Impact of tobacco control policies in hospitals: Evaluation of a national smoke-free campus ban in Spain

Abstract

Introduction: On January 2, 2011, the Spanish government passed a new smoking law that banned smoking in hospital campuses. The objective of this study was to evaluate the implementation of smoke-free campuses in the hospitals of Catalonia based on both airborne particulate matter and observational data.

Methods: This cross-sectional study included the hospitals registered in the Catalan Network of Smoke-free Hospitals. We measured the concentration of particulate matter < 2.5 µm in μg/m(3) at different locations, both indoors and outdoors before (2009) and after (2011) the implementation of the tobacco law. During 2011, we also assessed smoke-free zone signage and indications of smoking in the outdoor areas of hospital campuses.

Results: The overall median particulate matter < 2.5 µm concentration fell from 12.22 μg/m(3) (7.80-19.76 μg/m(3)) in 2009 to 7.80 μg/m(3) (4.68-11.96 μg/m(3)) in 2011. The smoke-free zone signage within the campus was moderately implemented after the legislation in most hospitals, and 55% of hospitals exhibited no indications of tobacco consumption around the grounds.

Conclusions: After the law, particulate matter < 2.5 µm concentrations were much below the values obtained before the law and below the annual guideline value recommended by the World Health Organization for outdoor settings (10 μg/m(3)). Our data showed the feasibility of implementing a smoke-free campus ban and its positive effects.

Keywords: ENSH, European Network of Smoke-free Hospitals; FCTC, Framework Convention on Tobacco Control; Hospitals; IARC, International Agency of Research on Cancer; IQRs, interquartile ranges; PM, particulate matter; Particulate matter; SHS, second-hand smoke; Second-hand smoke; Smoke-free campuses; Tobacco smoke pollution; WHO, World Health Organization; XCHsF, Catalan Network of Smoke-free Hospitals.