Assessing the responses of smokers to requests to stop smoking on hospital grounds

ISSUE ADDRESSED

Fear of aggression is often cited as an issue for health service staff in approaching smokers who are breaching smoke-free policies. This study collected data to quantify the interactions between Health Promotion Service staff and smokers. The aim was to trial de-escalation based protocols for Authorised Inspectors and one for general staff with regards to the aggression risk to staff when approaching smokers within hospital grounds.

METHODS

The study design was a non-randomised trial with no control group. A standard protocol was developed, based on de-escalation techniques. The primary outcomes of the study were measures of aggression and smokers' compliance with instructions to extinguish their cigarette. Aggression was recorded using the Modified Overt Aggression Scale (MOAS). Two hundred interactions were conducted with smokers during business hours by Health Promotion Service staff. The first 100 interactions were based on an enforcement methodology typically delivered by Authorised Inspectors, while the second 100 interactions were based on an information and assistance methodology to reflect those that could be delivered by general health service staff.

RESULTS

Only four instances of aggression were experienced, representing 2% of all interactions. Each of these was limited to verbal aggression. No self-aggression, aggression against property, or physical aggression was encountered. Smokers were significantly more compliant to instructions to extinguish their cigarette in the enforcement method (64%) than the information and assistance method (45%) (P < .001). Groups of smokers were more compliant than individual smokers in the enforcement method (76.3% compared to 56.5%, P < .05).

CONCLUSIONS

This study quantifies the risk of aggression to health service staff conducting smoking compliance interactions using two methodologies. By following de-escalation-based protocols, staff can approach smokers in a low-risk manner and support smoke-free policy implementation and compliance. For general staff, the emphasis of interactions must be on providing information and assistance to smokers, not enforcement, as indicated by the reduced rate of immediate compliance, introducing an increased risk of escalation if enforcement is attempted. SO WHAT?: These protocols could be implemented by other health services or organisations that are seeking to optimise the involvement of staff in supporting smoke-free policies.

Supporting visitor compliance with a smoke-free policy at hospital using a nicotine replacement therapy vending machine

ISSUE ADDRESSED

To support visitors to comply with Central Coast Local Health District's (CCLHD) smoke-free hospital grounds policy, a need was identified for round-the-clock availability of nicotine replacement therapy (NRT). Providing NRT through a vending machine was identified as a possible solution. This initiative complemented other strategies that provide staff and patients who smoke with NRT.

METHODS

NRT was originally provided through a snack vending machine; however, there were commercial and regulatory concerns with this method. In 2015, dedicated NRT vending machines were installed at Gosford and Wyong Hospitals, and were operated by the Health Promotion Service. The appropriate regulatory permission was gained to supply a specific brand of NRT. Sales and incident data were recorded, and ongoing smoking counts were performed both before and after installation.

RESULTS

In all, 247 sales of NRT gum were made through the vending machines from early 2017 to late 2019. Smoking counts show that there are very low rates of visitor smoking (<1%) in the approximately 4.5 years pre- and post-installation of dedicated vending machines. There was no statistically significant change in the smoking rate of visitors since the vending machine was installed at Wyong Hospital.

CONCLUSIONS

While NRT is generally provided to patients and staff within health settings to support compliance with smoke-free policies, alternatives to smoking for visitors are typically overlooked. A NRT vending machine achieves this. However, because there are few purchases made, the vending machines as currently operating are unlikely to make any significant impact on smoke-free policy compliance at these hospitals. SO WHAT?: While vending machines have limited effectiveness on overall smoke-free policy compliance, this strategy may have applicability to all sectors with smoke-free policies, especially those operating 24 hours a day, as a means of providing an alternative to smoking for visitors.

Smoking, Quitting, and the Provision of Smoking Cessation Support: A Survey of Orthopaedic Trauma Patients

OBJECTIVE

This study investigates orthopaedic trauma patients smoking cessation history, intentions to quit, receipt of smoking cessation care during hospital admission, and patient-related factors associated with receipt of smoking cessation care.

METHODS

An online cross-sectional survey of orthopaedic trauma patients was conducted in 2 public hospitals in New South Wales, Australia. Prevalence of smoking and associated variables were described. Logistic regressions were used to examine whether patient characteristics were associated with receipt of smoking cessation care.

RESULTS

Eight hundred nineteen patients (response rate 73%) participated. More than 1 in 5 patients (21.8%) were current smokers (n = 175). Of the current smokers, more than half (55.3%) indicated making a quit attempt in the last 12 months and the majority (77.6%) were interested in quitting. More than a third of smokers (37.4%) were not advised to quit; 44.3% did not receive any form of nicotine replacement therapy; and 24.1% reported that they did not receive any of these 3 forms of smoking cessation care during their admission. Provision of care was not related to patient characteristics.

CONCLUSIONS

The prevalence of smoking among the sample was high. Respondents were interested in quitting; however, the provision of care during admission was low. Smoking cessation interventions need to be developed to increase the provision of care and to promote quit attempts in this Australian population.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The role of middle managers in tobacco control after a national smoke-free hospital campus ban

BACKGROUND

Much of the recent health services research on tobacco control implementation has explored general views and perceptions of health professionals and has rarely taken into account middle management's perspectives. We state that middle managers may facilitate the implementation of smoke-free campus bans and thereby improve their effectiveness. The aim of this study was to assess middle managers' behaviors to enforce a new national smoke-free hospital campus ban, to evaluate their perceptions of the level of compliance of the new regulation, and to explore their attitudes towards how smoking affects the work environment.

METHODS

We used a cross-sectional survey, conducted online to evaluate middle managers of a general hospital in Catalonia, Spain. Close-ended and open-ended questions were included. Results were analyzed by using quantitative and qualitative methods. The managers' open opinions to the proposed topics were assessed using UCINET, and a graph was generated in NetDraw.

RESULTS

Sixty-three of the invited managers (78.7 %) participated in the survey. 87.2 % of them agreed that the hospital complied with the smoke-free campus ban and 79.0 % agreed that managers have an important role in enforcing the ban. They also perceived that smoking disturbs the dynamics of work, is a cause of conflict between smokers and non-smokers, and harms both the professional and the organization images. However, 96.8 % of respondents have never given out fines or similar measures and their active role in reminding others of the policy was limited; in addition, 68.2 % considered that hospitals should provide tobacco cessation treatments. Smoker middle managers were more likely than non-smokers to perceive that smoking has little impact on work.

CONCLUSIONS

Middle managers play a limited role in controlling tobacco consumption; smokers are less prone to think that smoking disturbs work dynamics than non-smokers. Tailored training and clear proceedings for middle managers could encourage more active roles.

Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys

BACKGROUND

Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws.

METHODS

Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law).

RESULTS

Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project.

CONCLUSIONS

A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.