Implementing and complying with the Smoke-free Hospitals Project in Catalonia, Spain

Cancer Prevention and Control Unit, Institut d'Investigacio Biomedicale Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.
European Journal of Cancer Prevention (Impact Factor: 3.03). 10/2006; 15(5):446-52. DOI: 10.1097/00008469-200610000-00010
Source: PubMed


The objective of the study was to describe the implementation of measures for preventing tobacco consumption developed in the Catalan Network of Smoke-free Hospitals. Information from 25 hospitals that are actively involved in the Catalan Network of Smoke-free Hospitals (April 2004) was used. The degree of implementation of the Smoke-free Hospitals Project was analysed by means of the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals; each hospital was analysed globally and according to the duration of its Network membership (<1 year: implementation stage; > or =1 year: consolidation stage). In terms of global indicators, there were high levels of commitment (64.8%), communication (74.7%), tobacco control (77.4%) and implementation of smoke-free environments (81.0%). A lower degree of implementation (<50%) was found in education and training, health promotion and healthy workplaces. According to the duration of Network membership, significant differences were observed for communication, environment, healthy workplaces and follow-up. Deficits were observed in areas such as specialist training and cessation support, and further input is required here. By identifying areas needing attention, providing a guide for policy development and by administering it periodically, one can ensure that progress is kept on track.

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    • "The SAQ is also a tool to acknowledge and reward continuous improvement by facilitating hospitals to categorize their progress. This instrument was developed to analyse the extent to which tobacco control measures are complied within hospitals [5]. The questionnaire includes 9 standards (see Figure 1) with different number of items: commitment (5 items), communication (1 item), education and training (4 items), identification and cessation support (8 items), tobacco control (2 items), environment (4 items), healthy workplace (6 items), health promotion (2 items), and follow-up (2 items). "
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    ABSTRACT: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smoke-free Hospitals before and after a comprehensive national smoking ban. We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two cross-sectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. The mean of the implementation score of tobacco control policies was 52.4 (95% CI: 45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.
    BMC Public Health 05/2009; 9(1):160. DOI:10.1186/1471-2458-9-160 · 2.26 Impact Factor
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    • "More recently the European Network of Smoke Free Hospital and Health Services (ENSH) has also promoted completely smoke-free hospital grounds[33]. In Spain, this has lead to the successful implementation of smoke-free hospital sites[34] and with the introduction of nationwide smoke-free legislation ETS exposure at these institutions is decreasing[35]. Despite these successes, there remain difficulties. "
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    ABSTRACT: Smoke-free policy aims to protect the health of the population by reducing exposure to environmental tobacco smoke (ETS), and World Health Organisation (WHO) guidance notes that these policies are only successful if there is full and proper enforcement. We aimed to investigate the problem of resistance to smoking restrictions and specifically compliance with smoke-free policy. We hypothesised that an explanation for non-compliance would lie in a measurable difference between the smoking behaviours of compliant and non-compliant smokers, specifically that non-compliance would be associated with nicotine dependence and different reasons for smoking. We conducted a questionnaire-based, descriptive, cross-sectional study of hospital employees. Seven hundred and four members of staff at Addenbrooke's Hospital, Cambridge, UK, completed the questionnaire, of whom 101 were smokers. Comparison between compliant and non-compliant smokers was made based on calculated scores for the Fagerström test and the Horn-Waingrow scale, and level of agreement with questions about attitudes. For ordinal data we used a linear-by-linear association test. For non-parametric independent variables we used the Mann-Whitney test and for associations between categorical variables we used the chi-squared test. The demographic composition of respondents corresponded with the hospital's working population in gender, age, job profile and ethnicity. Sixty nine smokers reported they were compliant while 32 were non-compliant. Linear-by-linear association analysis of the compliant and non-compliant smokers' answers for the Fagerström test suggests association between compliance and nicotine dependence (p = 0.049). Mann-Whitney test analysis suggests there is a statistically significant difference between the reasons for smoking of the two groups: specifically that non-compliant smokers showed habitual smoking behaviour (p = 0.003). Overall, compliant and non-compliant smokers did not have significantly different attitudes towards the policy or their own health. We demonstrate that those who smoke in this setting in contravention to a smoke-free policy do so neither for pleasure (promotion of positive affect) nor to avoid feeling low (reduction of negative affect); instead it is a resistant habit, which has little or no influence on the smoker's mood, and is determined in part by chemical dependence.
    BMC Public Health 02/2009; 9(1):238. DOI:10.1186/1471-2458-9-238 · 2.26 Impact Factor
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    ABSTRACT: The study aimed to identify the extent of smoking, compliance with tobacco restrictions, and attitudes toward smoking and tobacco control measures among the employees in a Comprehensive Cancer Center from 2001 to 2006 where a smoke-free policy was progressively introduced. Four cross-sectional surveys were conducted from 2001 to 2006. Survey items include smoking status, smoking history, environmental tobacco exposure, and agreement with tobacco initiatives. The prevalence of smoking has declined from 34.5% in 2001 to 30.6% in 2006. The decrease was present in all professional groups: Doctors from 20.0% in 2001 to 15.2% in 2006 and administrative clerks from 56.0% in 2001 to 37.0% in 2006 reduced the most. Among nurses, the prevalence of smoking was still high with a 2-point percent reduction (from 34.0% in 2004 to 32.6% in 2006). Other changes of the pattern of smoking were apparent: a reduction on the number of cigarettes smoked, decrease of daily smokers, and increase of smoking abstinence during the hospital duty. Compliance with smoke-free areas increased. We observed a very significant decrease of the perception of exposure to environmental tobacco exposure at work. The Smoke Free project helped to achieve a healthy work environment. Tailored smoking cessation programs should be designed to help healthcare professionals to stop smoking. In addition, healthcare professionals should play a key role in promoting a healthy smoke-free lifestyle.
    Cancer nursing 02/2008; 31(2):88-94. DOI:10.1097/ · 1.97 Impact Factor
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