Smoking by patients in a smoke-free hospital: Prevalence, predictors, and implications

Background. No-smoking policies are now mandated in all U.S. hospitals. The y require hospitalized smokers to abstain temporarily from tobacco. Little is known about patients' compliance with these policies or about their effe cts on patients' comfort and subsequent smoking behavior. Hospitalization i n a smoke-free hospital might precipitate nicotine withdrawal in smokers, b ut it might also offer smokers an opportunity to stop smoking. Methods. To assess the prevalence, predictors, and implications of smoking during hospitalization, we analyzed data from a cohort of 650 adult smokers who were admitted to an urban teaching hospital and participating in a smo king intervention trial. We measured nicotine withdrawal symptoms at study entry (24-48 h after admission) and patients' self-reports of smoking while hospitalized, compliance with the hospital no-smoking policy (smoking proh ibited indoors but permitted outdoors), and smoking status 1 and 6 months a fter discharge. Results. One-quarter of smokers admitted to a smoke-free hospital reported smoking during their hospital stay, although only 4% of smokers admitted vi olating policy by smoking indoors. Within 48 h of admission, 55% of smokers reported cigarette cravings and 29% of smokers reported difficulty refrain ing from smoking. Smokers with cigarette cravings were more likely to smoke while hospitalized (OR 3.6; 95% CI: 1.9-6.7). Those with nicotine withdraw al symptoms were more likely to violate the hospital no-smoking policy (OR 6.8; 95% CI: 5.3-8.3). Abstaining from tobacco use while hospitalized was a strong independent predictor of continued abstinence after discharge (OR 3 .8; 95% CI: 1.4-10.3). Conclusions. Smoking by patients in a smoke-free hospital was common. Cravi ng for cigarettes and symptoms consistent with nicotine withdrawal occurred frequently in hospitalized smokers and were associated with smoking during hospitalization, which was itself strongly linked with continuing to smoke after discharge. Pharmacologic treatment of cigarette cravings in hospital ized smokers could potentially improve patient comfort, increase compliance with hospital no-smoking policies, and promote smoking cessation after hos pital discharge, This approach deserves further study. (C) 2000 American He alth Foundation and Academic Press.