Smoke-free Hospital Research Articles

Association between Florida's smoke-free policy and acute myocardial infarction by race: A time series analysis, 2000–2013

IntroductionRacial disparities in acute myocardial infarctions (AMIs) are increasing over time. Previous studies have shown that the implementation of smoke-free policies is associated with reduced AMI rates. The objective of this study was to determine the association between smoke-free policy and AMI hospitalization rates and smoking by race. MethodsHealthcare Cost and Utilization Project data from Florida from 2000–2013 were analyzed using interrupted time series analysis to determine the relationship between Florida's smoke-free restaurant and workplace laws and AMI among the total adult population (aged ≥18years), by age, race, and gender. Behavioral Risk Factor Surveillance System data from Florida from 2000 to 2010 were analyzed using logistic regression to determine the association between policy and the adult smoking prevalence. ResultsAfter implementation of the smoke-free policy, no statistically significant associations between AMI hospitalization rates or smoking prevalence were detected in the total population. In the subgroup analysis, the policy was associated with declines in AMI hospitalization rates among non-Hispanic white adults aged 18–44years (β=−0.001 per 10,000, p-value=0.0083). No other relationships with AMI hospitalization rates and smoking prevalence were found in the subgroup analysis. ConclusionsMore comprehensive smoke-free and tobacco control policies are needed to further reduce AMI hospitalization rates, particularly among minority populations. Further research is needed to understand and address how the implementation of smoke-free policies affects secondhand smoke exposure among racial and ethnic minorities.

Are Canadian hospitals leading by example to promote smoke-free hospital properties? Rationale, challenges and opportunities

Knowing the devastation of tobacco use and the evidence to support proven tobacco reduction approaches, such as smoke-free hospital property policies, are Canadian hospitals doing all they can to lead by example? This paper explores the background and diverse views on smoke-free hospital properties to illuminate the rationale, challenges and opportunities of this important healthcare initiative. Currently, some hospitals in Canada have transitioned to smoke-free properties; however, many still allow smoking in designated areas or do not have any policies in place. Fear, speculation and reservations around compliance, leadership, negative perceptions, safety and patient care are some of the reasons that appear to be stalling progress in many healthcare facilities; nevertheless, the evidence supporting the implementation of comprehensive smoke-free hospital property policies far outweighs the concerns. Key considerations for successful policy implementation include: leadership and enforcement; systematic tobacco dependence treatment; and elimination of designated smoking areas (DSA’s) and policy exclusions. Hospitals are ideal institutions to continue the downward trend in tobacco use prevalence. Through smoke-free property policies, Canadian hospitals can make a significant impact and lead by example in their communities by creating opportunities to promote healthy choices, protecting individuals from exposure to environmental tobacco smoke (ETS), supporting those who are trying to quit or who have quit smoking and by sending a clear message that smoking and exposure to tobacco smoke is harmful. As witnessed though the learnings of leading hospitals, transitioning to a smoke-free hospital property is achievable.

Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization

Psychiatric hospitals are increasingly adopting smoke-free policies. Tobacco use is common among persons with mental illness, and nicotine withdrawal (NW), which includes symptoms of depression, anxiety, anger/irritability, and sleep disturbance, may confound psychiatric assessment and treatment in the inpatient setting. This study aimed to characterize NW and correlates of NW severity in a sample of smokers hospitalized for treatment of mental illness in California. Participants (N=754) were enrolled between 2009 and 2013, and averaged 17 (SD=10) cigarettes/day prior to hospitalization. Though most (70%) received nicotine replacement therapy (NRT) during hospitalization, a majority (65%) reported experiencing moderate to severe NW. In a general linear regression model, NW symptoms were more severe for women, African American patients, and polysubstance abusers. Though invariant by psychiatric diagnostic category, greater NW was associated with more severe overall psychopathology and greater cigarette dependence. The full model explained 46% of the total variation in NW symptom severity (F [19, 470]=23.03 p<0.001). A minority of participants (13%) refused NRT during hospitalization. Those who refused NRT reported milder cigarette dependence and stated no prior use of NRT. Among smokers hospitalized for mental illness, NW severity appears multidetermined, related to cigarette dependence, demographic variables, psychiatric symptom severity, and other substance use. Assessment and treatment of NW in the psychiatric hospital is clinically warranted and with extra attention to groups that may be more vulnerable or naïve to cessation pharmacotherapy.

Smoking habits among the hospital staff of a General Hospital in Northern Greece: a long way for smoke-free hospitals

The aim of the study was to evaluate the smoking habits of all staff working in a General Hospital, and to examine whether these habits comply with the introduction of a tobacco law in July 2002, where smoking in enclosed public areas, including hospital buildings, has been forbidden in Greece. All hospital staff in Serres General Hospital was asked to complete and return a questionnaire about their smoking habits. The questionnaire was voluntary and anonymous. The survey was conducted from October 2003 to January 2004. Six hundred and twenty three (74%) of the 847 members of staff responded; 310 (50%) were current smokers and 313 (50%) were non-smokers of whom 101 (32%) were ex-smokers. The prevalence of current smokers was the highest among nurses (57%) and the lowest among doctors (31%). Male smokers (42%) were outnumbered by female smokers (54%) in all age groups up to the age of 60 years (p<0,01), although the reverse is the trend in Greek population (47% and 29%, respectively). The highest rate of smokers was found at the age group of 31-40 years (60%), while these above sixty years had the smallest (29%). Seventy percent of current smokers had at least one family member who was current smoker vs 49% of non-smokers (p<0,001). The vast majority of smokers (94%) continued to smoke in hospital, of whom 62% smoke more than 5 cigarettes while at work. The high rate of smokers among the health professionals compared to those in the general population would probably have a negative influence on the development, implementation and inspection of workplace smoking bans in Greece. Increased efforts to promote tobacco education and intervention among doctors and nurses and to establish specialist smoking cessation services throughout the National Health Service should be the standard component of antismoking policy for the law to be effective.

Prevalencia de consumo de tabaco en trabajadores hospitalarios: metaanálisis en 45 hospitales catalanes

ObjectiveTo estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers’ sociodemographic characteristics and the type of hospital. MethodA meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. ResultsThe overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). ConclusionThe prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups.

Are Informing Knowledge and Supportive Attitude Enough for Tobacco Control? A Latent Class Analysis of Cigarette Smoking Patterns among Medical Teachers in China.

Background: This study is one part of a five-year tobacco-control project in China, which aimed to gain insight into the smoking behavior, knowledge, and attitudes among medical teachers in China. Methods: In May 2010, a cross-sectional survey was conducted among medical teachers of Xiangya Medical School, Central South University, China. Results: A total number of 682 medical teachers completed the surveys. Latent class analysis indicated the sample of smoking patterns was best represented by three latent subgroups of smoking consumption severity levels. Most respondents were informed of smoking related knowledge, but lack of knowledge on smoking cessation. Most of them held a supportive attitude towards their responsibilities among tobacco control, as well as the social significance of smoking. However, both smoking related knowledge and attitude were not correlated with severity of smoking consumption among medical teachers. Conclusion: The smoking prevalence among medical teachers in China remains high. Programs on smoking cessation training are required. Future study should also develop targeted interventions for subgroups of smokers based on smoking consumption. Persistent and effective anti-tobacco efforts are needed to achieve the goals of creating smoke-free campuses and hospitals.

一家三甲医院吸烟与控烟工作状况调查

Objective: To master the hospital smoking status and distribution, for providing a scientific basis for tobacco control measures in hospitals. Methods : A questionnaire was designed. Given a uniform standards, the synchronization investigation was carried out after the implementation of staff training. Results : The overall smoking rate was 9.66% in the hospital, and smoking rate among males was 25.78%. The smoking rate among administrative and support staffs is higher than the medical staff. Conclusion : Hospital overall smoking rate is lower than average, but smoking rate among males is still high. The hospitals should vigorously strengthen tobacco control training system, and create a smoke-free hospital environment to drive the smoking rates decline.

Towards a smoke-free hospital: how the smoking status of health professionals influences their knowledge, attitude and clinical activity. Results from a hospital in central Italy.

In Italy, the prevalence of smoking among health professionals is higher than in the general population and this might hamper their role in the promotion of health. This study aimed to investigate how the smoking status of healthcare professionals might influence knowledge, attitudes and clinical practice in a hospital in central Italy in order to enforce effective tobacco control measures. Physicians and professionals of the hospital were asked to complete an anonymous questionnaire which yielded epidemiological and environmental information on knowledge, attitude, clinical practice and quality of the hospital environments, in relation to smoking. Overall, among the employees of the hospital, the smoking prevalence was 47%, (42% among physicians and 43% among nurses); 30% admitted smoking in the hospital and three quarters of the smokers would like to quit. Some knowledge, opinions and attitudes differ statistically among the smoking categories. For example, only 35% of the smokers admitted that smoking is more dangerous to health than atmospheric and car pollution compared with 60% of the ex or never smokers (p=0.04). Fewer smokers realize that their behavior is seen as a role model by patients. A greater percentage of smokers state that patients (34%) and visitors (43%) often smoke in hospital and these percentages are significantly higher than those reported by ex or never smokers (p≤0.05). All smokers claim that they never smoke in patient rooms, infirmaries and clinics, whereas over 20% of ex or never smokers report that smoking sometimes occurs in these places (p=0.015). The mean concentration of PM 2.5 in the 25 rooms was 2.4 μg/m3 with a range from 1 to 7 μg/m3. This study implies that the prevalence of smoking among health professionals may be very high, and might be twice the rate observed in the general population. Generally, smokers report less knowledge compared with ex and never-smokers and it seems that they systematically underestimate the dangers related to smoking both in their knowledge and in their behavior, and try to socially "normalize" smoking. All this and the evidence of cigarette butts in hospital rooms and clinics, notwithstanding the good quality of the air thanks to the modern ventilation system, imply that there is still a long way to go towards a smoke-free hospital.

Smoking, attitudes to smoking and provision of smoking cessation advice in two teaching hospitals in Ireland: do smoke-free policies matter?

Brief cessation advice from health-care professionals in the hospital setting significantly increases the likelihood of patients quitting smoking, yet patients are not routinely provided with this advice. Smoke-free hospital policies aim to protect individuals from the adverse effects of smoking; however, it is unclear if such policies encourage systematic delivery of cessation advice by health-care professionals. The study's aim was to determine the prevalence of smoking and cessation advice received by in-patients in two teaching hospitals in Ireland which have implemented smoke-free hospital policies, and to examine patient attitudes towards smoking cessation. Change in smoking prevalence and delivery of smoking cessation advice prior to and post-policy implementation was also examined in one hospital. This study surveyed 466 in-patients across 2 hospital sites, over a 3-week and 5-week period, respectively. Data were also compared to a survey completed prior to the implementation of the smoke-free policy in one of the hospital sites. Smoking prevalence was 17% in Beaumont Hospital and 28% in Connolly Hospital. Overall, nicotine dependence was low (Mean Fagerström Test for Nicotine Dependence = 4.21, ±2.9). Overall, 62% of smokers did not receive smoking cessation advice from a health professional, although 55% indicated a willingness to engage with this type of service. The before-and-after analysis of Beaumont Hospital showed a reduction in smoking prevalence (17% vs 21%) amongst hospital in-patients, and a 6% increase in reported cessation advice provided following the introduction of the hospital smoke-free policy. Smoke-free hospital policies play a role in decreasing the prevalence of in-patient smokers, but further intervention is needed to increase rates of cessation advice provided. Positive attitudes to smoking cessation, coupled with low average nicotine dependence, suggest that low-intensity interventions would be beneficial for most smokers. A systematic focus on provision of brief smoking cessation advice is needed in hospitals.

Establishing smoke-free hospitals in Vietnam: A pilot project

In Vietnam, a pilot ‘smoke-free hospital’ model was implemented in nine hospitals in 2009–2010 to supply lessons learned that would facilitate a replication of this model elsewhere. This study aimed to assess smoking patterns among health professionals and to detect levels of second-hand smoke (SHS) exposure within hospital premises before and after the ‘smoke-free hospital’ model implementation. A pre- and post-intervention cross-sectional study was conducted in nine purposively selected hospitals. Air nicotine levels were measured using passive nicotine monitors; smoking evidence was collected through on-site observations; and smoking patterns were assessed through interviews with health workers. Despite the ‘smoke-free hospital’ intervention, smoking continued among health-care workers who were former smokers. Specifically, self-reported smoking prevalence significantly decreased post-intervention, but the number of daily cigarettes smoked at workplaces among male health workers remained unchanged. Post-intervention, smoking was more likely to take place outside buildings and cafeterias. However, air nicotine levels in the doctors' lounges and in emergency departments did not change post-intervention. Air nicotine levels at other sites decreased minimally. Tailored tobacco cessation programmes, targeting current smokers and mechanisms to enforce non-smoking, should be established to meet requirements of Vietnam's comprehensive National Tobacco Control Law effective in May 2013.

Clearing the air: improving smoke-free policy compliance at the national oncology hospital in Armenia.

BackgroundSmoke-free policies shown to reduce population exposure to secondhand smoke (SHS) are the norm in hospitals in many countries around the world. Armenia, a transition economy in the South Caucasus, has one of the highest male smoking rates in the European region. Although smoking in healthcare facilities has been banned since 2005, compliance with this ban has been poor due to lack of implementation and enforcement mechanisms and social acceptability of smoking. The study aimed to develop and test a model intervention to address the lack of compliance with the de jure smoking ban. The national oncology hospital was chosen as the intervention site.MethodsThis study used employee surveys and objective measurements of respirable particles (PM2.5) and air nicotine as markers of indoor air pollution before and after the intervention. The intervention developed in partnership with the hospital staff included an awareness campaign on SHS hazards, creation of no-smoking environment and building institutional capacity through training of nursing personnel on basics of tobacco control. The survey analysis included paired t-test and McNemar’s test. The log-transformed air nicotine and PM2.5 data were analyzed using paired t-test.ResultsThe survey showed significant improvement in the perceived quality of indoor air, reduced worksite exposure to SHS and increased employees’ awareness of the smoke-free policy. The number of employees reporting compliance with the hospital smoke-free policy increased from 36.0% to 71.9% (p < 0.001). The overall indoor PM2.5 concentration decreased from 222 μg/m3 GM (95% CI = 216-229) to 112 μg/m3 GM (95% CI = 99-127). The overall air nicotine level reduced from 0.59 μg/ m3 GM (95% CI = 0.38-0.91) to 0.48 μg/ m3 GM (95% CI = 0.25-0.93).ConclusionsThe three-faceted intervention developed and implemented in partnership with the hospital administration and staff was effective in reducing worksite SHS exposure in the hospital. This model can facilitate a tangible improvement in compliance with smoke-free policies as the first step toward a smoke-free hospital and serve as a model for similar settings in transition countries such Armenia that have failed to implement the adopted smoke-free policies.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-943) contains supplementary material, which is available to authorized users.

Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys.

BackgroundSpain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws.MethodsSix cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001–2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law).ResultsBaseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees’ overall support for the smoke-free hospital project.ConclusionsA long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.

Maintenance of tobacco cessation programmes in public hospitals in Catalonia, Spain

IntroductionThe provision of smoking cessation interventions in hospitals has been strongly recommended. The aim of this study is to determine the maintenance of smoking cessation programmes for inpatients and hospital workers in hospitals of Catalonia (Spain) seven years after the implementation of a Tobacco Cessation Programme. MethodsA cross-sectional survey was conducted in all hospitals that offer public service in Catalonia, Spain (n=73). An online questionnaire was sent to all coordinators of the smoke-free hospital project or managers of each hospital. The survey included questions about the type of hospital, type of programmes implemented and availability and source of smoking cessation drugs. ResultsResponses to the questionnaire were submitted by 58 hospitals (79.5%). 74% and 93.1% of the hospitals had smoking cessation programmes for inpatients and workers, respectively. Most of the hospitals maintained the programmes and started routinely buying smoking cessation drugs after a period of receiving them free-of-charge. However, 17.2% of the hospitals refused to buy these drugs and 24% never had these drugs available. ConclusionsThrough a supportive Tobacco Cessation Programme, most hospitals have smoking cessation programmes for both patients and workers. Most of them have incorporated smoking cessation drugs as a regular resource in their services' portfolio. The lack of these resources may jeopardise the maintenance of well-established programmes in hospitals.

Analysis of long-term abstinence rate among smokers at a smoking cessation clinic at a smoke-free hospital

A total of 133 smokers visiting our smoking cessation clinic from February 2009 to September 2010 were studied. The data were collected during initial assessments and over a follow-up period of 24 months. Long-term abstinence rate was observed. And logistic regression was employed to identify the independent predictors of successful quitting. There were 132 males and 1 female with a mean age of 47 years. They smoked an average of 26 cigarettes per day. The mean duration of smoking was 25 years. Among them, 57 smokers (42.9%) were severely nicotine dependent and 76 smokers (57.1%) were followed up for 24 months. And 20 smokers (26.3%) maintained 24 month abstinence. The predictor of avoiding relapse was immediate family members being nonsmokers. Key words: Smoking cessation; Treatment outcome

The impact of a smoke-free psychiatric hospitalization on patient smoking outcomes: a systematic review.

Smoke-free policies have been introduced in inpatient psychiatric facilities in most developed nations. Such a period of supported abstinence during hospitalization may impact smoking behaviours post discharge, yet little quantitative evidence exists. The aim of this review was to provide the first synthesis of the research evidence examining the impact of a smoke-free psychiatric hospitalization on patients' smoking-related behaviours, motivation, and beliefs. We conducted a systematic review of electronic databases PubMed, MEDLINE, PsycINFO, and EMBASE from inception to June 2013. Studies were included if they were conducted in an inpatient psychiatric facility with a smoke-free policy and if they examined any change in patients' smoking-related behaviours, motivation, or beliefs either during admission, post discharge, or both. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool. Fourteen studies were included in the review. Of the four studies that assessed change in smoking from admission to post discharge, two indicated a significant decline in cigarette consumption up to 3 months post discharge. Positive changes in motivation to quit and beliefs about quitting ability were identified in two studies. One study reported an increase in the rate of quit attempts and one reported a decline in nicotine dependence levels. A smoke-free psychiatric hospitalization may have a positive impact on patients' smoking-related behaviours, motivation, and beliefs, both during admission and up to 3 months post discharge. Further controlled studies with more rigorous designs are required to confirm this potential.

Impact of tobacco control policies in hospitals: Evaluation of a national smoke-free campus ban in Spain

IntroductionOn January 2, 2011, the Spanish government passed a new smoking law that banned smoking in hospital campuses. The objective of this study was to evaluate the implementation of smoke-free campuses in the hospitals of Catalonia based on both airborne particulate matter and observational data. MethodsThis cross-sectional study included the hospitals registered in the Catalan Network of Smoke-free Hospitals. We measured the concentration of particulate matter < 2.5 µm in μg/m3 at different locations, both indoors and outdoors before (2009) and after (2011) the implementation of the tobacco law. During 2011, we also assessed smoke-free zone signage and indications of smoking in the outdoor areas of hospital campuses. ResultsThe overall median particulate matter < 2.5 µm concentration fell from 12.22μg/m3 (7.80–19.76μg/m3) in 2009 to 7.80μg/m3 (4.68–11.96μg/m3) in 2011. The smoke-free zone signage within the campus was moderately implemented after the legislation in most hospitals, and 55% of hospitals exhibited no indications of tobacco consumption around the grounds. ConclusionsAfter the law, particulate matter < 2.5 µm concentrations were much below the values obtained before the law and below the annual guideline value recommended by the World Health Organization for outdoor settings (10μg/m3). Our data showed the feasibility of implementing a smoke-free campus ban and its positive effects.

Clinical management of tobacco dependence in inpatient psychiatry: provider practices and patient utilization.

This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization. Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization. The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman's ρ=-.30, p<.01), suggesting potential underdosing of more dependent smokers. During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.

Smoke-free or not: a pilot evaluation in selected Beijing Hospitals

BackgroundChina enacted a policy to ban smoking in hospitals. The Chinese Association for Tobacco Control (CATC) developed a program to help hospitals implement this policy. They conducted a program and an assessment in 3 Chinese cities (Beijing, Shanghai and Guangdong). A more in-depth evaluation was implemented with a sub-sample of hospitals in Beijing (N = 7) to provide an independent assessment. This independent assessment focused on evaluating policy development and an assessment of secondhand smoke (SHS) to determine compliance with the smoke-free policy initiative.MethodsPre- and post-survey data were collected at each of the selected hospitals with a total sample of 2835 physicians at pre-intervention and 2812 at post-intervention. Smoking rates pre- and post-policy implementation, change in knowledge, attitudes and practices among physicians, and compliance with policy were assessed. Measurements of airborne nicotine concentrations in selected locations in each hospital were taken: main hospital lobby; main outpatient center; emergency waiting room; and stairwell adjacent to a large inpatient ward. Hospital policies were collected, translated and rated for incorporated components necessary to implement a smoke-free policy.ResultsPhysicians’ smoking rates decreased and attitudes towards tobacco control improved significantly from pre-to post-intervention. Smoking was still reported in certain areas of the hospital with 96% of passive nicotine monitors as well as self-report indicating continued smoking. Nicotine levels ranged from <0.0056 to 3.94 μg/m3), with an overall mean of .667 μg/m3. Hospitals that established stronger policies seemed to have lower levels of nicotine, suggesting a relationship between policy development and compliance. This finding is interesting but just suggestive and requires further investigation to truly demonstrate if stronger policies improve compliance and produce better outcomes.ConclusionAs implementation strategies for smoke-free environments are improved and more resources are focused on hospitals, China is making progress toward achieving smoke-free hospitals. Using a model program could increase the prevalence of SHS policies across China. However, relying only on survey data may not provide an accurate assessment of this progress, and more extensive evaluation efforts are useful to understand how change can and does occur.

Implementation of a smoke-free policy in a high secure mental health inpatient facility: staff survey to describe experience and attitudes.

BackgroundIn 2008, a new forensic hospital was opened as a totally smoke-free facility. This study describes the attitudes and experience of mental health professionals working in the high secure mental health facility three years after it was opened. It is part of a larger evaluation describing the experience of current and discharged hospital patients.MethodsQuantitative data was collected using a survey of hospital staff (N = 111) with a 50% response rate. The survey collected demographic and smoking data to describe staff responses to statements relating to hospital smoking policy, patient care and staff support.ResultsAmong staff surveyed, 13% were current smokers and 41% were ex-smokers (10% quit after commencing employment in the smoke-free hospital). Most (88%) preferred to work in a smoke-free environment, although this was significantly lower in smokers compared to non-smokers (39% vs. 95%). While most staff felt that the smoke-free environment had a positive impact on the health of patients (86%) and on themselves (79%), smokers were significantly less likely to agree. Just over half (57%) of staff surveyed agreed that patient care was easier in a totally smoke-free environment, although less smokers agreed compared to non-smokers. Staff who smoked were also significantly less likely to indicate they had sufficient support working in a smoke-free environment, compared to non-smokers (15% vs. 38%).ConclusionsThe staff surveyed supported the smoke-free workplace policy; most agreed that patient care was easier and that the policy did not lead to an increase in patient aggression. Implementation of a total smoking ban can result in positive health outcomes for patients and staff, and may influence some staff to quit. Staff who smoke have a less positive experience of the policy and require additional support.

Change in secondhand smoke levels in a public hospital in Budapest following anti-smoking policy implementation in 2011

Our previous 2009 study demonstrated high secondhand smoke levels throughout a public hospital in Budapest. To compare changes in indoor air pollution level between 2009 and 2012, before and after the Hungarian anti-smoking policy legislation adopted in 2011. TSI SidePak AM510 Personal Aerosol Monitor was used. In-patient care department PM2.5 levels declined by 92% from 87.7 μg/m3 to 6.9 μg/m3. Non-patient care area PM2.5 level increased by 67% from 64.8 μg/m3 to 108.0 μg/m3. The increase was driven entirely by a large increase in the level in public toilets. Excluding these, there was a 83% drop in PM2.5 in non-patient care areas from 64.8 μg/m3 to 11.1 μg/m3. PM2.5 decreased significantly due to the 2011 law. However, smoking still occurred in the hospital, albeit in less frequently visited areas. A stricter enforcement of this beneficial law is needed to reach a comprehensive smoke-free hospital environment.