Hospital Smoke-Free Policy: Compliance, Enforcement, and Practices. A Staff Survey in Two Large Public Hospitals in Australia.

Sam Mccrabb,Amanda Baker,Kerrin Palazzi,Billie Bonevski,John Attia,Natalie Lott,Johnson George,Justine Naylor,Zsolt Balogh,Christopher Doran,Eliza Skelton,Luke Wolfenden,Ian Harris

doi:10.3390/ijerph14111358

Abstract

Background: Smoke-free hospital policies are becoming increasingly common to promote good health and quit attempts among patients who smoke. This study aims to assess: staff perceived enforcement and compliance with smoke-free policy; the current provision of smoking cessation care; and the characteristics of staff most likely to report provision of care to patients. Methods: An online cross-sectional survey of medical, nursing, and allied staff from two Australian public hospitals was conducted. Staff report of: patient and staff compliance with smoke-free policy; perceived policy enforcement; the provision of the 5As for smoking cessation (Ask, Assess, Advise, Assist, and Arrange follow-up); and the provision of stop-smoking medication are described. Logistic regressions were used to determine respondent characteristics related to the provision of the 5As and stop-smoking medication use during hospital admission. Results: A total of 805 respondents participated. Self-reported enforcement of smoke-free policy was low (60.9%), together with compliance for both patients (12.9%) and staff (23.6%). The provision of smoking cessation care was variable, with the delivery of the 5As ranging from 74.7% (ask) to 18.1% (arrange follow-up). Medical staff (odds ratio (OR) = 2.09, CI = 1.13, 3.85, p = 0.018) and full time employees (OR = 2.03, CI = 1.06, 3.89, p = 0.033) were more likely to provide smoking cessation care always/most of the time. Stop-smoking medication provision decreased with increasing age of staff (OR = 0.98, CI = 0.96, 0.99, p = 0.008). Conclusions: Smoke-free policy enforcement and compliance and the provision of smoking cessation care remains low in hospitals. Efforts to improve smoking cessation delivery by clinical staff are warranted.

Highlights

Tobacco smoking is one of the leading preventable causes of morbidity and mortality, leading to the death of approximately 6 million people each year [1]
Despite difficulties associated with smoke-free hospital policy implementation, the provision of smoking cessation care and the enforcement of and compliance with these policies remains low
It is integral that interventions to increase the provision of care and the enforcement of hospital policy are found

Summary

Introduction

Tobacco smoking is one of the leading preventable causes of morbidity and mortality, leading to the death of approximately 6 million people each year [1]. In relation to hospital smoking cessation policy, this indicates that there is a need to understand what current practice is and by whom it is being provided in order to highlight where interventions need to be targeted and who should deliver them. After determining these factors, the implementation of new interventions can be planned based on the identified barriers and facilitators to current practice. This study aims to assess: staff perceived enforcement and compliance with smoke-free policy; the current provision of smoking cessation care; and the characteristics of staff most likely to report provision of care to patients.

Objectives

Results

Discussion

Conclusion