Going Tobacco-Free: A Look at the Evidence

Research shows that tobacco-free hospitals have a number of health and safety benefits for patients. The Centre for Addiction and Mental Health (CAMH) recently went tobacco-free—part of a growing trend in health care centres across Canada.

On Sept. 9, from 11am to 12, over eighty stakeholders took part in an interactive webinar hosted by CAMH’s Tobacco-Free Initiative and Evidence Exchange Network. Dr. Tony George (top right) and Dr. Peter Selby (bottom right) looked at the evidence for going tobacco-free and also tackled a number of questions. Some had been submitted before the webinar; others were posted during the event.

Watch the webinar recording.

Here are some answers to questions the presenters couldn’t get to during the webinar itself:

How is the policy enforced for visitors?
The focus with visitors is on engagement and education, rather than enforcement. It is an expectation that all staff engage in a discussion with persons observed smoking on CAMH property. Our experience has been that a large majority of visitors are unaware of the policy and cooperate once asked to relocate.

What would be a recommended length of time to support staff with NRT that is beneficial for both the smoker and the organization?
Our approach to providing staff support integrates behavioural cessation supports as well as NRT. We offer a 6-week NRT program for staff combined with individualized cessation support by occupational health, safety, and wellness. In addition, we offer a smoking cessation support group for interested staff. At this group, the focus is on building partnerships and support networks.

From an evaluation perspective, what indicators are other hospitals using organization-wide (i.e. scorecards)? And aside from the staff and client surveys, is there a plan to evaluate the policy?
The hospital has developed a Tobacco-Free screener, using best practices in this area, and has indicated on our scorecard that at least 90% of all new admissions will be assessed using this screener within 24 hours of admission. The purpose of this screener is to open a clinical discussion about nicotine dependence, for the purpose of care planning, cessation support or withdrawal management, as appropriate.

To further evaluate the policy, we will be looking at changes in codes, practice and programmatic changes, changes in access, and a number of other indicators related to staff and patient outcomes.

Can you provide us with a list of medications affected by tobacco use?
Here is access to a list of medications that interact with the components of tobacco smoke and might need adjustment after someone quits. In general, one should inform the patient to report any symptoms that develop after quitting smoking and the practitioner must consider the deinduction of CYP 1A2 as a cause of this. The link below is up to date till 2011.
https://www.health.gov.bc.ca/pharmacare/pdf/sc-interact.pdf

What was the name of the medical marijuana in pill form?
The only legally available pill form in Canada is Cesamet or Nabilone. Marinol or Dronabinol was removed from the Canadian market in 2012. Also, there is a new product called Sativex which is a mouth spray and contains both THC and CBD. This link provides a chart and references on all the options including marijuana itself.
http://www.rxfiles.ca/rxfiles/uploads/documents/Pain-QandA-cannabinoids.pdf