No Smoking: Hospital non-smoking policies’ effect on smokers

How do hospitals’ non-smoking policies affect patients who smoke? A study published in the journal Health Policy analyzed the effects of non-smoking policies in two Canadian hospitals. The qualitative study explored patient perspectives of tobacco use, policy compliance, and abstinence support.

The authors interviewed patients in two hospitals, which had instituted smoke-free grounds policies three years prior. Study interviews focused on patients’ perceptions in four key areas: policy perspectives, experiences with tobacco during hospitalization, tobacco dependence treatment (primarily nicotine replacement therapy), and enforcement and compliance.

The grounds of the hospitals themselves were evaluated, and the authors found that the layout of both hospitals’ grounds made actually getting “off-campus” to smoke prohibitively difficult. This coupled with long, cold winters in both hospital locations made actually utilizing smoking areas very undesirable for smokers.

Among patients, there was common confusion on the specifics of the non-smoking policies. Almost all patients reported knowing the hospital grounds were smoke-free, but reported confusion on specifically what that meant. Some patients thought just being a certain distance from a hospital door, for example, was satisfactory.

The sentiments of both former-smokers and non-smokers reflected the concern that some patients did not go off the hospital property to smoke, and this resulted in second-hand and third-hand smoke risks to all patients. Policy enforcement was commonly cited as a problem, although most patients agreed that hospital staff who smoked did actually go off the property to smoke.

In some cases, the policy did promote cessation. Many patients reported that the inconvenience of going off the property to smoke made it easier to abstain from smoking during their hospital stay. However, current and former smokers reported inadequate treatment options for their tobacco dependence and withdrawal symptoms. Neither hospital combined their non-smoking policies with cessation program options for patients who were smokers, a weakness cited by the authors.

Overall, the authors report study participants acknowledged “the potential for positive health messages, the importance of de-normalization of smoking in health care settings, and their appreciation for personal protection from second-hand smoke.”

This study is limited in its scope; the authors only investigated two hospitals, and did not consider the perspectives of staff members or other patrons who are affected by a non-smoking policy. However, despite its limitations, the authors still conclude that second-hand smoke is a problem in hospitals, and a variety of individuals do feel the repercussions of existing, and sometimes problematic, smoke-free policies. This is especially salient in the two hospitals studied, since patients cannot safely or easily get off hospital property to smoke.

It will take greater enforcement of non-smoking policies for hospital goals to be fully realized. The authors conclude it will only be in the union of cessation or abstinence support, treatment options to help with smoking withdraw symptoms, and non-smoking policies, that safe and healthy hospital environments can be created for all patients.

Feature Photo: cc/(lanier67)