A smoke-free environment policy (SFEP) designed to promote and protect the health of patients and staff of Sydney South West Area Health Service (SSWAHS) was introduced in July 2007. As part of the policy, eight weeks of free nicotine replacement therapy (NRT) per year was made available to assist staff to quit smoking. We report the findings of a 90-day follow-up survey that identifies the impact of free NRT on staff quit rates.
Reducing smoking among health staff is important because of their role as potential health educators and role models.1 Research indicates that nurses who smoke are less willing to counsel patients to stop smoking2 and are less likely to encourage others to quit.3–5 Visible smoking by health professionals also has a negative impact on hospitalised patients’ smoking behaviour.6 Workplace smoking restrictions increase rates of smoking cessation, the probability of a quit attempt, and reduce consumption among continuing smokers.7–9 Implementing a SFEP in health care settings is therefore a priority.
The implementation of the policy coincided with the introduction of smoke-free bars and clubs in New South Wales and was advertised widely throughout the health service via posters, leaflets attached to payslips, memos to senior managers, articles in staff newsletters and intranet messages. Staff wishing to access NRT completed an assessment and consent form and presented it at their local hospital pharmacy, where the NRT was dispensed. Three months after the staff member received free NRT, they were surveyed by telephone using a questionnaire that took approximately 10 minutes to complete. The study was conducted from October to November 2007.
Of the 385 staff enrolled in the first six months of the program, 293 (76%) consented to be followed-up and 244 (83%) were successfully contacted. Of the 49 staff (17%) lost to follow-up, two declined to be interviewed, the remainder had either retired or changed position, did not provide adequate contact details or were unable to be contacted.
Overall, 31% (n=75) of staff who accessed free NRT had quit smoking at three months. Overall, 24% of staff members used a tobacco cessation service (i.e. Quitline) and 14% had bought additional NRT once their eight weeks of free supply had finished. Almost all staff (99%) demonstrated awareness of the SFEP (see Table 1).
|Current smoker (%)a|
|31% n=75||69% n=169||n=244|
|No. of weeks of NRT used (n=226)|
|Used cessation services (n=216)|
|Bought extra NRT (n=231)|
|Aware SFEP (n=223)|
Of the 169 (69%) staff who continued to smoke after receiving NRT, the majority (85%) had reduced the amount they smoked, 85% also indicated they were considering another quit attempt, with 40% reporting they would attempt to quit in the next month. Repeated quit attempts are associated with increased likelihood of cessation10 and use of NRT has been shown to double quit rates.11 Importantly, 83% of staff indicated that they would use NRT in their next quit attempt, and as the policy provides up to eight weeks of free NRT a year, this increases the likelihood that staff will make additional quit attempts.
The study had some limitations. Smoking cessation outcomes were not biochemically verified; however, a large-scale meta-analysis of community-based studies showed low rates of false reports.12 Staff were only followed-up for three months. However, we are confident that continued provision of free NRT and repeated advertising of this service will increase the likelihood of a quit attempt and the eventual chances of successful cessation.7
The findings of this study indicate that provision of free or subsidised NRT can help employees to reduce or discontinue use of tobacco. Strategies to support and promote quit attempts among health staff are necessary to reduce the prevalence of smoking and to reinforce the non-smoking message given to their patients.