Abstract
BackgroundSmoking is a cause of avoidable morbidity and mortality. In the United Kingdom (UK) the national smoking ban inside hospital buildings is widely adhered to. There is a perception it has led to smokers congregating around hospital entrances (Selbie D. 2016, It’s time for a truly smokefree NHS. Public Health Matters Blog. Public Health England). Efforts to shift social norms and create positive smokefree environments might be strengthened by delivering social norms messages. This study explored the impact of a social norms approach campaign to reduce levels of misperceptions surrounding support for smokefree hospital entrances.MethodRepeated cross sectional study design. Staff, patients, and hospital visitors at Pinderfields National Health Service (NHS) Hospital (Wakefield, United Kingdom (UK)) completed a survey before and after implementation of a public health social norms campaign (n = 481 surveyed before; n = 459 surveyed after). The main outcome measure was difference between perceived and reported levels of support for smokefree hospital entrances.ResultsThere were high levels of support for smokefree hospital entrances. The majority of participants agreed that patients (n = 849, 90% agreed), staff (n = 863, 92% agreed), and visitors (n = 850, 90% agreed) should not smoke in the hospital entrance.Participants underestimated the proportion of others who self-reported keeping the entrance smokefree. Over 90% of respondents reported not smoking in the hospital entrance, but the perception was that between 50 to 75% of hospital staff, patients, and visitors did not smoke in the hospital entrance.The mean percentage of hospital staff, patients, and visitors who respondents thought did not smoke in entrances was higher for respondents responding after, compared to those responding before, the campaign. There was an overall significant effect of time on attitudes towards smoking in the entrances; in all instances the mean percentage of hospital staff, patients, and visitors the participants believed agreed that hospital entrances should be smokefree was higher for those responding after, compared with before, the campaign.ConclusionsPeople hold misperceptions of the proportion of people who choose to smoke in the hospital entrance. The social norms approach campaign was associated with a strengthening of positive social norms. Such campaigns should be considered by Trusts as one evidence-based based tactic to denormalise smoking, increase support for smokefree policies.
Highlights
Smoking is a cause of avoidable morbidity and mortality
Participants underestimated the proportion of others who self-reported keeping the entrance smokefree
The social norms approach campaign was associated with a strengthening of positive social norms
Summary
In the United Kingdom (UK) the national smoking ban inside hospital buildings is widely adhered to. This study explored the impact of a social norms approach campaign to reduce levels of misperceptions surrounding support for smokefree hospital entrances. Smoking is a major cause of inequalities in health [1, 2] and an avoidable cause of morbidity and mortality in the United Kingdom [3, 4]. Evidence suggests that smoke-free legislation has been effective in protecting people from the harmful effects of second-hand smoke exposure while in public places and buildings [9,10,11]. There is evidence for mixed support for smoke-free policies in some NHS settings (e.g. psychiatric services) [12]. Countries report mixed results after implementing smokefree policies within hospital settings. Greece struggled to implement their 2002 ban of smoking in enclosed places [13]
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