Determinants of compliance with a national smoke-free hospital standard
A. M. Joseph, J. M. Knapp, K. L. Nichol and P. L. Pirie
Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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 during 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%. Six-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 [Cl], 2.05 to 29.65) and
inpatient smoking cessation services (OR, 1.24; 95% Cl, 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% Cl, 0.14 to 0.81),
number of substance abuse treatment beds (OR, 0.17; 95% Cl, 0.11 to 0.26),
and presence of an active task force to address smoking policy (OR, 0.56;
95% Cl, 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.
