title: Secondhand smoke in psychiatric units: patient and staff misperceptions.
abstract: BACKGROUND
  Mental health units have usually been exempted from complete smoke-free policies. The aim of this study was to compare the self-reported level of exposure to secondhand smoke (SHS) of patients and staff in psychiatric units to objective measures, and examine preference for different types of smoking bans.
  
  
  METHODS
  Cross-sectional survey about ban preferences and self-reported exposure to SHS by means of a self-administered questionnaire administered to patients and staff from 65 inpatient psychiatric units in Catalonia (95.5% of all units). We measured air concentrations of particulate matter ≤ 2.5 μm (PM2.5 in µg/m(3)) as a marker of SHS in these units.
  
  
  RESULTS
  600 patients and 575 professionals completed the questionnaire. 78.7% of them were objectively exposed to SHS (PM2.5>10 μm/m(3)) but 56.9% of patients and 33.6% of staff believed they were not exposed at all and 41.6% of patients and 28.4% of staff believed the environment was not at all unhealthy. Nurses had a higher smoking prevalence than psychiatrists (35.8% vs 17.2%; p<0.001), and nurses had a higher perception of being moderately highly exposed to SHS (40.3% vs 26.2%; p<0.001). PM2.5 levels were significantly different depending on the type of smoking ban implemented but unrelated to the perception of SHS levels by both patients and staff. Only 29.3% of staff and 14.1% of patients strongly supported total smoking bans.
  
  
  CONCLUSIONS
  Patients and staff have substantial misperceptions about the extent of their exposure to SHS and low awareness about the harmful environment in which they stay/work. This might have an influence on the preference for less restrictive smoke-free bans. It is particularly noteworthy that less that one-third of mental health staff supported smoke-free units, suggesting an urgent need for further education about the harmful health effects of SHS.
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Ballbè
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Xisca
authors.initials: X
authors.lastname: Sureda
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain Biostatiscs Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Martínez-Sánchez
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: Fu
authors.affiliation: Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain Health Plan Directorate, Ministry of Health, Generalitat de Catalunya, Barcelona, Spain Department of Public Health, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Saltó
authors.affiliation: Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Gual
authors.affiliation: Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016902:Air Pollution, Indoor / Q000032:analysis; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000032:analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000032:analysis; D010361:Patients; D011567:Psychiatric Department, Hospital; D061845:Smoke-Free Policy; D012907:Smoking / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000032:analysis; D055815:Young Adult
chemical_list: D052638:Particulate Matter; D014028:Tobacco Smoke Pollution
keywords: Health Services; Priority/special populations; Public policy; Secondhand smoke