Original Research
Occupational Health / Tobacco Control

Smoking Among Medical Workers in the Institute of Respiratory Medicine (IPR), Hospital Kuala Lumpur (SHAMSIR Study), 2002

Abstract and Study Overview

This cross-sectional survey investigated the prevalence of cigarette smoking and quit readiness among healthcare workers at the Institute of Respiratory Medicine (IPR), Hospital Kuala Lumpur. The study, conducted between March and April 2002, surveyed a total of 165 workers across all job categories using a pre-tested, self-administered questionnaire. Given that the IPR is a specialised institution dedicated to the management of respiratory diseases — many of which are caused or exacerbated by tobacco use — the smoking behaviour of its staff represents a particularly salient public health concern.

The principal finding was that 24.8% of the surveyed workforce were current smokers. Notably, smoking was found exclusively among male workers, yielding a male-specific prevalence of 60.3%. This rate exceeded the contemporaneous national smoking prevalence among Malaysian males, which was estimated at approximately 49.2% according to Ministry of Health data from the late 1990s and early 2000s. The majority of smokers were classified as moderate smokers, consuming between 10 and 20 cigarettes daily, and were predominantly drawn from the lower categories of the hospital workforce.

Smoking Initiation and Demographic Patterns

The median age at which smokers in this study began their tobacco use was 17.6 years, placing the typical initiation point during mid-adolescence. This finding is consistent with extensive literature demonstrating that the majority of lifelong smokers begin their habit during the teenage years. In the Malaysian context, adolescent smoking initiation has been linked to peer influence, curiosity, perceived stress relief, and the relative accessibility and affordability of tobacco products.

The concentration of smoking among lower-category workers echoes well-established socioeconomic gradients in tobacco use observed globally. Lower educational attainment, lower income levels, and occupational stress are recognised risk factors for higher smoking prevalence. In a hospital setting, workers in lower job categories — such as attendants, drivers, cleaners, and technical support staff — may have less exposure to health education messages that are more effectively reaching professional medical staff.

The Paradox of Healthcare Workers Who Smoke

The finding that healthcare workers at a respiratory medicine institute demonstrated smoking rates exceeding those of the general population raises important questions about the effectiveness of knowledge alone in modifying health behaviour. Healthcare workers possess more detailed knowledge about the harmful effects of smoking than the general population, yet this knowledge advantage does not necessarily translate into lower smoking rates, particularly among non-clinical and support staff.

This paradox has been documented in healthcare settings worldwide. Studies from various countries have shown that while physicians and senior clinical staff tend to have lower smoking rates than the general population, other categories of health workers — including nurses in some settings, and particularly non-clinical support staff — may smoke at equal or higher rates. The occupational stress of healthcare work, shift patterns disrupting daily routines, and the social dynamics of smoking breaks in the workplace may contribute to these patterns.

In the specific context of a respiratory medicine institute, the implications are particularly noteworthy. Healthcare workers who smoke may serve as poor role models for patients they encounter, potentially undermining cessation counselling. Research has shown that patients are less likely to follow smoking cessation advice from healthcare providers who themselves smoke.

Quit Readiness and Cessation Opportunities

The study found that 20 of the 38 identified smokers (52.6%) expressed readiness to quit smoking. This represents a substantial proportion of the smoking workforce and suggests a meaningful window of opportunity for workplace-based cessation interventions. The Transtheoretical Model of behaviour change posits that individuals progress through stages of precontemplation, contemplation, preparation, action, and maintenance when modifying addictive behaviours. Over half of the smokers in this study had progressed beyond precontemplation to at least the contemplation stage.

Workplace cessation programmes in healthcare settings can leverage several unique advantages. These include easy access to smoking cessation pharmacotherapy (nicotine replacement therapy, bupropion, and later varenicline), availability of medical colleagues who can provide counselling, and the professional motivation to align personal behaviour with professional health advocacy. Successful programmes have incorporated group counselling sessions, pharmacotherapy subsidies, smoke-free workplace policies, and ongoing follow-up support.

Characteristic	Finding
Total workers surveyed	165
Overall smoking prevalence	24.8%
Male smoking prevalence	60.3%
Female smoking prevalence	0%
Median age of smoking initiation	17.6 years
Typical consumption	10–20 cigarettes/day (moderate)
Smokers ready to quit	52.6% (20/38)
Predominant smoker category	Lower-category workers

Tobacco Control in Malaysia: Policy Context

At the time of this study (2002), Malaysia’s tobacco control landscape was evolving but faced significant challenges. The country had implemented the Control of Tobacco Products Regulations in 1993, which mandated health warnings on cigarette packaging and restricted advertising. However, enforcement remained variable, and smoking rates remained high, particularly among males.

Subsequent years saw Malaysia strengthen its tobacco control framework. The country ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005, committing to comprehensive measures including tax increases, smoke-free environments, graphic health warnings, and cessation support services. The progressive expansion of smoke-free zones to include healthcare facilities, government buildings, and eventually eateries represented important policy milestones.

The National Health and Morbidity Surveys conducted periodically by the Ministry of Health have tracked smoking prevalence trends over time, showing gradual but persistent declines in overall smoking rates while identifying subpopulations that remain at elevated risk. Studies such as this one contribute to the evidence base by identifying specific groups — such as non-clinical healthcare workers — that merit targeted intervention.

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