Issue addressed Smoking by patients, staff and visitors on the grounds of Central Coast Local Health District (CCLHD). Methods NSW Health introduced a smoke‐free buildings and vehicles policy in 1988. A smoke‐free grounds policy was implemented in 1999, and a smoke‐free by‐law adopted by CCLHD in 2013, making smoking on CCLHD grounds an offence. Smoking in high‐profile areas near hospital entrances was counted regularly since 2000. Several methods for communicating, monitoring and enforcing these smoke‐free interventions have been adopted, including signage, Public Address announcements and enforcement patrols to ensure by‐law compliance and to issue fines where required. Compliance with the smoke‐free interventions has been supported with the availability of Nicotine Replacement Therapy for patients and visitors. Results When monitoring counts first commenced in 2000, smoking rates in high‐profile areas were 8.1% at Gosford Hospital and 11.1% at Wyong Hospital. Counts conducted in 2018 indicated a substantial improvement, with the smoking rate in high‐profile areas reducing to 0.25% at Gosford Hospital and 0.5% at Wyong Hospital. Smoking rates in high‐profile areas have held steady at approximately 0.3% since 2014, after the by‐law was implemented. Conclusions The introduction of the smoke‐free by‐law added extra impetus to efforts to reduce smoking on CCLHD hospital grounds by providing the option to fine people who breach the by‐law. Smoking in high‐profile areas has declined substantially since 2011, and is minimal since the establishment of the smoke‐free by‐law. So what? The experiences of CCLHD in implementing the smoke‐free by‐law may provide insights for other health services looking to use a similar intervention at their facilities. There are also methodological lessons for other organisations looking to communicate, monitor and enforce smoke‐free policies, without enforcing fines.
Issue addressed: To support visitors to comply with CentralCoast Local Health District's (CCLHD) smoke-free hospital grounds policy, a need was identified for round-the-clock availability of nicotine replacement therapy (NRT). Providing NRT through a vending machine was identified as a possible solution. This initiative complemented other strategies that provide staff and patients who smoke with NRT.Methods: NRT was originally provided through a snack vending machine; however, there were commercial and regulatory concerns with this method.In 2015, dedicated NRT vending machines were installed at Gosford and Wyong Hospitals, and were operated by the Health Promotion Service. The appropriate regulatory permission was gained to supply a specific brand of NRT. Sales and incident data were recorded, and ongoing smoking counts were performed both before and after installation.Results: In all, 247 sales of NRT gum were made through the vending machines from early 2017 to late 2019. Smoking counts show that there are very low rates of visitor smoking (<1%) in the approximately 4.5 years pre-and post-installation of dedicated vending machines. There was no statistically significant change in the smoking rate of visitors since the vending machine was installed at Wyong Hospital. Conclusions:While NRT is generally provided to patients and staff within health settings to support compliance with smoke-free policies, alternatives to smoking for visitors are typically overlooked. A NRT vending machine achieves this. However, because there are few purchases made, the vending machines as currently operating are unlikely to make any significant impact on smoke-free policy compliance at these hospitals.So what? While vending machines have limited effectiveness on overall smoke-free policy compliance, this strategy may have applicability to all sectors with smoke-free policies, especially those operating 24 hours a day, as a means of providing an alternative to smoking for visitors.
Objective: The aims of this study were to explore the knowledge, attitudes, confidence and practices of Australian psychiatrists and psychiatry registrars with regard to smoking cessation with their patients and to promote clinical practice reflection and re-framing. Methods: A mixed-methods questionnaire was developed. Interviews were conducted via telephone or face-to-face utilising participatory action research principles. Qualitative data were de-identified and analysed following a reflexive thematic approach. Results: The questionnaire was completed with 15 participants. The majority worked in the public health sector and agreed that smoking cessation could be used as a clinical tool across mental health services. However, nearly all of the participants reported being unfamiliar with the latest literature. Only one-third of participants reported having had received formal training in smoking cessation. Overwhelmingly, more training was reported as necessary and welcomed by participants. Conclusion: Our study has identified gaps in psychiatrists’ and psychiatry registrars’ knowledge and confidence regarding the promotion, initiation and oversight of smoking cessation strategies for patients. It’s important that psychiatrists lead the way in re-framing and engaging with this issue, and consider smoking cessation as a tool that can improve mental health outcomes. A review of existing Australian policies, guidelines and training is recommended.
Issue addressed Fear of aggression is often cited as an issue for health service staff in approaching smokers who are breaching smoke‐free policies. This study collected data to quantify the interactions between Health Promotion Service staff and smokers. The aim was to trial de‐escalation based protocols for Authorised Inspectors and one for general staff with regards to the aggression risk to staff when approaching smokers within hospital grounds. Methods The study design was a non‐randomised trial with no control group. A standard protocol was developed, based on de‐escalation techniques. The primary outcomes of the study were measures of aggression and smokers’ compliance with instructions to extinguish their cigarette. Aggression was recorded using the Modified Overt Aggression Scale (MOAS). Two hundred interactions were conducted with smokers during business hours by Health Promotion Service staff. The first 100 interactions were based on an enforcement methodology typically delivered by Authorised Inspectors, while the second 100 interactions were based on an information and assistance methodology to reflect those that could be delivered by general health service staff. Results Only four instances of aggression were experienced, representing 2% of all interactions. Each of these was limited to verbal aggression. No self‐aggression, aggression against property, or physical aggression was encountered. Smokers were significantly more compliant to instructions to extinguish their cigarette in the enforcement method (64%) than the information and assistance method (45%) (P < .001). Groups of smokers were more compliant than individual smokers in the enforcement method (76.3% compared to 56.5%, P < .05). Conclusions This study quantifies the risk of aggression to health service staff conducting smoking compliance interactions using two methodologies. By following de‐escalation‐based protocols, staff can approach smokers in a low‐risk manner and support smoke‐free policy implementation and compliance. For general staff, the emphasis of interactions must be on providing information and assistance to smokers, not enforcement, as indicated by the reduced rate of immediate compliance, introducing an increased risk of escalation if enforcement is attempted. So what? These protocols could be implemented by other health services or organisations that are seeking to optimise the involvement of staff in supporting smoke‐free policies.
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