The impact of smokefree legislation from a hospital and

cardiac point of viewAJ McNeill,

Chairman Smokefree Hospital Initiative Committee,

M Campbell,

Smoking Cessation Co-ordinator

Altnagelvin Hospital, Londonderry

L/DERRY 1992

WHSSB: Western Health and Social Srvices Board

Standardised death rates NI

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NI standardised death rates by health board area

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EHSSB NHSSB SHSSB WHSSB NI

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The need for a change in attitude

• Smoking is the greatest single cause of preventable illness and premature death in Northern Ireland

• Around 2700 deaths a year

• Contributes to health inequalities

• Important cause of the gap in health between rich and poor

Smoking prevalence

• NI household survey 2006

• Smoking prevalence 33% WHSSB, 31% NI

• DHSSPS in NI Priorities for action

• Reduction in smoking prevalence for NI by 7% to 24%

• Reduction in health inequalities

Effects of second hand smoke

• 4000 chemicals

• Arsenic/benzene/formaldehyde/ammonia

• 60% carcinogenic

• More in “sidestream” than “mainstream”

• 85% room smoke is “sidestream”

Health risks to passive smokers

• Lung cancer: increased risk 20-30%• Heart disease: increased risk 25%

30 min passive smoking reduces coronary blood flow

• Stroke: increased risk 82% in men, 66% women

• Asthma: acute exaccerbations• Pregnancy complications: low birth weight

Legislation

• October 2005: minister announced ban on smoking in enclosed public places with effect from April 2007

• Public consultation: 91% support

• Ban effective from 30th April 2007

Hospital policy

• 1997: Trust policy on tobacco/smoking• 2004: Smokefree Hospital Initiative committee• Multidisciplinary. Representation from WHSSB• Part of World Health Organisation Smokefree

Hospital Initiative and Health Promoting Hospitals group

• Appointment of smoking cessation counsellor• Patient and staff training• Shortcomings obvious

Revised hospital policy

• With effect from 1st January 2007 (before legislation)

• Closure of patient and staff smoking rooms• Signed exclusion zone around entrances• No staff smoking on site (except cars)• Media coverage • Increased support for staff and patients• “Not punitive but supportive”

The impact of legislation and policy on staff attitude

• 1 day snapshot staff survey March 2007

• 46 staff, 50% never smoked, 28% current, 22% ex-smokers

• 96% believed passive smoking detrimental to health

• 85% believed smoke-free policy was creating a positive change in hospital

Staff attitude continued

• 85% agreed policy would result in positive health changes for patients

• 83% agreed staff had a duty to discourage patients from smoking

• 93% agreed staff had responsibility to stop those smoking in non-designated areas

Increase in referrals for cessation

• 1/1/07- 30/4/07: 218 referrals• 1/5/07-31/8/07: 302 referrals• Increase in staff uptake of training• Increase in management support for staff

training• Raised profile for smoking cessation eg in-

service training/induction/resuscitation • Multidisciplinary incl ancillary staff

The impact of legislation: public health

• Republic of Ireland: ban from 29/3/2004• South western Ireland (Cork)• March 2003/2004: 1277 admissions with acute

coronary syndromes• March 2004/2005: 1092 admissions• Decline 14.5%• Decline greater in smokers than non-smokers

Cronin et al. European Society of Cardiology, Vienna, 2007

Public health impact in Scotland

• Ban introduced March 2006• Review of admissions with heart attack to 9

hospitals (63% total admissions)• Year to March 2006: 3235 admissions• Year to March 2007: 2684 admissions• 17% reduction• 20% reduction non-smokers cf 14% in

smokers

Shortfalls

• Policy breeches by patients and visitors

• Policy breeches by staff

• Lack of “ownership” by some staff

• Sense of intimidation

• Senior management priorities

Action plan

• Continued opportunistic training

• Staff support and training

• Target specific patient groups

• Increased signage/ auditory systems

• Media awareness