Offered Nicotine Replacement Therapy Research Articles

Telehealth: a new opportunity to discuss smoking cessation with indigenous cancer patients and their families.

[Extract] Public health initiatives aimed at promoting the negative health impacts of smoking have led to decreases in smoking among non-indigenous populations; however, higher rates of smoking continue to be the leading cause of disease burden among indigenous populations throughout the developed world. For Aboriginal and Torres Strait Islander peoples (hereafter referred to as Indigenous Australians), the situation is dire with Indigenous Australians 1.9 times more likely to die of lung cancer Rates of smoking vary within and between Indigenous communities with significantly higher rates reported for Indigenous populations (41%) compared with non-Indigenous Australians (16%). Remoteness and younger age appear to be critical risk factors for higher rates of smoking among Indigenous Australians with rates as high as 62% reported for women aged 15 to 34 years in a remote community in North Queensland and 76% among men in a community in the Northern Territory.

Type of unit and population served matters when implementing a smoke-free policy in mental health settings: Perceptions of unit managers across England.

Globally, smoking remains a significant issue for mental health populations. Many mental health trusts in England are facing challenges of implementing the National Institute for Health and Care Excellence guidance according to which all mental health settings, no matter the type, should be entirely smoke-free and provide comprehensive smoking cessation support. The aim of this paper was to determine if unit type and unit manager smoking status influence mental health smoke-free policy implementation. This paper reports on the secondary analysis of data from a cross-sectional survey of 147 mental health inpatient settings in England, in 2010. The original study's main aim was to understand unit managers' perceived reasons for success or failure of smoke-free policy. Unit managers (n = 131) held a positive stance towards supporting smoke-free policy and most perceived that the policy was successful. Non-smoker unit managers were more likely to adopt complete bans than smoker unit managers, whereas smoker unit managers were more likely than non-smoker unit managers to think that stopping smoking aggravated patients' mental illness. Smoking rates for staff and patients remain high, as perceived by unit managers, regardless of unit type. Proportion of units offering nicotine replacement therapy and peer support to patients was significantly higher in locked units compared to semi-locked or residential rehabilitation. Applied strategies significantly vary by type of unit, whereas unit managers' knowledge, attitude and practices vary by their smoking status. There are nuanced differences in how smoke-free policy is enacted which vary by unit type. These variations recognise the differing contexts of care provision in different types of units serving different patient groups. Addressing staff smoking rates, promoting consistency of staff response to patients' smoking and providing staff education and support continue to be key strategies to successful smoke-free policy. Our results demonstrate the importance of taking into account the type of unit and acuity of patients when enacting smoke-free policy and addressing staff smoking.

Case Report: Nicotine Replacement Therapy (NRT) in Hospitalized Surgical Patient

Hospital surgical services are often reluctant to offer nicotine replacement therapy (NRT) to inpatients due to concerns that nicotine leads to vasoconstriction and impaired wound healing. However, multiple potential health benefits result from offering NRT to hospitalized surgical patients who use tobacco products. A 28-year-old female patient, hospitalized following a motor vehicle accident, experienced severe nicotine withdrawal symptoms and a strong desire to smoke. After a Tobacco Treatment Specialist (TTS) consultation, the Physical Medical and Rehabilitation service at the hospital began her on NRT with positive outcomes. The patient experienced decreased cravings and withdrawal symptoms, as well as an increased desire to remain tobacco free after discharge. More surgical patients may have an increased commitment to remain tobacco free after discharge, if their withdrawal symptoms are treated during hospitalization using NRT.

Assessing the effectiveness of a pharmacist-delivered smoking cessation program in the State of Qatar: study protocol for a randomized controlled trial.

BackgroundIt had been reported that up to 37% of the adult male population smokes cigarettes in Qatar. The Global Youth Tobacco Survey also stated that 13.4% of male school students aged 13 to 15 years in Qatar smoke cigarettes. Smoking cessation is key to reducing smoking-related diseases and deaths. Healthcare providers are in an ideal position to encourage smoking cessation. Pharmacists are the most accessible healthcare providers and are uniquely situated to initiate behavior change among patients. Many studies have shown that pharmacists can be successful in helping patients quit smoking. Studies demonstrating the effectiveness of pharmacist-delivered smoking cessation programs are lacking in Qatar. This proposal aims to test the effect of a structured smoking cessation program delivered by trained ambulatory pharmacists in Qatar.Methods/DesignA prospective, randomized, controlled trial is conducted at eight ambulatory pharmacies in Qatar. Participants are randomly assigned to receive an at least four-session face-to-face structured patient-specific smoking cessation program conducted by the pharmacist or 5 to 10 min of unstructured brief smoking cessation advice (emulating current practice) given by the pharmacist. Both groups are offered nicotine replacement therapy if feasible. The primary outcome of smoking cessation will be confirmed by an exhaled carbon monoxide test at 12 months. Secondary outcomes constitute quality-of-life adjustment as well as cost analysis of program resources consumed, including per case and patient outcome.DiscussionIf proven to be effective, this smoking cessation program will be considered as a model that Qatar and the region can apply to decrease the smoking burden.Trial registrationClinical Trials NCT02123329.

Do primary health care nurses address cardiovascular risk in diabetes patients?

AimsTo identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand. MethodsPrimary health care nurses (n=287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n=284) and telephone interview. Nurses provided details for 86% (n=265) of all diabetes patients they consulted on a randomly selected day. ResultsThe response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p=0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p<0.0001). ConclusionsMeasurement of blood pressure and advice on diet or physical activity were not related to patient's cardiovascular risk profile and management of smoking cessation was far from ideal. Education of the community-based nursing workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management.

Provision of smoking cessation support for pregnant women in England: results from an online survey of NHS stop smoking services for pregnant women

BackgroundSmoking during pregnancy is a major public health concern and an NHS priority. In 2010, 26% of UK women smoked immediately before or during their pregnancy and 12% smoked continuously. Smoking cessation support is provided through free at the point of use Stop Smoking Services for Pregnant women (SSSP). However, to date, little is known of how these services provide support across England. The aim of this study was to describe the key elements of support provided through English SSSP.MethodsSSSP managers were invited to participate in this survey by email. Data were then collected via an online questionnaire; one survey was completed for each SSSP. Up to four reminder emails were sent over a two month period.Results86% (121 of 141) of services completed the survey. Responding services were, on average, larger than non-responding services in terms of the number of pregnant women setting quit dates and successfully quitting (p < 0.01). In line with the 2010 NICE guidelines, Stop Smoking in Pregnancy and following Childbirth, one in five SSSP identified pregnant smokers using carbon monoxide (CO) testing and refer via an opt-out pathway. All services offered nicotine replacement therapy (NRT) to pregnant women and 87% of services also offered dual therapy NRT, i.e. combination of a patch and short acting NRT product.. The 2010 NICE guidelines note that services should be flexible and client-centred. Consistent with this, SSSP offer pregnant women a range of support types (median 4) including couple/family, group (open or closed) or one-to-one. These are available in a number of locations (median 5), including in community venues, clinics and women’s homes.ConclusionsEnglish Stop Smoking Services offer behavioural support and pharmacotherapy to pregnant women motivated to quit smoking. Interventions provided are generally evidence-based and delivered in a variety of both social and health care settings.

The development of the tobacco tactics website.

BackgroundWeb-based cessation interventions have been shown to reduce tobacco use, be more efficacious than self-help booklets, be more efficacious if they provide tailored messages, and enhance quit rates in conjunction with nicotine replacement therapy.ObjectiveThe objective of this study was to usability test and pilot test the Tobacco Tactics website for veterans.MethodsBoth formative and summative evaluations were used across three small successive studies to develop and test the Tobacco Tactics website for veterans, which was based on a prior face-to-face smoking cessation intervention. Once the website was developed, the research team and Web developers usability tested the website with 5 veteran smokers and former smokers. Feedback from the veterans was collected as they navigated each webpage, then used to revise the website. In pilot study 1, 9 veteran smokers were provided access to the website, and given a baseline and 30-day follow-up survey. In pilot study 2, 18 veteran smokers, who were also motivated to quit smoking, were recruited and randomized to either the Tobacco Tactics website plus nicotine replacement therapy or to the 1-800-QUIT-NOW telephone line.ResultsAs a result of usability testing, more than 27 modifications were made to improve the website. In pilot study 1, 50% (3/6) veterans who entered the website had cut down on the number of cigarettes and 83% (5/6) found the website enjoyable, easy to read, easy to navigate, and would recommend the website to others. In pilot study 2, which included only smokers motivated to quit and also offered nicotine replacement therapy, seven-day point prevalence abstinence at 30-day follow-up was 40% (4/10) in the intervention group compared to 13% (1/8) in the control group.ConclusionsThese preliminary results are promising and suggest the need for wider-scale testing of the Tobacco Tactics website for veterans.

Feasibility of offering nicotine replacement therapy as a relapse prevention treatment in routine smoking cessation services

BackgroundNational Health Service stop smoking services (NHS SSS) in the UK offer cost- effective smoking cessation services. Despite high abstinence rates after acute cessation treatment, the majority of clients have relapsed by one year. Several interventions have been identified, from trial data, as effective in preventing relapse to smoking. This study investigated uptake, feasibility and acceptability of offering nicotine replacement therapy (NRT) as a relapse prevention intervention (RPI) in NHS SSS.MethodsEligible smokers who had successfully completed acute cessation treatment using NRT at Nottingham City NHS SSS between April 2010 and January 2011 were offered the RPI and the rate of uptake was monitored. Consenting individuals completed a baseline questionnaire, providing demographic and smoking behaviour data. The RPI consisted of using NRT for a further 12 weeks after initial cessation-orientated treatment had ended. At a six-month review, self-reported smoking status was assessed via telephone. Anonymised demographic data on NHS SSS users who did not agree to participate in the study were retrieved from NHS SSS records and used to determine the presence of any socio-demographic differences between individuals who agreed to participate in the study and those who did not. Semi-structured telephone interviews were conducted with a selection of participants; these were audio-recorded, transcribed and analysed to identify participants’ views on the RPI.ResultsOf 493 stop smoking service clients who were assessed, 260 were eligible for and offered the RPI and 115 (44%, CI 38%- 50%) accepted. Individuals who accepted NRT were significantly more likely to be older (p < 0.001) and to pay for their prescriptions (p < 0.001). Quitters who had never worked or were unemployed were significantly less likely to accept the offer of relapse prevention compared to those in routine and manual occupations (55% reduction in odds, p = 0.026).Interview findings revealed that clients who accepted extended NRT felt the longer duration of pharmacological and psychological support were both valuable in helping them to remain abstinent.ConclusionIn routine smoking cessation service care, it is feasible to offer clients extended courses of NRT as a RPI. The RPI was acceptable to them as almost half of the eligible clients offered this treatment accepted it.

Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: randomised controlled trial

Objective To compare the effects of free nicotine replacement therapy or proactive telephone counselling in addition to standard smoking cessation support offered through a telephone quitline.Design Parallel group, 2×2 factorial,...

198 Identification of smoking status among hospitalized cardiac patients: Are we doing enough to promote smoking cessation?

Smoking has adverse prognostic consequences in patients with established coronary artery disease (CAD), including greater subsequent rates of non-fatal myocardial infarctions, recurrent coronary events, restenosis and all-cause mortality. Smoking cessation is the most effective lifestyle modification in the management of patients with CAD. Clearly, patient smoking status should be screened systematically in inpatient cardiac settings, and smoking patients should be offered evidence-based cessation therapies. This study investigated cardiac outpatients' recall of: (1) being asked about their smoking status, and (2) among smokers, their recall of being offered treatment while hospitalized. In this cross-sectional substudy, 155 consenting CAD outpatients referred to 1 of 5 Ontario cardiac rehabilitation (CR) programs were provided a self-report survey at their first CR intake visit. Patients were asked to report their current smoking status, whether they recalled being asked about their smoking status while in-hospital, whether they were offered treatment, and the nature of treatment offered. A descriptive examination was performed. Of all participants, 9 (5.8%) reported they had never smoked. 126 (81.8%) reported they had quit smoking (24.62 ± 13.87 years). Finally, 19 (12.3%) reported being current smokers (Mean = 13.78 ± 10.67 cigarettes/day for 33.8 ± 12.80 years). Of all participants, 25 (16.2%) reported not being asked in hospital whether or not they smoked. This did not differ by time since hospital discharge (mean 10.54 ± 14.18, median 6, weeks P = 0.641). Of cardiac patients that currently smoked, 2 (10.5%) did not recall being asked if they smoked. When asked whether a healthcare provider offered them treatment or counseling to assist them in smoking cessation, overall 41 (26.6%) responded affirmatively. Of the current smokers, 11 (57.9%) reported being offered treatment. Specifically, 5 (50%) were offered nicotine replacement therapy, 4 (40%) were offered counselling, and 1 (10%) was offered Champix. Approximately 1/6 of cardiac patients do not recall being asked about their smoking status while hospitalized, with a slightly higher rate of recall among smokers (10%). Moreover, approximately 40% of smoking cardiac patients do not recall being offered smoking cessation treatment or counseling by a healthcare provider. These findings may be explained by patient recall failure, however clearly we should be striving to achieve universal screening of all smoking cardiac patients, and application of evidence-based strategies to promote cessation, such as the Ottawa Model for Smoking Cessation.

Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

BackgroundUK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions.MethodsElectronic questionnaire survey of 185 UK Stop Smoking Services Managers.ResultsNinety six Stop Smoking Service managers returned completed questionnaires (52% response rate). Of these, 58.3% (n = 56) ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%), group (73%), and individual (54%). Just under half (48%, n = 27) offered nicotine replacement therapy (NRT), 21.4% (n = 12) bupropion; 19.6% (n = 11) varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22) believed that the government focus on four-week quit rates, and 42.9% (14 services) believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care.ConclusionsJust over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

The impact of a free nicotine patch starter kit on quit rates in a state quit line

All states offer telephone quit lines but they are under-used in part because of the costs associated with promotion. Offering nicotine replacement therapy (NRT) as well as behavioral counseling can increase treatment participation and abstinence rates, but is expensive. Offering less than a full NRT 8-week course can also generate calls to the quit line but less is known about its impact on program outcomes. In October 2004, Oregon--a state with over 3 million people, 500,000 smokers, and a state-funded quit line--introduced the Free Patch Initiative: a free 2-week introductory supply of NRT with phone counseling offered to all callers. We examined the impact of this intervention among insured callers. Most (97.2%) requested free patches, 86.2% used them, and 47.2% obtained additional patches on their own. Six-month outcome data were obtained from insured quit line participants before (n = 268) and after (n = 614) the Initiative launched. Compared with pre-Initiative controls, Free Patch participants were more satisfied with the quit line (84.8% vs. 89.8%; p = .04) and had higher 7-day quit rates using the assumption that eligible nonrespondents are smokers (9.3% vs. 17.0%, OR = 2.0; 95% CI 1.4-2.8) and using respondent only analysis (19% vs. 33.6%, OR = 2.15; 95% CI 1.52-3.04). Offering a free direct mail starter pack of NRT along with telephone counseling is an effective, cost-sharing method for promoting quit line use, enhancing participant satisfaction, and increasing the reach and effectiveness of quit lines among quit line callers with health insurance.

A randomised controlled trial of a smoking cessation intervention delivered by dental hygienists: a feasibility study.

BackgroundTobacco use continues to be a global public health problem. Helping patients to quit is part of the preventive role of all health professionals. There is now increasing interest in the role that the dental team can play in helping their patients to quit smoking. The aim of this study was to determine the feasibility of undertaking a randomised controlled smoking cessation intervention, utilising dental hygienists to deliver tobacco cessation advice to a cohort of periodontal patients.MethodsOne hundred and eighteen patients who attended consultant clinics in an outpatient dental hospital department (Periodontology) were recruited into a trial. Data were available for 116 participants, 59 intervention and 57 control, and were analysed on an intention-to-treat basis. The intervention group received smoking cessation advice based on the 5As (ask, advise, assess, assist, arrange follow-up) and were offered nicotine replacement therapy (NRT), whereas the control group received 'usual care'. Outcome measures included self-reported smoking cessation, verified by salivary cotinine measurement and CO measurements. Self-reported measures in those trial participants who did not quit included number and length of quit attempts and reduction in smoking.ResultsAt 3 months, 9/59 (15%) of the intervention group had quit compared to 5/57 (9%) of the controls. At 6 months, 6/59 (10%) of the intervention group quit compared to 3/57 (5%) of the controls. At one year, there were 4/59 (7%) intervention quitters, compared to 2/59 (4%) control quitters. In participants who described themselves as smokers, at 3 and 6 months, a statistically higher percentage of intervention participants reported that they had had a quit attempt of at least one week in the preceding 3 months (37% and 47%, for the intervention group respectively, compared with 18% and 16% for the control group).ConclusionThis study has shown the potential that trained dental hygienists could have in delivering smoking cessation advice. While success may be modest, public health gain would indicate that the dental team should participate in this activity. However, to add to the knowledge-base, a multi-centred randomised controlled trial, utilising biochemical verification would be required to be undertaken.

Acupressure for smoking cessation – a pilot study

BackgroundTobacco smoking is a serious risk to health: several therapies are available to assist those who wish to stop. Smokers who approach publicly funded stop-smoking clinics in the UK are currently offered nicotine replacement therapy (NRT) or bupropion, and group behaviour therapy, for which there is evidence of effectiveness. Acupuncture and acupressure are also used to help smokers, though a systematic review of the evidence of their effectiveness was inconclusive. The aim of this pilot project was to determine the feasibility of a study to test acupressure as an adjunct to one anti-smoking treatment currently offered, and to inform the design of the study.MethodsAn open randomised controlled pilot study was conducted within the six week group programme offered by the Smoking Advice Service in Plymouth, UK. All participants received the usual treatment with NRT and group behavioural therapy, and were randomised into three groups: group A with two auricular acupressure beads, group B with one bead, and group C with no additional therapy. Participants were taught to press the beads when they experienced cravings. Beads were worn in one ear for four weeks, being replaced as necessary. The main outcome measures assessed in the pilot were success at quitting (expired CO ≤ 9 ppm), the dose of NRT used, and the rating of withdrawal symptoms using the Mood and Symptoms Scale.ResultsFrom 49 smokers attending four clinics, 24 volunteered to participate, 19 attended at least once after quitting, and seven remained to the final week. Participants who dropped out reported significantly fewer previous quit attempts, but no other significant differences. Participants reported stimulating the beads as expected during the initial days after quitting, but most soon reduced the frequency of stimulation. The discomfort caused by the beads was minor, and there were no significant side effects. There were technical problems with adhesiveness of the dressing. Reporting of NRT consumption was poor, with much missing data, but reporting of ratings of withdrawal symptom scores was nearly complete. However, these showed no significant changes or differences between groups for any week.ConclusionAny effects of acupressure on smoking withdrawal, as an adjunct to the use of NRT and behavioural intervention, are unlikely to be detectable by the methods used here and further preliminary studies are required before the hypothesis can be tested.

Interactive voice response telephony to promote smoking cessation in patients with heart disease: A pilot study

Objective A pilot study was conducted to determine the feasibility and potential efficacy of an interactive voice response (IVR) follow-up system for smokers recently hospitalized with coronary heart disease (CHD). Methods Ninety-nine smokers hospitalized with CHD completed a baseline questionnaire, were provided with bedside counseling, and offered nicotine replacement therapy. They were randomly assigned to a usual care (UC) or an IVR group. The IVR group received automated telephone follow-up calls 3, 14 and 30 days after discharge inquiring about their smoking status and confidence in remaining smoke-free. When deemed necessary, they were offered additional counseling. Smoking status was determined 52 weeks after hospital discharge. Results The 52-week point prevalence abstinence rate in the IVR group was 46.0% compared to 34.7% in the UC group (OR = 1.60, 95% CI: 0.71–3.60; P = .25). After adjustment for education, age, reason for hospitalization, length of hospitalization, and quit attempts in the past year, the odds of quitting in the IVR group compared to the UC group were 2.34 (95% CI: 0.92–5.92; P = .07). Conclusions IVR is a promising technology for following CHD patients attempting to quit smoking following discharge from hospital, however, a larger trial is required to confirm its efficacy. Practice implications IVR may enhance the timely provision of follow-up counseling for smoking cessation in patients with CHD.

Designing smoking cessation services for school-age smokers: A survey and qualitative study

To identify the preferred design characteristics of smoking cessation services for school-age smokers, we conducted focus groups with teenage smokers motivated to stop smoking. We surveyed all pupils in years 9-11 (aged 13-16) in a random sample of 10 schools in Nottinghamshire, United Kingdom, to elicit details of smoking behavior, and conducted 25 focus groups in 6 schools with current smokers who wanted to stop smoking. Of 4,065 pupils surveyed, 888 (22%) were current smokers, and 438 (50% of smokers) wanted to quit smoking. We sampled 226 of these individuals for focus group studies, and 135 (60%) participated. These participants were motivated to quit, and almost all had tried to do so but had found it too difficult. Many were aware of smoking cessation methods but had low perceptions of their effectiveness based on their own or others' poor experiences of these interventions, and few were aware of the possibility of professional cessation support. Given clear, nondirective information about interventions, participants reported a preference for confidential, nonjudgmental services delivered during school time by a trained counselor, allowed the option to attend with friends, and offered nicotine replacement therapy (NRT). School-age smokers in Nottinghamshire, United Kingdom, who are motivated to stop smoking have low knowledge and opinions of smoking cessation interventions. Our findings indicate that young smokers would favor school-based services offering confidential professional counseling and NRT.

A Survey of Characteristics of Smokeless Tobacco Users in a Treatment Program

To determine the characteristics and outcomes of smokeless tobacco (ST) users receiving interventions in an outpatient tobacco-dependence treatment program. Survey was mailed with telephone follow-up to ST users treated during a 2-year period. Nicotine replacement therapy and family and social support were the most helpful intervention components in maintaining tobacco abstinence. Continuing ST users face significant barriers to abstinence such as high levels of nicotine dependence, lack of motivation, nicotine withdrawal symptoms, and stress. Enhancing confidence in their ability to quit, managing stress, prescribing bupropion SR, offering nicotine replacement therapy to relieve withdrawal symptoms, and providing ongoing support may be important for ST users in tobacco- dependence treatment programs.

Non-smoking policies and practices in Norwegian delivery units in 1994.

To determine the number of delivery units in Norway that have become smoke free for employees and patients. A pre-categorised questionnaire was sent in September 1994 to the physician or midwife responsible for each of the 68 delivery units in the country. Hospital smoking policies, reported difficulties in implementation, use of nicotine replacement therapy in patients, and provision of information on tobacco-related health hazards to patients. Fifty-six units (82.3%), accounting for 93% of all deliveries in Norway in 1993, responded. Of these, 42 (75%) were smoke-free for employees, and 33 (59%) for patients. Nearly all had become smoke-free after 1990. No significant difference was seen according to type or size of delivery unit. No difficulties in the implementation of policies restricting smoking were reported. Thirty-one (55%) routinely informed patients of the health implications of smoking during pregnancy. Two units offered nicotine replacement therapy to patients. Most Norwegian delivery units were smoke-free for both employees and patients. Provided that the recent trend toward adoption of smoke-free policies continues, all delivery units in Norway should be smoke-free by 1997-1998.