title: Factors associated with success of smoke-free initiatives in Australian psychiatric inpatient units.
abstract: OBJECTIVE
  Smoking is the largest cause of preventable illness in the United States, the United Kingdom, Canada, Australia, and many other countries. Smokers with mental illness smoke significantly more than those without mental illness and therefore experience even greater smoke-related harm. Internationally, there is increasing pressure on psychiatric inpatient settings to adopt smoke-free policies. This study examined smoke-free policies across psychiatric inpatient settings in Australia and thereby identified factors that may contribute to the success or failure of smoke-free initiatives in order to better inform best practice in this important area.
  
  
  METHODS
  Semistructured in-depth telephone interviews were conducted with 60 senior administrators and clinical staff with direct day-to-day experience with smoking activities in 99 adult psychiatric inpatient settings across Australia. Quantitative data were analyzed using descriptive statistical analysis and Pearson's chi square correlations measure of association.
  
  
  RESULTS
  Factors associated with greater success of smoke-free initiatives were clear, consistent, and visible leadership; cohesive teamwork; extensive training opportunities for clinical staff; fewer staff smokers; adequate planning time; effective use of nicotine replacement therapies; and consistent enforcement of a smoke-free policy.
  
  
  CONCLUSIONS
  A smoke-free policy is possible within psychiatric inpatient settings, but a number of core interlinking features are important for success and ongoing sustainability.
authors.affiliation: Department of Psychiatry, Flinders University, Room 4T306, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia 5001, Australia. sharon.lawn@health.sa.gov.au
authors.forename: Sharon
authors.initials: S
authors.lastname: Lawn
authors.forename: Jonathan
authors.initials: J
authors.lastname: Campion
mesh_terms: D001315:Australia; D006740:Hospital Administrators; D006778:Hospitals, Psychiatric; D006801:Humans; D007407:Interviews as Topic; D016134:Organizational Policy; D015397:Program Evaluation; D012907:Smoking / Q000331:legislation & jurisprudence*; D014028:Tobacco Smoke Pollution / Q000517:prevention & control
chemical_list: D014028:Tobacco Smoke Pollution