Abstract

To the Editor:

Environmental tobacco smoke (ETS) exposure has adverse health effects for children and adults,^1–3 and widespread concern about ETS exposure has aided in the successful passing of legislation to implement state-wide clean indoor air policies. In addition, there is increasing interest in hospitals enforcing comprehensive smoke-free workplace (SFW) policies in an effort to reduce ETS exposure and potentially improve the health of employees and visitors, as up to 84% of adults agree that smoking should not be allowed in hospitals.⁴However, there remains a lack of information on the acceptance of such policies. The aim of our study was to explore staff attitudes toward a new SFW policy 6 months before implementation at a large urban children’s hospital. The survey contained questions assessing demographics, attitudes about the effects of ETS on employees and visitors, acceptability of the SFW policy, and current tobacco behavior. An email survey was sent to all employees, and 2860 (31.4% of total employees) surveys were completed. The majority of subjects were 26 to 45 years old (56.2%), with 85.7% Caucasian, 8.7% African-American, and 5.6% other races. There were 2402 (84%) current nonsmokers. Smokers and nonsmokers were similar in all demographic variables. Overall, 1963 (68.6%) of employees were in favor of the new SFW policy, 2061 (72.1%) reported that the policy would benefit staff and patients, 1699 (59.4%) felt that most families would be in favor of the new policy, and 2558 (89.4%) and 1736 (60.7%), respectively, agreed that the hospital should provide free tobacco cessation classes and nicotine replacement therapy for employees and visitors once the policy took effect. Compared with smokers, nonsmokers reported that ETS exposure is a serious public health problem (95.2% versus 61.2%, P < 0.001) and a serious problem for staff and patients (79.1% versus 24.7%, P < 0.001); they were bothered by someone else smoking on campus 1 to 5 times/wk (42.5% versus 3.6%, P < 0.001); and that their work performance and job satisfaction would not decrease once the policy was implemented (98.4% versus 77.9%, P < 0.001, and 96.4% versus 58.8%, P < 0.001, respectively). Among smokers, 70.2% smoked 1 to 5 cigarettes on a typical work day, and 68.7% were in the precontemplation stage of quitting, and 37.4% agreed that they would be likely to quit smoking or decrease the amount that they smoke once the SFW policy took effect.