Smoke-free Health Care Research Articles

Smoke-free hospital grounds

This study investigated whether the implementation of a multicomponent intervention project could improve compliance with the New South Wales (NSW) Health smoke-free healthcare policy. Environmental interventions were implemented on the hospital grounds for a 12-week period. Compliance was measured by a pre- and postintervention observational count of smokers on the hospital grounds. After implementation, there was a significant 73% reduction in people smoking on the hospital grounds, indicating improved compliance with the NSW smoke-free healthcare policy through the use of a non-punitive multicomponent intervention.

Compromised Air Quality and Healthcare Safety from Smoking inside Hospitals in Shantou, China

Achieving smoke-free healthcare facilities remains a great challenge in countries with a high smoking prevalence and weak regulation. Assessment of the impact of environmental tobacco smoke (ETS) and its constituent PM2.5 on the air quality in Chinese hospitals has not been reported. In this study, we conducted air quality surveys by measuring real-time PM2.5 concentrations with Dylos Air Quality Monitors in five tertiary hospitals in Shantou, China during summer (July-August 2016) and winter (November-February 2017). Twenty-eight-day surveys inside the hospitals showed median PM2.5 concentrations above the China Air Quality Standard in elevator lobbies (51.0 μg/m3, IQR 34.5–91.7), restrooms (40.2, 27.1–70.3), and corridors (36.5, 23.0–77.4). Evidence of tobacco smoking was significantly associated with PM2.5 spikes observed in all the survey locations, contributing to the air quality undesirable for health in 49.1% of total survey hours or 29.3% of summer and 75.4% of winter survey hours inside the buildings, and 33.5%, 25.7%, and 6.8% of survey hours in doctor offices, nurse stations, and patient rooms, respectively. In conclusion, smoking inside hospitals induces PM2.5 spikes that significantly compromise the air quality and impose significant health risk to the hospital inhabitants. Reinforcing comprehensive smoking ban with the vested interest of all stakeholders followed by creative disciplinary actions are suggested to ensure healthcare safety.

English

Under the new NSW Health Smoke-free Health Care Policy, the smoke-free status of public hospital campuses has been reaffirmed and all clinical staff are required to provide routine brief interventions for all smoking patients. The policy creates a unique opportunity to assist smokers to quit permanently in a supportive environment when motivation to quit is high. Smoking remains the leading cause of preventable death and disability in New South Wales (NSW). Counselling beginning in hospital and continuing for at least 1 month after discharge significantly increases quit rates. Smoking can be addressed using the 5As model, which includes asking about smoking, assessing readiness to change and nicotine dependence, advising all smokers to quit, assisting smokers to quit and arranging follow-up. Postdischarge support is a vital ingredient for long-term success and should be arranged during the hospital stay. Nicotine replacement therapy (NRT) should be offered to all nicotine-dependent smokers soon after admission. NRT helps manage cravings and nicotine withdrawal symptoms and significantly increases quit rates. Most smokers commence NRT on a nicotine patch, with an oral form of NRT added as required. It is important to give patients detailed instructions on the correct use of NRT and to ensure an adequate dose is taken to relieve symptoms. NRT is well tolerated and can be used perioperatively, during pregnancy and in patients with cardiovascular disease. Blood levels of certain drugs rise within several days after smoking cessation, so dose reductions may be required. Drugs with a narrow therapeutic index such as clozapine, olanzapine, warfarin and theophylline are of special importance.

A review of smoke-free health care in mainland China [Review article

Male doctors in China have a high rate of smoking (41%). Smoke-free policies and help in quitting smoking in health care facilities would improve the health of staff and patients, and reduce smoking among doctors. A review of smoke-free activity in the health care sector was undertaken by conducting a search of PubMed, Google Scholar, Google and Globalink on smoke-free health care in China and by scanning the print media. Relevant published and unpublished documents were also reviewed. It is not mandatory for health care facilities to be smoke free. However, a Ministerial Decision issued in May 2009 requires all medical and health institutions to be smoke free by the end of 2011, and in Beijing, Shanghai and Guangzhou, legislation requires hospital buildings to be smoke free. A range of initiatives have been implemented to ensure the goal of smoke-free health care is met by the end of 2011. A limitation of this review is that it may understate the amount of smoke-free activity that is taking place in China. There was considerable media coverage on clusters of hospitals planning to go smoke free and other smoke-free health care initiatives, but coverage was often vague and it was therefore excluded from this review. Many provinces, municipalities and cities are working towards meeting the 2011 deadline imposed by the Ministry of Health and other health authorities for all health care facilities and organisations to be smoke free. Government and non-government funding is supporting this initiative.

Smoke Free Health Care: an organisational change to increase effective intervention for tobacco

In 1999, the NSW Health Smoke Free Workplace Policy directed that grounds of health sites would become smoke free, in addition to the existing policy requiring smoke-free buildings. This was one of the first attempts by any health service to exclude tobacco entirely from health sites. This task required the adoption of evidence-based management of tobacco dependence and changing the culture of smoking in the health service. There were many barriers to implementation.

A survey of staff attitudes to smoking-related policy and intervention in psychiatric and general health care settings

Although the move to smoke-free hospital settings is generally a popular initiative, it may be a more challenging and controversial issue in mental health care. A survey was carried out to investigate differences in attitudes between clinical staff in psychiatric and general medical settings to smoke-free policy and intervention. The sample comprised 2574 NHS staff working in two Acute Hospital Trusts and one Mental Health Trust in England. Attitudes were examined on two factors: health care settings as smoke-free environments and the role of staff in stop smoking intervention. The findings indicated that attitudes on the two factors were only moderately correlated. Psychiatric staff expressed significantly less favourable attitudes than general staff to smoke-free health care settings and also to the role of staff in stop smoking intervention. The largest difference between the settings concerned the implementation of smoking bans. While approximately 1 in 10 staff in the general setting disagreed with a smoking ban in their wards or clinics, nearly one in three psychiatric staff was against such a ban in their setting. Staff attitudes need to be carefully considered, particularly in psychiatric settings, in attempts to implement smoke-free policies in health care settings.

Making Canadian Healthcare Facilities 100% Smoke-Free: A National Trend Emerges

When the Calgary Health Region, the Mental Health Centre in Penetanguishene and Capital Health in Nova Scotia declared their sites 100% smoke-free (both buildings and grounds) in May of 2002 and May of 2003 respectively, the change was considered radical and foolish by some. Since then, the move to 100% smoke-free healthcare facilities has become a national trend in Canada, with many facilities following suit and many others planning to make the change. In this article, the authors reflect on what they have learned in these three jurisdictions and offer some advice for healthcare facilities preparing to implement smoke-free property policies.

Aren't health services already promoting health?

Smoke-free health care environments are now the norm in Australia and exemplify the way in which environments for health care can become more health promoting. Community health services that assist people with chronic illnesses and disabilities to increase control over their lives, hospitals that provide nutritious food choices for staff and patients, and general practices that encourage routine preventive care throughout the life span are other examples of health-promoting environments. In their roles as providers of services, employers, community corporations and citizens, health care organisations have a wide range of opportunities for developing their capacity for health promotion. These include transforming the principles and values on which service delivery models are based, developing an organisational capacity for health promotion through staff training and designing programs, services and facilities to promote health. While some industry accreditation programs are evolving to embody specific elements that are health promoting, significant barriers to this area of organisational development continue to exist. These include disincentives linked with health care financing and the values, priorities and skills of health care workers who must turn rhetoric into practice. Just as the introduction of smoke-free environments success on research findings and a supportive political and social milieu to be successful, the further development of environments for health care which are health promoting in other ways will need to be driven by evidence and advocacy.

Networking for smokefree health care premises

Networking for smokefree health care premises