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Smoke-free policies at North Carolina hospitals help protect patient health while promoting the denormalization of smoking in society. But could that progress be undone by the rise in popularity of e-cigarettes?

CHAPEL HILL, NC – In the first systematic survey of electronic cigarette use (e-cigarettes) in hospitals, researchers have found that the great majority of North Carolina hospitals appear to be regulating e-cigarettes in manners similar to other tobacco products, banning their use by patients, staff and visitors on the hospital campuses.

Researchers from the University of North Carolina’s Department of Family Medicine conducted a survey of all acute care hospitals in North Carolina, examining their policies on e-cigarettes, conventional cigarettes and other tobacco products, compliance with the policies, and communication about these policies to patients, staff and visitors to the hospital campus. Approximately 80% of hospitals across the state have e-cigarette policies, and the great majority of these policies do not allow e-cigarette use anywhere on the campus, similar to the existing campus policies on other tobacco products. One half of hospitals without a current e-cigarette policy surveyed reported that they were likely to create one within the next year.

“These findings demonstrate strong support for and little resistance to banning e-cigarettes on hospital campuses across North Carolina and should encourage other hospitals across the U.S. and internationally to incorporate e-cigarette policies into their existing smoke and tobacco-free hospital policies,” says Clare Meernik, UNC Research Associate and lead study author.

Hospitals surveyed reported three reasons as the primary motivation behind developing an e-cigarette policy: the harmful effects of e-cigarettes on users; concerns about second-hand exposure to e-cigarettes; and the concern that increased use of e-cigarettes might lead to a renormalization of smoking at hospitals.

The survey did indicate areas that needed improvement, especially for visitors to hospital campuses – 37 percent of hospitals reported difficulties with visitors not complying with tobacco policies, compared to 20 percent reporting trouble with patient non-compliance and only 12 percent with staff non-compliance.

The importance of this data stretches far beyond hospital campuses in North Carolina. The Global Network of Tobacco-Free Health Care Services and the International Network of Health Promoting Hospitals and Health Services have recommended that e-cigarette use be prohibited both indoors and outdoors at all hospitals and health care services.

“This study provides the first comprehensive data on the prevalence of e-cigarette policies on hospital campuses across a state,” said Dr. Adam Goldstein, Director of the UNC Tobacco Prevention and Evaluation Program. “Staff leadership in developing and communicating such policies is needed.”

The research was just published in the International Journal of Environmental Research and Public Health, and the researchers included Clare Meernik, Hannah M. Baker, Karina Paci, Isaiah Fischer-Brown, Daniel Dunlap, and Adam O. Goldstein.

The Tobacco Prevention and Evaluation Program (TPEP) at the University of North Carolina seeks to improve health by reducing tobacco-related morbidity and mortality. TPEP’s mission is to prevent tobacco use, tobacco-related addiction, and exposure to secondhand smoke by providing interdisciplinary research, training, and educational services to local, state, and national tobacco control programs; offering collaborative, utilization-focused, and participatory approaches in service delivery; and creating and disseminating tools that advance the development, implementation, and evaluation of tobacco prevention programs and policies.