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Anne M. Joseph, MD, MPH; Judy M. Knapp, MPH; Kristin L. Nichol, MD, MPH; Phyllis L. Pirie, PhD

JAMA. 1995;274(6):491-494.

Abstract
Objective.
—To determine the extent of compliance with the new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standard requiring acute care hospitals to be smoke-free, and to identify predictors of adoption of smoke-free hospital policies.

Design.
—We conducted a survey of a national sample of acute care hospitals and developed a predictive model for implementation of smoke-free policies using multiple logistic regression. We examined numerous factors that might predict adoption of smoke-free policies, such as hospital characteristics, patient care services, and experience with smoke-free initiatives.

Setting and Participants.
—A systematic 20% sample of JCAHO-accredited hospitals in the United States (n=1278). Military, Department of Veterans Affairs, Indian Health Service, psychiatric, substance abuse treatment, and children's hospitals were excluded.

Main Outcome Measure.
—Compliance with the JCAHO standard.

Results.
—The response rate was 85%. Sixty-five percent of hospitals were in compliance with the standard 16 months after it was introduced. Factors that were independently and positively associated with implementation of smoke-free policies were administrative support (odds ratio [OR], 7.82; 95% confidence interval [CI], 2.05 to 29.65) and inpatient smoking cessation services (OR, 1.24; 95% CI, 1.02 to 1.52). Factors negatively associated with implementation of smoke-free policy were the number of psychiatric treatment beds (OR, 0.57; 95% CI, 0.41 to 0.81), number of substance abuse treatment beds (OR, 0.17; 95% CI, 0.11 to 0.26), and presence of an active task force to address smoking policy (OR, 0.56; 95% CI, 0.40 to 0.77).

Conclusions.
—The majority of acute care hospitals are in compliance with the JCAHO national smoke-free policy initiative. The standard is well accepted by most patients and employees. It is critical to address the challenges presented by special populations, such as psychiatry patients, to accomplish the goal of completely smoke-free hospitals.

(JAMA. 1995;274:491-494)

Author Affiliations
From the Department of Medicine, Veterans Affairs Medical Center (Drs Joseph and Nichol), and Division of Epidemiology, School of Public Health (Dr Pirie), University of Minnesota, Minneapolis; and Minnesota Coalition for a Smoke-Free Society 2000, Minneapolis (Ms Knapp).

Footnotes
Presented in part at the Ninth World Conference on Tobacco and Health, Paris, France, October 13, 1994.

Reprint requests to Section of General Internal Medicine (111-0), Veterans Affairs Medical Center, 1 Veterans Dr, Minneapolis, MN 55417 (Dr Joseph).

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