Secondhand smoke in hospitals of Catalonia (Spain) before and after a comprehensive ban on smoking at the national level
Introduction
On January 1st 2006, Spain was the seventh European country after Finland, Ireland, Norway, Malta, Italy and Sweden that enacted a comprehensive regulation to prevent and control smoking. Smoking is banned in all indoor public workplaces, public transport, hospitality venues (with some exceptions), schools and universities, retail stores and shopping centers, as well as hospitals and other health care facilities (Fernandez, 2006). Although smoking in hospitals was already partially banned by previous regional and national laws, there was in fact a scarce fulfillment. Some hospitals opted to be smoke-free on their own initiative or in coordinated efforts such as the European Network for Smoke-free Hospitals and national networks (Fiore and Jorenby, 1992, Garcia et al., 2006).
Beside some flaws of the new Spanish law regarding restaurants, bars and pubs (Fernandez, 2006, Toledo, 2006), smoking is now totally banned in any location within hospitals and health care buildings, eliminating smoking rooms, smokers' cafeterias and smokers' areas within cafeterias. Since 2000, in Catalonia (Spain), the Catalan Network for Smoke-free Hospitals has granted practical guidance on implementing comprehensive tobacco control policies to the hospitals voluntarily affiliated to the Network (Mendez et al., 2004, O'Riordan, 2005) and provides continuous counseling to become a smoke-free hospital. The main areas of action concern ensuring the compliance of the norm, providing tobacco control training, designing and applying cessation programs addressed to professionals, patients and visitors, and guaranteeing common follow-up and evaluation (Garcia et al., 2006, Martinez et al., 2008).
Previous studies have evaluated SHS exposure using self-reported surveys or markers such as airborne nicotine in hospitals (Lopez et al., 2004, Martinez et al., 2008, Navas-Acien et al., 2004, Nebot et al., 2005, Stillman et al., 2007) and a few have used airborne nicotine to evaluate tobacco control policies in this setting (Becker et al., 1989, Stillman et al., 1990). However, there are no systematic assessments of secondhand smoke (SHS) in hospitals after a comprehensive national tobacco control law took effect.
This study evaluates the impact of the new law on SHS exposure in public hospitals in Catalonia, Spain, by assessing concentrations of airborne nicotine before (2005) and after (2006) the comprehensive national tobacco control law came into force.
Section snippets
Design and population
By the time of enforcing the new law (January 2006), 44 out of the 61 public hospitals (directly managed by or serving to the National Health Service) had joined the Network and had actively implemented the smoke-free hospital project (Garcia et al., 2006). These 44 hospitals participated in this study. Secondhand smoke was estimated by passive sampling of vapor-phase nicotine. A common protocol for the assessment of nicotine concentrations was developed, based on a previous multicountry study (
Results
Half of the 44 centers in the study were county hospitals of basic health care level, 10 were reference hospitals and 12 were university hospitals. The median number of beds was 250, with 18 hospitals having more than 300 beds, and the median number of workers was 612, with one third of the hospitals having more than 800 workers.
We detected airborne nicotine in 191 locations at baseline in 2005 (96.5% of the sample) and in 131 locations at follow-up in 2006 (66.2% of the sample). At baseline,
Main findings and comparison with other studies
Although airborne nicotine was detected at low levels in most places surveyed both before and after the ban (except in cafeterias), the concentrations decreased in most public hospitals after the ban. Cafeterias, where the highest nicotine levels were found at baseline, significantly reduced to levels similar to those found in the other locations studied. Hence, the new law boosted the compliance of the smoke-free areas in hospitals.
A comparison between hospitals according to the time of
Conclusions
The data show that before the law the compliance with smoking bans in hospital facilities in Catalonia (Spain) was good, but not complete. After the complete ban, SHS levels have decreased in hospitals, but there is room for improvement in some specific areas, such as the main entrance, fire escapes, emergency department waiting rooms, and cafeterias. The new law seems to decrease SHS exposure, but reinforcement in health policies is necessary and advisable to ensure the best compliance.
Conflicts of interest
The authors declare that there are no conflicts of interest.
Acknowledgments
We thank the collaboration of the Coordinators and other staff of the Smoke-free Hospital Committees in each of the participating hospitals: Centre Hospitalari de Manresa; Clínica Sant Josep, Manresa; Fundació Privada Hospital de Mollet; Fundació Sant Hospital, la Seud'Urgell; Hospital Casa de Maternitat, Barcelona; Hospital Clínic i Provincial de Barcelona; Hospital Comarcal de Blanes; Hospital de Campdevànol; Hospital de Figueres Fundació Privada; Hospital de l'Esperança, Barcelona; Hospital
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