Introduction:
HCWs have adopted certain attitudes and behaviors regarding smoking behavior and risk perception of respiratory diseases.

Methods:
An online anonymous survey was conducted between 01/12/2022 and 01/12/2023 based on a questionnaire. Demographic characteristics, tobacco smoking history, and immunization, including their attitude and risk towards influenza, COVID-19 disease, and CAP, were studied.

Results:
Four hundred seventy-five participants, 265 current smokers/210 ex-smokers, mean age of 43.5 ± 13.8 years, 284 worked in general hospitals, 171 in health care centers, and 20 in one-day clinics. Smokers presented 35±4 pack/yrs and Fagerström score (6±2), while ex-smokers presented 28±9 pack/yrs and Fagerström score (3±3). Active smokers reported a flu vaccine (2022-2023 period) rate of 58%, for SARS-CoV-2 23%, and 39% for CAP vaccines. Most smokers and ex-smokers were vaccinated for influenza as it is considered safer (p<0.001) than SARS-CoV-2 (p<0.003). Reasons for low COVID-19 immunization rate were fear of side effects (22.5%), doubt on efficacy (27%), unawareness of updated vaccine (13.5%), doubt on safety (20%), and lack of data (17%). Smoking may be a significant risk of flu (p<0.01) and of CAP (p<0.03), but a moderate risk of SARS-CoV-2 (p<0.07). Current smokers with a higher Fagerström Test intend to get vaccinated for CAP (33%) and (26%) for SARS-CoV-2. Only 37.7% of responders recommended vaccinations, and 21% were willing to undergo a Tobacco Cessation Program.

Conclusions:
Health promotion and education programs are needed to improve HCW’s knowledge about vaccination and immunization coverage.