North Carolina hospitals have chosen to develop and implement campus policies that address the use of all tobacco products, not just cigarettes. This is especially important in North Carolina because in the eastern and western parts of the state, they have double the national spit tobacco rate. Hospitals in other states are encouraged to go 'tobacco-free' vs. 'smoke-free' campus wide to assure that employees do not move from cigarettes to smokeless products.

As North Carolina (NC) hospitals have gone tobacco-free campus wide with support from the Healthy Hospital Initiative, there has been a dramatic increase in interest by employees in quitting the use of tobacco. For instance, at High Point Regional Health System, Sue Cumpston is the hospital's Wellness Coordinator. Prior to implementing the tobacco-free campus wide policy, she averaged about one employee per year came to her seeking assistance to quit the use of tobacco. In the two years since they announced and have implemented their tobacco-free campus wide policy, over 200 employees (and a few spouses) have come to her seeking assistance in quitting tobacco. North Carolina hospitals (list) have implemented tobacco-free campus wide policies since 2003 when the first small rural hospital (Pardee Hospital) in the mountains passed their policy. Pardee was motivated to work on this initiative in response to a letter that was written by a cancer patient going to the hospital for treatments who was upset about having to walk through a cloud of cigarette smoke to enter the hospital. The CEO, who had received many similar letters, decided to act.

As of May '07, 67 hospitals in North Carolina have passed tobacco-free campus wide policies and an additional 28 more will do so, with the majority going tobacco-free this July 4th (map). This map shows the status of every acute care hospital in NC and where it stands specific to this policy initiative. The map has proven to be an invaluable tool in promoting this effort and encouraging hospitals to initiate this policy discussion. The Healthy Hospital Initiative is a program of NC Prevention Partners, in partnership with the NC Hospital Association's foundation, and is funded by The Duke Endowment. NC Prevention Partners has posted information at the Healthy County Profile, which lists the contact information for the key person at every hospital in NC that has passed a tobacco-free campus wide policy - scroll down to see the listing of hospitals that are listed. Hosptials can use this information to communicate with each other and to learn from other's experiences.

With respect to clinical performance and quality, hospitals that seem to take smoking cessation the most seriously (e.g., prohibit physicians from writing exceptions to the no-smoking policy for their patients, document patient smoking history more consistently, employ more counseling methods and access more counseling resources) also appear to provide smoking cessation counseling to their patients with greater consistency (Williams et al., 2005). The Centers for Disease Control and Prevention Task Force on Community Preventative Services strongly recommended the adoption of policies banning smoking in workplaces and public areas as a key strategy for reducing environmental tobacco smoke (CDC, 2000) Given the impact on patient, employee and visitor health, it is not surprising that some experts have also suggested that the Joint Commission adopt a smoke-free campus standard (Sciamanna et al., 2000).

In Michigan, the smoke-free campus effort began in 1996 with United Memorial Hospital in Greenville becoming the first, following the example set by Mayo Clinic in 1987. Since 2000, the Michigan Department of Community Health has provided an annual grant to help increase smoke-free hospital campuses. The University of Michigan Health System became smoke-free in 1999, with Spectrum Health, Saint Mary's Health, and Metropolitan Hospital in Grand Rapids becoming the first to enact smoke-free campuses as a collaborative effort in 2003. The "how to" CD developed by this team has been sent to over 600 hospitals around the US. In 2006, the Michigan Hospital Association adopted a commitment to become the central source for assisting all Michigan hospitals to become smoke-free campuses by January of 2008. They will soon provide a website (mhasmokefreecampus.org)coming this summer that will provide access to local resources, the "honor roll" list of all committed or smoke-free hospitals, and extensive information to help campuses with policy changes. A list serve is available for communication between hospitals to brainstorm or problem solve at (http://www.smokefree.net/smokefree-hospitals-talk/) In 2007, they have already provided four statewide training sessions for over 100 hospitals on how to become a smoke-free campus. As of June, 2007, 114 out of 144 hopsitals have smoke-free campuses or are committed by 1/1/08.

The Michigan Smoke-Free Campus definition has always been three fold. Provide a smoke-free campus, provide smoking cessation support (ideally free of charge) for the local community, and provide inpatient smoking cessation programs as part of the policy change. Examples are the University of Michigan's Tobacco Cessation Program that provides over 6,000 inpatient interventions per year. A 32% 12 month quit rate has been shown (Fung et al, Chest 2005)in similar programs. The Helen DeVos Children's Hospital has an inpatient cessation program that provides cessation counseling to all identified smoking parents/caregivers of admitted children equaling over 700 interventions per year. (Winickoff et al, 2003), showed beneficial results with such a program for parents. The three hospitals in Grand Rapids mentioned above who went smoke-free together in 2003 have provided free cessation classes to the community since 2000. And the same hospitals have implemented a new policy together in 2007 called "smoke-free workday, everyday" that does not allow employees to smoke, or smell like smoke anytime they are on working hours, on or off the campus.

As mentioned above, smoke free policies do decrease smoking rates, and the smoke-free campuses are no different. Mayo Clinic reported a decrease from 17% to 12% employee smoking prevalence 2 years after the campus policy was implemented. University of Michigan reported a decrease from 17% to 11% within 2 years, and Spectrum Health reported a drop from 16% to 9% 3 years after the policy was adopted.

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