title: NHS patients, staff, and visitor viewpoints of smoking within a hospitals' ground: a qualitative analysis.
abstract: BACKGROUND
  Smoking is a public health concern and an avoidable cause of morbidity and mortality. Widening tobacco control policies might help shift social norms, the acceptability of exposing others to second-hand smoke, and cultural attitudes towards smoking. This study explored patient, staff, and visitor viewpoints of smoking within the grounds of a National Health Service hospital.
  
  
  METHODS
  Analysis of free text responses given as part of a larger repeat cross sectional questionnaire study. Free text qualitative responses analysed using thematic analysis. Pinderfields Hospital, a UK National Health Service hospital in the county of Yorkshire, provides a health service to around half a million people living in the Wakefield and North Kirklees area. Surveys were distributed 10th-18th September and 17th-21st December 2012. Of the n=952 participants who completed an anonymous survey n=306 participants provided a response to the optional free text question.
  
  
  RESULTS
  Thematic analysis revealed 5 distinct themes: (1) smoking is a dirty problem; (2) smokers are free to do as they wish; (3) the poor smoker; (4) smoke in our space: the battleground; and (5) no smoking please. Of the n=272 represented by the five themes, generally people accepted that smoking is socially unacceptable but their understanding of smoking behaviours and attitudes towards management and control of smoking differed. There was a strong sense that action is needed to separate the space smokers and non-smokers share. We identified a distinct group of participants that supported a hard line approach and suggested enforcing the no smoking policy through fines and monitoring.
  
  
  CONCLUSIONS
  Smoking on hospital grounds remains a contentious issue. Participants acknowledge that smoking is an increasingly unacceptable social behaviour but their understanding and acceptance of smokers vary. There is a strong sense of dislike about the impact of smoke and smokers on the shared hospital environment, with a focus on the hospital entrance. Participants suggest separating smokers and non-smokers and moving smokers away from the hospital entrance with the introduction of smoking shelters. These results suggest a complex narrative that should be investigated further to inform the implementation of the no-smoking policy across hospital settings.
authors.forename: Alina
authors.initials: A
authors.lastname: Serafin
authors.forename: Sarah
authors.initials: S
authors.lastname: Franklin
authors.forename: Rashesh
authors.initials: R
authors.lastname: Mehta
authors.forename: Scott
authors.initials: S
authors.lastname: Crosby
authors.forename: Diane
authors.initials: D
authors.lastname: Lee
authors.forename: Becky
authors.initials: B
authors.lastname: Edlin
authors.affiliation: Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds LS2 9LJ, UK. b.m.bewick@leeds.ac.uk.
authors.forename: Bridgette M
authors.initials: BM
authors.lastname: Bewick
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D014789:Visitors to Patients / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution