Hospitalized smokers: Compliance with a nonsmoking policy and its predictors

Abstract

Background.

Factors associated with compliance with smoke-free policies among hospitalized smokers are poorly described. A better understanding of these factors may improve smoking cessation during admission and in the long-term.

Methods.

Two cross-sectional studies were conducted in an urban teaching hospital in Spain during 2002 and 2004. We interviewed 229 admitted smokers gathering data on smoking history, admission diagnosis, belief that hospitalization is related to smoking, policy's awareness, and smoking during admission and place of smoking.

Results.

Among hospitalized patients, approximately a third were current smokers. The compliance with the nonsmoking policy in 2002 and 2004 was respectively 71.9% (IC95%: 63.9–79.9) and 60.1% (IC95%: 50.9–69.3). In the multivariate regression model, factors significantly associated with compliance were: contemplation stage, confidence in quitting after discharge, belief that current symptoms or illness were related to smoking, and mild withdrawal symptoms.

Conclusions.

Admission in a smoke-free hospital does not guarantee that patients will refrain from smoking. Factors associated with compliance identified may be modified by tailored smoking cessation interventions. Our results might help physicians to understand inpatients' difficulties to abstain from cigarettes and enhance their efforts to take advantage of the hospitalization as a window opportunity to quit.

Introduction

Admission to a smoke-free hospital provides a favorable environment to stop smoking influencing: the severity of nicotine withdrawal syndrome (NWS); the stages of change (Prochaska and DiClemente, 1983); perceived health threat and self-efficacy (Barth and Bengel, 2000); and social norms. Little information is available about smoking behavior among inpatients. More than 75.0% of them comply with nonsmoking policies, which is associated with long-term cessation (Rigotti et al., 2000). A better understanding of factors associated with compliance could improve the effectiveness of cessation interventions maximizing the opportunity to quit.

This was the first such study within the Spanish health system. Primary objectives were to assess the prevalence of compliance with a nonsmoking policy and to identify its associated factors among inpatient in a smoke-free hospital. In order to guide policy, we also aimed to analyze potential time differences in the policy's compliance. Therefore, we recruited smokers during two separated time-periods: October 2002 and January to April 2004.