Smoking policy in pediatric hospitals and wards

The American Academy of Pediatrics has recommended that pediatricians take the lead in banning cigarette smoking in all pediatric health care facilities. This study investigated the use of "nonsmoking" policies and their planned revisions, problems in enforcement, and any history of challenges to restrictive or lenient policies. The surveys were mailed to 329 hospitals affiliated with pediatric training programs as the institutions most likely to attempt to comply with the American Academy of Pediatrics recommendations. Representatives from 199 (60%) of the programs responded. The programs had a range of 12 to 350 pediatric beds in children's hospitals (27%), pediatric wards (69%), or general hospitals (4%). Only nine hospitals were "smoke-free," ie, having no designated indoor area for smoking. Another 35 had "restrictive" policies allowing smoking in only a single site or two preselected sites. Pediatric hospitals or wards were no more likely to have smoke-free policies than general hospitals. Existence of smoke-free or restrictive policies was unrelated to any other factor examined. Smoke-free and restrictive policies were more likely to be rigorously enforced but not more likely to engender formal challenges. Although almost all policies had been recently or are being revised, pediatric hospitals and wards remain remiss in controlling childhood smoke exposure.