In my role leading the charge to go tobacco free, I am frequently asking people to share their tobacco free stories – for some this story is celebratory, for some this story is reflective and for others, this story can be nostalgic.
I was recently asked to share my own tobacco free story, and it dawned on me that I, too, had been on that transformational journey. As an undergraduate student, I completed a co-op placement at an Alzheimer’s day treatment program. As part of my role in that program, I was responsible for taking out one of the clients for a cigarette after meals. I recall that on some particularly cold days she would ask me “why are we going outside?” After raising this to my supervisors, they responded by telling me that if we failed to take her outside, she would be in withdrawal and would be difficult to manage.
Unfortunately, just a few short weeks after leaving this placement, I learned that this client had passed away from tobacco related complications. This was a transformational moment in how I saw tobacco use, and it was this experience that highlighted the importance of taking a public health and care planning approach to the management of tobacco use and tobacco related triggers. Maybe had we managed her withdrawal effectively, things would have ended differently.
CAMH treats thousands of people for tobacco dependence annually, and in line with the evidence-base in this field, CAMH began its transition to becoming tobacco free in November of 2013. The goals of this policy are to: reduce exposure to tobacco and secondhand smoke on hospital property, to increase mindfulness about the impact of exposure to secondhand smoke, and to decrease tobacco triggers on our campus. In response to this change, we consulted and continue to consult with our patients, staff, and community, and what we continue to see as a result of these consultations, is a positive change in attitudes towards this change.
These days, when someone is observed smoking on CAMH property, more people are engaging in respectful conversations, and the people smoking are aware and cooperative when approached. In this role, I have had the opportunity to build mutually respectful relationships with several staff and patients that smoke; the focus really is on being supportive and making this about care and recovery.
A recent survey indicates that Canada’s tobacco use prevalence is at an all-time low with 15% of the Canadian population smoking. This reduction in tobacco use reflects a change in attitudes towards tobacco use; similarly, here at CAMH, since the launch of tobacco free, there has been a significant shift in attitudes favoring the transition by both patients and staff.
What do staff members think of a tobacco free CAMH?
Attitudes survey results were shared in the early stages of implementation prior to the full implementation of the policy; since that time, a subsequent survey was launched in order to look at whether attitudes have changed. This second survey was completed by 356 staff members. Below are the results showing how this policy has shifted staff attitudes since full implementation of the policy:
• Staff confidence in CAMH’s ability to become tobacco free has increased by 9 percentage points (49% vs. 40%)
• 78% of staff agree/strongly agree that they having access to team/management support in order to comply with the tobacco free policy (vs. 54%)
• 72% of staff agree/strongly agree that if a client wants to stop smoking, they know where to refer him/her and/or how they can provide support (vs. 59%)
• 37% of staff are concerned that smoking cessation could exacerbate client/patient symptoms, a significant reduction from the 43% of staff that indicated this concern at the time of our previous survey.
• We continue to see high agreement in support of the policy (79%)
From these responses, it’s clear that we are experiencing a culture change that supports the adoption of tobacco free when positioned in the framework of care planning and recovery. These results also indicate that in order to continue to be successful, we need to continue engaging and supporting our staff in care planning and clinical capacities, in order to gain their confidence in the success of this project.
What do patients think of a tobacco free CAMH?
Realizing that it is possible, even likely, that patients may have a different perspective from staff on this policy, we also anonymously surveyed 106 patients (both in- and outpatients) – to see what they had to say about this policy. It was inspiring and encouraging to see that like the staff, patients attitudes are also shifting in a positive way. Here’s how patients responded:
• 72% of patients agree/strongly agree that lowering tobacco use on CAMH property is important (vs. 63% pre-launch)
• 71% of patients agree/strongly agree that they support the making of a tobacco free policy at CAMH (vs. 59%)
• 76% of patients agree/strongly agree that they will not smoke on CAMH property (vs. 69%)
• 66% of patients agree/strongly agreed that the tobacco free policy at CAMH will be successful (vs. 48%)
• It is also worthwhile to note that we continue to see strong agreement that stopping smoking is important to patients (67%), that tobacco free policies lead to better health (76%) and that patients know where they can get supports to stop using tobacco (75%).
Perhaps most incredibly, patients actually have a higher level of confidence that we will be successful at becoming tobacco free (66 per cent of patients agree compared to only 49 per cent of staff).
These results speak to a number of factors; it seems that patients and staff are seeing this change as one that is increasingly becoming about care – as staff and patients both report knowing how and where to access supports, and a shift is occurring whereby both staff and patients are speaking out about the positive benefits of this change.
These results further debunk the myth that psychiatric patients are not interested in making changes to their tobacco use, and further illuminate the importance of providing care focused access to behavioural and pharmacological supports.
With that in mind, it is still apparent that we aren’t at 100% support by either patients or staff, and to get there we need all hands on deck. We need to hear what is and isn’t working so we can continue to make this change a positive one, and we want to hear from you. Please share in the comments below how CAMH can continue to support patients and staff in this transition to becoming tobacco free.
We want to hear your thoughts about tobacco free. To have your voice heard and included in the nest tobacco free attitudes survey, please complete this brief survey. Your participation will take no more than 5 minutes.