by Lilian Riad-Allen
In the cigar shop that doubled as a convenience store by my first residence in university, I remember the old cigarette ads plastered across the wall: Doctors in white coats promoting their favourite brand of cigarettes, children and even babies in cigarette ads, and women talking about the weight loss benefits of smoking.
I was always intrigued by these images as they seemed to reflect a reality that I couldn’t imagine. Attitudes had shifted so much since then that the idea of a physician advocating for tobacco use seemed almost satirical.
Attitudes have indeed been shifting. Since the first US surgeon general’s report in 1964 , the number of people smoking has been in constant decline to where we are now, 50 years later, with approximately 17 per cent of Canadians still smoking.
When you compare that to the number of people with mental health and addiction issues who smoke, you see a striking difference – with an estimated smoking prevalence of over 60 per cent.
The relationship between smoking and mental health is a complicated one, with a long history of behavioural reinforcements in mental health agencies and cognitive benefits offered by nicotine.
However, research has consistently confirmed that people living with a mental illness have an interest in quitting smoking, and can be as successful at quitting as those without a mental illness.
As CAMH is transitioning to a tobacco free environment, the project team wanted to explore the attitudes of both patients and staff – and the results were somewhat surprising.
What do staff members think of a tobacco free CAMH?
With 450 staff members responding to a brief survey, here’s what they had to say:
- 81% agree/strongly agree that addressing tobacco use at CAMH is important
- 71% of agree/strongly agree that they support a tobacco free CAMH
- 69% agree/strongly agree that going tobacco free will open dialogue about quitting smoking
- 59% responded with uncertainty (undecided/unsure) or disagreement (disagree or strongly disagree) to the statement “I am confident that the tobacco free policy at CAMH will be successful”
- 43% agree/strongly agree to the statement “I am concerned that smoking cessation could exacerbate client/patient symptoms”
- 46% of staff agree/strongly agree that tobacco free policies will make tobacco users feel stigmatized
From these responses, it’s clear that:
- Staff members realize the benefits of being tobacco free
- They are not confident that our tobacco free initiative will be successful
- They have concerns about exacerbating patient symptoms and stigmatization
These responses clearly indicate that as a project, the tobacco free initiative needs to focus on clinical care strategies and supports in order to be successful. These results also indicate that we need to continue to engage and support staff in order to gain their confidence in the success of this project.
What do patients think of a tobacco free CAMH?
Even more importantly, we anonymously surveyed 123 patients (both in- and outpatients) – and almost half (42 percent) said they are smokers. Here’s what they had to say:
- 79% of patients agree/strongly agree that tobacco free policies will lead to better health
- 70% of patients agree/strongly agree that stopping smoking is important for them
- 59% of patients agree/strongly agree that they support the tobacco free policy at CAMH
- 69% of patients agree/strongly agree that they will not smoke on CAMH property
- 54% of patients agree/strongly agree that they can get supports to follow the policy
- 65% of patients disagree/strongly disagree that stopping smoking could make their illness worse
- 48% of patients agree/strongly agreed that the tobacco free policy at CAMH will be successful
- 44% of patients agree/strongly agree that tobacco free policies will make tobacco users feel stigmatized
Incredibly, we see a comparable level of support from patients and even a higher level of confidence that we will be successful at becoming tobacco free (48 per cent of patients agree compared to only 40 per cent of staff).
We also see a high level of disagreement that stopping smoking will worsen patient symptoms, indicating that despite staff concerns over worsening patient symptoms, patients don’t appear to agree with this concern.
Of note, however, is that we see comparable levels of concern over stigmatization of tobacco users, which again speaks to the need for this approach to be clinical in nature.
These survey results coupled with staff feedback that this change is improving air quality and reducing tobacco triggers for those making changes to their tobacco use are inspiring and useful.
Clearly changes are being made, and in the same way that those old cigarette ads now seem antiquated, it will soon seem incredible that tobacco use was permitted on hospital properties.
What supports can CAMH put in place to improve tobacco free outcomes without stigmatizing tobacco users?