Determinants of compliance with a national smoke-free hospital standard.

OBJECTIVE: To determine the extent of compliance with the new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standard requiring acute care hospitals to be smoke-free, and to identify predictors of adoption of smoke-free hospital policies. DESIGN: We conducted a survey of a national sample of acute care hospitals and developed a predictive model for implementation of smoke-free policies during multiple logistic regression. We examined numerous factors that might predict adoption of smoke-free policies, such as hospital characteristics, patient care services, and experience with smoke-free initiatives. SETTING AND PARTICIPANTS: A systematic 20% sample of JCAHO-accredited hospitals in the United States (n = 1278). Military, Department of Veterans Affairs, Indian Health Service, psychiatric, substance abuse treatment, and children's hospitals were excluded. MAIN OUTCOME MEASURE: Compliance with the JCAHO standard. RESULTS: The response rate was 85%. Six-five percent of hospitals were in compliance with the standard 16 months after it was introduced. Factors that were independently and positively associated with implementation of smoke-free policies were administrative support (odds ratio [OR], 7.82; 95% confidence interval [Cl], 2.05 to 29.65) and inpatient smoking cessation services (OR, 1.24; 95% Cl, 1.02 to 1.52). Factors negatively associated with implementation of smoke-free policy were the number of psychiatric treatment beds (OR, 0.57; 95% Cl, 0.14 to 0.81), number of substance abuse treatment beds (OR, 0.17; 95% Cl, 0.11 to 0.26), and presence of an active task force to address smoking policy (OR, 0.56; 95% Cl, 0.40 to 0.77). CONCLUSIONS: The majority of acute care hospitals are in compliance with the JCAHO national smoke-free policy initiative. The standard is well accepted by most patients and employees. It is critical to address the challenges presented by special populations, such as psychiatry patients, to accomplish the goal of completely smoke-free hospitals.

Managing tobacco dependence in chemical dependency treatment facilities: a survey of current attitudes and policies.

This paper presents survey results of Minnesota licensed chemical dependency treatment facility directors. The baseline survey was conducted by telephone in May and June of 1988; and the self-administered follow-up survey was conducted in February and March of 1990, subsequent to a statewide tobacco dependence educational campaign which targeted Minnesota's chemical dependency professionals. Both the baseline (n = 227) and the follow-up (n = 257) surveys contained items concerning the directors' beliefs about the health effects of tobacco use, their attitudes regarding tobacco use in chemical dependency treatment, current tobacco policy in the facility, and barriers to banning tobacco use in the facility. The study used a matched-pair analysis (n = 104) of the survey data to assess changes in attitudes and practices during the two years of the study. The majority (71%) of chemical dependency directors at follow-up agree that tobacco dependence should be treated like other drug dependencies. The percentage of matched facilities that treat tobacco dependence increased from 10% at baseline to 18% at follow-up. The percentage of facilities that prohibit smoking increased from 11% at baseline to 27% at follow-up. Implications of the findings and areas for further research are discussed.

A controlled trial to implement smoke-free hospitals.

Hospitals would logically become leaders if the nation is to accept former Surgeon General C. Everett Koop's challenge to make its public institutions smoke-free by the year 2000. We tested whether printed materials, workshops, newsletters, and consultations could increase both the number of smoke-free hospitals in a state and the rate at which they became smoke-free. All acute-care hospitals in Minnesota (n = 166) were compared to a sample of 51 acute-care hospitals in a reference area, western Wisconsin, before and after a one-year campaign. While 2.4% of the hospitals in Minnesota were smoke-free before the campaign, none of the hospitals in the reference area sample was smoke-free at this time. Both areas experienced a significant increase in the proportion of hospitals that became smoke-free during the year--30.7% of the Minnesota hospitals and 15.7% of the hospitals in the reference area sample (p less than .01) were smoke-free after the one-year campaign--and the campaign did appear to marginally increase the rate of adoption in Minnesota over that of the reference area (p = .08). The results of this study indicate that smoke-free hospitals are feasible and that a statewide initiative can facilitate the hospitals' decision to become smoke-free.