title: Impact of tobacco control policies in hospitals: Evaluation of a national smoke-free campus ban in Spain.
abstract: BACKGROUND
  On January 2, 2011, the Spanish government passed a new smoking law that banned smoking in hospital campuses. The objective of this study was to evaluate the implementation of smoke-free campuses in the hospitals of Catalonia based on both airborne particulate matter and observational data.
  
  
  METHODS
  This cross-sectional study included the hospitals registered in the Catalan Network of Smoke-free Hospitals. We measured the concentration of particulate matter < 2.5 µm in μg/m(3) at different locations, both indoors and outdoors before (2009) and after (2011) the implementation of the tobacco law. During 2011, we also assessed smoke-free zone signage and indications of smoking in the outdoor areas of hospital campuses.
  
  
  RESULTS
  The overall median particulate matter < 2.5 µm concentration fell from 12.22 μg/m(3) (7.80-19.76 μg/m(3)) in 2009 to 7.80 μg/m(3) (4.68-11.96 μg/m(3)) in 2011. The smoke-free zone signage within the campus was moderately implemented after the legislation in most hospitals, and 55% of hospitals exhibited no indications of tobacco consumption around the grounds.
  
  
  CONCLUSIONS
  After the law, particulate matter < 2.5 µm concentrations were much below the values obtained before the law and below the annual guideline value recommended by the World Health Organization for outdoor settings (10 μg/m(3)). Our data showed the feasibility of implementing a smoke-free campus ban and its positive effects.
authors: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.
authors: Xisca
authors: X
authors: Sureda
authors: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain.
authors: Montse
authors: M
authors: Ballbè
authors: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain; Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain.
authors: Cristina
authors: C
authors: Martínez
authors: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.
authors: Marcela
authors: M
authors: Fu
authors: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain.
authors: Esther
authors: E
authors: Carabasa
authors: Public Health Agency, Ministry of Health, Generalitat de Catalunya, Spain; Department of Public Health, Universitat de Barcelona, Barcelona, Spain.
authors: Esteve
authors: E
authors: Saltó
authors: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.
authors: Jose M
authors: JM
authors: Martínez-Sánchez
authors: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain; Catalan Network of Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain.
authors: Esteve
authors: E
authors: Fernández
keywords: ENSH, European Network of Smoke-free Hospitals; FCTC, Framework Convention on Tobacco Control; Hospitals; IARC, International Agency of Research on Cancer; IQRs, interquartile ranges; PM, particulate matter; Particulate matter; SHS, second-hand smoke; Second-hand smoke; Smoke-free campuses; Tobacco smoke pollution; WHO, World Health Organization; XCHsF, Catalan Network of Smoke-free Hospitals