Electronic Cigarettes on Hospital Campuses

Smoke and tobacco-free policies on hospital campuses have become more prevalent across the U.S. and Europe, de-normalizing smoking and reducing secondhand smoke exposure on hospital grounds. Concerns about the increasing use of electronic cigarettes (e-cigarettes) and the impact of such use on smoke and tobacco-free policies have arisen, but to date, no systematic data describes e-cigarette policies on hospital campuses. The study surveyed all hospitals in North Carolina (n = 121) to assess what proportion of hospitals have developed e-cigarette policies, how policies have been implemented and communicated, and what motivators and barriers have influenced the development of e-cigarette regulations. Seventy-five hospitals (62%) completed the survey. Over 80% of hospitals reported the existence of a policy regulating the use of e-cigarettes on campus and roughly half of the hospitals without a current e-cigarette policy are likely to develop one within the next year. Most e-cigarette policies have been incorporated into existing tobacco-free policies with few reported barriers, though effective communication of e-cigarette policies is lacking. The majority of hospitals strongly agree that e-cigarette use on campus should be prohibited for staff, patients, and visitors. Widespread incorporation of e-cigarette policies into existing hospital smoke and tobacco-free campus policies is feasible but needs communication to staff, patients, and visitors.

Focusing management in implementing a smoking ban in a university hospital in Sweden

To explore the impact of various steps when introducing a smoking ban at the Karolinska Hospital (1000 beds; 6000 employees) in Stockholm, Sweden, a multiple evaluation strategy was performed over 5 years. All heads of clinical departments (N = 41) and a random sample of employees (n = 517) and a convenience sample of hospital labour managers (n = 17) were separately addressed through questionnaire surveys at different time intervals after the introduction of the ban in 1992. An observational and interview study completed the follow-up. The implementation process was supplemented by a comprehensive information strategy over 5 years. The two most important steps during implementation were management support and focus on environmental tobacco. The ban was well known at introduction. Heads of clinical departments reported a third of staff to be satisfied with the restrictions. In contrast, the staff survey revealed 62% to be positive. A shift in favour of a radical tobacco-free hospital was perceived during follow-up. Co-operation between hospital board, heads of clinical departments and local labour managers proved successful. The consecutive evaluations served as tools in labour management and contributed to staff compliance. A total ban, including the selling of tobacco and smoking in the hospital grounds is still to be achieved.

Hospital smoking policies: who enforces them?

As opprobrium is increasingly given to the act of smoking, many institutions--hospitals especially--are seeking to curtail the amount of smoking that occurs within their buildings through various policies. This, however, raises two necessary questions: What does policy enforcement mean? And who shall enforce the rules? The article below discusses the results of a survey of North Carolina hospitals that asked these questions and more.

Effect of a hospital nonsmoking policy on patients' knowledge, attitudes, and smoking behavior

PURPOSE

To explore patients' knowledge of and attitudes toward a hospital nonsmoking policy and to examine changes in patients' smoking behavior before admission and after discharge.

DESIGN

Patients were surveyed by mail 1 week after hospitalization.

SETTING

A 379-bed Boston tertiary teaching hospital.

SUBJECTS

Seven hundred twenty-six patients were surveyed. There were 337 respondents, yielding a response rate of 59%.

OUTCOME MEASURES

Policy knowledge, policy satisfaction, and smoking cessation assistance. Smoking status was assessed retrospectively by self-report 1 week before admission and at the time of the survey.

RESULTS

Bivariate and multiple logistic regression techniques were used to explore relationships among explanatory variables and outcomes. Knowledge of the policy was fair, although satisfaction with the policy was high. Twenty percent of patients reported that they had quit smoking at the time of the survey; 53% of quitters said they quit because of the policy. Thirty-nine percent of patients reported receiving assistance from medical providers, and 88% were satisfied with this help. Smoking cessation assistance was not associated with quitting but was related to smoking less (p < 0.02).

CONCLUSIONS

A hospital nonsmoking policy was well accepted by patients and may have had a favorable impact on patients' smoking behavior. Because intervention by health care providers was limited but appeared to be effective, smoking cessation assistance programs need to be developed and implemented in other hospitals so that these results can be generalizable.

Public policy for the control of tobacco-related disease

Public policies concerning tobacco shape the environment of the smoker and nonsmoker alike. These policies use diverse means to achieve the common goal of reducing tobacco use and its attendant health consequences. Educational interventions such as warning labels, school curricula, and public service announcements serve to inform the public about the hazards of tobacco smoke. These are countered by the pervasive marketing of tobacco products by the tobacco industry, despite a ban on tobacco advertising on radio and television. Further restrictions on tobacco advertising and promotion have been proposed and await action. Cigarette excise taxes and smoker-nonsmoker insurance premium differentials discourage smoking by making it more costly to purchase cigarettes. Conversely, health insurance reimbursement for smoking cessation programs could reduce the cost of giving up the habit and might encourage cessation. Restricting or banning smoking in public places and workplaces decreases a smoker's opportunities to smoke, further inhibiting this behavior. Reducing the availability of cigarettes to children and adolescents may help to prevent them from starting to smoke. The environment of the smoker is conditioned by this pastiche of influences. Physicians who become involved in tobacco-control issues have the opportunity to alter the environmental influences on their patients. This is likely to be synergistic with physicians' efforts inside the office to encourage individual smokers to quit. As a first step toward advocacy outside the office, physicians can help to create a smoke-free health-care facility in their own institution. Beyond that, advocacy groups or the voluntary health organizations (e.g., American Lung Association) provide avenues for physicians to take a stand on community issues relevant to tobacco control. Physicians who take these steps to alter the environment of smokers beyond the office are likely to magnify the effect of their work with individual patients who smoke.

One-year longitudinal study of a no-smoking policy in a medical institution

Smoking and health are increasingly understood to be incompatible. To evaluate, prospectively and retrospectively, the attitudes of employees, staff physicians, and patients of a medical institution, a questionnaire was administered before and after implementation of a no-smoking policy. Of many questions, select ones reviewed here focused on the following concerns: (1) how tobacco smoke affects employees and patients, (2) employee acceptance of a no-smoking policy before and after its implementation, and (3) the consequences of the policy on employee smokers. Open-ended questions about smoking were constructed by a committee comprised of clinicians, investigators, and administrators. The questionnaire was given to 2,000 randomly selected patients and the institution's entire staff of 4,200 employees and 225 staff physicians. Data were obtained on three occasions: six months before, six months after, and one year after the implementation of the no-smoking policy. The majority of patients, employees, and physicians indicated that the smoke of others bothered them and ranked the following as most offensive: smell, eye irritation, provocation of sinus problems, coughing, and headache. Approximately 80 percent of employees and patients favored the policy before its inception; and employees increasingly favored it through the year after its implementation with a favorable attitude increasing by nearly 10 percentage points. One year after implementation, 80 percent of patients were in favor of the policy. In the final survey, 74 percent of respondents indicated the policy had helped them. One year after policy implementation, employee smoking was reduced significantly from 22 to 14 percent; and of those employees who continued to smoke, 81 percent smoked less than eight cigarettes per day.(ABSTRACT TRUNCATED AT 250 WORDS)