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Ainscough TS, Mitchell A, Hewitt C, Horspool M, Stewart P, Ker S, Colley L, Paul C, Hough P, Hough S, Britton J, Ratschen E. Investigating Changes in Patients' Smoking Behavior, Tobacco Dependence, and Motivation to Stop Smoking Following a "Smoke-Free" Mental Health Inpatient Stay: Results From a Longitudinal Survey in England. Nicotine Tob Res 2021; 23:1010-1018. [PMID: 33277655 PMCID: PMC8150132 DOI: 10.1093/ntr/ntaa258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/03/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In line with national guidance, mental health Trusts in England are implementing complete smoke-free policies. We investigated inpatients' changes in smoking behavior, tobacco dependence, vaping, and motivation to stop smoking between pre-admission and post-discharge. METHODS We surveyed acute adult mental health inpatients from 14 wards in three mental health Trusts in England in 2019. Structured face-to-face and telephone interviews with patients who smoked on or during admission were conducted during the admission period and at one week and one month after discharge. Data on smoking status; daily cigarette consumption; Heaviness of Smoking Index (HSI); Strength of Urges to Smoke (SUTS); Motivation to Stop Smoking (MTSS) and vaping were collected and analyzed using regression and probit models. RESULTS Inpatient smoking prevalence was 51.9%, and a total of 152 of all 555 eligible smokers (27%) were recruited. Attrition was high: 49.3% at the first and 50.7% at the second follow-up interview. Changes in self-reported smoking status, motivation to quit, and vaping did not change significantly over the study period. Cigarette consumption (p < 0.001) and Heaviness of Smoking Index (p < 0.001) modestly reduced. The frequency and strength of urges to smoke (p = 0.011 and 0.012, respectively) decreased modestly after discharge but were scored as high by 57% and 60% of participants during admission respectively. Just over half (56%) reported being offered smoking cessation support on admission. CONCLUSIONS This study identified very modest changes in smoking-related outcomes during and after admission and indicates major challenges to smoke-free policy implementation, including limited support for patients who smoke. IMPLICATIONS Despite mental health Trusts in England had developed and implemented smoke-free policies to meet national guidelines, adherence to these policies and provision of effective smoking cessation and temporary abstinence support for inpatients admitted to acute adult mental health wards appear to be limited. Patients who smoke on admission are likely to continue to do so during admission and after discharge, and only a very modest change in smoking behaviors appears to take place. Important opportunities to promote smoking cessation in this population are missed. Barriers to effective support need to be identified and addressed.
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Affiliation(s)
| | - Alex Mitchell
- Department of Health Sciences, University of York, York, UK
| | | | - Michelle Horspool
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Pete Stewart
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Suzy Ker
- Tees, Esk and Wear Valleys Foundation NHS Trust, Stockton-on-Tees, UK
| | - Lesley Colley
- Tees, Esk and Wear Valleys Foundation NHS Trust, Stockton-on-Tees, UK
| | - Claire Paul
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Phil Hough
- Vale Royal Relative Support Group, Chester, UK
| | - Simon Hough
- Vale Royal Relative Support Group, Chester, UK
| | - John Britton
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Elena Ratschen
- Department of Health Sciences, University of York, York, UK
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Lightfoot K, Panagiotaki G, Nobes G. Effectiveness of psychological interventions for smoking cessation in adults with mental health problems: A systematic review. Br J Health Psychol 2020; 25:615-638. [DOI: 10.1111/bjhp.12431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/05/2020] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - Gavin Nobes
- School of Psychology University of East Anglia Norwich UK
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Spaducci G, McNeill A, Hubbard K, Stewart D, Yates M, Robson D. Smoking-related violence in a mental health setting following the implementation of a comprehensive smoke-free policy: A content analysis of incident reports. Int J Ment Health Nurs 2020; 29:202-211. [PMID: 31513336 DOI: 10.1111/inm.12659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/28/2022]
Abstract
Smoke-free policies in mental health settings are important to protect health but are often impeded by staff concerns that physical violence may increase. We aimed to address the literature gap about the frequency, nature, and management of physical violence in relation to smoking. We compared the antecedents and containment of smoking-related incidents of physical violence over a two-year period, (12 months when an indoor-only smoke-free policy was in place, followed by 12 months after a new comprehensive smoke-free policy was introduced) using incident reports completed by staff in a large mental health organization in London, UK. Sixty-one smoking-related incidents occurred during the indoor-only smoke-free policy period; 32 smoking-related incidents occurred during the comprehensive smoke-free policy. We identified four antecedent categories for physical violence: i) patient request to smoke denied by staff; ii) during a supervised smoking break; iii) staff response to a patient breach of the smoke-free policy iv) asking for, trading or stealing smoking materials. The antecedent pattern changed across the two policy periods, with fewer incidents of denying a patient's request to smoke and a greater number of incidents involving staff responding to breaches occurring after the introduction of the comprehensive smoke-free policy. The prohibition of smoking breaks removed this source of violence. Timeout and PRN medication were the most common containment interventions. Understanding the context of smoking-related violence may inform clinical guidelines about its prevention and management.
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Affiliation(s)
- Gilda Spaducci
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Kathryn Hubbard
- Health Services and Population Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Duncan Stewart
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Mary Yates
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, London, UK
| | - Deborah Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Abstract
Abstract. Background: The prevalence of tobacco smoking among people with severe mental illness (SMI) substantially exceeds smoking rates in the general population and has been identified as the largest contributor to health inequalities in this group. Historically deeply embedded in the culture of mental health treatment environments, smoking until very recently was the norm in inpatient settings and still prevails in many settings internationally. In England however, mental health Trusts are currently implementing recent national guidance, according to which mental health settings will become entirely smokefree, with no exemptions, providing comprehensive evidence-based support to patients for smoking cessation and smoking abstinence during the inpatient stay. Aim: The aim of this article is to summarise the rationale for and the debate surrounding smokefree mental health inpatient settings, and to review and discuss the evidence on challenges, opportunities and impact of smokefree policy implementation in these settings, with a focus on the English debate and experience to date.
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Smith CA, McNeill A, Kock L, Shahab L. Exploring mental health professionals' practice in relation to smoke-free policy within a mental health trust: a qualitative study using the COM-B model of behaviour. BMC Psychiatry 2019; 19:54. [PMID: 30717722 PMCID: PMC6360690 DOI: 10.1186/s12888-019-2029-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/16/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Smoking has played a significant role in the historical culture of mental healthcare settings. Mental health professionals (MHPs) often hold dismissive attitudes regarding the importance of smoking cessation in the context of mental healthcare. In 2007, English mental health inpatient buildings were required by law to become smoke-free, and healthcare trusts have more recently begun to implement comprehensive policies (i.e. smoke-free grounds and buildings) and staff training in response to national guidance. It is therefore important to explore MHPs practice around smoking, smoking cessation, and smoke-free policy adherence. This study aimed to explore these issues by using the COM-B (capability, opportunity, motivation, behaviour) model to systematically identify barriers to, and facilitators for, MHPs addressing smoking with their patients. METHODS Five focus groups with a total of 36 MHPs were conducted between March and August 2017. MHPs were recruited from one of the largest mental health trusts in Europe. Discussions were guided by a semi-structured guide. Responses were audio recorded, transcribed and coded using thematic analysis and the COM-B framework. RESULTS Addressing smoking with patients was undermined by MHPs' 1) psychological capability to recall training content, misunderstand the potential benefits of addressing patient smoking and harm reduction approaches; 2) physical opportunity in terms of time constraints, and easy accessibility of tobacco in the community; 3) social opportunity in terms of increased cultural value of tobacco following inpatient smoke-free policy implementation, and lack of support from colleagues to enforce the smoke-free policy; 4) automatic motivation, including intrinsic biases regarding patients abilities and motivations to quit, and 5) reflective motivation, including perceived job role and decision making processes related to addressing behaviours deemed more important than smoking. The main facilitating factors identified were MHPs' having opportunity in the form of patients asking directly for support, and MHPs having access to resources such as stop smoking services and spirometers. CONCLUSION Multiple barriers were identified across all key domains of the COM-B framework that undermine MHPs' practice regarding smoking cessation. Few facilitators were identified which may have implications for future smoke-free policy and clinical practice.
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Affiliation(s)
- Charlie Albert Smith
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Ann McNeill
- National Addiction Centre, King’s College London, 4 Windsor Walk, London, SE5 8BB UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, NG5 1PB UK
| | - Loren Kock
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
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Huddlestone L, Sohal H, Paul C, Ratschen E. Complete smokefree policies in mental health inpatient settings: results from a mixed-methods evaluation before and after implementing national guidance. BMC Health Serv Res 2018; 18:542. [PMID: 29996855 PMCID: PMC6042321 DOI: 10.1186/s12913-018-3320-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco smoking is extremely prevalent in people with severe mental illness (SMI) and has been recognised as the main contributor to widening health inequalities in this population. Historically, smoking has been deeply entrenched in the culture of mental health settings in the UK, and until recently, smokefree policies tended to be only partially implemented. However, recent national guidance and the government's tobacco control plan now call for the implementation of complete smokefree policies. Many mental health Trusts across the UK are currently in the process of implementing the new guidance, but little is known about the impact of and experience with policy implementation. METHODS This paper reports findings from a mixed-methods evaluation of policy implementation across 12 wards in a large mental health Trust in England. Quantitative data were collected and compared before and after implementation of NICE guidance PH48 and referred to 1) identification and treatment of tobacco dependence, 2) smoking-related incident reporting, and 3) prescribing of psychotropic medication. A qualitative exploration of the experience of inpatients was also carried out. Descriptive statistical analyses were performed, and the feasibility of collecting relevant and complete data for each quantitative component was assessed. Qualitative data were analysed using thematic framework analysis. RESULTS Following implementation of the complete smokefree policy, increases in the numbers of patients offered smoking cessation advice (72% compared to 38%) were identified. While incident reports demonstrated a decrease in challenging behaviour during the post-PH48 period (6% compared to 23%), incidents relating to the concealment of smoking materials increased (10% compared to 2%). Patients reported encouraging changes in smoking behaviour and motivation to maintain change after discharge. However, implementation issues challenging full policy implementation, including covert facilitation of smoking by staff, were reported, and difficulties in collecting relevant and complete data for comprehensive evaluation purposes identified. CONCLUSIONS Overall, the implementation of complete smokefree policies in mental health settings may currently be undermined by partial support. Strategies to enhance support and the establishment of suitable data collection pathways to monitor progress are required.
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Affiliation(s)
- Lisa Huddlestone
- Department of Epidemiology and Public Health, University of Nottingham, City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Harpreet Sohal
- Department of Epidemiology and Public Health, University of Nottingham, City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Claire Paul
- Leeds and York Partnership NHS Foundation Trust, Becklin Centre, Alma Street, Leeds, LS9 7BE UK
| | - Elena Ratschen
- Department of Health and Social Sciences, University of York, Heslington, York, YO10 5DD UK
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Hutchinson J, Mangera Z, Searle L, Lewis A, Agrawal S. Treatment of tobacco dependence in UK hospitals: an observational study. Clin Med (Lond) 2018; 18:35-40. [PMID: 29436437 PMCID: PMC6330918 DOI: 10.7861/clinmedicine.18-1-35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Over a million smokers are admitted to hospitals in the UK each year. The extent to which tobacco dependence is identified and addressed in this population is unclear. Data on 14,750 patients from 146 hospitals collected for the British Thoracic Society smoking cessation audit were analysed to determine smoking prevalence, attempts to ask smokers about quitting, and referrals to smoking cessation services. Associations with hospital organisational factors were assessed by logistic regression. Overall hospital smoking prevalence was 25%. Only 28% of smokers were asked whether they would like to quit, and only one in 13 smokers was referred for treatment of tobacco dependence. There was a higher chance of smokers being asked about quitting in organisations with smoke-free sites, dedicated smoking cessation practitioners, regular staff training, and availability of advanced pharmacotherapy. Treatment of tobacco dependence in smokers attending UK hospitals is poor and could be associated with organisational factors.
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Affiliation(s)
| | | | - Laura Searle
- Quality Improvement and Clinical Audit, British Thoracic Society, London, UK
| | - Anna Lewis
- Cwm Taf University Health Board, Wales, Abercynon, UK
| | - Sanjay Agrawal
- Institute for Lung Health, Glenfield Hospital, Leicester, UK
| | - on behalf of the British Thoracic Society
- Sherwood Forest Hospitals, Nottinghamshire, UK
- North Middlesex Hospital, London, UK
- Quality Improvement and Clinical Audit, British Thoracic Society, London, UK
- Cwm Taf University Health Board, Wales, Abercynon, UK
- Institute for Lung Health, Glenfield Hospital, Leicester, UK
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Perry BI, Meehan K, Jainer AK. Assessing the second-hand effects of a new no-smoking policy in an acute mental health trust. BJPsych Bull 2017; 41:325-330. [PMID: 29234509 PMCID: PMC5709681 DOI: 10.1192/pb.bp.116.055749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims and method To examine whether a new no-smoking policy in an in-patient mental health setting had any effects outside of smoking cessation. Our hypothesis stated that a forced smoking ban for in-patients may result in an increased susceptibility for clinical incidents, aggression and lower admission rates. All patients admitted to adult in-patient mental health services in Coventry and Warwickshire Partnership NHS Trust were included in the analysis. Data 6 months post-implementation of the smoking policy (1 July 2015 to 1 January 2016) were compared with the same period 1 year prior (1 July 2014 to 1 January 2015). Patient demographics, admission rates, ward occupancy, average lengths of stay, numbers of reported incidents and use of the Mental Health Act 1983 (MHA) were compared. Results We analysed 4223 admissions. We found a significantly increased number of admissions under the MHA (P = 0.007), a significantly greater number of reported smoking-related incidents (P < 0.001) and aggression-related incidents in the psychiatric intensive care unit (P < 0.001). However, we found no significant difference in capacity of in-patient wards (P = 0.39), admission length (P = 0.34) or total aggression-related incidents (P = 0.86). Clinical implications Although further comparisons over longer time periods are necessary, our results suggest that enforced smoking cessation on acutely unwell psychiatric patients admitted to the most restricted environments may have some negative effects. Nicotine replacement therapy should be offered to all patients to minimise the risk of clinical incident.
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Shu BC, Lung FW, Guo SE, Chen KC, Fang SY, Wang AL. Ineffectiveness of the Tobacco Hazards Prevention Act in patients with severe and persistent mental illness. Public Health 2017; 153:118-127. [PMID: 29032168 DOI: 10.1016/j.puhe.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The effect of the Tobacco Hazards Prevention Act (THPA) on the reduction of tobacco use in the general population in Taiwan is understood. However, there has been little research on how these policies affect people with severe and persistent mental illness (SPMI). Hence, the influence of the THPA on daily cigarette use by patients with SPMI was investigated in a 3-year follow-up. The risk and protective factors in smoking behavior and cessation were investigated. STUDY DESIGN This is an observational study. METHODS A total of 144 participants (78 of whom had smoked >100 cigarettes throughout their lifetime) were randomly selected from a healthcare network. Then, 100 of 144 patients with SPMI, included 50 smokers and 50 non-smokers, have agreed with 1st year follow-up. Eighty-two patients with SPMI, consisted of 44 smokers and 38 non-smokers, have agreed with 2nd year follow-up. RESULTS Although women were less likely to smoke than men, those who did smoke reduced the number of cigarettes less than men over the 3-year period. Less-educated patients were more likely to smoke than those who were more educated but reduced the number of daily cigarettes more after implementation of the THPA. Maternal overprotection was a risk factor and paternal care a protective factor for smoking. Addiction, a perception of pleasure, interpersonal relationships, and self-destructive behavior increased cigarette smoking. Patients perceived that smoking alleviated their depressive symptoms. CONCLUSIONS The THPA was ineffective for patients with SPMI. Some factors had different effects on the development of smoking behavior and the cessation process. Understanding the etiology of smoking can help policymakers establish more effective programs for smoking prevention and cessation.
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Affiliation(s)
- B-C Shu
- Institute of Allied Health Sciences and Department of Nursing, National Cheng Kung University, Tainan, Taiwan
| | - F-W Lung
- Calo Psychiatric Center, Pingtung County, Taiwan; Graduate Institute of Medical Science, National Defense Medical University, Taipei, Taiwan; Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - S-E Guo
- Graduate Institute of Nursing and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - K-C Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - S-Y Fang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - A-L Wang
- National Cheng Kung University Hospital Dou-Liou Branch, Tainan, Taiwan
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Wye PM, Stockings EA, Bowman JA, Oldmeadow C, Wiggers JH. Effectiveness of a clinical practice change intervention in increasing the provision of nicotine dependence treatment in inpatient psychiatric facilities: an implementation trial. BMC Psychiatry 2017; 17:56. [PMID: 28173823 PMCID: PMC5297214 DOI: 10.1186/s12888-017-1220-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities. METHODS We undertook an interrupted time series analysis of nicotine dependence treatment provision before, during and after a clinical practice change intervention to increase clinician recorded provision of nicotine dependence treatment for all hospital discharges (aged >18 years, N = 4175) over a 19 month period in two inpatient adult psychiatric facilities in New South Wales, Australia. The clinical practice change intervention comprised six key strategies: leadership and consensus, enabling systems and procedures, training and education, information and resources, audit and feedback and an on-site practice change support officer. Systematic medical record audit and segmented logistic regression was used to determine differences in proportions for each nicotine dependence treatment outcome measure between the 'pre', 'during' and 'post-intervention' periods. RESULTS The prevalence of all five outcome measures increased significantly between the pre and post-intervention periods, including clinician recorded: assessment of patient smoking status (36.43 to 51.95%; adjusted odds ratio [AOR] = 2.39, 99% Confidence Interval [CI]: 1.23 to 4.66); assessment of patient nicotine dependence status (4.74 to 11.04%; AOR = 109.67, 99% CI: 35.35 to 340.22); provision of brief advice to quit (0.85 to 8.81%; AOR = 97.43, 99% CI: 31.03 to 306.30); provision of nicotine replacement therapy (8.06 to 26.25%; AOR = 19.59, 99% CI: 8.17 to 46.94); and provision of nicotine dependence treatment on discharge (8.82 to 13.45%, AOR = 12.36; 99% CI: 6.08 to 25.14). CONCLUSIONS This is the first study to provide evidence that a clinical practice change intervention may increase clinician recorded provision of nicotine dependence treatment in inpatient psychiatric settings. The intervention offers a mechanism for psychiatric facilities to increase the provision of nicotine dependence treatment in accordance with clinical guidelines.
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Affiliation(s)
- Paula M. Wye
- 0000 0000 8831 109Xgrid.266842.cSchool of Psychology, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia ,grid.413648.cHunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia ,Hunter New England Population Health (HNEPH), Longworth Ave, Wallsend, New South Wales 2287 Australia
| | - Emily A. Stockings
- 0000 0004 4902 0432grid.1005.4National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, New South Wales 2031 Australia
| | - Jenny A. Bowman
- 0000 0000 8831 109Xgrid.266842.cSchool of Psychology, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia ,grid.413648.cHunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia
| | - Chris Oldmeadow
- grid.413648.cHunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia
| | - John H. Wiggers
- grid.413648.cHunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales 2305 Australia ,Hunter New England Population Health (HNEPH), Longworth Ave, Wallsend, New South Wales 2287 Australia ,0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia
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No Ifs, No Butts: Compliance with Smoking Cessation in Secondary Care Guidance (NICE PH48) by Providers of Cancer Therapies (Radiotherapy and Chemotherapy) in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121244. [PMID: 27983709 PMCID: PMC5201385 DOI: 10.3390/ijerph13121244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 11/17/2022]
Abstract
Background: Legislation preventing smoking in public places was introduced in England in July 2007. Since then, smoke-free policies have been extended to the majority of hospitals including those providing cancer therapies. Whilst studies have been conducted on the impact and effectiveness of hospital smoke-free policy in the UK and other countries, there have not been any studies with a focus on cancer care providers. Cancer patients are a priority group for smoking cessation and support and this study aimed to examine implementation of the National Institute Clinical Excellence (NICE) guidance (PH48) in acute cancer care trusts in the UK. Methods: Participants were recruited from UK radiotherapy and chemotherapy departments (total 80 sites, 65 organisations) and asked to complete a 15 min online questionnaire exploring the implementation of NICE guidance at their hospital site. Results: Considerable variability in implementation of the NICE guidance was observed. A total of 79.1% trusts were smoke-free in theory; however, only 18.6% were described as smoke-free in practice. Areas of improvement were identified in information and support for patients and staff including in Nicotine Replacement Therapy (NRT) provision, staff training and clarity on e-cigarette policies. Conclusions: While some trusts have effective smoke-free policies and provide valuable cessation support services for patients, improvements are required to ensure that all sites fully adopt the NICE guidance.
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Sheals K, Tombor I, McNeill A, Shahab L. A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses. Addiction 2016; 111:1536-53. [PMID: 27003925 PMCID: PMC5025720 DOI: 10.1111/add.13387] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/25/2015] [Accepted: 03/07/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS People with mental illnesses and substance abuse disorders are important targets for smoking cessation interventions. Mental health professionals (MHPs) are ideally placed to deliver interventions, but their attitudes may prevent this. This systematic review therefore aimed to identify and estimate quantitatively MHPs attitudes towards smoking and main barriers for providing smoking cessation support and to explore these attitudes in-depth through qualitative synthesis. METHODS The online databases AMED, EMBASE, Medline, PsychINFO, HMIC and CINAHL were searched in March 2015 using terms relating to three concepts: 'attitudes', 'mental health professionals' and 'smoking cessation'. Quantitative or qualitative studies of any type were included. Proportions of MHPs' attitudes towards smoking and smoking cessation were pooled across studies using random effects meta-analysis. Qualitative findings were evaluated using thematic synthesis. RESULTS Thirty-eight studies including 16 369 participants were eligible for inclusion. Pooled proportions revealed that 42.2% [95% confidence interval (CI) = 35.7-48.8] of MHPs reported perceived barriers to smoking cessation interventions, 40.5% (95% CI = 30.4-51.0) negative attitudes towards smoking cessation and 45.0% (95% CI = 31.9-58.4) permissive attitudes towards smoking. The most commonly held beliefs were that patients are not interested in quitting (51.4%, 95% CI = 33.4-69.2) and that quitting smoking is too much for patients to take on (38%, 95% CI = 16.4-62.6). Qualitative findings were consistent with quantitative results, revealing a culture of smoking as 'the norm' and a perception of cigarettes as a useful tool for patients and staff. CONCLUSIONS A significant proportion of mental health professionals hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions; many report a lack of time, training and confidence as main barriers to addressing smoking in their patients.
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Affiliation(s)
- Kate Sheals
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Ildiko Tombor
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience UK Centre for Tobacco and Alcohol Studies, London, UKKing's College LondonLondonUK
| | - Lion Shahab
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
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Frazer K, McHugh J, Callinan JE, Kelleher C. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database Syst Rev 2016:CD011856. [PMID: 27230795 PMCID: PMC10164285 DOI: 10.1002/14651858.cd011856.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Smoking bans or restrictions can assist in eliminating nonsmokers' exposure to the dangers of secondhand smoke and can reduce tobacco consumption amongst smokers themselves. Evidence exists identifying the impact of tobacco control regulations and interventions implemented in general workplaces and at an individual level. However, it is important that we also review the evidence for smoking bans at a meso- or organisational level, to identify their impact on reducing the burden of exposure to tobacco smoke. Our review assesses evidence for meso- or organisational-level tobacco control bans or policies in a number of specialist settings, including public healthcare facilities, higher education and correctional facilities. OBJECTIVES To assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health-related outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE, EMBASE, and the reference lists of identified studies. We contacted authors to identify completed or ongoing studies eligible for inclusion in this review. We also checked websites of state agencies and organisations, such as trial registries. Date of latest searches was 22nd June 2015. SELECTION CRITERIA We considered studies that reported the effects of tobacco bans or policies, whether complete or partial, on reducing secondhand smoke exposure, tobacco consumption, smoking prevalence and other health outcomes, in public healthcare, higher educational and correctional facilities, from 2005 onwards.The minimum standard for inclusion was having a settings-level policy or ban implemented in the study, and a minimum of six months follow-up for measures of smoking behaviour. We included quasi-experimental studies (i.e. controlled before-and-after studies), interrupted time series as defined by the Cochrane Effective Practice and Organization of Care Group, and uncontrolled pre- and post-ban data. DATA COLLECTION AND ANALYSIS Two or more review authors independently assessed studies for inclusion in the review. Due to variation in the measurement of outcomes we did not conduct a meta-analysis for all of the studies included in this review, but carried out a Mantel-Haenszel fixed-effect meta-analysis, pooling 11 of the included studies. We evaluated all studies using a qualitative narrative synthesis. MAIN RESULTS We included 17 observational studies in this review. We found no randomized controlled trials. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before-and-after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before-and-after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group.The four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking-related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (risk ratio (RR) 0.71, 95% confidence interval ( CI) 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking-related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16).We judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. AUTHORS' CONCLUSIONS We found evidence of an effect of settings-based smoking policies on reducing smoking rates in hospitals and universities. In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported. However, we rated the evidence base as low quality. We therefore need more robust studies assessing the evidence for smoking bans and policies in these important specialist settings.
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Affiliation(s)
- Kate Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland
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Sohal H, Huddlestone L, Ratschen E. Preparing for Completely Smoke-Free Mental Health Settings: Findings on Patient Smoking, Resources Spent Facilitating Smoking Breaks, and the Role of Smoking in Reported Incidents from a Large Mental Health Trust in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E256. [PMID: 26927143 PMCID: PMC4808919 DOI: 10.3390/ijerph13030256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/09/2016] [Accepted: 02/15/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite high smoking prevalence and excessive smoking-related morbidity and mortality among people with mental disorder compared to the general population, smoking treatment is often neglected in mental health settings. The UK National Institute of Health and Clinical Excellence (NICE) recently issued public health guidance stipulating completely smoke-free mental health settings. This project evaluated existing smoking-related practices in preparation for guidance implementation. The objectives were to: audit the recording of smoking-related information and treatment provision; explore current arrangements relating to the facilitation of patient smoking; measure staff time spent and identify costs of facilitating smoking; and explore the role of smoking in smoking-related incidents. METHODS A mixed-methods study was conducted across four acute adult mental health wards, accommodating 16 patients each, over six months. It included a case-note audit, on-site observations, and a qualitative content analysis of incident reports. RESULTS Smoking status was recorded for less than half of the 290 patients admitted (138, 48%). Of those, 98 (71%) were recorded as current smokers, of whom 72 (74%) had received brief smoking cessation advice. Staff spent 6028 h facilitating smoking, representing an annual cost of £ 131,040 across four wards. Incident reports demonstrated that smoking facilitation was often central to the cause of incidences, triggered frustration in patients, and strained staff resources. CONCLUSION The findings highlight the importance and potential of implementing completely smoke-free policies using comprehensive pathways.
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Affiliation(s)
- Harpreet Sohal
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
| | - Lisa Huddlestone
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
| | - Elena Ratschen
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
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Hashimoto K, Makinodan M, Matsuda Y, Morimoto T, Ueda S, Kishimoto T. Smoking bans in mental health hospitals in Japan: barriers to implementation. Ann Gen Psychiatry 2015; 14:35. [PMID: 26516338 PMCID: PMC4625877 DOI: 10.1186/s12991-015-0076-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A number of studies have reported that smoking rates are higher and smoking cessation rates are lower in patients with mental disorders than in the general population. Despite the harmful effects of smoking, implementing total smoking bans in mental health hospitals is difficult. We investigate the status of smoking bans and the barriers to the implementation of total smoking bans in Japanese mental health hospitals. METHODS A questionnaire survey was administered to the directors of 1242 Japanese mental health hospitals in March 2013. RESULTS Forty-nine percent (n = 612) of the hospital directors responded. Of these, 24 % implemented total smoking bans and 14 % limited the bans to hospital buildings. In 66 and 68 % of the remaining hospitals, smoking rooms were located in open and closed wards, respectively, and completely separate from nonsmoking areas. Hospitals that had not implemented total smoking bans were concerned that introducing a total ban would exacerbate patients' psychiatric symptoms (46 %) or increase the incidence of surreptitious smoking (65 %). However, of the hospitals that had implemented total smoking bans, only 2 and 30 % identified "aggravation of psychiatric symptoms" and "increased surreptitious smoking" as disadvantages, respectively. The other concerns regarding the implementation of total smoking bans were staff opposition (21 %) and incidence of smoking around hospital grounds (46 %). These concerns were overcome by educating staff about smoking and cleaning the area around the hospital. CONCLUSIONS There are some barriers to implementing total smoking bans in Japanese mental health hospitals. However, our study indicates that implementation of total smoking bans in mental health hospitals was minimally problematic and that barriers to the implementation of smoking bans could be overcome. As the current number of hospitals that have implemented total smoking bans is low in Japan, more hospitals should introduce total smoking bans.
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Affiliation(s)
- Kazumichi Hashimoto
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Manabu Makinodan
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Yasuhiro Matsuda
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Tsubasa Morimoto
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Shotaro Ueda
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Faculty of Medicine, Nara Medical University, 840 Shijocho Kashihara, Nara, 634-8522 Japan
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Lawn S, Feng Y, Tsourtos G, Campion J. Mental health professionals' perspectives on the implementation of smoke-free policies in psychiatric units across England. Int J Soc Psychiatry 2015; 61:465-74. [PMID: 25298224 DOI: 10.1177/0020764014553002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The original audit on which this 2013 secondary analysis is based, was conducted in 2010. It explored implementation of smoke-free policies from the perspective of unit managers in 147 psychiatric units across England comprising a randomly selected sample of nine different unit types. MATERIAL Two main themes are presented: positive perspectives of smoke-free policy implementation, and barriers and problems with smoke-free policy implementation. Analysis of unit managers' experiences and perspectives found that 96% of participants thought smoke-free policy had achieved positive outcomes for staff, patients, services and care. DISCUSSION Consistency of response was the most prominent factor associated with policy success. Quality of the physical environment and care delivery were clear positive outcomes which enabled the environment to be more conducive to supporting staffs' and patients' quit attempts. Lack of consistency and a prevailing culture of acceptance of smoking were identified as some of the most reported perceived continuing problems. Solutions included the need to acknowledge that this type of complex systems change takes time and ongoing staff education and training. CONCLUSION Our results demonstrate the importance of taking into account the experiences and attitudes of staff responsible for enacting smoke-free policy.
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Affiliation(s)
- Sharon Lawn
- Department of Psychiatry, Flinders University, Adelaide, South Australia, Australia
| | - Yi Feng
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - George Tsourtos
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jonathan Campion
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK Department of Population Mental Health, University College London, UCL Partners, London, UK
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Grant LG, Oliffe JL, Johnson JL, Bottorff JL. Health care professionals implementing a smoke-free policy at inpatient psychiatric units. QUALITATIVE HEALTH RESEARCH 2014; 24:1732-1744. [PMID: 25216860 DOI: 10.1177/1049732314549026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Smoke-free grounds policies (SFGPs) were introduced to inpatient psychiatric hospital settings to improve health among patients, staff, and visitors. We conducted an ethnographic study in Northern British Columbia, Canada, to describe how the implementation of SFGPs is affected by institutional cultures. Data reported here included participant observation, document review, informal discussions (n = 11), and interviews with health care professionals (HCPs; n = 19) and staff (n = 2) at two hospitals. We used iterative and inductive processes to derive thematic findings. Findings related to HCPs illustrate how local contexts and cultural factors affect SFGP implementation. These factors included individual beliefs and attitudes, the influence of group norms, leadership and consensus building, and locale-specific norms. Strong, consultative leadership, in which leaders solicited input from and long-term support of people most directly responsible for policy implementation, was key to success.
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Affiliation(s)
- Lyle G Grant
- Saskatchewan Institute of Applied Science and Technology, Saskatoon, Saskatchewan, Canada
| | - John L Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joy L Johnson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Bottorff
- University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
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Serafin A, Franklin S, Mehta R, Crosby S, Lee D, Edlin B, Bewick BM. NHS patients, staff, and visitor viewpoints of smoking within a hospitals' ground: a qualitative analysis. BMC Public Health 2014; 14:1015. [PMID: 25266492 PMCID: PMC4247108 DOI: 10.1186/1471-2458-14-1015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/21/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking is a public health concern and an avoidable cause of morbidity and mortality. Widening tobacco control policies might help shift social norms, the acceptability of exposing others to second-hand smoke, and cultural attitudes towards smoking. This study explored patient, staff, and visitor viewpoints of smoking within the grounds of a National Health Service hospital. METHODS Analysis of free text responses given as part of a larger repeat cross sectional questionnaire study. Free text qualitative responses analysed using thematic analysis. Pinderfields Hospital, a UK National Health Service hospital in the county of Yorkshire, provides a health service to around half a million people living in the Wakefield and North Kirklees area. Surveys were distributed 10th-18th September and 17th-21st December 2012. Of the n=952 participants who completed an anonymous survey n=306 participants provided a response to the optional free text question. RESULTS Thematic analysis revealed 5 distinct themes: (1) smoking is a dirty problem; (2) smokers are free to do as they wish; (3) the poor smoker; (4) smoke in our space: the battleground; and (5) no smoking please. Of the n=272 represented by the five themes, generally people accepted that smoking is socially unacceptable but their understanding of smoking behaviours and attitudes towards management and control of smoking differed. There was a strong sense that action is needed to separate the space smokers and non-smokers share. We identified a distinct group of participants that supported a hard line approach and suggested enforcing the no smoking policy through fines and monitoring. CONCLUSIONS Smoking on hospital grounds remains a contentious issue. Participants acknowledge that smoking is an increasingly unacceptable social behaviour but their understanding and acceptance of smokers vary. There is a strong sense of dislike about the impact of smoke and smokers on the shared hospital environment, with a focus on the hospital entrance. Participants suggest separating smokers and non-smokers and moving smokers away from the hospital entrance with the introduction of smoking shelters. These results suggest a complex narrative that should be investigated further to inform the implementation of the no-smoking policy across hospital settings.
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Affiliation(s)
- Alina Serafin
- />Leeds Teaching Hospital NHS Trust, St James’s University Hospital, Leeds, LS9 7TF UK
| | - Sarah Franklin
- />Wakefield Metropolitan District Council, Wakefield, WF1 2DD UK
| | - Rashesh Mehta
- />Wakefield Metropolitan District Council, Wakefield, WF1 2DD UK
| | - Scott Crosby
- />Wakefield Metropolitan District Council, Wakefield, WF1 2DD UK
| | - Diane Lee
- />Wakefield Metropolitan District Council, Wakefield, WF1 2DD UK
| | - Becky Edlin
- />Magpie Creative Communications Ltd, Leeds, LS2 9NG UK
| | - Bridgette M Bewick
- />Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9LJ UK
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Wye P, Gow LB, Constable J, Bowman J, Lawn S, Wiggers J. Observation of the extent of smoking in a mental health inpatient facility with a smoke-free policy. BMC Psychiatry 2014; 14:94. [PMID: 24679109 PMCID: PMC3994248 DOI: 10.1186/1471-244x-14-94] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental illness experience a higher burden of smoking-related disease. Smoke-free policies in mental health facilities provide an opportunity to reduce smoking-related harms for patients and staff alike. Limited evidence regarding the effect of such policies on preventing smoking in mental health facilities has been reported. The aims of this study are to describe the extent of smoking and the provision of nicotine replacement therapy (NRT) to patients in a mental health facility with a smoke-free policy. METHODS Cross-sectional studies of smoking (cigarette butt count and observed smoking) and nicotine dependence treatment (patient record audit) were undertaken over 9 consecutive weekdays in one mental health facility in Australia. A smoke-free policy incorporating a total smoking ban and guidelines for treating nicotine dependence among patients was implemented in the facility 4 years prior to the study. RESULTS Two thousand one hundred and thirty seven cigarette butts were collected and 152 occasions of people smoking were observed. Staff members were observed to enforce the policy on 66% of occasions. Use of NRT was recorded for 53% of patients who were smokers. CONCLUSION Implementation of the smoke-free policy was less than optimal and as a consequence ineffective in eliminating smoking and in optimising the provision of NRT. Additional strategies to improve the provision of nicotine dependence treatment to patients and the monitoring of adherence are needed to ensure the intended benefits of smoke-free policies are realised.
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Affiliation(s)
- Paula Wye
- University of Newcastle, University Drive, Callaghan, New South Wales (NSW) 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
- University of Newcastle Priority Research Centre for Health Behaviour (PRCHB), Room 271, Level 2, David Maddison Building, Cnr King and Watt Streets, Newcastle, NSW 2300, Australia
- Hunter New England Population Health (HNEPH), Longworth Ave, Wallsend, NSW 2287, Australia
| | - Leanne Beth Gow
- University of Newcastle, University Drive, Callaghan, New South Wales (NSW) 2308, Australia
- Hunter New England Population Health (HNEPH), Longworth Ave, Wallsend, NSW 2287, Australia
| | - Jude Constable
- Hunter New England Mental Health Service, Mater Hospital, Cnr Edith and Platt Streets, Waratah, NSW 2298, Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, New South Wales (NSW) 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
- University of Newcastle Priority Research Centre for Health Behaviour (PRCHB), Room 271, Level 2, David Maddison Building, Cnr King and Watt Streets, Newcastle, NSW 2300, Australia
| | - Sharon Lawn
- Department of Psychiatry, Flinders University, PO Box 2100, Adelaide, South Australia 5001, Australia
| | - John Wiggers
- University of Newcastle, University Drive, Callaghan, New South Wales (NSW) 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
- University of Newcastle Priority Research Centre for Health Behaviour (PRCHB), Room 271, Level 2, David Maddison Building, Cnr King and Watt Streets, Newcastle, NSW 2300, Australia
- Hunter New England Population Health (HNEPH), Longworth Ave, Wallsend, NSW 2287, Australia
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Lawn S, Campion J. Achieving smoke-free mental health services: lessons from the past decade of implementation research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4224-44. [PMID: 24025397 PMCID: PMC3799524 DOI: 10.3390/ijerph10094224] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 11/16/2022]
Abstract
The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders' continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to synthesise what we know works, why it works, and the remaining barriers to smoke-free policy and how appropriate interventions are provided to people with mental disorder.
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Affiliation(s)
- Sharon Lawn
- Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, Flinders University, Room 4T306, Margaret Tobin Centre, Flinders University, GPO Box 2100, Adelaide 5001, Australia
| | - Jonathan Campion
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham PR3 3BX, UK; E-Mail:
- Department of Population Mental Health, University College London, UCL Partners, London WC1E 7HB, UK
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Wood VJ, Curtis SE, Gesler W, Spencer IH, Close HJ, Mason JM, Reilly JG. Spaces for smoking in a psychiatric hospital: social capital, resistance to control, and significance for 'therapeutic landscapes'. Soc Sci Med 2013; 97:104-11. [PMID: 24161095 DOI: 10.1016/j.socscimed.2013.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/02/2013] [Accepted: 08/09/2013] [Indexed: 12/11/2022]
Abstract
This paper reports on research framed by theories of therapeutic landscapes and the ways that the social, physical and symbolic dimensions of landscapes relate to wellbeing and healing. We focus especially on the question of how attributes of therapeutic landscapes are constructed in different ways according to the variable perspectives of individuals and groups. Through an ethnographic case study in a psychiatric hospital in the North of England we explore the perceived significance for wellbeing of 'smoking spaces' (where tobacco smoking is practiced in ways that may, or may not be officially sanctioned). We interpret our findings in light of literature on how smoking spaces are linked to the socio-geographical power relations that determine how smoking is organised within the hospital and how this is understood by different groups using the hospital building. We draw on qualitative research findings from discussion groups, observations, and interviews with patients, carers and staff. These focused on their views about the building design and setting of the new psychiatric hospital in relation to their wellbeing, and issues relating to smoking spaces emerged as important for many participants. Creating and managing smoking spaces as a public health measure in psychiatric hospitals is shown to be a controversial issue involving conflicting aims for health and wellbeing of patients and staff. Our findings indicate that although from a physical health perspective, smoking is detrimental, the spaces in which patients and staff smoke have social and psychological significance, providing a forum for the creation of social capital and resistance to institutional control. While the findings relate to one case study setting, the paper illustrates issues of wider relevance and contributes to an international literature concerning the tensions between perceived psychological and psychosocial benefits of smoking vs. physical harm that smoking is likely to cause. We consider the implications for hospital design and the model of care.
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Affiliation(s)
- Victoria J Wood
- Department of Geography, Durham University, Wolfson Research Institute, Queens Campus, Stockton-on-Tees DH17 6BH, UK.
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Ballbe M, Sureda X, Martinez-Sanchez JM, Salto E, Gual A, Fernandez E. Second-hand smoke in mental healthcare settings: time to implement total smoke-free bans? Int J Epidemiol 2013; 42:886-93. [DOI: 10.1093/ije/dyt014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kerr S, Woods C, Knussen C, Watson H, Hunter R. Breaking the habit: a qualitative exploration of barriers and facilitators to smoking cessation in people with enduring mental health problems. BMC Public Health 2013; 13:221. [PMID: 23497231 PMCID: PMC3599988 DOI: 10.1186/1471-2458-13-221] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/05/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Smoking in people with mental health problems (MHPs) is an important public health concern as rates are two to three times higher than in the general population. While a strong evidence base exists to encourage and support smoking cessation in the wider population, there is limited evidence to guide the tailoring of interventions for people with MHPs, including minimal understanding of their needs. This paper presents findings from theoretically-driven formative research which explored the barriers and facilitators to smoking cessation in people with MHPs. The aim, guided by the MRC Framework for the development and evaluation of complex interventions, was to gather evidence to inform the design and content of smoking cessation interventions for this client group. METHODS Following a review of the empirical and theoretical literature, and taking a critical realist perspective, a qualitative approach was used to gather data from key stakeholders, including people with enduring MHPs (n = 27) and professionals who have regular contact with this client group (n = 54). RESULTS There was a strong social norm for smoking in participants with MHPs and most were heavily addicted to nicotine. They acknowledged that their physical health would improve if they stopped smoking and their disposable income would increase; however, more important was the expectation that, if they attempted to stop smoking, their anxiety levels would increase, they would lose an important coping resource, they would have given up something they found pleasurable and, most importantly, their mental health would deteriorate. Barriers to smoking cessation therefore outweighed potential facilitators and, as a consequence, impacted negatively on levels of motivation and self-efficacy. The potential for professionals to encourage cessation attempts was apparent; however, they often failed to raise the issue of smoking/cessation as they believed it would damage their relationship with clients. The professionals' own smoking status also appeared to influence their health promoting role. CONCLUSIONS Many opportunities to encourage and support smoking cessation in people with MHPs are currently missed. The increased understanding provided by our study findings and literature review have been used to shape recommendations for the content of tailored smoking cessation interventions for this client group.
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Affiliation(s)
- Susan Kerr
- Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 OBA, UK
| | - Charlotte Woods
- School of Health & Life Sciences, Glasgow Caledonian University, Scotland, UK
| | - Christina Knussen
- Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 OBA, UK
| | - Hazel Watson
- School of Health & Life Sciences, Glasgow Caledonian University, Scotland, UK
| | - Robert Hunter
- NHS Greater Glasgow & Clyde/Psychiatric Research Institute of Neuroscience, University of Glasgow, Scotland, UK
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Voci S, Bondy S, Zawertailo L, Walker L, George TP, Selby P. Impact of a smoke-free policy in a large psychiatric hospital on staff attitudes and patient behavior. Gen Hosp Psychiatry 2010; 32:623-30. [PMID: 21112455 DOI: 10.1016/j.genhosppsych.2010.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 07/29/2010] [Accepted: 08/23/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objectives of this work were to examine changes over time in degree of staff support for the implementation of a smoke-free policy in Canada's largest public mental health and addiction teaching hospital and to assess the impact of the policy on patient behavior. METHOD Staff completed an anonymous survey, which assessed views toward the smoke-free policy and perceived change in patient behavior, 2-7 and 31-33 months after an indoor smoke-free policy was implemented (September 21, 2005). Objective indicators of patient behavior were also collected in the form of number of emergency code whites (aggressive behavior) and that of code reds (fire) called 1 year prior to and 2 years following policy implementation. RESULTS Survey response rates were 19.0% (n=481) and 18.1% (n=500) at 2-7 and 31-33 months, respectively. The proportion of staff who supported the policy increased from pre-implementation (82.6%) to post-implementation (89.1%), and a high level of support was maintained 2 years after policy enactment (90.1%). The number of emergency codes did not significantly change after policy implementation, and staff did not perceive a change in most forms of patient behavior. CONCLUSION A smoke-free policy can be implemented in a large psychiatric hospital with a high degree of support from staff and no substantial negative impact on patient behavior.
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Affiliation(s)
- Sabrina Voci
- Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1
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ALLSOP STEVE, CARTER OWEN, LENTON SIMON. Enhancing clinical research with alcohol, tobacco and cannabis problems and dependence. Drug Alcohol Rev 2010; 29:483-90. [DOI: 10.1111/j.1465-3362.2010.00171.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Fernández E, Martínez C. [Smoke-free hospital campus: the next challenge for tobacco control in Spain]. Med Clin (Barc) 2009; 134:633-4. [PMID: 19939418 DOI: 10.1016/j.medcli.2009.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/08/2009] [Accepted: 09/10/2009] [Indexed: 11/20/2022]
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