Smoking care provision in smoke-free hospitals in Australia

BACKGROUND: The study aimed to (1) determine the current routine smoking care that smoke-free public hospitals in New South Wales (NSW), Australia, provide to inpatients who are smokers; (2) determine current strategies supporting such care; and (3) examine the association between smoking care provision and hospital characteristics and support strategies. METHOD: A cross-sectional survey of 169 senior hospital managers was undertaken. Survey items included smoking care practices such as identification of smoking status and provision of nicotine replacement therapy as well as hospital activities such as existence of policies and staff training. Hospital characteristics such as size and geographic location were also collected. RESULTS: Twenty percent of respondents reported provision of minimally 'adequate' smoking care, defined as providing five or more smoking care items to 80% or more of patients. Larger hospitals were significantly less likely to provide adequate smoking care. Nurse training, the existence of signs indicating a smoke-free site and signs indicating location of designated smoking areas were also associated with smoking care provision. The existence of three or more support strategies was associated with smoking care provision. CONCLUSION: Even in the context of a smoke-free hospital site, the majority of inpatients who are smokers receive inadequate smoking care. Considered investment is required for hospitals to implement strategies to institutionalise the routine provision of appropriate smoking care.     

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.     

Smokers’ compliance with smoke-free policies, and non-smokers’ assertiveness for smoke-free air in the workplace: a study from the Balkans

Objective

Identify the psychosocial variables that predict smokers’ compliance with smoke-free policies at work, and non-smokers’ assertiveness for smoke-free rights in Greek and Bulgarian workplaces.

Methods

Data were collected from employees in Greece and Bulgaria. The main outcome measures were smokers’ compliance with smoke-free policies, and non-smokers’ assertiveness intentions. Demographic variables, tobacco use and dependence, as well as beliefs about second-hand smoke (SHS) exposure and smoking at work were also assessed.

Results

Regression analyses showed that smokers’ compliance with smoke-free policies was predicted by age, perceived health risks of smoking, and beliefs related to the benefits of smoking at work. Non-smokers’ assertiveness was predicted by annoyance from exposure to SHS at work, and assertiveness-related social cognitions (e.g., attitudes, social norms, and self-efficacy).

Conclusions

Interventions to promote support for tobacco control policies at work in Greece and Bulgaria may benefit from targeting smokers’ beliefs about the actual effects of tobacco use on health and job performance. Accordingly, efforts to promote non-smokers assertiveness should build stronger assertiveness-related attitudes, convey anti-smoking normative messages, and strengthen self-efficacy skills.     

A "smoke-free" hospital in Israel--a possible mission

BACKGROUND: A revised antismoking law in Israel (August 2001) called for a complete ban of smoking in hospitals. An evaluation of a hospital process and short-term outcome of implementing such policy may guideline its sustainability. METHODS: Two cross-sectional, random-sample surveys of employees 3 months before policy implementation, and 6-9 months post-implementation. The pre-implementation survey included 368 employees (90.4% response rate) and the post-implementation survey, 364 (92.8% response rate). RESULTS: The 'smoke-free' policy significantly reduced smoking in the unauthorized areas. Before implementation, 63% of staff reported frequently observing smoking in the hospital, compared to 40% 6 months post-policy implementation (P < 0.001). Significantly more smokers reported leaving their workplace to smoke (17% pre- vs. 62% post-implementation, P < 0.0001). Sixty-five percent of smokers, in both surveys, agreed that "a smoke-free policy is unfair to smokers". Fewer nonsmokers subscribed to this belief: 42% pre- and 34% post-implementation. Smoker prevalence remained unchanged (19%). CONCLUSIONS: Implementation of a "smoke-free" policy is an effective way to reduce smoking in the hospital environment. More effort is required, however, to help staff quit smoking altogether.     

Hospitalized smokers: compliance with a nonsmoking policy and its predictors

BACKGROUND: Factors associated with compliance with smoke-free policies among hospitalized smokers are poorly described. A better understanding of these factors may improve smoking cessation during admission and in the long-term. METHODS: Two cross-sectional studies were conducted in an urban teaching hospital in Spain during 2002 and 2004. We interviewed 229 admitted smokers gathering data on smoking history, admission diagnosis, belief that hospitalization is related to smoking, policy's awareness, and smoking during admission and place of smoking. RESULTS: Among hospitalized patients, approximately a third were current smokers. The compliance with the nonsmoking policy in 2002 and 2004 was respectively 71.9% (IC95%: 63.9-79.9) and 60.1% (IC95%: 50.9-69.3). In the multivariate regression model, factors significantly associated with compliance were: contemplation stage, confidence in quitting after discharge, belief that current symptoms or illness were related to smoking, and mild withdrawal symptoms. CONCLUSIONS: Admission in a smoke-free hospital does not guarantee that patients will refrain from smoking. Factors associated with compliance identified may be modified by tailored smoking cessation interventions. Our results might help physicians to understand inpatients' difficulties to abstain from cigarettes and enhance their efforts to take advantage of the hospitalization as a window opportunity to quit.     

Opportunities for improving inpatient smoking cessation programs: a community hospital experience

BACKGROUND: This cohort study examined the role of smoking during hospitalization, duration of cessation counseling, patient awareness of the hospital's smoke-free policy, belief that smoking is associated with a current symptom or disease, and the presence of withdrawal symptoms with 12-month smoking cessation among inpatients enrolled in a smoking cessation program. METHODS: Inpatients in four community hospitals (N = 1,317) participated in a smoking cessation intervention consisting of face-to-face counseling at baseline and four follow-up counseling phone calls. Patients were classified as nonsmokers only if they reported not smoking at both the 6- and the 12-month interviews. All patients lost to follow-up were considered smokers. RESULTS: At 1 year the smoking cessation rate was 22.5%. Cessation was independently associated with reporting no smoking during hospitalization, noting no withdrawal symptoms at baseline, and believing that a current illness or symptom is related to smoking. Length of counseling interview and awareness of the hospital's smoke-free policy were not independently associated with cessation. CONCLUSIONS. Smoking cessation programs and hospital policies that decrease smoking during hospitalization, address withdrawal symptoms during hospitalization, and make clear the connection between a patient's health and cigarette smoking may increase the effectiveness of their smoking cessation efforts.     

Evaluation of the 1990 Centers for Disease Control and Prevention smoke-free policy

PURPOSE. To determine the prevalence of tobacco use among Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) employees and the effect of the smoke-free policy on smoking behavior and air quality at work. DESIGN. A stratified telephone survey of 1181 CDC/ATSDR employees randomly selected from employee rosters. SETTING. CDC/ATSDR work sites in Atlanta, Georgia, and other major CDC locations throughout the United States and Puerto Rico. SUBJECTS. Randomly selected employees of CDC/ATSDR1, or about 22% of the total CDC/ATSDR population; 98% of eligible persons selected agreed to participate. MEASURES. Demographic and smoking history variables, attitudes toward and impact of the smoke-free policy on smoking behavior, and self-report changes in air quality were the measures used. RESULTS. Overall cigarette smoking prevalence was only 11.1%. One percent reported using chewing tobacco, 1.1% reported smoking a pipe, and 1.4% reported smoking cigars. Average self-reported, daily cigarette consumption significantly decreased after the smoking ban took effect. Overall, 90% of the employees supported the smoke-free policy, and 80% of the employees believed that smokers were complying with the smoke-free policy. Most employees believed that the air quality of work areas and nonwork areas (65% and 69%, respectively) had improved since the smoke-free policy was implemented. CONCLUSIONS. These findings are consistent with previous evaluations of smoke-free policies and suggest that most employees are generally supportive of workplace smoking restrictions. Such policies can also have a positive impact on smoking behavior and perceived air quality.     

Impact of a smoke-free workplace policy in a company

OBJECTIVE: To assess the impact of a smoke-free workplace policy in a company. METHOD: The impact of the implementation of a smoke-free workplace policy was assessed between October 2001 and February 2003 in a company with 184 employees. Two surveys of the entire staff were performed, one before the implementation of the new policy and the other 14 months after. RESULTS: Both passive exposure to tobacco smoke and tobacco consumption among smokers decreased. The proportion of workers free of tobacco smoke exposure at their workplace increased from 32% to 84% (p < 0.001) and, among smokers, the mean daily consumption of cigarettes was reduced by 7.3 cigarettes (p = 0.049). CONCLUSIONS: Demarkation of areas where smoking is allowed not only reduces passive exposure to tobacco smoke at the workplace but also seems to encourage smokers to quit smoking or to reduce tobacco consumption.     

北京市丰台区1182名医务人员吸烟及控烟情况调查

目的了解丰台区医务人员吸烟及控烟情况，为下一步开展医院控烟工作提供基础资料。方法采用分层抽样的方法抽取北京市丰台区一、二、三级医院各2家，再在被抽中的医院中以系统抽样的方式抽取1182名医务人员进行问卷调查。调查内容包括一般情况、吸烟和戒烟情况、医院控烟情况。结果男性吸烟率为41．8％，女性吸烟率为0．8％，男性高于女性（P〈0．01）。男性中，医生的吸烟率为31．5％，后勤人员吸烟率为75．6％。不同文化程度者吸烟率不同，中专及以下者吸烟率最高，平均为13．6％，其中男性为69．2％，女性为1．7％。在吸烟者中，有54．0％的人曾经戒过烟，戒烟失败的主要原因为缺乏意志力，占50．0％。36．0％的医务人员不知道该如何戒烟，只有23．7％知道“五日戒烟法”，3．8％知道“安非他酮是尼古丁替代品”。结论男性医务人员吸烟率高，控烟知识和技能较差，临床医务人员的控烟工作还面临着巨大挑战。     

A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use

OBJECTIVES: In this cohort study, we assessed the impact of smoke-free work-site policies on smoking cessation behaviors. METHODS: Smokers were tracked as part of the Community Intervention Trial for Smoking Cessation. Telephone surveys were administered to 1967 employed smokers in 1993 and 2001. Data were gathered on personal and demographic characteristics, tobacco use behaviors, and restrictiveness of worksite smoking policies. RESULTS: People who worked in environments that changed to or maintained smoke-free policies between 1993 and 2001 were 1.9 times more likely (odds ratio [OR] = 1.92; 95% confidence interval [CI] = 1.11, 3.32) than people whose worksites did not do so to have stopped smoking by 2001. Continuing smokers decreased their average daily consumption by 2.57 cigarettes. People working in environments that had smoke-free policies in place in both 1993 and 2001 were 2.3 times more likely (OR=2.29; 95% CI=1.08, 4.45) than people not working in such environments to have quit by 2001, and continuing smokers reported a decline in average daily consumption of 3.85 cigarettes. CONCLUSIONS: Smoke-free worksite policies help employees reduce their cigarette consumption and stop smoking.     

The use of nicotine-replacement therapy by hospitalized smokers

BACKGROUND: No-smoking policies are mandatory in U.S. hospitals. Consequently, smokers who are hospitalized must temporarily stop smoking. Nicotine-replacement therapy (NRT) could help hospitalized smokers relieve nicotine withdrawal symptoms, comply with no-smoking policies, and sustain tobacco abstinence after discharge. The extent of NRT use in the hospital setting is unknown. We describe the prevalence and patterns of NRT use in hospitalized smokers. DESIGN: Prospective observational study within a randomized smoking-intervention trial. SETTING/PARTICIPANTS: Six hundred fifty adult smokers admitted to the medical and surgical services of a large urban teaching hospital that prohibits smoking in all indoor areas. Follow-up was at 6 months. MAIN OUTCOME MEASURE: Inpatient pharmacy records of nicotine patch or gum use. RESULTS: Only 34 of 650 smokers (5.2%) received NRT during their hospital stay, including only 9.6% of smokers who reported difficulty refraining from smoking while hospitalized and 9.0% of hospitalized smokers with nicotine withdrawal. NRT was more likely to be prescribed to patients with nicotine withdrawal (OR 2.23; 95% CI: 1.01, 4.90), a higher daily cigarette consumption (OR 1.04; 95% CI: 1.01, 1.06), and a longer hospitalization (OR 1.05; 95% CI: 1.00, 1.10). NRT use was independent of a patient's intention to quit smoking after discharge and was not associated with smoking cessation 1 and 6 months after discharge. CONCLUSIONS: NRT was rarely used in this hospital, even among those who could have benefited from it to treat nicotine-withdrawal symptoms. When NRT was used, relief of nicotine withdrawal, rather than assistance with smoking cessation, appeared to be the primary goal. Greater use of NRT could benefit the estimated 6.5 million smokers who are hospitalized annually by reducing nicotine withdrawal, encouraging smoking cessation, and ensuring compliance with hospital no-smoking policies.     

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.     

Tobacco policy regression in Arizona worksites

PURPOSE: To learn how worksite tobacco policies in Arizona changed between 1998 and 2001. DESIGN: Telephone survey panel design. SETTING: Arizona. SUBJECTS: Private workplaces with at least five employees (N = 1008). MEASURES: Workplace policies were rated as "smoke free" (no smoking by employees in any indoor areas or in company vehicles except for designated smoking areas enclosed by physical barriers and having separate ventilation systems), "partial" policies (restrictive tobacco policies that did not meet the "smoke-free" standard), or no tobacco policy. ANALYSIS: Bivariate statistical tests included chi2 and analysis of variance. Logistic regression was performed to identify the variables that best predicted the workplaces that weakened or eliminated their policies. RESULTS:. Tobacco policy in Arizona worksites improved overall, but 10.8% of worksites had weakened or eliminated tobacco policies present at baseline. Among worksites that were smoke free at baseline, 15.5% were no longer smoke free at follow-up. CONCLUSION:. Policy regression is a disturbing finding that should be further explored. Our findings suggest that efforts to promote workplace tobacco policies should not end when policies are in place.     

Compliance and support for smoke-free school policies

Our objective was to examine factors associated with compliance and support for a smoke-free campus before and after a 1995 campus-wide smoking ban for everyone, including teachers and visitors, in California. Adolescent (12-17 years) data from the 1993, 1996, 1999 and 2002 (N approximately 6000 each year) California Tobacco Surveys (population-based telephone surveys) were analyzed. Trends in compliance with smoke-free school policies and support for smoke-free campuses were examined among students in public and private schools. Perceived compliance with the no-smoking rule by most or all student smokers increased from 43.7 +/- 1.6% in 1993 to 71.5 +/- 1.4% in 2002. While non-smokers have overwhelmingly favored smoke-free school grounds since 1993 (more than 85% each survey year), support among current smokers increased from 55.8 +/- 4.7% in 1996 to 69.1 +/- 6.8% in 2002. Student smokers who saw teachers smoking in school were less likely to favor school smoking bans (odds ratio = 0.25, 95% confidence interval 0.12-0.49). The percentage of private school students seeing teachers smoke on school grounds has been at least twice that of public school students since 1996. Compliance with and support for smoke-free schools increased since smoking was banned on campus for everyone. Perceived compliance by teachers, much lower in private schools, appears to undermine student smokers' support of this policy. Increased efforts are necessary to communicate to teachers the importance of their modeling of policy compliance to students.     

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

BACKGROUND: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: Staff attitudes need to be carefully considered, particularly in psychiatric settings, in attempts to implement smoke-free policies in health care settings.     

The effects on smokers of Boston's smoke-free bar ordinance: a longitudinal analysis of changes in compliance, patronage, policy support, and smoking at home.

OBJECTIVE: We prospectively examined effects of the implementation of a smoking ban in bars on Boston, Massachusetts, smokers. METHODS: A representative sample of Massachusetts smokers was interviewed before and after the smoking ban was implemented in Boston. Participants were adult smokers living in Boston (n = 83) and in 203 other Massachusetts cities and towns that did not adopt smoking bans in bars prior to July 2004 (n = 903). The outcome measures were changes in reports of smoking in bars, frequency of bar patronage, support for smoke-free bars, smoking at home, and exposure to secondhand smoke at home based on town of residence. RESULTS: Compared to changes over the same time period among smokers in towns where smoking in bars was permitted, smokers in Boston were significantly less likely to observe smoking and less likely to decrease their bar patronage after the smoking ban was implemented. Changes in support for smoke-free bars, smoking patterns at home, and exposure to secondhand smoke at home did not differ between the groups. Conclusion: Expectations about noncompliance, declines in patronage, and displacement of smoking to the home as a consequence of extending smoking restrictions to bars are not supported by the data.     

The making of a smoke-free hospital may not be as easy as you think.

Literature describing experiences in the implementation of a smoke-free policy in a hospital suggests that, with careful preparation and close monitoring, a smoke-free policy can be successfully instituted. Despite this pervasive viewpoint, any hospital personnel considering the adoption of a smoke-free policy should be aware that the institution of such a policy may be quite difficult. The experience at University Hospital suggests that a strong policy statement, administrative support, and a comprehensive implementation plan have helped to achieve widespread compliance with the smoke-free policy among hospital employees. Unfortunately, the smoke-free policy has been less successful changing the smoking activities of the patients. Although others have not reported this compliance problem, we believe it is a real problem that many institutions will face. We present methods used to identify, combat, and monitor this compliance problem.     

The impact of cigarette warning labels and smoke-free bylaws on smoking cessation: evidence from former smokers

BACKGROUND: To effectively address the health burden of tobacco use, tobacco control programs must find ways of motivating smokers to quit. The present study examined the extent to which former smokers' motivation to quit was influenced by two tobacco control policies recently introduced in the Waterloo Region: a local smoke-free bylaw and graphic cigarette warning labels. METHODS: A random digit-dial telephone survey was conducted with 191 former smokers in southwestern Ontario, Canada in October 2001. Former smokers who had quit in the previous three years rated the factors that influenced their decision to quit and helped them to remain abstinent. RESULTS: Thirty-six percent of former smokers cited smoke-free policies as a motivation to quit smoking. Former smokers who quit following the introduction of a total smoke-free bylaw were 3.06 (CI95 = 1.02-9.19) times more likely to cite smoking bylaws as a motivation to quit, compared to former smokers who quit prior to the bylaw. A total of 31% participants also reported that cigarette warning labels had motivated them to quit. Former smokers who quit following the introduction of the new graphic warning labels were 2.78 (CI9 = 1.20-5.94) times more likely to cite the warnings as a quitting influence than former smokers who quit prior to their introduction. Finally, 38% of all former smokers surveyed reported that smoke-free policies helped them remain abstinent and 27% reported that warning labels helped them do so. CONCLUSION: More stringent smoke-free and labelling policies were associated with a greater impact upon motivations to quit.