title: Transition to a smoke-free culture within mental health and drug and alcohol services: A survey of key stakeholders.
abstract: Tobacco smoking is common among people with mental illnesses, and they carry a higher burden of smoking-related illnesses. Despite this, smoke-free policies and systems for supporting cessation have proved difficult to introduce in mental health and drug and alcohol services (MHDAS). This paper examines the barriers to becoming smoke free within New Zealand services. Key informants, including staff, smoke-free coordinators, and cessation specialists were interviewed. Of the 142 invited informants 61 agreed (42%) to participate in a telephone interview, and 56 provided useable data. Organizations had a permissive or transitioning smoking culture, or were smoke free, defined by smoke-free environments, smoke-free-promoting attitudes and behaviours of management and staff, and cessation support. Most organizations were on a continuum between permissive and transitional cultures. Only eight services had a fully smoke-free culture. MHDAS face many challenges in the transition to a smoke-free culture. They are not helped by exemptions in smoke-free policies for mental health services, staff smoking, negative staff attitudes to becoming smoke free, poor knowledge of nicotine dependence, smoking-related harm and comorbidities, and poor knowledge and skills regarding cessation-support options. Health inequalities will continue across both service and socioeconomic divides without a concerted effort to address smoking.
authors.affiliation: Centre for Tobacco Control Research, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Marewa
authors.initials: M
authors.lastname: Glover
authors.forename: Trish
authors.initials: T
authors.lastname: Fraser
authors.forename: Chris
authors.initials: C
authors.lastname: Bullen
authors.forename: Mark
authors.initials: M
authors.lastname: Wallace-Bell
authors.forename: Hayden
authors.initials: H
authors.lastname: McRobbie
authors.forename: Georgy
authors.initials: G
authors.lastname: Hadwen
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000451:nursing* / Q000523:psychology; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003625:Data Collection; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D061845:Smoke-Free Policy; D016540:Smoking Cessation / Q000523:psychology*; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000451:nursing* / Q000523:psychology
keywords: mental health and drug and alcohol service; smoke free; smoking cessation; tobacco use