Barriers and Challenges for Tobacco Control in a Smoke-Free Hospital

Cancer Prevention and Control Unit, Institut Català d'Oncologia, Barcelona, Spain.
Cancer nursing (Impact Factor: 1.97). 02/2008; 31(2):88-94. DOI: 10.1097/
Source: PubMed


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.

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Available from: Cristina Martínez
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    • "(Martinez et al., 2009); however, that was a voluntary requirement in a strategy to become smoke-free and promote smoking prevention and cessation. There is evidence that indoor smoking bans alone promote slight decreases in tobacco consumption, are supported by employees, and elicit satisfaction among patients and visitors (Hopkins et al., 2010; IARC, 2009; Longo et al., 1996, 2001; Martinez et al., 2008). However, some studies suggest that more restrictive smoke-free policies, including outdoor bans, would support employees in attempts to reduce or cease smoking (Fernandez and Martinez, 2010; Gadomski et al., 2010; Williams et al., 2009). "
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    ABSTRACT: Introduction: On 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. Methods: This 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. Results: The 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. Conclusions: After 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.
    Full-text · Article · Oct 2014
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    • "Previous studies evaluating SHS exposure have also used self-reported surveys, qualitative studies, or assessment of airborne nicotine in worksites and hospitals [9,11,12,19-26]. One such study in China found compliance with smoking restriction policies was poor, with more than 40% of smokers working under a smoke-free policy reporting smoking was still occurring “sometimes” in their workplaces [21]. Evidence from focus groups conducted in 3 Chinese provinces found extensive misconceptions about SHS policies among physicians and educators [24]. "
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    ABSTRACT: China 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. Pre- 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. Physicians' 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 mug/m3), with an overall mean of .667 mug/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. As 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.
    Full-text · Article · Oct 2013 · BMC Public Health
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    • "So we should increase and intensify the hospitals' measures addressed to inform and ask for the commitment of the tobacco policies to new staff members, monitor their tobacco consumption, and provide cessation programs inside the institutions. The growth in those areas could be a solution to work out with the lack of support and fulfillment of health professionals in the implementation of smoke-free polices at hospitals showed in other studies [18,19]. Although smoking inside the hospitals is forbidden, there are still areas where SHS is detectable [14]. "
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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.
    Full-text · Article · May 2009 · BMC Public Health
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