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Elizabeth Fee and Theodore M. Brown

Elizabeth Fee is with the History of Medicine Division, National Library of Medicine, National Institutes of Health, Bethesda, Md. Theodore M. Brown is with the Departments of History and of Community and Preventive Medicine at the University of Rochester, Rochester, NY.

Correspondence: Requests for reprints should be sent to Elizabeth Fee, PhD, Building 38, Room 1E21, 8600 Rockville Pike, Bethesda, MD 20894 (e-mail: elizabeth_fee{at}nlm.nih.gov).

Source. Prints and Photographs Collection, History of Medicine Division, National Library of Medicine, Bethesda, Md.

THIS 1990 POSTER FROM THE Johns Hopkins Hospital in Baltimore proclaims the institution’s smoke-free policy in a clear and dramatic manner. The Hopkins Employee Handbook is even more forceful in its application of the policy to hospital staff. Failure to comply with the ban on smoking in a nondesignated area is a "critical violation" of the employee code of conduct, in the same category as deliberate inattention to patient care, the falsification of records, and the unauthorized possession of a deadly weapon.¹ Disciplinary action, depending on the circumstances, will lead to suspension or immediate termination of employment.

Johns Hopkins’s stringent enforcement of a smoke-free policy for hospital staff was part of a national movement that gathered strength in the 1980s and accelerated in the early 1990s as hospitals around the country prepared to implement a new standard enacted by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), effective December 31, 1993.^2–4 By 1994, more than 96% of US hospitals complied with the new smoking ban standard and more than 41% had enacted policies that were even stricter.^5,6

The effective implementation of JCAHO standards had set up a natural experiment; US hospitals were undergoing the first industry-wide ban on smoking in the workplace. Investigators soon discovered that the smoking ban—established to protect the health of patients—had not only transformed the environment of health care institutions but had also had a marked and salutary effect on the smoking behavior and thus the health of hospital workers. Compared with other workers in the same communities, hospital workers had a significantly higher rate of quitting smoking.⁷ This difference began with the smoking ban and continued for 5 years. Later studies found that the differences in quit ratios held up over time, although both sets of workers tended to relapse at the same rate.⁸ Antismoking advocates would thus like to see workplace smoking bans extended to all industries; they estimate that such a policy would cut overall smoking prevalence by 10% and have the greatest impact on groups with the highest smoking rates.⁵

	References

TOP References

 
1. Johns Hopkins Health System, Johns Hopkins Hospital. Employee handbook—represented employees. Critical violations. Available at: http://www.hopkinsmedicine.org/jhhr/hbook_bu.htm. Accessed October 5, 2003.

2. Kales SN. Smoking restrictions at Boston-area Hospitals, 1990–1992: a serial survey. Chest. 1993;104:1589– 1591.[Abstract/Free Full Text]

3. Jenista JA. Smoking policy in pediatric Hospitals and wards. Am J Dis Child. 1989;143:567–569.[Abstract]

4. Barker AF, Moseley JR, Glidewell BL. Components of a smoke-free hospital program. Arch Intern Med. 1989; 149:1357–1359.[Abstract]

5. Longo DR, Feldman MM, Kruse RL, Brownson RC, Petroski GF, Hewett JE. Implementing smoking bans in American hospitals: results of a national survey. Tob Control. 1998;7:47–55.[Abstract/Free Full Text]

6. Longo DR, Brownson RC, Kruse RL. Smoking bans in US hospitals: results of a national survey. JAMA. 1995;274:488–491.[Abstract]

7. Longo DR, Brownson RC, Johnson JC, et al. Hospital smoking bans and employee smoking behavior: results of a national survey. JAMA. 1996;275: 1252–1257.[Abstract]

8. Longo DR, Johnson JC, Kruse RL, Brownson RC, Hewett JE. A prospective investigation of the impact of smoking bans on tobacco cessation and relapse. Tob Control. 2001;10:267–272.[Abstract/Free Full Text]

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This Article Extract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Fee, E. Articles by Brown, T. M. Search for Related Content PubMed PubMed Citation Articles by Fee, E. Articles by Brown, T. M. Related Collections Other Respiratory Health Health Care Facilities/Services Health Promotion History Other Tobacco Smoking Cessation