Sustainability of the prevention of passive infant smoking within well-baby clinics.

This study assessed the antecedents of continued use of an education program to prevent passive smoking in infants. It consists of a booklet for parents and a manual for health professionals describing a five-step procedure for discussing passive smoking. A questionnaire was sent to 67 managers, 670 nurses, and 335 physicians working in well-baby clinics (response rate: 70%, 53%, 47% respectively). Questions concerned the completeness of use, level of institutionalization, and characteristics of the organization, the user, and the dissemination strategy. Seventy-one percent of nurses and 42% of physicians worked with the program. They foremost provided the first three steps of the five-step procedure. Physicians' completeness of use was related to their perceived responsibility in providing this education, and nurses' use was related to their perceived self-efficacy, responsibility, training attendance, participation in the adoption decision, and level of institutionalization. Diffusion efforts should focus on improving the completeness of use and level of institutionalization.

Exposure to environmental tobacco smoke (ETS) and determinants of support for complete smoking bans in psychiatric settings.

OBJECTIVE: To measure environmental tobacco smoke (ETS) exposure in psychiatric settings and to assess determinants of support for complete smoking bans. DESIGN: Cross sectional study SETTING: Dutch psychiatric hospitals, outpatient care institutions, and sheltered home facilities. SUBJECTS: A random sample of 540 treatment staff, 306 attendants/nurses, and 93 patients. MAIN OUTCOME MEASURES: Self reported ETS exposure, current smoking policy, compliance with smoking policy, beliefs about smoking bans. RESULTS: 87% of respondents were exposed to tobacco smoke in psychiatric institutions; 29% said that on an average day they were exposed to "a lot of smoke". Although ETS originates mainly from smoking patients, both non-compliance from patients and employees with existing bans resulted in non-smokers being exposed to ETS. Due to non-compliance, ETS exposure was quite high when there is a general smoking ban (designated areas option). Only with a complete ban was compliance good and employees sufficiently protected from ETS exposure. Psychiatrists, psychologists, physicians, attendants, and nurses were most concerned about resistance from patients, partly because of the fear of infringing on patients' freedom to smoke. CONCLUSIONS: Complete smoking bans are the only way to fully protect those working in psychiatry from ETS exposure, mainly because general smoking bans are not sufficiently complied with. Communication strategies to improve compliance with complete bans are crucial to protect those working in psychiatry from ETS. Compliance could be improved by addressing the belief that the ban will effectively result in less ETS exposure and the issue of patients' freedom to smoke versus employees' right to work in a smoke-free environment.