Research from South Dakota State University (SDSU) has shown that healthcare facilities vary wildly in their efforts to maintain a tobacco-free environment.

"To be tobacco-free, a facility must prohibit tobacco and smoking in buildings and on campus grounds it owns and leases," said SDSU assistant nursing professor Heidi Mennenga, PhD, RN. "It must be enforced 24-7 and prohibit smoking or tobacco for all people." 

Mennenga acknowledged that from a hospital's perspective, this is a difficult task. "Is it my job as a staff nurse or is that security's responsibility? And what are the consequences?"

With a goal to encourage facilities to develop and improve those policies, the researchers surveyed healthcare facilities that included clinics, hospitals, Women, Infants and Children and family planning centers, mental health and substance abuse treatment facilities, and cancer centers. Each was asked to provide a tobacco-free or smoke-free policy and answer additional questions regarding tobacco use assessment and referral procedures for patients, Mennenga explained.

The research team evaluated 348 healthcare facilities using four general areas as a policy review tool: 

• Whether there was a comprehensive policy that was clearly communicated to those who work at or visit the facility; 
• How complete the tobacco ban was, including what specific products were prohibited, such as chewing tobacco; 
• Whether the issue of enforcement was addressed for employees and volunteers, patients and clients, visitors and contractors/vendors, along with disciplinary actions for noncompliance; and
• Whether tobacco users were encouraged to quit and then offered guidance on how to do so.

Using scores based on the completeness of policies, Mennenga and colleagues gave the facilities ratings that ranged from 3 percent on the low end to 90 percent for the top facilities. Hospitals, clinics and cancer treatment centers were among the facilities with more comprehensive policies, all scoring above 60 percent, while mental health and substance abuse treatment facilities averaged 30 percent for comprehensiveness.

EHRs also played a part, with the researchers finding 77 percent of the facilities had EHR systems that prompted them to assess patients' tobacco use. “Among those facilities without [EHR]s, only 45 percent had a tobacco cessation section in their intake process," said research associate Jennifer Kerkvliet, MA.

Two topics that were not scored in the research included electronic cigarettes and third-hand smoke. "People are accustomed to not smoking in public places, but there are so many misperceptions about E-cigarettes," Mennenga said.

While 56.6 percent of facilities prohibited electronic cigarettes, only 25.3 percent of the facility policies addressed third-hand smoke, which Mennenga described as "the smell and residue left on surfaces, including a smoker's hands, hair and clothing, that can cause potentially harmful effects."

With their continuing research, the next step for Mennenga and her team will be to give each facility feedback on how to improve its policy, with the final step being interviews at select facilities, representing low, mid and high evaluation scores. "We want to identify barriers and facilitators to developing and implementing tobacco-free policies," Mennenga said.