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Making hospitals in China smoke-free: a prospective study of implementing the new standard.

OBJECTIVES
In the run-up to all Chinese health care facilities becoming smoke-free, the feasibility of the new standard was assessed by monitoring its implementation in a sample of Chinese hospitals.


METHODS
Forty-one hospitals across 20 provinces were asked to ban smoking inside the hospital and provide advice and referral to stop-smoking treatment. Smoking status of more than 24,000 members of staff at 21 hospitals was surveyed at baseline (April 2009) and at follow-up (October 2010). Surveys monitored implementation of several specific aspects of the new standard to identify potential barriers to nationwide implementation.


RESULTS
All hospitals managed to implement the ban and most set up smoking cessation clinics. Routine recording of patients' smoking status proved more difficult to implement. The hospitals improved significantly in 8 out of 11 monitored policy parameters. Smoking prevalence among staff decreased from 14.8% to 10.7% (p < .001), suggesting an important collateral benefit of making hospitals smoke-free. Outdoor smoking areas facilitated the indoor ban. Staff education emerged as the key priority.


CONCLUSIONS
The smoke-free standard is feasible even in a country with a widespread acceptance of smoking inside health facilities. Several challenges need to be addressed when the new standard is disseminated across China.