Academic journal article Australian Health Review

Do Smoke-Free Environment Policies Reduce Smoking on Hospital Grounds? Evaluation of a Smoke-Free Health Service Policy at Two Sydney Hospitals

Academic journal article Australian Health Review

Do Smoke-Free Environment Policies Reduce Smoking on Hospital Grounds? Evaluation of a Smoke-Free Health Service Policy at Two Sydney Hospitals

Article excerpt


Objective. To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy.

Methods. Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation.

Results. There was an overall significant 36% (P<0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P0.05) in staff, 37% (P0.05) in visitors and remained unchanged among inpatients.

Conclusions and implications. The Smoke-free Environment Policy was effective in reducing visitors and staffobserved smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

What is known about the topic? Smoke-free environment policies have been developed and introduced worldwide. These policies reduce tobacco use and protect the community from environmental tobacco smoke.

What does this paper add? This paper focusses on a method used to monitor compliance of a smoke-free environment policy in a healthcare setting. The paper tracks what happened over 2 years before and after the policy was implemented. Among staff, there was evidence of compliance with the policy; however, there was no apparent change in policy compliance amongst inpatients.

What are the implications for practitioners? Policy makers and staffimplementing smoke-free policies should ensure adequate support for staffand inpatients are available, with continued promotion and enforcement of the policy. Further investigations are needed into multi-strategic cessation interventions for inpatients who smoke.

Received 18 January 2011, accepted 25 July 2011, published online 28 February 2012


The benefits of smoke-free environment policies are well recognised1-3 - they are associated with increased quit attempts and cessation; protect members of the public and stafffrom exposure to environmental tobacco smoke; and provide a platform for healthcare workers to actively promote smoking cessation to inpatients. Over the last decade, smoke-free environment policies have been introduced in healthcare settings within Australia and internationally to reduce tobacco use and exposure to environmental tobacco smoke.4-6

In 1988,NSWimplemented a ban on smoking within hospital buildings. In 1999, NSW Health introduced a policy for Area Health Services (AHS) to ban all smoking by patients, staffand visitors on the grounds of health facilities and in vehicles by 2008.7

At the time of the evaluation,NSWhad eight AHS. Each AHS has been responsible for implementing the NSW Smoke-free Workplace Policy. In Sydney South West Area Health Service (SSWAHS), a Smoke-free Environment (SFE) Taskforce was established to plan, implement and evaluate compliance with the smoke-free environment policy (SFEP). Implementation of the policy has had four phases (Table 1); the final phase is ongoing. The SSWAHS policy has included provision of 8 weeks supply of free nicotine replacement therapy (NRT) per year and counselling services, including staffhealth clinics, Quit Online (support website for NSW Health staff) and NSW Quitline, for staffwho want to quit smoking. The policy has ensured ongoing stafftraining opportunities to assist with identification and assessment of inpatients for nicotine dependence and withdrawal management by provision ofNRT. Referral of inpatients toNSWQuitline for additional and ongoing support has been available. All SSWAHS staffhave been responsible for enforcing the SFEP.

To evaluate compliance with the smoke-free environment policy, we conducted a study using systematic observation of smoking behaviour by trained observers in standard outdoor areas within hospital grounds over 2 years. …

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