National Conference on Tobacco or Health December 2003 Flowers in the Ashcans The Struggle Towards Smoke-Free Hospital Property Christina Krause, MSc, Yvette Penman, MEd & Pat Reader, BSc Tobacco Reduction Health Promotion & Disease Prevention

National Conference on Tobacco or Health December 2003 Tobacco Reduction Policy As of May 31, 2002, through a phased-in approach, tobacco use is prohibited in or on all Calgary Health Region owned, funded or operated premises and facilities. Special considerations were made for:  Long-term care, palliative care, mental health and home-based services  Culturally related ceremonial use of tobacco  Other extenuating circumstances approved by the Region

National Conference on Tobacco or Health December 2003 Factors Leading to a Smoke-Free Property Policy Public complaints re: facility access Literature review Confirmation of strategy effectiveness (Mayo Clinic) Medical staff consultation Staff survey (Oct - Nov 1999) Desire to position for future advocacy re: municipal smoking bylaw

National Conference on Tobacco or Health December 2003 Implementation Process Board approval of implementation plan No smoking within 10 m of entranceways Cessation programs/ aids available to staff Staff training to support patients (CTI) Process Evaluation Smoking shelter removal Special consideration recommendations complete NRT Algorithm developed June 00 Sept. 00 Oct. 00 Nov. 00 Feb. 01 July 01 Oct. 01 Apr. 02 Work groups developed recommendations for special consideration areas Promotion of NRTs on hospital formulary Signage to inform visitors, patients and staff Education and information sessions regarding tobacco reduction policy Developed compliance protocol

National Conference on Tobacco or Health December 2003 Implementation Process (con’t) Staff benefits plan enhanced Lines removed “World No Tobacco Day” No smoking for staff, patients and visitors Address site specific issues Monitor inpatient NRT and staff benefit usage Redo process evaluation CTI training Apr. 02 May 31, 02 Oct 02 Ongoing Jan/May 03 BOLD Signs installed Home-based services recommendations implemented Continue to implement long-term care recommendations Promote changes to staff benefits plan Ongoing implementation of recommendations re: mental health inpatients

National Conference on Tobacco or Health December 2003 Key Elements of Implementation Communication Plan Site Preparation Supports for Patients, Visitors and Staff Staff Training and Resources Monitoring progress

National Conference on Tobacco or Health December 2003 Patient, Staff and Visitor Supports Patients l Information on Policy available at admitting l “Thinking About Quitting Smoking?” brochure (as well as for staff and visitors) l Nicotine Replacement Therapy and Zyban (buproprion) on hospital formulary l Staff training in Clinical Tobacco Interventions Staff l Financial support to attend a smoking cessation program l Smoking cessation aids available through benefits plan (up to $3000 lifetime limit) l Self-help booklet, “Taking Control of Smoking” available through Wellness Office Visitors l Nicotine Replacement Therapy available at Outpatient Pharmacies

National Conference on Tobacco or Health December 2003

Policy Implemented Provincial tax Increase

National Conference on Tobacco or Health December 2003 Initial Challenges Apprehension/resistance in moving smoking off property Concerns about neighbouring residences/businesses Implementing a “first time in Canada” policy Communication with patients and visitors (high turnover) Rumour circulation

National Conference on Tobacco or Health December 2003 Ongoing Challenges Ownership related to policy enforcement and communication Frustration of Protection Services (lead enforcers) “carrying the weight of the policy on our shoulders” Issues related to accommodation of mental health inpatients Some problems with litter Lack of consequences re: noncompliance for staff

National Conference on Tobacco or Health December 2003 Policy Outcomes: Staff Smoking Behaviours maintenance of smoking prevalence (8%) from 2001 to 2003 decrease in number of smokers who indicated no intentions of quitting  32% in 2001; 19% in 2003 staff smoke fewer cigarettes at work in comparison with home and non-work days (Staff Survey, 2003) Number of Cigarettes Work Days Non-Work Days Home 1 – 10 74% 71% 46% 11 – 25 3% 14% 39% 26 or more 0% 0% 1% no response 3% 15% 14%

National Conference on Tobacco or Health December 2003 Staff Support for the Policy Year2003 Smoking Status Agreement Questions NS FS CS 1. I support the Tobacco Reduction Policy. 87%90%96%88% 53% 2. The Tobacco Reduction Policy is 85%90%95%87% 57% important in improving the health of patients. 3. The Tobacco Reduction Policy is 87%90%96%88% 48% important in improving the health of staff. 4. I believe the Tobacco Reduction Policy 88%91%94%89% 59% sends a message to the community that smoking is very harmful to health. NS = Never smoker; FS = Former Smoker; CS = Current Smoker

National Conference on Tobacco or Health December 2003 Next Steps Further enhance clinical skills Enhance communications around achievements Continue to engage frontline staff and key stakeholders Continue to work on enforcement issues Develop policy re: Tobacco Company sponsorship/donation

National Conference on Tobacco or Health December 2003 Further Information Website