Bulgarian doctors say NO to smoking liberalization 

Over 85% of doctors say NO to smoking in public places;

Over 64% of doctors think removing the current smoking ban will have serious negative consequences to health;

Over 73% of doctors are convinced they can have a positive influence witth patients and society in general in prevention of smoking;

(11 June 2013) - There is ongoing debate in Bulgaria to revert already adopted legislation for smoking ban at public places. This debate has intensified with the completion of the general elections and forming of the new government. One of the first initiatives of the leading socialist party (BSP) was to liberalize smoking at public places. This initiative sparkled a wave of controversies widely communicated in local media. The debate on smoking is still ongoing.

Healthgrouper, an international health services research project, conducted a rapid survey among doctors in Bulgaria to assess their attitudes over smoking and the ongoing debate. The survey was aimed to assess doctors’ opinions in relation to the new government initiative to allow smoking in public places. Healthgrouper posses’ largest database of verified email addresses of doctors from South East Europe including Bulgaria. A brief questionnaire consisted of only 8 questions was developed and distributed to 300 randomly selected doctors, out of whom 150 participated in the survey. This press release presents only the preliminary data. By the end of the week Healthgrouper will release its full report that will also include data among general public. (CLICK HERE TO ACCESS FULL PRESS RELEASE)

Our study population was consisted of 200 medical doctors, of whom 46% were females, and 54% were males. The great majority of the surveyed doctors were specialists (76.8%) representing different specialties across the whole country. Only 12.4% of the surveyed doctors were general practitioners. Around 9% of the participants doctors were dentists. The average age of the doctors was 50.6 years. 

When asked if they are current smokers, over 2/3 or 73% of the surveyed doctors stated they are non smokers, while less than one third (27%) confirmed they are smokers.

Doctors were also asked to express their opinion on the consequences to health if the existing smoking legislation is changed. Table 4 presents distribution of doctors’ responses to this question.

A majority of 63% of the doctors stated that the consequences to the health of the people would be negative if the current legislation is stopped.

Healthgrouper Comments

According to the latest WHO Euro data one of the most important risk factors in overall mortality in Bulgaria is smoking. A recent WHO report "Mortality attributable to tobacco" estimated that smoking was responsible for one in three of deaths in Bulgaria in the 30 to 44 age group, and one in two deaths in the 45 to 59 age group. In Bulgaria 82% of deaths from cancer of the trachea, bronchus and lung were due to tobacco use.The Bulgarian average standardized death rate for smoking-related causes in 2011 was estimated to be 317/100 000, which is almost twice as high as the EU15 average. The chart below presents the distribution of standardized death rates of smoking related causes for Bulgaria and selected countries. The latest available data on prevalence of smoking from the European Health Survey found that 40.5% of males and 18.9% of females are daily smokers in Bulgaria. This is triple the rates of US adult population estimated at 19.8%. In addition according to latest available data from Eurobarometar study “Attitudes of Europeans Towards Tobacco” Bulgaria is with the highest proportion of smokers next to Greece that is No 1 in Europe. Daily use of manufacture cigarettes is highest in Bulgaria with 94% of smokers who use these products every day. 

Jerusalem (June 11, 2013) Ted Tulchinsky, member of the International advisory board at and professor of public health at the Braun School of Public Health and Community Medicine in Jerusalem on the results:
“Smoking kills more people than any other single cause. Governments around the world are restricting cigarette advertising and smoking in public places. Any government that moves to remove these restrictions is guilty of deliberately contributing to the death of many of its citizens and should be held accountable.



Healthgrouper is health services research project in South-East Europe. Healthgrouper conducts research in all countries where it is active, in order to make comparative analyses of the conditions in the health systems in the region and improve the quality of healthcare. The results of the surveys are published in local media, scientific publication and are available online. Healthgrouper is a registered trademark in European Union.