Background:
Children and pregnant women are vulnerable to the harms of tobacco smoke. All healthcare professionals (HCPs) have a responsibility to protect them from tobacco smoke. This study aims to identify the gaps between this knowledge and real world practice in a clinical setting.

Methods:
Self administered questionnaires were distributed to 2436 HCPs at a women´s and children´s hospital. The HCPs were asked about their practice of smoking/tobacco smoke exposure (TSE) assessment and provision of smoking cessation advice/assistance in their clinical work, and the barriers they face in carrying out these activities.

Results:
The response rate was 74.6% (1817 respondents), from 276 (15.2%) doctors, 1498 (82.4%) nurses and 43 pharmacists (2.4%). Only 20% of HCPs would always ask about smoking/TSE, while 19.5% do not at all. Only 15.1% of HCPs would always provide smoking cessation advice/assistance to patient smokers or smoker parents/caregivers, while 28.4% do not at all. Only 7.9% of Paediatrics HCPs would always ask about smoking/TSE, while 38.7% of O&G HCPs would always do so (p = 0.000). The reasons/barriers for not always assessing smoking/TSE or providing smoking cessation advice/assistance are listed in Table 1.

[Table 1 - Reasons and Barriers]


The most common interventions for patient smokers and smoker parents/caregivers are provision of general advice for the smoker to quit smoking (36.5%), assessment of smoker willingness to quit (15.7%), and provision of reading materials (9.9%). The suggestions from HCPs on how to overcome the barriers identified are relevant training courses for all HCPs (62.2%), setting up of smoking cessation clinics (42.4%), and training more smoking cessation counselors (30.6%).

Conclusions:
There is room for improvement in the real world practice of HCPs in protecting children and women from tobacco smoke. Awareness and mindset issues are barriers to be addressed. Fear of negative reaction and lack of counseling skills limit HCPs´ confidence but the majority are receptive to receiving training.