A survey on policies of smoking control in Italian hospitals

In Italy National regulations forbidding smoking inside hospitals have existed since 1975. Current International medical standards for staff include refraining from smoking as an intervention of health education aimed at promoting healthy lifestyles as well as reinforcing smoking cessation advice, which staff should give patients. According to a National survey 33.3% of staff are active smokers and up to 80% of them admit to smoking in the workplace. This study was aimed at asking the hospital administrative authorities about the current situation of smoking control, according to their experience and about activities and policies they think could be effective in implementing smoking control.

As a part of a European survey, financed by the EC, 217 questionnaires were sent by mail to the General Managers of various hospitals in Italy, selected at random. The letter introducing the questionnaire was also signed by the unit of smoking control of the National Institute of Health (Rome).

Out of the 217 questionnaires sent (56.8% in Northern Italy, 19.8% in Central Italy, 23.4% in Southern Italy), 85 (39.2%) were returned, 56.5% from Northern Italy, 22.3% from Central Italy, 21.2% from Southern Italy. Even if a smoking control policy is reported by the 82% of our sample, only 37.3% reported a complete ban of smoking. In 72% of hospitals there are no areas designated for smokers; only 51.3% provide help for smoking cessation and 83.2% report that no financial support is given to this policy. When asked about a point for smoking control the majority (72.9%) think of education of staff and half of the sample of reinforcing controls and repression as well as free smoking cessation treatments. Finally, when evaluation of compliance to existing rules is asked an insufficient or absent compliance is reported in 25.4% and the majority (50.7%) reported no smoking cessation clinic or service inside. Due to the low redemption rate, our sample cannot be considered as representative of the national hospital network. However, considering that only managers referring a good or sufficient smoking control have probably answered our questionnaire, we can conclude that the situation enlightened by our sample could be worse but not better in reality.

In Italy the control of smoking in hospitals is far from reached. An implementation of smoking control needs support for cultural changes as well as a comprehensive policy towards smoking staff.