Smoking bans in mental health hospitals in Japan: barriers to implementation.

Kazumichi Hashimoto,Shotaro Ueda,Toshifumi Kishimoto,Yasuhiro Matsuda,Tsubasa Morimoto,Manabu Makinodan

doi:10.1186/s12991-015-0076-9

Abstract

BackgroundA number of studies have reported that smoking rates are higher and smoking cessation rates are lower in patients with mental disorders than in the general population. Despite the harmful effects of smoking, implementing total smoking bans in mental health hospitals is difficult. We investigate the status of smoking bans and the barriers to the implementation of total smoking bans in Japanese mental health hospitals.MethodsA questionnaire survey was administered to the directors of 1242 Japanese mental health hospitals in March 2013.ResultsForty-nine percent (n = 612) of the hospital directors responded. Of these, 24 % implemented total smoking bans and 14 % limited the bans to hospital buildings. In 66 and 68 % of the remaining hospitals, smoking rooms were located in open and closed wards, respectively, and completely separate from nonsmoking areas. Hospitals that had not implemented total smoking bans were concerned that introducing a total ban would exacerbate patients’ psychiatric symptoms (46 %) or increase the incidence of surreptitious smoking (65 %). However, of the hospitals that had implemented total smoking bans, only 2 and 30 % identified “aggravation of psychiatric symptoms” and “increased surreptitious smoking” as disadvantages, respectively. The other concerns regarding the implementation of total smoking bans were staff opposition (21 %) and incidence of smoking around hospital grounds (46 %). These concerns were overcome by educating staff about smoking and cleaning the area around the hospital.ConclusionsThere are some barriers to implementing total smoking bans in Japanese mental health hospitals. However, our study indicates that implementation of total smoking bans in mental health hospitals was minimally problematic and that barriers to the implementation of smoking bans could be overcome. As the current number of hospitals that have implemented total smoking bans is low in Japan, more hospitals should introduce total smoking bans.Electronic supplementary materialThe online version of this article (doi:10.1186/s12991-015-0076-9) contains supplementary material, which is available to authorized users.

Highlights

A number of studies have reported that smoking rates are higher and smoking cessation rates are lower in patients with mental disorders than in the general population
54 % reported that smoking bans were in force in their outpatient wards, and 71 % reported that smoking areas were located outside hospital buildings, close to outdoor nonsmoking areas in the hospital grounds
This study investigated the status of smoking bans in Japanese mental health hospitals

Summary

Introduction

A number of studies have reported that smoking rates are higher and smoking cessation rates are lower in patients with mental disorders than in the general population. Despite the harmful effects of smoking, implementing total smoking bans in mental health hospitals is difficult. We investigate the status of smoking bans and the barriers to the implementation of total smoking bans in Japanese mental health hospitals. In Japan, the Health Promotion Act was introduced in 2002 to maintain health and prevent the spread of modern disease [4]. According to this law, superintendents of facilities used by a large number of people—such as schools, hospitals, and public amenities—are required to protect users from secondhand smoke, which is a risk factor for lung cancer [5] and heart disease mortality [6]. The notice “Concerning Measures for Passive Smoking Prevention” was issued by the Director General of the Health Service

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Discussion

Conclusion