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. The study identifies the success of existing strategies and appropriateness of response when difficulties with compliance were encountered. Addressing these challenges as they arise has allowed SSWAHS to continue to role model the benefits of not smoking to the community, staffand inpatients.
The aim of the paper is to report the findings of an observational study conducted to evaluate staff, inpatient and visitor compliance with the SFEP before, and at regular intervals over 2 years after the SSWAHS became completely smoke-free.
At the time of the study,SSWAHSwas the most populousAHSin NSW, with an estimated population of 1.3 million. It consisted of 14 public hospitals and numerous healthcare facilities stretching over 15 local government areas, from metropolitan inner Sydney to regional areas of Wingecarribe and Wollondilly.
The study was undertaken within the two largest (700 + beds) tertiary referral and teaching hospitals in SSWAHS. HospitalAis located near the centre of metropolitan Sydney and Hospital B is located in Sydney's south-west. For an able bodied person, it would take less than 5 min to leave either hospitals' grounds to comply with the policy.
Study design and observation procedures
Three sites at each hospital were observed. At each hospital, a previously designated smoking area and two non-designated smoking areas were included in the observation study. All observation sites selected were accessible from various thoroughfares of each hospital. The sites observed are described in Table 2.
Baseline observations were conducted at the six sites 2 weeks before implementation of the SFEP (June 2007) for 3.5 h on 3 consecutive days. To correspond with staffmeal breaks, observation occurred between the times of: 1000-1100, 1200-1400 and 1530-1600 hours. Observations were replicated at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. …