Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys

BMC Public Health

Esteve Fernández²  Albert Gallart⁶  Xisca Sureda²  Anna Riccobene⁵  Ana Andrés¹  Montse Ballbè²  Paz Fernández³  Laura Antón⁵  Jose María Martínez-Sánchez⁴  Marcela Fu⁶  Cristina Martínez⁶ 

[1] Department of Methodology for the Behavioural Sciences, University of Barcelona, Barcelona, Spain;Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n. 08907 L’Hospitalet del Llobregat, Barcelona, Spain;Nursing Research Unit, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199–203, 08908 L’Hospitalet de Llobregat (Barcelona), Spain, Barcelona, Spain;Biostatistic Unit, Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, C. Josep Trueta s/n. 08915 Sant Cugat del Valles, Barcelona, Spain;Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain;Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain

关键词: Ban;    Smoking;    Health care providers;    Smoke-free policies;    Hospital;   

Others  :  1122883
DOI  :  10.1186/1471-2458-14-1228

 received in 2014-07-28, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

Background

Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws.

Methods

Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001–2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1^st law; 2^nd law vs. 1^st law).

Results

Baseline smoking prevalence was 33.1%. After passage of the 1^st and 2^nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2^nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees’ overall support for the smoke-free hospital project.

Conclusions

A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.

【 授权许可】

   
2014 Martínez et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]WHO Tobacco Free Initiative: 2012 global progress report on implementation of the WHO Framework Convention on Tobacco Control. Edited by WHO. Geneva: WHO; 2012. Available at: http://www.who.int/fctc/reporting/2012_global_progress_report_en.pdf webcite
• [2]Hyland A, Barnoya J, Corral JE: Smoke-free air policies: past, present and future. Tob Control 2012, 21(2):154-161.
• [3]Americans for Non Smokers’ Rights http://www.no-smoke.org/goingsmokefree.php?id=499 webcite
• [4]Callinan JE, Clarke A, Doherty K, Kelleher C: Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2010., 4CD005992
• [5]U.S. Department of Health and Human Services: Ending the Tobacco Epidemic: Progress Toward a Healthier. Washington: U.S: Department of Health and Human Services, Office of the Assistant Secretary for Health; 2012. Available: http://www.hhs.gov/ash/initiatives/tobacco/tobaccoprogress2012.pdf webcite
• [6]WHO Framework Convention on Tobacco Control: Review of accreditation of nongovernmental organizations with observer status to the Conference of the Parties to the WHO Framework Convention on Tobacco Control. 2010. FCTC/COP/4/22 Rev.1
• [7]Tobacco free Kids: Smoke free laws. http://global.tobaccofreekids.org/en/solutions/international_issues/smoke_free_laws/ webcite
• [8]Martinez C, Martinez-Sanchez JM, Robinson G, Berther C, Fernandez E: Protection to Secondhand Smoke in the WHO European Region: an assessment of legislation. 2013. In press
• [9]Gadomski AM, Stayton M, Krupa N, Jenkins P: Implementing a smoke-free medical campus: impact on inpatient and employee outcomes. J Hosp Med 2010, 5(1):51-54.
• [10]Martinez C, Fu M, Martinez-Sanchez JM, Ballbe M, Puig M, Garcia M, Carabasa E, Salto E, Fernandez E: Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia. Spain. BMC Public Health 2009, 9:160. BioMed Central Full Text
• [11]Ratschen E, Britton J, Doody GA, McNeill A: Smoke-free policy in acute mental health wards: avoiding the pitfalls. Gen Hosp Psychiatry 2009, 31(2):131-136.
• [12]Williams SC, Hafner JM, Morton DJ, Holm AL, Milberger SM, Koss RG, Loeb JM: The adoption of smoke-free hospital campuses in the United States. Tob Control 2009, 18(6):451-458.
• [13]Fernandez E, Martinez C, Fu M, Martinez-Sanchez JM, Lopez MJ, Invernizzi G, Ouranou A, Dautzenberg B, Nebot M: Second-hand smoke exposure in a sample of European hospitals. Eur Respir J 2009, 34(1):111-116.
• [14]Sureda X, Fu M, Jose Lopez M, Martinez-Sanchez JM, Carabasa E, Salto E, Martinez C, Nebot M, Fernandez E: Second-hand smoke in hospitals in Catalonia (2009). A cross-sectional study measuring PM(2.5) and vapor-phase nicotine. Environ Res 2010, 110(8):750-755.
• [15]Martinez C, Garcia M, Mendez E, Peris M, Fernandez E: Barriers and challenges for tobacco control in a smoke-free hospital. Cancer Nurs 2008, 31(2):88-94.
• [16]Ratschen E, Britton J, McNeill A: Smoke-free hospitals - the English experience: results from a survey, interviews, and site visits. BMC Health Serv Res 2008, 8:41. BioMed Central Full Text
• [17]Knight J, Slattery C, Green S, Porter A, Valentine M, Wolfenden L: Smoke-free hospitals: an opportunity for public health. J Public Health (Oxf) 2008, 30(4):516.
• [18]Reid RD, Mullen KA, Slovinec D’Angelo ME, Aitken DA, Papadakis S, Haley PM, McLaughlin CA, Pipe AL: Smoking cessation for hospitalized smokers: an evaluation of the “Ottawa Model”. Nicotine Tob Res 2010, 12(1):11-18.
• [19]Schultz AS, Finegan B, Nykiforuk CI, Kvern MA: A qualitative investigation of smoke-free policies on hospital property. CMAJ 2011, 183(18):E1334-E1344.
• [20]Shopik NA, Schultz AS, Nykiforuk CI, Finegan BA, Kvern MA: Impact of smoke-free hospital grounds policies: patient experiences and perceptions. Health Policy 2012, 108(1):93-99.
• [21]LEY 28/2005: De 26 De Diciembre, de Medidas Sanitarias frente al tabaquismo y reguladora de la venta, el suministro, el consumo y la publicidad de los productos del tabaco. 2005. [Health measures of the selling, use, consumption and publicity of tobacco products] Volume BOE Núm. 309 de 27 de diciembre
• [22]Ley 42/2010, de 30 de diciembre, por la que se modifica la Ley 28/2005, de 26 de diciembre, de medidas sanitarias frente al tabaquismo y reguladora de la venta, el suministro, el consumo y la publicidad de los productos del tabaco: Law that modifies Lay 28/2005 of health measures of the selling, use, consumption and publicity of tobacco products, Volume BOE Núm. 318. 2010.
• [23]Batlle E, Boixet M, Agudo A, Almirall J, Salvador T: Tobacco prevention in hospitals: long-term follow-up of a smoking control programme. Br J Addict 1991, 86(6):709-717.
• [24]Garcia M, Mendez E, Martinez C, Peris M, Fernandez E: Implementing and complying with the Smoke-free Hospitals Project in Catalonia. Spain. Eur J Cancer Prev 2006, 15(5):446-452.
• [25]ENSH: European Network for the Smoke free Hospitals. Paris: European Network for Smoke-free Hospitals and Health Care Services. 2009. Available at: http://www.ensh.eu/most-downloaded.php?id=34 webcite
• [26]Martinez C, Martinez-Sanchez JM, Ballbe M, Nieva G, Fu M, Puig M, Carabasa E, Sanchez-Garcia JM, Salto E, Fernandez E, Tobacco Cessation Program Project Coordinators: Smoking cessation in hospital workers: effectiveness of a coordinated program in 33 hospitals in Catalonia (Spain). Cancer Nurs 2012, 35(5):327-336.
• [27]Martinez C, Garcia M: Evaluation of the degree of implementation of tobacco control interventions in the Catalan Network of Smoke-Free Hospitals. Enferm Clin 2007, 17(4):177-185.
• [28]Fernandez Ruiz ML, Sanchez Bayle M: Evolution of the prevalence of smoking among female physicians and nurses in the Autonomous Community of Madrid, Spain. Gac Sanit 2003, 17(1):5-10.
• [29]Precioso J, Lopez MJ, Calheiros JM, Macedo M, Ariza C, Sanchez F, Schiaffino A, Fernandez E, Nebot M: Indoor air pollution caused by cigarette smoke in public places in Portugal. Rev Saude Publica 2007, 41(5):808-813.
• [30]Ravara SB, Calheiros JM, Aguiar P, Barata LT: Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: a cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban. BMC Public Health 2011, 11:720. BioMed Central Full Text
• [31]Departament de Salut. Generalitat de Catalunya: Enquesta de Salut de Catalunya 2006. 2006.
• [32]Hughes JR, Keely JP, Niaura RS, Ossip-Klein DJ, Richmond RL, Swan GE: Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tob Res 2003, 5(1):13-25.
• [33]Prochaska JO, DiClemente CC, Norcross JC: In search of how people change. Applications to addictive behaviors. Am Psychol 1992, 47(9):1102-1114.
• [34]Fichtenberg CM, Glantz SA: Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ 2002, 325(7357):188.
• [35]Longo DR, Brownson RC, Johnson JC, Hewett JE, Kruse RL, Novotny TE, Logan RA: Hospital smoking bans and employee smoking behavior: Results of a national survey. JAMA 1996, 275(16):1252-1257.
• [36]Longo DR, Feldman MM, Kruse RL, Brownson RC, Petroski GF, Hewett JE: Implementing smoking bans in American hospitals: results of a national survey. Tob Control 1998, 7(1):47-55.
• [37]Servei Català de la Salut: Enquesta de Salut de Catalunya 2002. 2002.
• [38]Servei Català de la Salut: Enquesta consum tabac 2011. Servei Català de la Salut. Departament de Sanitat i Seguretat Social. Generalitat de Catalunya 2012.
• [39]WHO Tobacco Free Iniciative: The role of health professionals in tobacco control. Edited by WHO. Ginebra; 2005. Anonymous
• [40]Smith DR, Leggat PA: An international review of tobacco smoking in the medical profession: 1974–2004. BMC Public Health 2007, 7:115. BioMed Central Full Text
• [41]Fitzpatrick P, Gilroy I, Doherty K, Corradino D, Daly L, Clarke A, Kelleher CC: Implementation of a campus-wide Irish hospital smoking ban in 2009: prevalence and attitudinal trends among staff and patients in lead up. Health Promot Int 2009, 24(3):211-222.
• [42]Tong EK, Strouse R, Hall J, Kovac M, Schroeder SA: National survey of U.S. health professionals’ smoking prevalence, cessation practices, and beliefs. Nicotine Tob Res 2010, 12(7):724-733.
• [43]Gruer L, Tursan d’Espaignet E, Haw S, Fernandez E, Mackay J: Smoke-free legislation: global reach, impact and remaining challenges. Public Health 2012, 126(3):227-229.
• [44]Rogers EM: Diffusion of Innovations. 5th edition. New York: Free Press; 2003.
• [45]Hung DY, Leidig R, Shelley DR: What’s in a setting? Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use. Health Care Manage Rev 2014, 39(2):154-63.
• [46]Britton J, Bogdanovica I: Tobacco control efforts in Europe. Lancet 2013, 381(9877):1588-1595.
• [47]Freund M, Campbell E, Paul C, Sakrouge R, McElduff P, Walsh RA, Wiggers J, Knight J, Girgis A: Increasing smoking cessation care provision in hospitals: a meta-analysis of intervention effect. Nicotine Tob Res 2009, 11(6):650-662.
• [48]Fernandez E, Martinez C, Alonso B, Chalom D, Dumont J, Gunning M, Mihaltan F, O’Riordan A, Rustler C: Tobacco-Free Hospital Campuses in Europe. http://tobaccocontrol.bmj.com/content/18/6/451/reply#content-block webcite
• [49]Ballbe M, Nieva G, Mondon S, Pinet C, Bruguera E, Salto E, Fernandez E, Gual A, Smoking and Mental Health Group: Smoke-free policies in psychiatric services: identification of unmet needs. Tob Control 2012, 21(6):549-554.
• [50]Campbell S, Pieters K, Mullen KA, Reece R, Reid RD: Examining sustainability in a hospital setting: case of smoking cessation. Implement Sci 2011, 6:108. BioMed Central Full Text
• [51]Knudsen HK, Muilenburg J, Eby LT: Sustainment of smoking cessation programs in substance use disorder treatment organizations. Nicotine Tob Res 2013, 15(6):1060-8.
• [52]Warner KE, Burns DM: Hardening and the hard-core smoker: concepts, evidence, and implications. Nicotine Tob Res 2003, 5(1):37-48.
• [53]Ravara SB, Castelo-Branco M, Aguiar P, Calheiros JM: Smoking behaviour trends among Portuguese physicians: are they role models? A conference-based survey. Public Health 2014, 128(1):105-109.
• [54]Hovengen R, Nordhagen R: Occasional smoking–an increasing problem. Tidsskr Nor Laegeforen 2004, 124(24):3222-3223.
• [55]Bodner ME, Miller WC, Rhodes RE, Dean E: Smoking cessation and counseling: knowledge and views of Canadian physical therapists. Phys Ther 2011, 91(7):1051-1062.
• [56]Sarna L, Wewers ME, Brown JK, Lillington L, Brecht ML: Barriers to tobacco cessation in clinical practice: report from a National Survey of Oncology Nurses. Nurs Outlook 2001, 49(4):166-172.
• [57]Sarna LP, Brown JK, Lillington L, Rose M, Wewers ME, Brecht ML: Tobacco interventions by oncology nurses in clinical practice: report from a national survey. Cancer 2000, 89(4):881-889.
• [58]Mackay J: Implementing tobacco control policies. Br Med Bull 2012, 102:5-16.
• [59]Ramos MC, Vinagre S, Cardoso MF: Knowledge, behavior and ethical responsibility of health professionals with regard to smoking. Rev Port Cardiol 2010, 29(6):923-946.
• [60]Connor Gorber S, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M: The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res 2009, 11(1):12-24.