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The evidence for CAMH going tobacco free

cigarette butts in sand

Evidence informs much of what we do in health care, and that is true not just for clinical interventions, but also for decisions like the implementation of a new organizational policy.

Understanding the evidence base for these types of initiatives can be particularly important when the issue is a challenging one that affects our staff, our clients, and our community.

CAMH’s decision to become a tobacco-free hospital is supported by research that speaks specifically to the issues involved in such a complex decision, and is particularly supported by new evidence that has come to light in the last five or six years. Understanding the link between evidence and policy is a key element to the success of our tobacco-free initiative, so we are committed to clear communication on the subject.

The evidence clearly tells us that our clients are disproportionately affected by smoking – in terms of rates of smoking as well as direct health outcomes and social impacts. In fact, the leading cause of death among people with serious mental illness and addictions is tobacco-related illness.

One of the common misperceptions that new evidence speaks directly to is the idea that tobacco use can somehow have a beneficial impact on the medical and psychiatric outcomes of our clients. Recent research, however, clearly demonstrates a link between smoking cessation and better treatment outcomes, and also tells us that there is no increase in aggression or violent incidents when smoke-free policies are implemented. Our own experience here at CAMH after our 2010 smoke-free policy change reflected this experience: a study conducted by our staff indicated there was no perceived change in levels of verbal or physical aggression, as corroborated by code white data.

There is also evidence specific to this type of policy implementation to guide us. Partial bans have been shown to be less effective than full bans, and facilities that have implemented tobacco-free policies have noted some significant benefits. Improvements in patient health outcomes, cleaner indoor and outdoor spaces, increases in staff satisfaction and more time to provide treatment have been reported. In addition to this research, we have the experience of other hospitals in Ontario to draw upon, many of which have already implemented full smoking bans.

This is just a small sampling of the recent evidence available that has helped to inform our decision to go tobacco-free. As we move forward with this important initiative, we’ll be communicating more about the role of research and evidence in our planning, implementation and evaluation of this important initiative.

Photo: Jayaprakash R on Flickr

16 Comments Post a comment
  1. again, CAMH shows they have no understanding about mental health. Again, I am so disappointed in CAMH. I am a Transforming Lives recipient and was very thankful for all the help CAMH gave me years ago. But now I have no respect for them and for all the new rulings. You don’t care anymore!!!

    April 22, 2014
  2. As long as tobacco is a legal product available to the general population, nobody has the right to forbid a vulnerable mentally ill, often defenseless person, to carry tobacco or to be forced to stop using it through direct or backdoor means under the pretext that it’s for their own good.

    Compassion and ethics dictate that healthcare providers do not cause unnecessary stress and suffering to people who don’t comply to their dictates. But obviously the Hippocratic Oath is a thing that we only read in history books now!

    Iro Cyr
    CAGE Canada

    April 22, 2014
  3. With the knowledge that 60-70% of the potential patients smoke and that the vast majority of those patients, with far more severe emotional and cognitive disabilities, will have to be convinced to enter voluntarily.

    What does it say of the administrators, who put up no smoking signs, as a clear indication to most patients, that they are no longer welcome?

    April 22, 2014
  4. thefxr #

    With the knowledge that 60-70% of the potential patients smoke and that the vast majority of those patients, with far more severe emotional and cognitive disabilities, will have to be convinced to enter voluntarily.

    What does it say of the administrators, who put up no smoking signs, as a clear indication to most patients, that they are no longer welcome?

    Sometimes good old common sense is a better guide for policy makers, than wheelbarrows filled with statistics, driven by a smoker free agenda.

    April 22, 2014
  5. Patricia Jane #

    My concern is for people with schizophrenia and other psychotic illnesses who are in crisis, but refusing to go to the hospital because they are addicted to cigarette smoking. Most have tried many times to quit and nicotine replacement therapy has not worked for them. It should be a civil right to receive care and treatment at a publicly funded hospital with no barriers or strings attached that are not absolutely necessary. A total ban on cigarette smoking and possession of cigarettes on hospital property is not necessary in order to create a hospital free of second-hand smoke or smoking triggers. Somewhere between the extremes of a constant cloud of second-hand smoke everywhere and a complete ban, there is a rational compromise. Hospital designers have known for decades how to design a ventilation system that does not spread air-borne infectious diseases throughout the hospital. They could design a smoking area that is visually hidden from the general public and from the rooms of patients wanting to avoid smoking triggers, and ventilate it so that second-hand smoke does not spread from this space to other areas of the hospital.

    April 22, 2014
  6. The entire Public health focus on creating an environment that is uncomfortable to smokers, over eaters or others with lifestyle choices they don’t agree with, is an effort that can never escape a definition as structural violence. Both an aggressive and regressive dehumanizing force, that kills far more people, than smoking could ever kill by direct statistical comparisons. It is probably the key ingredient that keeps the United States in the 34th position in longevity, compared to places like Japan with a smoking rate double that in the states and family or social structures that encourage individuals rather than judge and categorize them.

    The “campaign” or “movement” that we have seen evolving in medicine over the past twenty years or so is going further than just insulting people it is a formation of treating people as if they were an offensive disease. Which has probably killed more people than all the traditional disease vectors combined [with the exception of medical care], and very soon old age will be it’s only true competition, which if you look, is already one of it’s most notable victims.

    Structural Violence, is a term that should be on the minds of everyone in the Public Health sector, because it will soon be a factor they will be defending themselves and their actions against. Turn around is fair play.

    Violence you do to others can not be seen as anything less than a crime.

    http://www.juancole.com/2014/04/inequality-crashes-combined.html

    http://www.bmj.com/content/339/bmj.b4471

    http://www.structuralviolence.org/structural-violence/

    http://scoyne.weebly.com/structural-violence.html

    http://peacejustice.msu.edu/exhibits/show/structuralviolence/meaning

    April 23, 2014
  7. If you’re afraid of second-hand smoke, you should also avoid cars, restaurants…and don’t even think of barbecuing.

    here are just some of the chemicals present in tobacco smoke and what else contains them:

    Arsenic, Benzine, Formaldehyde.

    Arsenic- 8 glasses of water = 200 cigarettes worth of arsenic

    Benzine- Grilling of one burger = 250 cigarettes

    Formaldehyde – cooking a vegetarian meal = 100 cigarettes

    When you drink your 8 glasses of tap water (64 ounces) a day, you’re safely drinking up to 18,000 ng of arsenic by government safety standards of 10 nanograms/gram (10 ng/gm = 18,000ng/64oz) for daily consumption.

    Am I “poisoning” you with the arsenic from my cigarette smoke? Actually, with the average cigarette putting out 32 ng of arsenic into the air which is then diluted by normal room ventilation for an individual exposure of .032 ng/hour, you would have to hang out in a smoky bar for literally 660,000 hours every day (yeah, a bit hard, right?) to get the same dose of arsenic that the government tells you is safe to drink.

    So you can see why claims that smokers are “poisoning” people are simply silly.

    You can stay at home all day long if you don’t want all those “deadly” chemicals around you, but in fact, those alleged 4000-7000 theorized chemicals in cigarettes are present in many foods, paints etc. in much larger quantities. And as they are present in cigarettes in very small doses, they are harmless. Sorry, no matter how much you like the notion of harmful ETS, it’s a myth.

    April 23, 2014
  8. Colleges being forced to go smokefree by Obama Administration

    The U.S. Department of Health and Human Services announced an initiative to ban smoking from college campuses last month. This is part of the HHS goal to create a society free of tobacco-related disease and death, according to their action plan released by the HHS in 2010.

    Colleges who fail to enact campus-wide smoking bans and other tobacco-free policies may soon face the loss of grants and contracts from the HHS, according to the plan. Western receives grants through a subdivision of the HHS called the National Institutes of Health, Acting Vice Provost for Research Kathleen Kitto said.

    Obama administration to push for eliminating smoking on college campuses

    Read more: http://dailycaller.com/2012/09/11/obama … z29zJ2V2TV

    President Barack Obama has already promised not to smoke cigarettes in the White House. If his administration has its way, American college students will soon be required to follow suit while they’re on campus.

    Howard Koh, assistant secretary for health at the U.S. Department of Health and Human Services, will announce a national initiative Wednesday at the University of Michigan School of Public Health to stamp out tobacco use on college campuses.

    April 23, 2014
  9. Thanks for sharing your views about CAMH’s tobacco free initiative.

    CAMH has been a smoke free environment for many years. We are moving to become tobacco free because we want to give our patients the best environment for both physical and mental health. ‎The evidence is clear. Our patients are dying 20 years too soon, and smoking is killing them.

    At CAMH, we believe in the possibility of recovery for our patients. We also recognize that recovery from mental illness is a difficult journey. Eliminating the effects of tobacco during mental health treatment has been shown to improve health outcomes for people with mental illness.

    Our decisions surrounding a tobacco free environment are based on sound evidence*, supported by our values and principles, and informed by wide consultation that included people living with mental illness. During their care at CAMH, our patients are offered the tools they need to overcome their addiction to tobacco as part of their treatment plan.

    I understand that not everyone agrees with the CAMH decision to take the step from a smoke free to a tobacco free environment. As a healthcare facility, CAMH holds patient safety and quality of care as our most important planning principle. Removing tobacco from our facilities creates a safer environment and supports mental and physical recovery. Our patients deserve better.

    *List of evidence: http://bit.ly/1rteGVb (pdf)

    April 25, 2014
  10. Patricia Jane #

    Dr. Zahn, there is an asterisk at the end of your reply with a link for “list of evidence.” But when I googled this link, it does not match with any document. Could you kindly post the name of the document and the link to it? Thank you.

    April 25, 2014
  11. Hi Patricia,

    The link should be clickable – here is the full link: http://www.camh.ca/en/hospital/visiting_camh/Documents/Evidence_Based_TobaccoFree_academic.pdf

    It opens a pdf document called “Tobacco Free CAMH: Evidence Based Support” – a summary of the evidence as well as citations. It is also linked in the blog post above. Apologies for any confusion, but it’s not possible to hyperlink text in the comments. By copying and pasting the above link in your browser, you should be able to access the document. Thanks.

    April 25, 2014
    • Robert #

      Yes there are many citations but there is no bibliography. There citations don’t make any sense without an expanded bibliography detailing the reference sources. Could you add this information?

      September 18, 2014
  12. As I posted in the Huffington Post following the evidence Lilian from your institution presented there, even if all the studies were valid, irrefutable and unbiased, (which they are not) they are no justification for trampling on the human rights of psychiatric patients unless there is informed and voluntary consent. In my opinion, a one for all tobacco-free policy is neither ethical nor legal and this as long as tobacco remains a legal substance for the general population. The rights of these patients are even outlined in the CAMH Patient Bill of rights as follows :

    The patient:

    ”has the right to have services provided in a manner that respects the dignity, independence and self-determination of the individual.”

    ” has the right to retain and use personal possessions, with access to secure storage, in keeping with safety requirements and other clients’ rights.”

    ” has the right to all freedoms in accordance with the law.”

    ” has the right to respect of her/his needs, wishes, values, beliefs and experience.”

    ” has the right to identify their own needs, to have those needs form the basis of the development of a plan for services, and to have services provided in accordance with that plan.”

    ”has the right to access care without undue difficulty to meet basic needs.
    Every client has the right to reasonable accommodations required to access services.”

    ” has a right to choose the least restrictive care.”

    For the sake of all patients and especially those who don’t wish to give up smoking at this point in their life, I remain hopeful that the CAMH follows its own principles and Australia’s example of lifting the smoking ban and allowing patients a designated, if not indoor at least outdoor smoking area and allow patients to hold on to their ”possessions” i.e. their tobacco products.

    Thank you,
    Iro Cyr
    Vice-Presidente
    CAGE Canada

    April 26, 2014
  13. Paris #

    Sadly, this is just a form of bullying. This isn’t about smoking, its about the right to choose. Your position was once so commendable, offering a multitude of smoking cessation options, support, and education. This tactic is high-handed and destroys trust. I wish you would go back to treating patients with dignity.

    April 29, 2014
  14. waltc #

    You seem to assume that torturing the already-tortured for the couple of weeks that they’re in your custody is going to save their physical health and/or lives. This assumes what? That upon their release from your facility they’ll never smoke again? Aren’t you the same people who keep claiming that quitting tobacco is harder than quitting heroin? the same people who say that the first several quit attempts usually fail, even when they’re voluntary? I’m willing to bet that your punitive restrictions have absolutely zero long-term effect but merely create a lot of short-term misery.

    Please stop pretending your agenda is benign and just admit it’s your agenda and you happen to be in a position to impose it.

    May 3, 2014

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