Article Text

Download PDFPDF
The adoption of smoke-free hospital campuses in the United States
  1. S C Williams,
  2. J M Hafner,
  3. D J Morton,
  4. A L Holm,
  5. S M Milberger,
  6. R G Koss,
  7. J M Loeb
  1. The Joint Commission, Illinois, USA
  1. Correspondence to Dr Scott C Williams, The Joint Commission, One Renaissance Blvd, Oakbrook Terrace, IL 60181, USA; swilliams{at}


Background: The adoption of a smoke-free hospital campus policy is often a highly publicised local event. National media coverage suggests that the trend towards adopting these policies is growing, and this publicity can frequently lead hospital administrators to consider the adoption of such policies within their own institutions. Little is actually known, however, about the prevalence of these policies or their impact.

Objectives: To determine the national prevalence of smoke-free hospital campus policies and the relation between these policies and performance on nationally standardised measures for smoking cessation counselling in US hospitals.

Methods: 4494 Joint Commission-accredited hospitals were invited to complete a web-based questionnaire assessing current smoking policies and future plans. Smoking cessation counselling rates were assessed through nationally standardised measures.

Results: The 1916 hospitals responding to the survey (43%) were statistically similar to non-responders with respect to performance measure rates, smoking policies and demographic characteristics. Approximately 45% of responders reported an existing smoke-free hospital campus policy. With respect to demographics, higher proportions of smoke-free campus policies were reported in non-teaching and non-profit hospitals. Smoke-free campus hospitals were also more likely to provide smoking cessation counselling to patients with acute myocardial infarction, heart failure and pneumonia who smoke (p<0.001).

Conclusions: By February 2008, 45% of US hospitals (up from approximately 3% in 1992) had adopted a smoke-free campus policy; another 15% reported actively pursuing the adoption of such a policy. By the end of 2009, it is likely that the majority of US hospitals will have a smoke-free campus.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding The project was supported by a Robert Wood Johnson Foundation grant #61567 administered through the Substance Abuse Policy Research Program (SAPRP). Additional support was provided by grant #062576_CIA from the Flight Attendants Medical Research Institute (FAMRI).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Human subjects protection The study protocol and documents were submitted to Independent Review Consulting (IRC), Inc, 100 Tamal Plaza, Suite 158, Corte Madera, CA 94925 ( for review; the study was deemed exempt for signed informed consent and waiver was received. Participants were advised that completing the questionnaire implied consent.