A systematic review of smoking bans in psychiatric hospitals

Abstract

Background Smoking prevalence is the highest in people with mental illness. As more and more countries develop governmental regulations to protect employees from exposure to environmental tobacco smoke, complete smoking bans or partial smoking bans have been introduced in many psychiatric hospitals.

Objectives To systematically review the literature to examine the impact of smoking bans in psychiatric hospitals, to identify the obstacles to implement tobacco-free policy and provide recommendations for policy-making in Mainland China on implementing tobacco-free policy in psychiatric hospitals.

Methods Multiple searches for key words were conducted through electronic sources including PubMed, Medline, PsycINFO, Cochrane Library, Google Scholar, and CNKI database for all relevant English language and Chinese language articles. The PICO (patient problem or population, intervention, comparison and outcomes) indicators were used as basic inclusion/exclusion criteria, data extraction and quality assessment.

Results A total of 227 studies were identified (188 English language articles including 4 reviews and 39 Chinese language articles), and 25 articles (19 English articles and 5 Chinese articles) were included in this paper. For the English language studies, psychiatric inpatients generally had positive attitudes towards the tobacco-free policy in psychiatric hospitals and increasing number of inpatients wanted to quit smoking after hospitalized in a tobacco-free psychiatric hospital. Increasing number of staff members working in psychiatric hospitals were supportive of the tobacco-free policy compared to previous reviews. No change in patients’ aggressive behaviors after implementing smoking bans in the psychiatric hospitals was observed in most studies. Factors identified for successful implementation of tobacco-free policy in psychiatric hospitals included comprehensive planning time, good leadership and significant attitudinal and system changes, high level and consistency of staff support and cohesive teamwork, extensive training for staff and effective use of nicotine replacement therapy (NRT). For the Chinese language studies, negative outcomes of psychiatric inpatients were observed after a total smoking ban in one psychiatric hospital, but positive effects were observed when only the smoking amount was controlled in four psychiatric hospitals.

Conclusions The tobacco-free policy aims at eliminating tobacco smoking for both staff members and patients in psychiatric hospitals so as to create a healthy place for work and stay. This goal can be achieved with the efforts of the hospitals and staff, and the cooperation of patients. National legislation to ban smoking in all hospitals, indoor and outdoor, are urgently needed in China Mainland.