoking was similarly rare among US dentists. These studies suggest therefore, that tobacco smoking is probably uncommon among medically-trained health care workers in the United States. As such, a summary of these studies suggests that fewer than one-in-ten American or Australian physicians, currently smokes tobacco. Physicians in both countries therefore, could be described as tobacco control exemplars, at least with regard to anti-smoking health promotion.
On the other hand, contemporary tobacco smoking rates among physicians in some other developed countries is less encouraging, with research among Italian doctors warranting particular concern . Between 1995 and 2000 for example, five separate investigations by Italian researchers found that between 24% and 39% of physicians reported themselves to be active smokers [61–65]. From these studies it appears that Italian physicians may not be setting a good example as role models for their patients, at least as far as tobacco smoking is concerned. Somewhat disturbingly, La Vecchia et al  also reported that female Italian physicians may even be smoking at higher rates than the community in which they live. On the other hand, an Italian study by Nardini et al  found that while 39% of the physicians surveyed were current smokers, their rate was actually one of the lowest of all staff at a general hospital, particularly when compared to nursing students and auxiliaries. Future reductions of tobacco usage among Italian health care workers may therefore be difficult to achieve, although exactly how Italian physicians can and should move forward is beyond the scope of the current paper.
While a detailed discussion of smoking in Japan is beyond the scope of the current paper, some comparisons between the smoking habits of Australian physicians and their Japanese counterparts is still worthwhile. At least five English-language studies have looked at tobacco smoking among Japanese physicians in recent years [66–70]. The highest prevalence rate appears to have been documented in 1990, when 32% of Fukuoka physicians reported themselves to be smokers . High smoking rates were also found among physicians during local surveys conducted in Tokyo , Okayama  and Fukui . A nationwide survey of Japanese physicians during the year 2000 revealed that 27% of male physicians and 7% of female physicians smoked, a rate which was about half that of the national average for the general population, at the time . Even so, from these results it can be seen that at least one-in-five Japanese physicians still consumes tobacco on a regular basis. The continued high prevalence of smoking among them is somewhat ironic, as it was a Japanese physician, Takeshi Hirayama, who published some of the first scientific evidence linking lung cancer to passive smoking . Hirayama's work has withstood the test of time and has now become a classic paper in tobacco control . Similar to Australia, the Japanese tobacco control environment did improve somewhat in the late 20th century. In recent years, more anti-smoking measures have been introduced to Japan, particularly after 1998 when lung cancer rose to become the leading cause of death, ahead of stomach cancer . Although this is clearly a step in the right direction, further efforts will still need to be made to encourage Japanese physicians and the medical students who precede them, to quit smoking [74, 75].
In leading the fight against tobacco, it is important for physicians in all countries to recognize their unique role as tobacco control exemplars. One reason that Japanese physicians continue to smoke at high rates may be because they lack awareness of their status as public role models . But physicians do occupy a very important role in preventive medicine, in all countries, both as health care providers and as public health exemplars. Physicians are not only responsible for smoking cessation treatment, but also for anti-smoking campaigns . The impact of their preventive efforts should not be underestimated, as it is well-known that medical interventions can be effective in helping patients to quit smoking . Aside from being a non-smoking role model in public, the physicians' clinic and hospital should also be a model of non-smoking behavior . Similarly, medical and dental students need to be encouraged not to smoke [79, 80].
Although smoking rates within the Australian medical profession have clearly declined in recent years, there remains some debate as to whether physicians are doing enough to stop their patients smoking . It has been suggested that physicians are not always successful in recognizing which of their patients actually smoke, with a study of Australian general practitioners for example , finding that only 56% of current smokers were correctly identified as such. Additional work to help convince the Australian public of the important role that physicians play in tobacco control may also be appropriate in future. In a survey conducted in the early 1990s for example, 52% of people still believed that 'a lot of doctors smoke' . Despite these potential caveats, smoking rates in the Australian medical profession have clearly declined, with one of the more recent surveys of hospital personnel for example  finding that staff in the 'medical' job category still had the lowest smoking rate of all (around 2%). Significant reductions in the smoking rates of physicians in some other countries has also been occurring, particularly in the US . From a historical perspective America was the first country to introduce health warnings on cigarette packets in 1966 , and by later that decade, the US Public Health Service had began to publicly promote physicians as non-smoking role models. Community smoking rates subsequently declined, and at least part of the credit for these achievements could be given to physicians.
On the other hand, tobacco use remains problematic in Japanese society, an issue that will require additional government commitment to help reduce the current burden . From a philosophical perspective it is difficult to understand why any physicians would smoke at all, given that they are well-placed to not only receive information about the adverse effects of smoking, but also to understand the science behind it and act accordingly. As such, it is important that this type of health information reaches physicians promptly, both via government networks and professional medical associations. Even so, up-to-date epidemiological data on the smoking habits of physicians remains important for two reasons. Firstly, it helps predict how effective anti-smoking campaigns may be. That is, it would be very difficult to convince the general public not to smoke if their physician role models continued to do so . Secondly, it allows policy makers to determine how 'mature' a particular country's smoking epidemic currently is, and thus, how soon the community prevalence rate may be expected to decline. Historical data on physician's smoking rates is particularly useful, as it permits analysis of social trends regarding tobacco use, and also allows policy makers to see what control strategies were successful in the past, and what policies might be appropriate in the future.
Overall, this review suggests that the prevalence of smoking among Australian physicians has fallen dramatically throughout the latter half of the 20th century, with reductions beyond that achieved by the general population. While tobacco usage rates in the community have generally declined over time, credit should be given to the small number of physicians who encouraged their patients to quit, long before the health risks had been widely accepted by the general community. Such behavior has not been universal, however, with some international comparisons suggesting that while Australian trends are generally similar to those seen in the US, further effort is still required in countries such as Japan and Italy. While a detailed discussion of why physicians in some countries smoke at higher rates than others is beyond the scope of this paper, it nevertheless, highlights an important topic for future research in tobacco control. Whatever their geographical region, the fact that any physicians continue to smoke is unfortunate given their status as exemplars, and implies that further preventive efforts will need to be focused on personal health behaviors. It is important that smoking in the Australian medical profession continues its decline in future years, so that physicians in all countries can lead the way as tobacco control exemplars in the 21st century.
- World Health Organization (WHO): Why is tobacco a public health priority?. [http://www.who.int/tobacco/health_priority/en/index.html]
- World Health Organization (WHO): WHO framework convention on Tobacco control (WHO FCTC). [http://www.who.int/fctc/en/index.html]
- Doll R, Hill AB: The mortality of doctors in relation to their smoking habits: A preliminary report. BMJ. 1954, 1 (4877): 1451-1455.PubMed CentralView ArticlePubMedGoogle Scholar
- Doll R, Hill AB: The mortality of doctors in relation to their smoking habits: A preliminary report. 1954. BMJ. 2004, 328: 1529-1533. 10.1136/bmj.328.7455.1529.PubMed CentralView ArticlePubMedGoogle Scholar
- Doll R, Peto R, Boreham J, Sutherland I: Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004, 328: 1519-1528. 10.1136/bmj.38142.554479.AE.PubMed CentralView ArticlePubMedGoogle Scholar
- Doll R, Peto R, Boreham J, Sutherland I: Mortality from cancer in relation to smoking: 50 years observations on British doctors. Br J Cancer. 2005, 92: 426-429. 10.1038/sj.bjc.6602450.PubMed CentralView ArticlePubMedGoogle Scholar
- Stampfer M: New insights from the British doctors study. BMJ. 2004, 328: 1507-10.1136/bmj.328.7455.1507.PubMed CentralView ArticlePubMedGoogle Scholar
- Garfinkel L: Cigarette smoking among physicians and other health professionals, 1959–1972. CA Cancer J Clin. 1976, 26: 373-375. 10.3322/canjclin.26.6.373.View ArticlePubMedGoogle Scholar
- Davis RM: When doctors smoke. Tob Control. 1993, 2: 187-188. 10.1136/tc.2.3.187.PubMed CentralView ArticleGoogle Scholar
- Smith D, Leggat P: An international review of tobacco smoking in the medical profession: 1974–2004. BMC Public Health. 2007, 7 (1): 115-10.1186/1471-2458-7-115.PubMed CentralView ArticlePubMedGoogle Scholar
- Gardner MN, Brandt AM: The Doctors' Choice Is America's Choice: The Physician in US Cigarette Advertisements, 1930–1953. Am J Public Health. 2006, 96: 222-232.PubMed CentralView ArticlePubMedGoogle Scholar
- Kawane H: When doctors advertised cigarettes. Tob Control. 1993, 2: 45.Google Scholar
- Smith DR: The historical decline of tobacco smoking among United States physicians: 1949–1984. Tob Induc Dis. 2008, 4 (1): 9-10.1186/1617-9625-4-9.PubMed CentralView ArticlePubMedGoogle Scholar
- Nishizumi M, Kuratsune M: A survey of smoking habits of physicians in Western Japan. Nippon Koshu Eisel Zasshi. 1967, 14: 1273-1294.Google Scholar
- Adriaanse H, van Reek J: Physicians' smoking and its exemplary effect. Scand J Prim Health Care. 1989, 7: 193-196. 10.3109/02813438909088663.View ArticlePubMedGoogle Scholar
- Lee DJ, LeBlanc W, Fleming LE, Gomez-Marin O, Pitman T: Trends in US smoking rates in occupational groups: The National Health Interview Survey 1987–1994. J Occup Environ Med. 2004, 46: 538-548. 10.1097/01.jom.0000128152.01896.ae.View ArticlePubMedGoogle Scholar
- Nelson DE, Emont SL, Brackbill RM, Cameron LL, Peddicord J, Fiore MC: Cigarette smoking prevalence by occupation in the United States. A comparison between 1978 to 1980 and 1987 to 1990. J Occup Med. 1994, 36: 516-525.PubMedGoogle Scholar
- Nelson DE, Giovino GA, Emont SL, Brackbill R, Cameron LL, Peddicord J: Trends in cigarette smoking among US physicians and nurses. JAMA. 1994, 271: 1273-1275. 10.1001/jama.271.16.1273.View ArticlePubMedGoogle Scholar
- Kaetsu A, Fukushima T, Moriyama M, Shigematsu T: Smoking behavior and related lifestyle variables among physicians in Fukuoka, Japan: A cross sectional study. J Epidemiol. 2002, 12: 199-207.View ArticlePubMedGoogle Scholar
- Chapman S, Byrne F, Carter SM: "Australia is one of the darkest markets in the world": the global importance of Australian tobacco control. Tob Control. 2003, 12 (Suppl 3): iii1-3.PubMedGoogle Scholar
- Hill DJ, White VM, Gray NJ: Measures of tobacco smoking in Australia 1974–1986 by means of a standard method. Med J Aust. 1988, 149 (1): 10-12.PubMedGoogle Scholar
- Magnus P: Cigarette smoking and the Australian medical profession. Med J Aust. 1989, 150 (8): 437.PubMedGoogle Scholar
- US National Library of Medicine: PubMed database. [http://www.ncbi.nlm.nih.gov/entrez]
- Anonymous: 4,776 answer MM smoking survey. Modern Medicine of Australia. 1964, 8 (August): 1-4.Google Scholar
- Anonymous: 5,976 answer MM smoking survey. Modern Medicine of Australia. 1970, 17 (August): 1-4.Google Scholar
- Rankin DW, Gray NJ, Hill DJ, Evans DR: Attitudes and smoking habits of Australian doctors. Med J Aust. 1975, 2: 822-824.PubMedGoogle Scholar
- Dodds AM, Rankin DW, Hill DJ, Gray NJ: Attitudes and smoking habits of doctors in Victoria. Community Health Stud. 1979, 3 (1): 28-31.View ArticleGoogle Scholar
- Anonymous: You're setting the pace in the fitness stakes. Medical Practice. 1983, 9 (September): 22-24.Google Scholar
- Nyman K: The health of general practitioners. A pilot survey. Aust Fam Physician. 1991, 20 (5): 637-641. 644–635PubMedGoogle Scholar
- Roche AM, Parle MD, Stubbs JM, Hall W, Saunders JB: Management and treatment efficacy of drug and alcohol problems: What do doctors believe?. Addiction. 1995, 90: 1357-1366. 10.1111/j.1360-0443.1995.tb03553.x.View ArticlePubMedGoogle Scholar
- Roche AM, Parle MD, Saunders JB: Managing alcohol and drug problems in general practice: A survey of trainees' knowledge, attitudes and educational requirements. Aust NZ J Public Health. 1996, 20 (4): 401-408. 10.1111/j.1467-842X.1996.tb01053.x.View ArticleGoogle Scholar
- McCall L, Maher T, Piterman L: Preventive health behaviour among general practitioners in Victoria. Aust Fam Physician. 1999, 28 (8): 854-857.PubMedGoogle Scholar
- Young JM, Ward JE: Declining rates of smoking among medical practitioners. Med J Aust. 1997, 167: 232.PubMedGoogle Scholar
- Young JM, Ward JE: Implementing guidelines for smoking cessation advice in Australian general practice: opinions, current practices, readiness to change and perceived barriers. Fam Pract. 2001, 18 (1): 14-20. 10.1093/fampra/18.1.14.View ArticlePubMedGoogle Scholar
- Doll R, Peto R, Wheatley K, Gray R, Sutherland I: Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ. 1994, 309: 901-911.PubMed CentralView ArticlePubMedGoogle Scholar
- Fowler G, Mant D, Fuller A, Jones L: The "Help Your Patient Stop" initiative. Evaluation of smoking prevalence and dissemination of WHO/UICC guidelines in UK general practice. Lancet. 1989, 1: 1253-1255. 10.1016/S0140-6736(89)92342-8.View ArticlePubMedGoogle Scholar
- Woodward SD: Trends in cigarette consumption in Australia. Aust N Z J Med. 1984, 14 (4): 405-407.View ArticlePubMedGoogle Scholar
- Gray NJ, Hill DJ: Patterns of tobacco smoking in Australia. Med J Aust. 1975, 2 (22): 819-822.PubMedGoogle Scholar
- Gray NJ, Hill DJ: Patterns of tobacco smoking in Australia. 2. Med J Aust. 1977, 2 (10): 327-328.PubMedGoogle Scholar
- Hill DJ, Gray NJ: Patterns of tobacco smoking in Australia. Med J Aust. 1982, 1 (1): 23-25.PubMedGoogle Scholar
- Hill D, Gray N: Australian patterns of tobacco smoking and related health beliefs in 1983. Community Health Stud. 1984, 8 (3): 307-316.View ArticlePubMedGoogle Scholar
- Hill DJ: Australian patterns of tobacco smoking in 1986. Med J Aust. 1988, 149 (1): 6-10.PubMedGoogle Scholar
- Hill DJ, White VM, Gray NJ: Australian patterns of tobacco smoking in 1989. Med J Aust. 1991, 154 (12): 797-801.PubMedGoogle Scholar
- Australian Institute of Health and Welfare (AIHW): Statistics on drug use in Australia 2004. 2005, AIHW Report No. PHE 62, CanberraGoogle Scholar
- Anonymous: SMOKER'S respiratory syndrome. Medical Journal of Australia. 1953, 2 (9): 343-344.Google Scholar
- National Health and Medical Research Council (NHMRC): Smoking and lung cancer: Report of the 53rd session of the NHMRC. 1962, CanberraGoogle Scholar
- Rieger C: Correspondence: The A.M.A.'s policy on smoking tobacco. Med J Aust. 1967, 1967 (2 Suppl): 66.Google Scholar
- Australian Bureau of Statistics (ABS): Alcohol and tobacco consumption patterns, February 1977. 1978, ABS Cat No. 4312.0, CanberraGoogle Scholar
- Margo J: The doctors who fight cancer with spray cans. The Sydney Morning Herald. 1983, 19 Feb: 32.Google Scholar
- Woodward S: Everything Dick Smith said (and wanted to say) is true. The Australian. 1987, 23 April : 3.Google Scholar
- Armstrong BK, Daube MM, Shean RE: A smoke-free Australia – our bicentenary resolution?. Med J Aust. 1988, 149 (1): 1-2.PubMedGoogle Scholar
- Australian Medical Association (AMA): AMA position statement: Tobacco smoking – 2005. [http://www.ama.com.au/node/2241]
- Royal Australian College of General Practitioners (RACGP): SNAP: Smoking, nutrition, alcohol and physical activity. [http://www.racgp.org.au/guidelines/snap]
- The Royal Australasian College of Physicians (RACP) and The Royal Australian and New Zealand College of Psychiatrists (RANZCP): Tobacco policy: Using evidence for better outcomes. [http://www.racp.edu.au/download.cfm?DownloadFile=A955EED6-2A57-5487-D35E68AC78E06E42]
- Brink SG, Gottlieb NH, McLeroy KR, Wisotzky M, Burdine JN: A community view of smoking cessation counselling in the practices of physicians and dentists. Public Health Rep. 1994, 109: 135-142.PubMed CentralPubMedGoogle Scholar
- Hill HA, Braithwaite RL: Attitudes, beliefs, and practices regarding smoking and smoking cessation among African-American physicians and dentists. J Natl Med Assoc. 1997, 89: 745-751.PubMed CentralPubMedGoogle Scholar
- An LC, Bernhardt TS, Bluhm J, Bland P, Center B, Ahluwalia JS: Treatment of tobacco use as a chronic medical condition: Primary care physicians' self-reported practice patterns. Prev Med. 2004, 38: 574-585. 10.1016/j.ypmed.2003.11.016.View ArticlePubMedGoogle Scholar
- Misra R, Vadaparampil ST: Personal cancer prevention and screening practices among Asian Indian physicians in the United States. Cancer Detect Prev. 2004, 28: 269-276. 10.1016/j.cdp.2004.02.004.View ArticlePubMedGoogle Scholar
- Kenna GA, Wood MD: The prevalence of alcohol, cigarette and illicit drug use and problems among dentists. J Am Dent Assoc. 2005, 136: 1023-1032.View ArticlePubMedGoogle Scholar
- Smith DR, L'Abbate N, Lorusso A: Tobacco smoking among Italian physicians and the role of occupational medicine. Med Lav. 2008, 99 (1): 3-7. [http://www.lamedicinadellavoro.it/]PubMedGoogle Scholar
- Nardini S, Bertoletti R, Rastelli V, Donner CF: The influence of personal tobacco smoking on the clinical practice of Italian chest physicians. Eur Respir J. 1998, 12: 1450-1453. 10.1183/09031936.98.12061450.View ArticlePubMedGoogle Scholar
- Zanetti F, Gambi A, Bergamaschi A, Gentilini F, De Luca G, Monti C: Smoking habits, exposure to passive smoking and attitudes to a non-smoking policy among hospital staff. Public Health. 1998, 112: 57-62. 10.1016/S0033-3506(98)00208-X.View ArticlePubMedGoogle Scholar
- Nardini S, Bertoletti R, Rastelli V, Ravelli L, Donner CF: Personal smoking habit and attitude toward smoking among the health staff of a general hospital. Monaldi Arch Chest Dis. 1998, 53: 74-78.PubMedGoogle Scholar
- La Vecchia C, Scarpino V, Malvezzi I, Baldi G: A survey of smoking among Italian doctors. J Epidemiol Community Health. 2000, 54: 320-10.1136/jech.54.4.320a.View ArticlePubMedGoogle Scholar
- Pizzo AM, Chellini E, Grazzini G, Cardone A, Badellino F: Italian general practitioners and smoking cessation strategies. Tumori. 2003, 89: 250-254.PubMedGoogle Scholar
- Kaetsu A, Fukushima T, Moriyama M, Shigematsu T: Change of the smoking behavior and related lifestyle variables among physicians in Fukuoka, Japan: A longitudinal study. J Epidemiol. 2002, 12: 208-216.View ArticlePubMedGoogle Scholar
- Kawakami M, Nakamura S, Fumimoto H, Takizawa J, Baba M: Relation between smoking status of physicians and their enthusiasm to offer smoking cessation advice. Intern Med. 1997, 36: 162-165. 10.2169/internalmedicine.36.162.View ArticlePubMedGoogle Scholar
- Kawane H, Soejima R: Smoking among doctors in a medical school hospital. Kawasaki Med J. 1996, 22: 211-216.Google Scholar
- Kawahara K, Ohida T, Osaki Y, Mochizuki Y, Minowa M, Yamaguchi N: Study of the smoking behavior of medical doctors in Fukui, Japan and their antismoking measures. J Epidemiol. 2000, 10: 157-162.View ArticlePubMedGoogle Scholar
- Ohida T, Sakurai H, Mochizuki Y, Kamal AM, Takemura S, Minowa M: Smoking prevalence and attitudes toward smoking among Japanese physicians. JAMA. 2001, 285: 2643-2648. 10.1001/jama.285.20.2643.View ArticlePubMedGoogle Scholar
- Hirayama T: Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan. Br Med J (Clin Res Ed). 1981, 282 (6259): 183-185.View ArticleGoogle Scholar
- Ong E, Glantz SA: Hirayama's work has stood the test of time. Bull World Health Organ. 2000, 78 (7): 938-939.PubMed CentralPubMedGoogle Scholar
- Ohida T, Kawane H, Kamal AMM, Takemura S, Sakurai H: Smoking among Japanese physicians. JAMA. 2001, 286 (8): 917-10.1001/jama.286.8.917.View ArticleGoogle Scholar
- Kawane H: The prevalence of smoking among physicians in Japan. Am J Public Health. 1993, 83: 1640-10.2105/AJPH.83.11.1640.PubMed CentralView ArticlePubMedGoogle Scholar
- Smith DR, Takahashi K: Too many Japanese university students are still smoking tobacco. Tob Induc Dis. 2008, 4 (1): 10-10.1186/1617-9625-4-10.PubMed CentralView ArticlePubMedGoogle Scholar
- Kawane H: Smoking cessation: Physician responsibility and government's role. Respir Med. 1996, 90 (7): 440-10.1016/S0954-6111(96)90124-9.View ArticlePubMedGoogle Scholar
- Fowler G: Educating doctors in smoking cessation. Tob Control. 1993, 2: 5-6. 10.1136/tc.2.1.5.PubMed CentralView ArticleGoogle Scholar
- Nett LM: The physician's role in smoking cessation: A present and future agenda. Chest. 1990, 97 (2 Suppl): 28S-32S. 10.1378/chest.97.2_Supplement.28S.PubMedGoogle Scholar
- Smith DR, Leggat PA: An international review of tobacco smoking among medical students. J Postgrad Med. 2007, 53 (1): 55-62.View ArticlePubMedGoogle Scholar
- Smith DR, Leggat PA: An international review of tobacco smoking among dental students in 19 countries. Int Dent J. 2007, 57 (6): 452-458.View ArticlePubMedGoogle Scholar
- Hill D, Borland R: Are doctors doing enough to stop their patients smoking?. Med J Aust. 1989, 150 (8): 413-414.PubMedGoogle Scholar
- Dickinson JA, Wiggers J, Leeder SR, Sanson-Fisher RW: General practitioners' detection of patients' smoking status. Med J Aust. 1989, 150 (8): 420-2, 425-426.PubMedGoogle Scholar
- Chapman S, Wong WL, Smith W: Self-exempting beliefs about smoking and health: differences between smokers and ex-smokers. Am J Public Health. 1993, 83 (2): 215-219. 10.2105/AJPH.83.2.215.PubMed CentralView ArticlePubMedGoogle Scholar
- Jones TE, Crocker H, Ruffin RE: Smoking habits and cessation programme in an Australian teaching hospital. Aust N Z J Med. 1998, 28 (4): 446-452.View ArticlePubMedGoogle Scholar
- Chapman S, Carter SM: "Avoid health warnings on all tobacco products for just as long as we can": a history of Australian tobacco industry efforts to avoid, delay and dilute health warnings on cigarettes. Tob Control. 2003, 12 (Suppl 3): iii13-22.PubMed CentralPubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.