Implementing and enforcing a smoke‐free policy and by‐law on hospital grounds at Central Coast Local Health District

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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.

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Supporting visitor compliance with a smoke‐free policy at hospital using a nicotine replacement therapy vending machine

Giles

Bauer

2020

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Hospital entrance smoking is reduced by broadcasting recorded antitobacco messages from Australian primary school children over entrance public address system

Webb

Tascone

Wickham

et al. 2020

Issue addressed: Smoking near hospital entrances occurs frequently despite smokefree policies, resulting in multiple issues including second-hand smoke exposure (SHS) to vulnerable populations. Primary school children were engaged through their health curriculum to produce antismoking audio recordings for broadcast over a hospital entrance loudspeaker system to determine if this reduced smoking.Method: Students produced original recordings against hospital grounds smoking during class workshops, from which a collection (n = 16) was selected. Episodes of entrance smoking and total entrance traffic were recorded using security camera infrastructure over a 5-week period. A computer-controlled entrance loudspeaker played a message which was followed by silence until a new (different) message was played. Intensity of messaging was moderate in week 3 (every 5 minutes), increasing to high in week 4 (3 minutely) and compared to no messages (weeks 1-2 preintervention) and week 5 (postintervention).Results: Smokers presented 316 times, smoking 523 cigarettes over 155 hours of observation (patients 70.6%, visitors 29.4%). SHS exposure was high given 172 others used the entrance/hour. Smoking was highest in the preintervention period (weeks 1-2), median five cigarettes/hr [IQR,3-7 (min = 0, max = 12)], falling to four cigarettes/ hr during 5-minutely broadcasts [IQR,2-5 (min = 1, max = 14)] (P = .06), but zero cigarettes/hr during 3-minutely broadcasts [IQR,0-1(min = 0, max = 7)] (P < .0001).Postintervention (no broadcasts), smoking increased from zero to 1 cigarette/hr [IQR,0-3 (min = 0, max = 5)]; (P = .052). Nonsmoker movements did not change significantly between each period. Conclusion: Intensive (3 minutely) broadcasting of short antismoking messages significantly reduced hospital entrance smoking. So what?: Health services can positively interact with the health curriculum of primary schools against tobacco use while developing low-cost strategies to effectively deter entrance smoking.

Assessing the responses of smokers to requests to stop smoking on hospital grounds

Giles

2021

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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.