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FAQ

The aim of this Frequently Asked Questions (FAQ) section is to provide links that will help you attain the information you need to make a case for your hospital becoming smoke free.

Reasons to Implement Tobacco Control Policies

Q: What are the health effects of tobacco use?
Q: How harmful is secondhand smoke?
Q: What are the benefits of a smoke-free hospital campus?
Q: What are the costs of employees who smoke?
Q: What impact can tobacco control policies have on patient health?

Experiences at Other Hospitals and Clinics

Q: How many hospitals and clinics in the U.S. have declared their campuses smoke free?
Q: Has there been any legislation mandating that all hospitals in a state become smoke-free campuses?
Q: Are there examples of tobacco control policies that I can read?
Q: What other ways might a hospital or clinic promote tobacco awareness?
Q: Where can I go to network with others interested in tobacco control policies?

Establishing a Smoke-free Campus

Q: I’d like to see our hospital or clinic establish a smoke-free campus policy. Where do I start?
Q: How will a smoke-free campus affect employees?
Q: How will a smoke-free campus affect patients?
Q: How will a smoke-free campus affect visitors?
Q: Isn’t it a personal right to be able to smoke?
Q: Where can we refer patients or visitors who want to quit smoking?
Q: How might we share our successful tobacco control and smoke-free campus policies?

Q: What are the health effects of tobacco use?

A: According to a recent Surgeon General Report, tobacco use affects virtually every organ in the human body, causing many diseases and reducing the health of smokers in general. The adverse health effects from cigarette smoking account for an estimated 438,000 deaths — nearly 1 of every 5 deaths — each year in the United States. This estimate includes approximately 38,000 deaths from secondhand smoke exposure.

Tobacco use is the leading preventable cause of death in the United States. More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.

On average, adults who smoke cigarettes die 14 years earlier than nonsmokers.

Resource links:

For excellent fact sheets on the health effects of smoking and tobacco use, refer to the United States Department of Health and Human Services Centers for Disease Control and Prevention Web site at http://www.cdc.gov/tobacco/data_statistics/Factsheets/index.htm

Copies of the full “Health Consequences of Smoking: A Report of the Surgeon General” and related materials are available from the Centers for Disease Control and Prevention, Office on Smoking and Health, 1-800-CDC-1311, www.cdc.gov/tobacco and on the surgeon general’s Web site at www.surgeongeneral.gov.

Q: How harmful is secondhand smoke?

A: There is no risk-free level of secondhand smoke exposure. Even brief exposure can be dangerous. Secondhand smoke has multiple negative health effects and is potentially harmful to hospital employees, patients, and their visitors. It is especially harmful to compromised patients already suffering from heart disease, cancer, COPD, asthma, emphysema, etc.

* Secondhand smoke contains at least 250 chemicals known to be toxic, including more than 50 that can cause cancer.
* Nonsmokers who are exposed to secondhand smoke at home or work increase their heart disease risk by 25–30% and their lung cancer risk by 20–30%.
* Breathing secondhand smoke has immediate harmful effects on the cardiovascular system that can increase the risk of heart attack. People who already have heart disease are at especially high risk.
* Secondhand smoke exposure causes respiratory symptoms in children and slows their lung growth.
* Secondhand smoke can cause sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more frequent and severe asthma attacks in children.

Resource link: For a fact sheet on the health effects of secondhand smoke with specific source citations, refer to the Centers for Disease Control and Prevention Web site:
http://www.cdc.gov/tobacco/data_statistics/Factsheets/SecondhandSmoke.htm

Q: What are the benefits of a smoke-free hospital campus?

A: There are many benefits to a hospital going smoke free, including:

1. Reduced exposure to the health hazards of smoking and improved health of patients, employees, and visitors.
2. Decreased costs and concerns of tobacco-related illness.
3. Increased credibility of the hospital as an advocate and role model for healthy lifestyles. It is counterproductive for a hospital to permit smoking on its premises when the medical community is fully aware of the adverse health effects of tobacco and secondhand smoke.
4. Hospitalization is a unique opportunity for the medical community to intervene and educate patients about smoking cessation strategies and support patients in avoiding tobacco by providing a smoke-free environment.

Resource links:

Article in American Family Physician:
http://findarticles.com/p/articles/mi_m3225/is_n1_v49/ai_14786240

Quotes from healthcare providers who support Smoke-free hospitals on the American for Nonsmokers’ Rights site: http://no-smoke.org/document.php?id=446

Q: What are the costs of employees who smoke?

A: Employee smoking results in many direct and indirect costs including additional health care and insurance costs, lost productivity, absenteeism, and property damage and maintenance costs.

Resource link: Document on costs to employers with employees who smoke: http://www.workingsmokefree.com/whygosmokefree/costs.htm

For article on the study entitled Smoking Cessation Counseling in U.S. Hospitals: A Comparison of High and Low Performers: http://www.workingsmokefree.com/whygosmokefree/costs.htm

Q: What impact can tobacco control policies have on patient health?

A: Tobacco control policies can have many positive effects on patient health. Hospitals that implement policies to consistently identify and document the smoking histories of patients and document the smoking cessation interventions utilized (such as referrals to support groups and prescriptions for smoking cessation aids) are able to provide more consistent patient smoking cessation counseling, which ultimately results in higher quit rates and improved health.

Resource link:

For article on the study entitled Smoking Cessation Counseling in U.S. Hospitals: A Comparison of High and Low Performers: http://turner-white.com/jc/abstract.php?PubCode=jcom_jul05_smoke

For discussion about how to improve health of both smokers and non-smokers alike: See Alkaline Diet Truth.

Experiences at Other Hospitals and Clinics

UC Davis Medical Center and Shriners Hospitals for Children Northern California declared their campuses smoke free on July 1, 2008. Their 143 acres form the largest smoke-free area in Sacramento, California.

Q: How many hospitals and clinics in the U.S. have declared their campuses smoke free?

A: There are over 1,250 local and/or state hospitals, healthcare systems, and clinics that have adopted 100% smoke-free campus grounds policies that protect all employees, visitors, and patients from secondhand smoke exposure within their campuses – including but not limited to facility buildings, outdoor areas, and parking lots. This number is increasing. For the latest data, check the resource link below.

Resource link: For an up-to-date list of smoke-free hospitals, healthcare systems, and clinics in the United States, refer to the Americans for Nonsmokers Rights Web site. http://www.no-smoke.org/pdf/smokefreehealthcare.pdf

Q: Has there been any legislation mandating that all hospitals in a state become smoke-free campuses?

A: Yes.

In 2005, Arkansas passed a law that bans smoking on hospital grounds. Hospitals are required to post prominent smoke free signage. Violators may face a maximum $100 fine.

Also, many states have smoking bans in public buildings and workplaces that often include hospitals.

Resource links:

Article on Arkansas ban: http://www.arkansasnews.com/archive/2006/04/05/News/335411.html

Wikipedia maintains a list of smoking bans for each state and country. Many states have smoking bans in workplaces that include hospitals. http://en.wikipedia.org/wiki/List_of_smoking_bans_in_the_United_States

Q: Are there examples of tobacco control policies that I can read?

A:Yes. Click on the link below for access to sample policies from hospitals and states throughout the country.

Resource link: Tobacco Control Network’s Model Tobacco Free Hospital Policy Example:
http://www.ttac.org/TCN/peers/restrictions/08.31.07.html

Q: What other ways might a hospital or clinic promote tobacco awareness?

A: Hospitals can effectively promote tobacco awareness through health fairs celebrating events such as World No Tobacco Day, the Great American Smokeout, and COPD Awareness month. Posters and brochures about the health consequences of smoking, effects of secondhand smoke, and steps to quitting can be made available in multiple languages. Tobacco related articles in employee newsletters are also helpful (examples are included in the Resource Links section). Hospital staffs will benefit from CME/CE classes about cessation interventions. Hospitals can also provide patient bedside counseling and make pharmacotherapy available during the hospital stay. Patients can be shown patient education videos on closed circuit television; a link to one company that sells these videos is included below.

Resource links:

World No Tobacco Day, May 31
http://www.who.int/tobacco/wntd/2008/en/

American Cancer Society’s The Great American Smokeout, third Thursday of November http://www.cancer.org/docroot/subsite/greatamericans/content/All_About_Smokeout.asp

American Association for Respiratory Care’s COPD (Chronic Obstructive Pulmonary Disease) Awareness Month: http://www.aarc.org/headlines/07/09/copd_day/

Educational Videos
http://www.milner-fenwick.com/products/gn10/index.asp

Q: Where can I go to network with others interested in tobacco control policies?

A: The National Conference on Tobacco or Health is an excellent conference for anyone interested in learning practical ways to improve tobacco control programs and activities. The next conference as of this writing is June 2009 in Phoenix.

Resource link: For more information about the conference, including archives from previous conferences:
http://www.tobaccocontrolconference.org/2009/overview.html

Establishing a Smoke-free Campus

Q: I’d like to see our hospital or clinic establish a smoke-free campus policy. Where do I start?

A: You may want to start by organizing a steering committee of interested people in your medical community. Be sure to include representatives from key departments such as Nursing, Physicians, Human Resources, Safety/Security, and Respiratory Therapy. Decide together what types of policies you would like to implement, prepare a proposal, and take steps to obtain management approval. It is imperative to gain buy-in for a smoke-free campus from senior executives, especially the president or COO. We hope this Web site will assist you by providing links to the information you need to make your case and implement a successful program. One of the best resources is The Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence (June 2000). It has many suggestions for how to implement a program in hospital and clinic settings and even includes sample forms for hospital use.

You can also find a checklist of steps to consider when implementing a smoke-free environment on the Web site of the University of Michigan Health System Tobacco Consultation Service. They also have a CD you can order with additional information.

Resource links: The Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence (June, 2000) http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf

The University of Michigan Health System Tobacco Consultation Service Checklist to Implement a Smoke-free Environment: http://www.med.umich.edu/mfit/tobacco/freeenvironment.htm

Q: How will a smoke-free campus affect employees?

A: Employee smoking prevalence will decrease when the environment does not support and promote their smoking addiction. To ease the process, some hospitals provide employee smoking cessation classes and provide nicotine gum during work hours. Some provide low-cost or no-cost nicotine replacement treatment for smoking cessation.

A research study funded by the Robert Wood Johnson Foundation’s (RWJF) national Tobacco Policy Research and Evaluation Program found that workers in hospitals where smoking was prohibited were more successful at quitting than smokers whose workplaces permitted smoking. Peer pressure, socialization, and being forced to stay away from cigarettes for the length of entire workdays were credited with helping hospital workers to quit.

o The quit ratio was greater for hospital employees than for employees in the same community in workplaces without a ban. According to the JAMA abstract, “for those sites that were five years post ban, the quit ratio was 0.506 in smoke-free workplaces compared with 0.377 in workplaces where smoking was permitted.”
o Among hospital employees who quit smoking, 21.2 percent were smoke-free for at least one year, compared to 12.9 percent of smokers with comparable jobs in workplaces without a smoking ban.

Resources links:
Article, Smoke-Free Hospitals Lead to Smoke-Free Employees
http://www.rwjf.org/reports/grr/022931.htm

Article on four different health systems’ strategies for implementing no smoking policies.
http://www.henryfordhealth.org/body.cfm?xyzpdqabc=0&id=46335&action=detail&ref=715

Article on WikiHealthCare about Smoke-free Hospital Campuses.

http://wikihealthcare.jointcommission.org/twiki/bin/view/Perform/SmokeFreeHospitalCampus

Q: How will a smoke-free campus affect patients?

A: Hospitals are in a unique position to reduce the alarming statistics related to tobacco use. A hospital visit provides a meaningful teachable moment in the life of a smoker. The patient must abstain temporarily from tobacco use and is accessible to interventions. The Public Health Service-sponsored Clinical Practice Guideline provides strategies and recommendations designed to assist the medical community in delivering and supporting effective treatments for tobacco use and dependence.

Another practical resource is the Health Care Provider’s Tool Kit for Delivering Smoking Cessation Services developed by Next Generation California Tobacco Control Alliance. It includes tools for tracking patient smoking status and multiple ways to encourage cessation. It covers in detail the 5 A’s Model. The 5 A’s Model is a simple road map for health practitioners that includes five basic steps: ASK, ADVISE, ASSESS, ASSIST, and ARRANGE.

* ASK every patient for tobacco use status.
* ADVISE patients that quitting smoking is the most important thing they can do to protect their health.
* ASSESS if the patient is ready to quit.
* ASSIST patients who are ready to quit counseling and pharmacotherapy if appropriate.
* ARRANGE for follow-up with the patient.

Resource links:

The Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence (June 2000). http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf

Health Care Provider’s Tool Kit for Delivering Smoking Cessation Service: http://www.tobaccofreealliance.org/pdfs/NGAToolkit_FINAL_FORWEB.pdf

Q: How will a Smoke-free campus affect visitors?

A: It can take some time for visitors to become aware of and adjust to a smoke-free policy, but smoke-free environments are becoming more common and visitors adapt to the new cultural norm. The hospital can help by posting clear signage and providing ongoing education that a smoke-free campus promotes the better health and welfare of all patients, employees, and visitors. Many hospitals assist visitors by providing cards or brochures with smoking cessation tips and information about accessing smoking cessation classes, Web sites, or telephone support. Many hospitals sell nicotine gum in their gift shops and some provide visitors with free samples of nicotine lozenges or gum with instructions for their use.

Resource link: Article on four different health systems’ strategies for implementing no smoking policies. http://www.henryfordhealth.org/body.cfm?xyzpdqabc=0&id=46335&action=detail&ref=715

Q: Isn’t it a personal right to be able to smoke?

A: The short answer is no.

The following summary paragraph is from the Tobacco Control Legal Consortium’s publication entitled There is No Constitutional Right to Smoke: 2008. “The so-called “right to smoke” is actually a smokescreen. There is no constitutional right to smoke. Therefore, advocates are free to seek enactment of new smoke-free laws or the amendment or repeal of existing laws that harm the public health despite claims by their opponents invoking a right to smoke. As long as proposed smoke-free legislation is rationally related to a legitimate government goal, the Constitution will not stand in the way of its passage. Courts are quick to find that smoke-free legislation is rationally related to a legitimate government goal, since they have long held that protecting the public’s health is one of the most essential functions of government.”

Resource link: The complete publication referenced above can be found at http://tobaccolawcenter.com/documents/constitutional-right.pdf

Q: Where can we refer patients or visitors who want to quit smoking?

A: Many hospitals and clinics offer their own smoking cessation programs, but if these are not available there are many resources that can be accessed by phone or on the Internet. A partial listing of smoking cessation resources is provided in the links below.

Resource links:

For online smoking cessation tips, go to American Lung Association’s Freedom from Smoking Online
http://www.lungusa.org

Online Guide to Quitting from SmokeFree.Gov:
http://www.smokefree.gov/quit-smoking/index.html

To call for access to smoking cessation programs in your area or for telephone support, call the following numbers:
For services in California, call 1-800-NO-BUTTS (1-800-662-8887)
For services outside California, call 1-800-QUIT-NOW (1-800-784-8669)

Q: How might we share our successful tobacco control and smoke-free campus policies?

A: The possibilities for publicizing your smoke-free success are many! Some ideas from other hospitals that have gone smoke-free include the following: posters on walls, doors, bulletin boards, elevators, internal and external signage, articles in employee newsletters, e-mails, inserts in admission packets, health fairs, Web site pages, brochures, pharmacy bag inserts, business card size handouts, banners, and giveaways like buttons, hats, t-shirts, balloons, etc. One hospital had success printing a smoke-free graphic on scrubs for the hospital staff to wear. Going smoke free is good news for the entire community and public relation opportunities are plentiful. Plan a special event to kick off the new smoke-free status and invite the staff, community, and media to celebrate!