World Journal of Urology

, Volume 36, Issue 8, pp 1219–1224 | Cite as

Knowledge of smoking as a risk factor for disease among urology clinic patients in Australia

  • Munad Khan
  • Nathan Papa
  • Todd Manning
  • Tatenda Nzenza
  • Lauren Simionato
  • Nathan Lawrentschuk
Original Article



Smoking remains a common habit among the general population. Despite the well-established risks of smoking, relatively few studies have been undertaken to assess the understanding of these risks among the general population. We intended to assess the understanding of smoking as a risk factor for various conditions in a urology outpatient cohort to assess the level of knowledge as well as particular strengths and weaknesses they possess.


A four-page questionnaire was distributed among urology outpatients over a 5 month period. The questionnaire captured information regarding the knowledge of smoking as a risk factor for various urological and non-urological conditions. Results were collated and stratified according to patient’s cancer history as well as smoking status.


A total of 112 participants were included in our analytical sample. Our study demonstrated a deficiency in knowledge regarding smoking and urological conditions. When ranked by level of knowledge, four of the bottom five conditions were urological in nature. Furthermore, we found that patients with a personal cancer history demonstrated generally poorer knowledge of smoking as a risk factor compared to patients without a cancer history. Conversely, smokers themselves demonstrated a greater understanding of risks compared to non-smokers.


Our study suggests there is much work to be done in the education of patients on the risks of smoking from a urological point of view. We believe more initiative needs to be taken by the specialists treating such patients to achieve an improved level of knowledge.


Smoking Smoking cessation 



We would like to acknowledge the clerical staff at the Austin Health outpatient department for their assistance with distribution of the questionnaire.

Author contribution

MK: protocol development, data collection, data analysis, manuscript writing. NP: data analysis, manuscript writing, manuscript editing. TM: data collection, manuscript writing. TN: data collection. LS: data collection, manuscript writing. NL: protocol development, data analysis, manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Participant entry into the study was voluntary and all participants were given written information outlining the nature and scope of the study as well as the publication intentions. No identifying details were collected in this study.

Supplementary material

345_2018_2276_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 22 kb)


  1. 1.
    AIHW (2012) Risk factors contributing to chronic disease. Australian Institute of Health and Welfare, Canberra (Cat. no. PHE 157) Google Scholar
  2. 2.
    WHO Tobacco fact sheet: World Health Organisation; 2017.
  3. 3.
    Crow P, Bayley J, Keeley F (2008) Smoking and urological disease. BJU Int 103:1317–1322CrossRefGoogle Scholar
  4. 4.
    Guzzo T, Hockenberry M, Mucksavage P, Bivalacqua T, Schoenberg M (2012) Smoking knowledge assessment and cessation trends in patients with bladder cancer presenting to a tertiary referral center. Urology 79(1):166–171CrossRefPubMedGoogle Scholar
  5. 5.
    Parker A, Arnold M, Diehl N, Hassan L, Thiel D (2014) Evaluation of awareness of risk factors for kidney cancer among patients presenting to a urology clinic. Scand J Urol 48(3):239–244CrossRefPubMedGoogle Scholar
  6. 6.
    Gottlieb J, Higley C, Sosnowski R, Bjurlin M (2016) Smoking related genitourinary cancers: a global call to action in smoking cessation. Rev Urol 18(4):194–204PubMedPubMedCentralGoogle Scholar
  7. 7.
    Brennan P, Bogillot O, Cordier S, Greiser E, Schill W, Vineis P et al (2000) Cigarette smoking and bladder cancer in men: a pooled analysis of 11 case-control studies. Int J Cancer 15(86(2)):289–294CrossRefGoogle Scholar
  8. 8.
    Lipworth L, Tarone R, McLaughlin J (2006) The epidemiology of renal cell carcinoma. J Urol 176(6 Pt 1):2353–2358CrossRefPubMedGoogle Scholar
  9. 9.
    van Osch FH, Jochems SH, van Schooten FJ, Bryan RT, Zeegers MP (2016) Quantified relations between exposure to tobacco smoking and bladder cancer risk: a meta-analysis of 89 observational studies. Int J epidemiol 45(3):857–870CrossRefPubMedGoogle Scholar
  10. 10.
    Kenfield S, Stampfer M, Chan J, Giovannucci E (2011) Smoking and prostate cancer survival and recurrence. JAMA 305:2548–2555CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    De Nunzio C, Andriole G, Thompson I Jr, Freedland S (2015) Smoking and prostate cancer: a systematic review. Eur urol focus 1:28–38CrossRefPubMedGoogle Scholar
  12. 12.
    Crivelli J, Xylinas E, Kluth L, Rieken M, Rink M, Shariat S (2014) Effect of smoking on outcomes of urothelial carcinoma: a systematic review of the literature. Eur Urol. 65(4):742–754CrossRefPubMedGoogle Scholar
  13. 13.
    Rink M, Crivelli J, Shariat S, Chun F, Messing E, Soloway M (2015) Smoking and bladder cancer: a systematic review of risk and outcomes. Eur Urol Focus 1(1):17–27CrossRefPubMedGoogle Scholar
  14. 14.
    Cumberbatch MG, Rota M, Catto JW, La Vecchia C (2016) The role of tobacco smoke in bladder and kidney carcinogenesis: a comparison of exposures and meta-analysis of incidence and mortality risks. Eur Urol 70(3):458–466CrossRefPubMedGoogle Scholar
  15. 15.
    Xu Y, Qi Y, Zhang J, Lu Y, Song J, Dong B et al (2014) The impact of smoking on survival in renal cell carcinoma: a systematic review and meta-analysis. Tumour Biol 35(7):6633–6640CrossRefPubMedGoogle Scholar
  16. 16.
    Brown M, Riley G, Schussler N, Etzioni R (2002) Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care 40(8 Suppl):104–117Google Scholar
  17. 17.
    Ploeg M, Aben K, Kiemeney L (2009) The present and future of urinary bladder cancer in the world. World J Urol 27(3):289–293CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Glanz K (1997) Theory at a glance: a guide for health promotion practice. U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, Bethesda, MDGoogle Scholar
  19. 19.
    Nieder A, John S, Messina C, Granek I, Adler H (2006) Are patients aware of the association between smoking and bladder cancer? J Urol 176(6 Pt 1):2405–2408CrossRefPubMedGoogle Scholar
  20. 20.
    Bjurlin M, Cohn M, Freeman V, Lombardo L, Hurley S, Hollowell C (2012) Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases. J Urol 188:724–728CrossRefPubMedGoogle Scholar
  21. 21.
    Bassett J, Gore J, Chi A, Kwan L, McCarthy W, Chamie K et al (2012) Impact of bladder cancer diagnosis on smoking behaviour. J Clin Oncol 30(15):1871–1878CrossRefPubMedGoogle Scholar
  22. 22.
    Lee A, Ozakinci G, Leung S, Humphris G, Dale H, Hamlet N (2016) Lifestyle change in the cancer setting using ‘the teachable moment’: a protocol for a proof-of-concept pilot in a urology service. Pilot Feasibil Stud 2:65CrossRefGoogle Scholar
  23. 23.
    Bjurlin M, Goble S, Hollowell C (2010) Smoking cessation assistance for patients with bladder cancer: a national survey of American urologists. J Urol 184:1901–1906CrossRefPubMedGoogle Scholar
  24. 24.
    The health consequences of smoking—50 years of progress a report of the surgeon general (2014) united states department of health and Human services2014. Accessed 21 May 2017
  25. 25.
    Hellberg D, Valentin J, Eklund T, Nilsson S (1987) Penile cancer: is there an epidemiological role for smoking and sexual behaviour? BMJ 295(6609):1306–1308CrossRefPubMedGoogle Scholar
  26. 26.
    Daling J, Madeleine M, Johnson L, Schwartz S, Shera K, Wurscher M et al (2005) Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer 116(4):606–616CrossRefPubMedGoogle Scholar
  27. 27.
    Olano-Espinosa E, Matilla-Pardo B, Minue C, Anton E, Gomez-Gascon T, Ayesta F (2013) Effectiveness of a health professional training program for treatment of tobacco addiction. Nicotine Tob Res 15(10):1682–1689CrossRefPubMedGoogle Scholar
  28. 28.
    Bjurlin M, Cohn M, Kim D, Freeman V, Lombardo L, Hurley S et al (2013) Brief smoking cessation intervention: a prospective trial in the urology setting. J Urol 189:1843–1849CrossRefPubMedGoogle Scholar
  29. 29.
    Sitas F, Weber M, Egger S, O’Connell D (2014) Smoking cessation after cancer. J Clin Oncol 32(32):3593–3595CrossRefPubMedGoogle Scholar
  30. 30.
    Toll B, Brandon T, Gritz E, Warren G, Herbst R (2013) Assessing tobacco use by cancer patients and facilitating cessation: an American Association for cancer research policy statement. Clin Cancer Res 19(8):1941–1948CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Stewart B, Cotter PB, Bishop JF (2010) Cancer and tobacco: its effects on individuals and populations. In: Robotin M, Olver I, Girgis A (eds) When cancer crosses disciplines: a physician’s handbook. Imperial College Press, LondonGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Melbourne, Austin HospitalMelbourneAustralia
  2. 2.Olivia Newton-John Cancer Research InstituteAustin HospitalMelbourneAustralia
  3. 3.Urology Department, Level 8 HSBAustin HealthHeidelbergAustralia

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