Evaluation of the Implementation of the Smoke Free WA Health System Policy: A research presentation

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Evaluation of the Implementation of the Smoke
Free WA Health System Policy
A research presentation
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Presentation structure

• Research objectives and methodology
• Need for action
• Site compliance
• Evidence of smoking
• Signage and communication
• Policy enforcement
• Benefits future directions of the Policy

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Research objectives and methodology
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Research objectives

• The evaluation focussed on four key elements of
  compliance with the Policy
• Communication tools and methods
• Evidence of non-compliance (smoking)
• Identification and description of smoking
  areas and smoking behaviour and
• Understanding of how non-compliance is managed
  in various settings.

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Methodology
1) Project inception meeting with DOH TNS
2) Selection of sites for inclusion within the
research
3) Design of observation checklist
Total of 98 site visits across 42 selected site
4) Conduct of observational site visits
10 follow-up interviews
5) Follow-up interviews with selected sites
6) Analysis and reporting
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Need for action
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Need for action
Why the need for a total smoke free environment?

• Research shows
• smokers consume 11-15 less and quit at a
  rate that is 84 higher in smoke free
  environments.

Benefits of quitting for WA

• Reducing current prevalence of smoking (15) to
  5 would save
• 938 million, or
• 5,600 for each person prevented from smoking
  over 15 years.

__________________________________________________
__________________________________________________
_____________ Borland R, Chapman S, Owen N, Hill
D. Effects of workplace smoking bans on cigarette
consumption. Am J Public Health 1990 80
178-180. Borland R, Owen N, Hocking B. Changes
in smoking behaviour after a total workplace
smoking ban. Aust J Public Health 1991 15
130-134. Hurley SF. Letter Hospitalisations
and costs attributable to tobacco smoking in
Australia 2001-2002. Medical Journal Australia ,
2006. 184(1), 45.
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Site compliance
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Number of people smoking during site observations

• Interviewers physically observed smoking
  on-site by staff (19), patients (20) and
  visitors (35 of observation occasions)

• Whilst may sound alarming, the average number
  of people per observation was low

• Interviewers reported that for 30 of all site
  observations, they were able to smell tobacco or
  cigarette smoke on-site

Note Base number of observations range from 93
to 97 Base Site observations which it was
observed people smoking (base varies between
n7 observations and n33
observations) 1 Examples of staff include
gardeners, cleaners, doctors, nurses,
tradespeople
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Who is contributing to the ETS on site and off
site?
On site
Off site
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Average duration of smoking during observations

• On average, most people spent around 1 to 5
  minutes both on and off-site

• A small proportion of off-site smokers did
  however spend around 11 to 15 minutes smoking

Base number of observations of people smoking
on the site 44 Base number for observations
of people smoking off the site 27
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Evidence of smoking
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Evidence of smoking

• High proportion of cigarette butts were noted
  to be littered across the ground (both on and off
  site)

• One-third of site observations also found the
  presence of ash trays/ butt bins on-site
• - In some instances these were make-shift
  bins, such as disposable cups, tins, soft-drink
  cans

Note Base number of observations range from 93
to 98 Examples include matches, cigarette
lighters, cigarette/tobacco packaging and
cigarette papers
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Evidence of compliance
Evidence of complianceExamples
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Signage and communication
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Signage

• Signs/ posters were prevalent at doorways and
  building entrances for 68 of observations

• Signage was seen as you enter the site for 48
  of observations

• A very positive result was that on almost all
  of the observations, the signage at all
  locations was
• - Clearly legible (87 of observations)
• - Clearly visible and within eyesight (95
  of observations).

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Signage - Qualitative feedback

• There are mixed messages regarding the
  continual effectiveness of signs
• - Now easily ignored and would not deter your
  persistent smoker
• VS
• - Persistent smoking behaviour not the result of
  poor communication or signage

Key learning Signage needs to be linked with
ongoing educational and communication programs to
remind people of the No smoking Policy
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Communication - Qualitative feedback

• The most common methods of communication include
• Staff global emails, smoking committee
  group, staff meetings, signage
• Patients hospital pre-admission forms
• Visitors signage, posters, brochures, site
  enforcement

• Unique communication methods used across some
  sites
• Pay slips
• Screensavers
• On-hold message
• Competitions, quizzes and brochures

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Policy enforcement
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Policy EnforcementQuantitative results

• There were no observations of intervention
  recorded

However

• People were recorded as smoking alone in the
  majority of observations.

• Specifically, there were
• no instances recorded of site security being in
  the presence of a person smoking,
• only a small proportion of observations where
  staff were present and chose not to intervene
  (15 of observations).

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Policy EnforcementQualitative feedback
The main issue raised is. Who is
responsible for and most effective in enforcing
the Policy?

• Issues more prevalent on the larger sites
  where
• - Staff and long term patients are the most
  frequent smokers
• - Sites with emergency departments and
  mental health wards
• - Sites that have a small distance between
  main entrances and site boundaries

• Some of the bigger sites have contemplated
  disciplinary action

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Hurdles to overcome

• Deciding who is responsible for enforcing the
  Policy
• Different site types each faced unique challenges
  when enforcing the policy.
• Secondary concerns stemming from the image
  problems created by moving smokers into adjacent
  community areas technically off site but still
  visibly close to the grounds.

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Benefits future direction of the Policy
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Benefits of the Policy

• Nicotine replacement therapy (NRT) for staff
  has been successful in helping a significant
  number to quit or cut down their smoking. In
  six metropolitan sites alone over 500 staff have
  accessed free NRT to make a quit attempt.
• Having to walk off site has prompted some
  smokers to reduce the number of smoking
  breaks and to consider quitting.
• Some of the smaller sites have managed to
  achieve 100 compliance.
• For the larger sites there were indirect
  benefits from increased communication
  between health professionals, other staff and
  patients.

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Recommendations

• A need to revitalise communication strategies for
  staff, patients and visitors.
• To develop a comprehensive, tailored approach to
  enforcement.
• To develop closer relationships with local
  government to reduce littering.
• To undertake continual evaluation and monitoring
  of the Policy.

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Next steps implementation of the recommendations
What has been done so far?

• Included smoke free policy information in
  Occupational Health Safety induction sessions
  and staff employment packs
• Reviewed the website, information and resource
  material. Resources available online include
• - Updated Policy guidelines
• - Downloadable patient staff information
  brochures
• - Evaluation presentation with instruction
  document
• - Fagerstrom Test cards

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Next steps implementation of the
recommendations Action at a local level
Have you considered.

• Revitalising communication strategies and signage
  
• Training sessions for staff in dealing with
  compliance
• Training sessions for staff for treating nicotine
  dependence
• Local success stories
• Nicotine Replacement Therapy to staff
• Working within local government

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??? Questions ???
Visit www.health.wa.gov.au/smokefree for more
information or to download a copy of the
evaluation report.