Hospital smoke-free policy: Compliance, enforcement, and practices. A staff survey in two large public hospitals in Australia

Sam McCrabb, Amanda L. Baker, John Attia, Zsolt J. Balogh, Natalie Lott, Kerrin Palazzi, Justine Naylor, Ian A. Harris, Christopher M. Doran, Johnson George, Luke Wolfenden, Eliza Skelton, Billie Bonevski

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Background: Smoke-free hospital policies are becoming increasingly common to promote good health and quit attempts among patients who smoke. This study aims to assess: staff perceived enforcement and compliance with smoke-free policy, the current provision of smoking cessation care, and the characteristics of staff most likely to report provision of care to patients. Methods: An online cross-sectional survey of medical, nursing, and allied staff from two Australian public hospitals was conducted. Staff report of: patient and staff compliance with smoke-free policy, perceived policy enforcement, the provision of the 5As for smoking cessation (Ask, Assess, Advise, Assist, and Arrange follow-up), and the provision of stop-smoking medication are described. Logistic regressions were used to determine respondent characteristics related to the provision of the 5As and stop-smoking medication use during hospital admission. Results: A total of 805 respondents participated. Self-reported enforcement of smoke-free policy was low (60.9%), together with compliance for both patients (12.9%) and staff (23.6%). The provision of smoking cessation care was variable, with the delivery of the 5As ranging from 74.7% (ask) to 18.1% (arrange follow-up). Medical staff (odds ratio (OR) = 2.09, CI = 1.13, 3.85, p = 0.018) and full time employees (OR = 2.03, CI = 1.06, 3.89, p = 0.033) were more likely to provide smoking cessation care always/most of the time. Stop-smoking medication provision decreased with increasing age of staff (OR = 0.98, CI = 0.96, 0.99, p = 0.008). Conclusions: Smoke-free policy enforcement and compliance and the provision of smoking cessation care remains low in hospitals. Efforts to improve smoking cessation delivery by clinical staff are warranted.

Original languageEnglish
Article number1358
Number of pages12
JournalInternational Journal of Environmental Research and Public Health
Issue number11
Publication statusPublished - Nov 2017
Externally publishedYes


  • Smoke-free policy
  • Smoking cessation care
  • Tobacco control


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