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An estimated 10 percent of smokers don’t tell their doctor they are lighting up, a new survey reveals. That translates into more than six million people who don’t tell their doctor they smoke, according to MSNBC.

Some smokers may be reluctant to discuss their smoking because of its increasing stigma. The survey found 42 percent of people who didn’t discuss their smoking with their doctor said it was because they were ashamed.

The growth in bans on public smoking and the increase in smoke-free workplaces may be unintentionally making smokers feel less willing to talk about smoking with their doctor, said Cheryl G. Healton, President and Chief Executive Officer of Legacy, the organization that conducted the study.

“Health care providers play a critical role in reaching smokers with appropriate messages and resources for quitting, especially now that insurance coverage has expanded to include some smoking cessation treatments. It becomes a missed public health opportunity if what amounts to more than six million smokers in the United States do not talk to doctors and nurses about smoking and quitting,” Healton said in a news release.

The group has developed a guide for health care providers that provides strategies on how to conduct more productive conversations with their patients about smoking and quitting.

The online survey of 3,146 smokers and former smokers was funded in part by the pharmaceutical company Pfizer.

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