珠海市无烟医院建设效果评价

目的通过开展无烟医院建设,了解珠海市医疗卫生机构工作人员控烟知识、态度和行为,评价无烟医院建设的干预效果。方法在全面开展无烟医院建设前及1年后,采用随机抽样方法,在珠海市抽取市级医院1家,香洲、斗门和金湾3个行政区内分别抽取3家区级医院、3家私立医院、6家镇级医院（或社区卫生服务中心）的在职工作人员进行干预前后烟草流行情况调查,了解医疗机构工作人员控烟知识态度行为变化。结果在全面开展无烟医院建设前后,珠海市医疗机构的无烟环境得到改善,单位禁烟规定的制定及执行差异有统计学意义（χ2值分别为67.29和110.66,P均〈0.05）;干预后工作人员对吸烟及被动吸烟与疾病关系的正确认知有不同程度的提高（t值分别为-8.40和-5.28,P〈0.05）,工作人员的吸烟率和上班时间吸烟比例较干预前降低（χ2值分别为5.64和9.32,P〈0.05）。结论珠海全面开展无烟医院建设1年后,医疗卫生机构的控烟工作取得了一定成效。     

Banning smoking in a children's hospital: are employees supportive?

This study surveyed 762 professional and auxiliary employees in a large urban children's hospital to assess readiness for a total ban on smoking. The prevalence of never smokers was 63.1%, former smokers was 21.1%, and current smokers was 15.1%. Among nonsmokers, 83% indicated that a children's hospital should be smoke-free. The attitudes of former smokers were almost identical to those of never smokers. Less than half of current smokers (43%) agreed with a ban on smoking which suggests some support for a smoke-free setting even among smokers. In multivariate analysis, smokers, however, were eight times less likely to agree with such a policy, independent of age, sex, and occupation. This study suggests that the majority of employees are supportive of a total ban on smoking but that special efforts to help smokers stop smoking may enhance the effectiveness of a policy banning smoking in a children's health care facility.     

Total smoking bans in psychiatric inpatient services: a survey of perceived benefits,barriers and support among staff

Background  

The introduction of total smoking bans represents an important step in addressing the smoking and physical health of people with mental illness. Despite evidence indicating the importance of staff support in the successful implementation of smoking bans, limited research has examined levels of staff support prior to the implementation of a ban in psychiatric settings, or factors that are associated with such support. This study aimed to examine the views of psychiatric inpatient hospital staff regarding the perceived benefits of and barriers to implementation of a successful total smoking ban in mental health services. Secondly, to examine the level of support among clinical and non-clinical staff for a total smoking ban. Thirdly, to examine the association between the benefits and barriers perceived by clinicians and their support for a total smoking ban in their unit.     

Acceptability and impact of a partial smoking ban in a psychiatric hospital

OBJECTIVE: The acceptability and impact of partial smoking bans in psychiatric hospitals are not well documented. We assessed the impact of a partial smoking ban in a psychiatric hospital in Switzerland. METHODS: Before the intervention, smoking was not allowed in bedrooms and dining rooms, but this ban was not enforced. The intervention consisted of banning smoking everywhere, except in dedicated smoking rooms. Patients and staff were surveyed before (October 2003, 49 patients and 57 staff) and 2 months after the smoking ban (April 2004, 54 patients and 54 staff). Analyses included both patients and staff. RESULTS: Compared with baseline, after the intervention twice as many non-smokers reported that they were "never" exposed to environmental tobacco smoke (ETS) in bedrooms (before=25.0%, after=54.5%, p=0.046), dining rooms (35.5 vs. 65.5%, p=0.037), corridors (10.4 vs. 30.9%, p=0.001) and meeting rooms (36.8 vs. 75.0%, p=0.012). The smoking ban was loosely enforced; although the ban reduced ETS, substantial exposure to ETS remained after it was introduced. Most participants (87%) rejected the idea of a total smoking ban. CONCLUSION: The partial smoking ban was well accepted and was associated with less exposure to ETS. However, even a partial ban proved difficult to enforce in this hospital.     

Challenges to HIV prevention in psychiatric settings: perceptions of South African mental health care providers

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers' perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support.     

Regulation of environmental tobacco smoke by Australian drug treatment agencies

OBJECTIVE: To determine how smoking is regulated in alcohol and other drug treatment agencies. METHOD: Australian drug treatment agencies were mailed questionnaires for completion by the manager and one other staff member (553 packages posted). RESULTS: Questionnaires were returned by 260 (59.8%) eligible agencies. Most respondents (82.5% managers, 76.7% other staff) indicated their agency had a written policy regulating smoking. The vast majority (88.2% managers, 82.3% other staff) reported smoking was banned inside their agency, with the highest proportion of bans being in the area health category (95.8% managers, 93.7% other staff) and the lowest in the residential rehabilitation category (75.6% managers, 62.8% other staff). Of the respondents reporting a ban, 19.1% of managers and 27.5% of other staff reported their agency's ban was not 'always' enforced. Paired analyses suggested that other staff were more likely to indicate that the agency had no written policy or be unsure and managers were more likely to report that smoking bans were 'always' stringently enforced. Overall, a substantial minority of respondents (managers 28.6%, other staff 40.2%) indicated that smoking occurred inside their agency at least occasionally. CONCLUSIONS AND IMPLICATIONS: A substantial proportion of Australian drug and alcohol agencies continue to permit smoking inside their premises. Policy initiatives and educational campaigns are required to promote the expansion of smoke-free conditions in this sector. Serious consideration should be given to making the adoption and enforcement of internal smoke-free policies a condition of any continued government funding.     

Medical students' contribution to the development of a smoke-free hospital policy in a university medical centre: a relevant learning experience

In a research methodology course, second-year medical students conducted a survey on 'Enforcing a Smoking Ban in the Soroka Medical Center: a Survey of Hospital Employees on Facilitating Factors and Obstacles'. They defined the study objectives and design, developed the study instrument, carried out the survey, coded and entered the data into mainframe computers, analysed the computer output, and prepared oral and written reports. The aims of the project were twofold: to survey employees' attitudes to a hospital smoking ban and to train medical students in the planning and conduct of a research project on public health or preventive medicine. Twelve students conducted a cross-sectional survey of 208 hospital employees (10% of the hospital staff). Employees were surveyed regarding smoking status, interest in quitting smoking, knowledge of the law banning smoking in public places, knowledge of the health effects of passive smoking, attitudes towards a hospital smoking ban and potential obstacles to its implementation. The students rated the course as excellent. They gained important research skills, as well as practical medical and public health experience through active participation in the design and execution of a study project with public health implications. At the first meeting of the hospital committee appointed to enforce a smoke-free hospital, the students' findings were reported in full, and their recommendations have guided policy decisions.     

沈阳市某医院职工吸烟状况及控烟行为调查

目的 了解沈阳市创建无烟医院职工吸烟现状、控烟知识、态度和行为,为更好地开展控烟工作提供依据。 方法 使用统一问卷,采用询问和自我填表的形式对沈阳市某无烟医院的在职职工进行调查。 结果 本次调查的无烟医院职工2722人,总吸烟率为13.2%,吸烟以男性为主,吸烟率为36.2%;93.4%的职工表示支持在医院实施100%无烟政策;96.2%的医务人员表示会主动建议吸烟患者戒烟。 结论 医院的吸烟率仍较高,必须进一步在医院职工中开展吸烟危害、戒烟知识和戒烟方法的培训,深化无烟医院创建工作。     

An evaluation of tobacco brief intervention training in three indigenous health care settings in north Queensland

OBJECTIVE: To evaluate the pilot phase of a tobacco brief intervention program in three Indigenous health care settings in rural and remote north Queensland. METHODS: A combination of in-depth interviews with health staff and managers and focus groups with health staff and consumers. RESULTS: The tobacco brief intervention initiative resulted in changes in clinical practice among health care workers in all three sites. Although health workers had reported routinely raising the issue of smoking in a variety of settings prior to the intervention, the training provided them with an additional opportunity to become more aware of new approaches to smoking cessation. Indigenous health workers in particular reported that their own attempts to give up smoking following the training had given them confidence and empathy in offering smoking cessation advice. However, the study found no evidence that anybody had actually given up smoking at six months following the intervention. Integration of brief intervention into routine clinical practice was constrained by organisational, interpersonal and other factors in the broader socioenvironmental context. CONCLUSIONS/IMPLICATIONS: While modest health gains may be possible through brief intervention, the potential effectiveness in Indigenous settings will be limited in the absence of broader strategies aimed at tackling community-identified health priorities such as alcohol misuse, violence, employment and education. Tobacco and other forms of lifestyle brief intervention need to be part of multi-level health strategies. Training in tobacco brief intervention should address both the Indigenous context and the needs of Indigenous health care workers.     

甘肃省医疗卫生从业人员控烟知信行现状分析

目的：调查甘肃省医疗卫生机构从业人员控烟相关知识、态度、行为现状,分析其在创建无烟医疗卫生系统和参与、引领社会控烟等方面作用的发挥及其存在的问题,为进一步开展医疗卫生专业机构控烟工作与完善控烟策略提供依据。方法：采用分层整群抽样的方法确定34家医疗卫生机构,使用自行设计的问卷,对各级各类医疗卫生机构从业人员进行现场自填法调查其控烟相关的知识、态度、行为。结果：甘肃省医疗卫生从业人员对烟草危害缺乏深度和广度认识,虽在控烟态度上较积极,但控烟的综合服务能力不足,对受众戒烟帮助的方式方法欠规范。Logistic回归分析显示,影响医务人员控烟能力的主要因素为自身吸烟情况、劝阻吸烟行为、询问吸烟情况。结论：对医疗卫生从业人群进行针对性的烟草知识和戒烟技能培训,降低该人群吸烟率,增强行政后勤管理人员控烟意识,是建设无烟医疗卫生系统、引领社会控烟的关键环节。     

Evaluating performance of and organisational capacity to deliver brief interventions in Aboriginal and Torres Strait Islander medical services

Objective: This study assessed brief intervention (BI) activity and organisation capacity for smoking, nutrition, alcohol and physical activity (SNAP framework) and key clinical prevention activities in four Aboriginal and Torres Strait Islander medical services in Queensland.
Methods: A mixed methods design was used including: staff surveys of knowledge and attitudes (n=39), focus groups to discuss perceived barriers and enablers and chart audits (n=150) to quantify existing BI activity.
Results: Of 50 clinical staff, 46 participated in the staff survey and focus groups across the four sites. BI was perceived to be important. There was significant variation in completion of records for SNAP risk factors, key clinical and BI activities across the sites. At least one SNAP factor status was recorded in 130/150 (86.7%) patient charts audited and there was a significant trend of increased recording of SNAP factors with increasing number of patient visits. Of those identified at risk 78% received at least one BI. Where risk was identified 65/96 (67.7%) patients required multiple BIs. BI for tobacco use was consistently high across all sites. Only one site recorded regular care planning and Adult Health Checks. Impacting factors included leadership, high staff turnover, multiple medical records and staff health status.
Conclusions: Inflexible staff training, competing health priorities and high levels of staff turnover were identified as key barriers to the delivery of BI in clinical settings. The data suggests a good base of existing BI activity for smoking and key clinical activities which may improve with further support.     

The attitudes of occupational health personnel to smoking at work

Attitudes of occupational health care professionals toward smoking and their activity to address smoking issues were investigated by a questionnaire survey. Data were also collected on employees' exposure to environmental tobacco smoke and on smoking policies that existed in workplaces. Questionnaires were mailed to all occupational health care centers (n = 1,004) in Finland. The prevalence of daily smokers was 9.6% among physicians and 3.6% among nurses; 15% and 11%, respectively, smoked occasionally. Smoking restrictions were enforced in more than 70% of all workplaces, but only 3.6% of them had a total smoking ban. Nonsmoking professionals were in favor of smoke-free workplaces and smoking restrictions significantly more often than their smoking colleagues. Nonsmokers also regarded smoking as a serious problem to the organizational climate of workplaces. Almost half of nonsmoking respondents, but only 11% of daily smokers, would totally ban smoking in workplaces. Although the personal smoking status of the respondent had a strong effect on attitudes to smoking regulations, it did not have a clear influence on interest in discussing smoking issues when seeing patients. Nurses were more active in addressing smoking issues than physicians. Occupational health professionals of large companies reported stricter smoking policies at work than those who represented small enterprises. Am. J. Ind. Med. 34:73–78, 1998. © 1998 Wiley-Liss, Inc.     

Characteristics of Patients Adhering to a Hospital''s No-Smoking Policy

Objectives. The purpose of this paper is to examine the characteristics of smokers who adhere to a hospital smoking ban, compared to those who do not.Design. The data presented in this paper are baseline and discharge survey data collected among hospitalized smokers.Setting. This study was conducted in two teaching hospitals in a northeastern city.Patients/participants. The subjects were 358 smokers who participated in a larger smoking intervention trial.Main results. Seventy-six percent of the subjects reported adhering to the smoke-free policy during their hospital stay. In a multivariate model, demographic factors that predicted adherence included being older, having shorter length of stay, not reporting recreational drug use in the previous 12 months, and not having alcohol-related problems. Smoking history variables that predicted adherence included having had at least 24 h of abstinence in the 7 days prior to hospitalization; self-efficacy variables (e.g., confidence in ability to quit smoking in 1 month and less anticipated difficulty refraining from smoking during hospitalization) also predicted adherence.Conclusions. Understanding the factors that predict adherence to health care policies can provide useful information for health promotion interventions in a medical setting. The implications of these findings are discussed.     

青岛市部分医院医务人员吸烟行为与控烟能力干预效果评价

目的评价控烟干预对医务人员吸烟行为的影响效果,探讨提高医务人员控烟能力的方法,推进医院无烟环境建设。方法以参加无烟城市盖茨中国控烟项目的青岛市5家医院的医务人员为研究对象,经过1年的环境、政策、健康教育等控烟干预手段,评价医务人员吸烟行为和控烟能力干预效果。结果经过1年的干预,医务人员总体吸烟率下降,吸烟量降低;对吸烟和二手烟的认知有了改变;支持无烟政策,在诊疗过程中为就诊者提供烟草危害知识和戒烟服务能力提高。结论针对医务人员控烟的行为是积极可行的,对医务人员进行控烟健康教育措施效果显著,但在戒烟技巧、戒烟政策常态化方面应进一步提高和改善。     

Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness

As in other countries worldwide, adults with severe mental illness (SMI) in Brazil are disproportionately infected with HIV relative to the general population. Brazilian psychiatric facilities lack tested HIV prevention interventions. To adapt existing interventions, developed only in the US, we conducted targeted ethnography with adults with SMI and staff from two psychiatric institutions in Brazil. We sought to characterize individual, institutional, and interpersonal factors that may affect HIV risk behavior in this population. We conducted 350 hours of ethnographic field observations in two mental health service settings in Rio de Janeiro, and 9 focus groups (n=72) and 16 key-informant interviews with patients and staff in these settings. Data comprised field notes and audiotapes of all exchanges, which were transcribed, coded, and systematically analyzed. The ethnography identified and/or characterized the institutional culture: (1) patients' risk behaviors; (2) the institutional setting; (3) intervention content; and (4) intervention format and delivery strategies. Targeted ethnography also illuminated broader contextual issues for development and implementation of HIV prevention interventions for adults with SMI in Brazil, including an institutional culture that did not systematically address patients' sexual behavior, sexual health, or HIV sexual risk, yet strongly impacted the structure of patients' sexual networks. Further, ethnography identified the Brazilian concept of "social responsibility" as important to prevention work with psychiatric patients. Targeted ethnography with adults with SMI and institutional staff provided information critical to the adaptation of tested US HIV prevention interventions for Brazilians with SMI.     

Acceptability and impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital

OBJECTIVE: To assess the impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital in Switzerland. METHODS: In 2003, smoking was allowed everywhere in psychiatric units. In 2004, smoking was prohibited everywhere except in smoking rooms. In 2006, smoking rooms were removed and smoking was totally prohibited indoors. Patients and staff were surveyed in 2003 (n=106), 2004 (n=108), 2005 (n=119) and 2006 (n=134). RESULTS: Exposure to environmental tobacco smoke (ETS) decreased after the partial ban and further decreased after the total ban. Among patients, after the total ban, more smokers attempted to quit smoking (18%) relative to before the total ban (2%, odds ratio=10.1, p=0.01). More smokers said that hospital staff gave them nicotine replacement products after the total ban (52%), compared with before (13%, odds ratio=7.6, p<0.001). Many participants (55%) commented that the total ban was too strict, and most (64%) preferred the partial ban. CONCLUSIONS: The partial ban decreased exposure to ETS and the total ban further improved the situation and increased the proportion of smokers who attempted to quit smoking and received nicotine medications. The total ban was loosely enforced and was overall acceptable, but most participants preferred a partial ban.     

Diffusion of local restaurant smoking regulations in Massachusetts: identifying disparities in health protection for population subgroups.

OBJECTIVES: The objectives of this study were to examine the diffusion of smoke-free restaurant regulations and identify socioeconomic and racial/ethnic disparities in health protection from secondhand smoke exposure in restaurants. METHODS: We examined the relationship between adoption of local smoking regulations by restaurants for each of the 351 cities and towns in Massachusetts and a number of individual variables over nine time points, starting when there were no 100% smoke-free restaurant regulations and ending with the eventual imposition of the statewide ban on smoking in restaurants and bars. RESULTS: We found that over the 10 years before the statewide ban went into effect, only 36 percent of the total population was covered by local regulations that protected them from secondhand smoke exposure in restaurants. We also observed a substantial disparity in protection based on educational status, with up to 7 percentage points fewer nongraduates protected by local smoke-free restaurant regulations.     

Exposure to secondhand smoke at work: a survey of members of the Australian Liquor, Hospitality and Miscellaneous Workers Union

OBJECTIVE: To measure workers' attitudes towards and experiences of exposure to secondhand smoke (SHS) in the workplace. METHOD: A stratified random sample of members from the Victorian Branch of the Australian Liquor, Hospitality and Miscellaneous Workers Union (LHMU) was interviewed by telephone in September 2001. Of the 1,078 respondents surveyed (77% response rate), hospitality workers comprised 49% of the sample, while the remainder comprised community services, property services and manufacturing workers. RESULTS: Overall, 54% of union members were employed in workplaces that did not completely ban smoking and 34% reported being exposed to SHS during their typical working day. Workplaces with total smoking bans had a high level of compliance with these restrictions, with no workers in these settings indicating exposure to SHS at work. Compared with other workers, hospitality workers reported working in environments that had more permissive smoking policies. Consistent with this, 56% of hospitality workers said they were exposed to SHS during a typical day at work compared with 11% of other workers. Overall, 79% of workers expressed concern about exposure to SHS, including 66% of smokers. Compared with other workers, hospitality workers reported a higher level of concern about exposure to SHS at work. CONCLUSION: These findings provide evidence that many workers, and especially those employed in the hospitality sector, are exposed to SHS during their working day and are concerned about the effects of such exposure on their health. IMPLICATIONS: These findings indicate that workplace smoke-free policies are effective in reducing worker exposure to SHS and demonstrate support for the extension of smoke-free policies to hospitality workplaces.     

Evaluation of an educational program for long-term care nursing assistants

OBJECTIVES: To determine if an educational program can improve knowledge and attitude among ancillary staff on end-of-life care issues in a long-term care facility. DESIGN: A pilot study using a pre- and post-test design prior to and at the completion of an education intervention. SETTING: A long-term care facility in suburban Philadelphia that has 150 assisted living beds and 53 nursing home beds. PARTICIPANTS: Long-term care ancillary staff including certified nursing assistants (called "care managers" at this facility), social workers, recreational therapists, and food service workers. INTERVENTION: The intervention was a novel educational program consisting of five in-service lectures with accompanying take home self-study modules for ancillary staff in long-term care entitled "Dignity in Dementia." MEASUREMENTS: Ancillary staff attitudes and knowledge on end-of-life issues in dementia were assessed with a knowledge and attitude questionnaire pre- and post-intervention. One-year follow-up questionnaires were administered to assess long-term maintenance of knowledge and attitude changes. RESULTS: Thirty-two ancillary staff completed the pre-intervention questionnaires. Twenty-nine ancillary staff completed the post-intervention questionnaires (90.6%). There was a significant change in the end-of-life knowledge level of the ancillary staff (P =.0270). Specifically, there was a significant change in one question dealing with dementia as a terminal disease (P = .006). There were also significant changes in the average attitude scores of the ancillary staff. (P = .0242). One-year follow-up revealed that both knowledge and attitude changes were maintained. CONCLUSIONS: This pilot project demonstrates that a staff educational program on end-of-life care for dementia residents can improve end-of-life knowledge and attitudes among long-term care ancillary staff and that this improvement can be maintained for up to 1 year. This intervention is easily reproducible in the long-term care setting. This project is an important step in helping improve end-of-life care for dementia residents in long-term care settings by improving the knowledge and attitudes of their caregivers.