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The impact of smokefree legislation from a hospital and
cardiac point of viewAJ McNeill,
Chairman Smokefree Hospital Initiative Committee,
M Campbell,
Smoking Cessation Co-ordinator
Altnagelvin Hospital, Londonderry
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L/DERRY 1992
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WHSSB: Western Health and Social Srvices Board
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Standardised death rates NI
0
50
100
150
200
250
1996 1998 2000 2002 2004
Lung ca.IHDStroke
Report of CMO NI 2005
Per100kPopn.
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NI standardised death rates by health board area
0
20
40
60
80
100
120
140
EHSSB NHSSB SHSSB WHSSB NI
Lung caIHDStroke
Per100kPopn.
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The need for a change in attitude
• Smoking is the greatest single cause of preventable illness and premature death in Northern Ireland
• Around 2700 deaths a year
• Contributes to health inequalities
• Important cause of the gap in health between rich and poor
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Smoking prevalence
• NI household survey 2006
• Smoking prevalence 33% WHSSB, 31% NI
• DHSSPS in NI Priorities for action
• Reduction in smoking prevalence for NI by 7% to 24%
• Reduction in health inequalities
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Effects of second hand smoke
• 4000 chemicals
• Arsenic/benzene/formaldehyde/ammonia
• 60% carcinogenic
• More in “sidestream” than “mainstream”
• 85% room smoke is “sidestream”
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Health risks to passive smokers
• Lung cancer: increased risk 20-30%• Heart disease: increased risk 25%
30 min passive smoking reduces coronary blood flow
• Stroke: increased risk 82% in men, 66% women
• Asthma: acute exaccerbations• Pregnancy complications: low birth weight
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Legislation
• October 2005: minister announced ban on smoking in enclosed public places with effect from April 2007
• Public consultation: 91% support
• Ban effective from 30th April 2007
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Hospital policy
• 1997: Trust policy on tobacco/smoking• 2004: Smokefree Hospital Initiative committee• Multidisciplinary. Representation from WHSSB• Part of World Health Organisation Smokefree
Hospital Initiative and Health Promoting Hospitals group
• Appointment of smoking cessation counsellor• Patient and staff training• Shortcomings obvious
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Revised hospital policy
• With effect from 1st January 2007 (before legislation)
• Closure of patient and staff smoking rooms• Signed exclusion zone around entrances• No staff smoking on site (except cars)• Media coverage • Increased support for staff and patients• “Not punitive but supportive”
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The impact of legislation and policy on staff attitude
• 1 day snapshot staff survey March 2007
• 46 staff, 50% never smoked, 28% current, 22% ex-smokers
• 96% believed passive smoking detrimental to health
• 85% believed smoke-free policy was creating a positive change in hospital
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Staff attitude continued
• 85% agreed policy would result in positive health changes for patients
• 83% agreed staff had a duty to discourage patients from smoking
• 93% agreed staff had responsibility to stop those smoking in non-designated areas
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Increase in referrals for cessation
• 1/1/07- 30/4/07: 218 referrals• 1/5/07-31/8/07: 302 referrals• Increase in staff uptake of training• Increase in management support for staff
training• Raised profile for smoking cessation eg in-
service training/induction/resuscitation • Multidisciplinary incl ancillary staff
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The impact of legislation: public health
• Republic of Ireland: ban from 29/3/2004• South western Ireland (Cork)• March 2003/2004: 1277 admissions with acute
coronary syndromes• March 2004/2005: 1092 admissions• Decline 14.5%• Decline greater in smokers than non-smokers
Cronin et al. European Society of Cardiology, Vienna, 2007
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Public health impact in Scotland
• Ban introduced March 2006• Review of admissions with heart attack to 9
hospitals (63% total admissions)• Year to March 2006: 3235 admissions• Year to March 2007: 2684 admissions• 17% reduction• 20% reduction non-smokers cf 14% in
smokers
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Shortfalls
• Policy breeches by patients and visitors
• Policy breeches by staff
• Lack of “ownership” by some staff
• Sense of intimidation
• Senior management priorities
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Action plan
• Continued opportunistic training
• Staff support and training
• Target specific patient groups
• Increased signage/ auditory systems
• Media awareness
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