Evaluation of the Breathe Easy smoke free policy

Investigators: James Ogloff, Rachael Fullam, Margaret Nixon, Jeff Pfeifer

Rationale and aims:

  • The Breathe Easy Smoke Free Project is a clinical initiative intended to improve the health and wellbeing of Forensicare staff and patients in line with the Victorian Health Priorities 2012-2022. All Forensicare sites, including the 116 bed maximum security Thomas Embling Hospital, will become smoke free as of 1st July 2015.
  • The Breathe Easy Smoke Free project was established to implement the smoke free policy at Forensicare and to develop and deliver smoking cessation support programs for staff and patients.
  • To date, few published studies have examined the implementation and impact of smoke free initiatives in forensic inpatient settings. None of the existing studies are based in Australia.
  • The Breathe Easy project is a major health intervention within a complex clinical environment. The implementation and outcome of the intervention require formal evaluation. This study will help to establish the impact of the initiative across a range of outcomes.
  • The aims of the present study are to examine:
    • The effectiveness of communication and support around the implementation of the smoke-free policy
    • Compliance with the policy and uptake of programs/education opportunities, and Nicotine Replacement Therapy.
    • The impact of the smoke-free policy and associated support measures on attitudes towards smoking, nicotine dependence/withdrawal, and psychological symptoms related to withdrawal.
    • The impact of the smoke-free policy on biological measures of respiratory and metabolic function in patients
    • The impact of the smoke-free policy on aggressive/violent incidents, arson related fires, drug related incidents, incidents of suicide and self-harm, use of seclusion and PRN medication use.
    • The impact of the policy on patient attendance at education and gym programs.
    • The impact of the policy on the TEH workforce, including staff absence, recruitment, and retention

Methodology

  • Pre and post-implementation surveys of staff and patients assessing opinions regarding the implementation of the policy ban, cessation supports, attitudes towards smoking, nicotine dependence/withdrawal, and psychological symptoms related to withdrawal.
  • Post implementation patient interviews and focus groups examining the impact of the smoke-free policy on patients and ongoing support required to maintain long-term cessation
  • Collection of institutional data on pre and post implementation incidents/infractions, PRN medication use, uptake of smoking cessation supports, measured of cardio-respiratory and metabolic function, education program and gym attendance, staff absence rates and staff turnover.