Implementing and enforcing a smoke-free policy and by-law on hospital grounds at Central Coast Local Health District

Abstract

ISSUE ADDRESSED: Smoking by patients, staff and visitors on the grounds of Central Coast Local Health District (CCLHD). METHODS: NSW Health introduced a smoke-free buildings and vehicles policy in 1988. A smoke-free grounds policy was implemented in 1999, and a smoke-free by-law adopted by CCLHD in 2013, making smoking on CCLHD grounds an offence. Smoking in high-profile areas near hospital entrances was counted regularly since 2000. Several methods for communicating, monitoring and enforcing these smoke-free interventions have been adopted, including signage, Public Address announcements and enforcement patrols to ensure by-law compliance and to issue fines where required. Compliance with the smoke-free interventions has been supported with the availability of Nicotine Replacement Therapy for patients and visitors. RESULTS: When monitoring counts first commenced in 2000, smoking rates in high-profile areas were 8.1% at Gosford Hospital and 11.1% at Wyong Hospital. Counts conducted in 2018 indicated a substantial improvement, with the smoking rate in high-profile areas reducing to 0.25% at Gosford Hospital and 0.5% at Wyong Hospital. Smoking rates in high-profile areas have held steady at approximately 0.3% since 2014, after the by-law was implemented. CONCLUSIONS: The introduction of the smoke-free by-law added extra impetus to efforts to reduce smoking on CCLHD hospital grounds by providing the option to fine people who breach the by-law. Smoking in high-profile areas has declined substantially since 2011, and is minimal since the establishment of the smoke-free by-law. SO WHAT?: The experiences of CCLHD in implementing the smoke-free by-law may provide insights for other health services looking to use a similar intervention at their facilities. There are also methodological lessons for other organisations looking to communicate, monitor and enforce smoke-free policies, without enforcing fines.