Trends in acute hospital smoking prevalence and support of campus ban in Dublin, Ireland (1997-2018)

BACKGROUND: St Vincent's University Hospital (SVUH), a major hospital in Dublin, Ireland pioneered a hospital smoke-free campus policy in 2009; pre/post this intervention it conducted periodic surveys of patients, staff & visitors for smoking prevalence and policy attitudes. As rates of smoking decline nationally in Ireland, it is important to monitor trends for at-risk groups, including lower socioeconomic status (SES). METHODS: Repeat questionnaires were administered by census surveys of inpatients, quota or random sub-sample surveys of staff, and quota surveys with outpatients and visitors between 1997 and 2018. As a proxy for social deprivation, the rate of inpatients eligible by income for the state-funded General Medical Services (GMS) card was assessed. Chi square test for trend and SPSS v.27 were used for analysis. RESULTS: Support for and awareness of the campus smoking ban increased steadily; post ban agreement varied by smoking status (64.7% smokers, 89.7% ex-smokers; 92.5% non-smokers, p = 0.002). Smoking rates declined in all groups but significantly in outpatients (19.5% vs. 10%; p < 0.01), visitors (27.4% vs 9.5%; p < 0.0001) and staff (30.0% vs 10.8%; p < 0.0001). Rates of inpatient GMS entitlement was high at 54.2% average, compared with national rates of approximately 30% in 2021. Rates of smoking were non-significantly higher in GMS entitled inpatients (33.2% vs 26.8%; p = 0.09) across all survey periods. CONCLUSIONS: While hospital smoking prevalence has decreased and campus ban support persists, the campus is not immune to challenges in keeping it smoke-free. There are many socioeconomically deprived patients who smoke; this in part may reflect a private hospital on the same campus where affluent smokers are more likely to attend. Recent national initiatives for free nicotine replacement therapy and targeted smoking cessation courses in deprived areas work to address inequalities. We are not aware of similar studies in a hospital population over 25 years. KEY MESSAGES: • Periodic hospital smoking surveys show trends in prevalence which mirror the falling national trends in Ireland. • Socioeconomic differences persist in smoking rates among hospital patients.