A survey of staff attitudes to smoking-related policy and intervention in psychiatric and general health care settings
Abstract
BACKGROUND: Although the move to smoke-free hospital settings is generally a popular initiative, it may be a more challenging and controversial issue in mental health care. A survey was carried out to investigate differences in attitudes between clinical staff in psychiatric and general medical settings to smoke-free policy and intervention. METHOD: The sample comprised 2574 NHS staff working in two Acute Hospital Trusts and one Mental Health Trust in England. Attitudes were examined on two factors: health care settings as smoke-free environments and the role of staff in stop smoking intervention. RESULTS: The findings indicated that attitudes on the two factors were only moderately correlated. Psychiatric staff expressed significantly less favourable attitudes than general staff to smoke-free health care settings and also to the role of staff in stop smoking intervention. The largest difference between the settings concerned the implementation of smoking bans. While approximately 1 in 10 staff in the general setting disagreed with a smoking ban in their wards or clinics, nearly one in three psychiatric staff was against such a ban in their setting. CONCLUSIONS: Staff attitudes need to be carefully considered, particularly in psychiatric settings, in attempts to implement smoke-free policies in health care settings.
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Health professionals might be reluctant to intervene with some smokers because they believe that this might be detrimental to their mental health.
“health professionals might be reluctant to intervene with some smokers because they believe that this might be detrimental to their mental health.”
From Change in mental health after smoking cessation: systematic review and meta-analysis (2014) · cites this paper as [23]
The Results (‘Good practice orientation’) find that psychiatric staff had less favourable attitudes toward stop-smoking intervention, and ‘What this study adds’ says routine intervention may encounter more resistance in psychiatric settings. The paper does not establish that staff are reluctant because they believe intervention would harm smokers’ mental health; the Introduction and Limitations discuss other possible reasons for resistance. Page numbers were not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThere is a widely held belief among healthcare professionals that smoking cessation should only be attempted after mental health has improved.
“there is a widely held belief among healthcare professionals that smoking cessation should only be attempted after mental health has improved. 7 , 8”
From Service‐user experiences of an integrated psychological intervention for depression or anxiety and tobacco smoking in improving access to psychological therapies services: A qualitative investigation into mechanisms of change in quitting smoking. (2023) · cites this paper as [8]
The ‘Good practice orientation’ results report that staff in psychiatric settings had less favourable attitudes to stop-smoking intervention than staff in general settings. The paper does not establish a widely held belief that cessation should be attempted only after mental health improves; its reported comparison does not address that timing condition. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSmokers might be less likely to stop if they believe their mental health will suffer.
“Smokers might be less likely to stop if they believe their mental health will suffer”
From Change in mental health after smoking cessation: systematic review and meta-analysis (2014) · cites this paper as [23]
The Introduction discusses the role of smoking in psychiatric care, and the study examines staff attitudes to smoking restrictions and cessation support. Neither those passages nor the additional searches for beliefs about worsening mental health address whether smokers who hold that belief are less likely to stop. (LLM, conf=0.73)
Experimental — accuracy not yet measured
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“In the study by Macnally et al. [20], the Cronbach’s α value of the reliability of the tool was .84, and in the study by Choi and Kim [21], the Cronbach’s α value was .88, whereas, in the present study, it was .78.”
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“While there seems to be sizeable resistance against the implementation of smoke-free grounds before policies are enacted, these negative responses have been proven time and time again to subside (El-Guebaly, Cathcart, Currie, Brown, & Gloster, 2002; Lawn & Pols, 2005; McNally et al., 2006).”
BackgroundTreating nicotine dependence in mental health hospitals
Wye, P. M., Bowman, J., Wiggers, J. H., Freund, M., Wolfenden, L., & Stockings, E. (2011) · Mental Health and Substance Use · doi:10.1080/17523281.2011.555077 · Cited by 4 · see citing works
“There was also evidence that medical staff were more supportive of total smoking bans compared to nurses and other allied health professionals (McNally et al., 2006).”
BackgroundImproving access to stop smoking support for people with mental health problems
Edmonds, N., & Bremner, J. (2007) · Journal of Public Mental Health · doi:10.1108/17465729200700003 · Cited by 4 · see citing works
Program and System Level Interventions to Address Tobacco Amongst Individuals with Schizophrenia
Ziedonis, D. M., Parks, J., Zimmermann, M. H., & McCabe, P. (2007) · Journal of Dual Diagnosis · doi:10.1300/j374v03n03_10 · Cited by 4 · see citing works
Does smoking reduction worsen mental health? A comparison of two observational approaches
Taylor, G. M. J., Taylor, A. E., Munafo, M. R., McNeill, A. D., & Aveyard, P. N. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-007812 · Cited by 3 · see citing works
“patients’ smoking behaviour for fear that they may cause harm to mental health.(40) 41 This study adds to the evidence from previous studies that reducing daily cigarette”
ResultSmoking ban in psychiatric wards raises safety and ethical issues
Subramaniam, A. (2015) · Australasian Psychiatry · doi:10.1177/1039856215576422 · Cited by 3 · see citing works
Dahal, R., Bhattarai, A., & Adhikari, K. (2020) · Tobacco Prevention & Cessation · doi:10.18332/tpc/127523 · Cited by 3 · see citing works
Lee, Y., & Kim, Y.-H. (2022) · The Journal of Korean Academic Society of Nursing Education · doi:10.5977/jkasne.2022.28.2.147 · Cited by 3 · see citing works
“[20] and translated into Korean by Choi and Kim [16].”
MethodChawłowska, E., Karasiewicz, M., Marcinkowska, K., Giernaś, B., Jóźwiak, P., & Lipiak, A. (2022) · Healthcare · doi:10.3390/healthcare10091735 · Cited by 3 · see citing works
“According to McNally et al. (2006), it is often psychiatric staff who are reluctant towards adopting smoking restrictions [32].”
BackgroundGhodse, H. (2007) · International Psychiatry · doi:10.1192/s174936760000504x · Cited by 3 · see citing works
Mwebe, H. P., Volante, M., & Weaver, T. D. (2020) · British Journal of Mental Health Nursing · doi:10.12968/bjmh.2020.0005 · Cited by 2 · see citing works
Wu, A. D., Lindson, N., Perera, R., Gao, M., Aveyard, P. N., Begh, R. A., & Hartmann‐Boyce, J. (2025) · BMC Family Practice · doi:10.1186/s12875-025-02843-9 · Cited by 2 · see citing works
“Moreover, healthcare providers may hesitate to promote smoking cessation to this group due to misguided concerns about exacerbating mental health symptoms [26, 27] —though research has shown that these concerns are generally unfounded [19, 46].”
Assessing the second-hand effects of a new no-smoking policy in an acute mental health trust
Perry, B. I., Meehan, K., & Jainer, A. K. (2017) · BJPsych Bulletin · doi:10.1192/pb.bp.116.055749 · Cited by 2 · see citing works
de Oliveira, R. M., & Furegato, A. R. F. (2014) · Paidéia (Ribeirão Preto) · doi:10.1590/1982-43272458201414 · Cited by 2 · see citing works
“The perception of the professionals regarding this measure influences the support provided throughout the process (Longo et al., 1998; McNally et al., 2006).”
BackgroundMwebe, H. P., Volante, M., & Weaver, T. D. (2020) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2020.0157 · Cited by 2 · see citing works
Bax, O. K., Hakim, N., Jeggo, M., Phelan, D., Stevens, T., & Gupta, S. (2020) · BMJ Open Quality · doi:10.1136/bmjoq-2020-001002 · Cited by 2 · see citing works
Moving Towards Smoke‐free Mental Health Services
Bauld, L., Ferguson, J., Kerr, A., McKenzie, K., & McNeill, A. D. (2007) · Mental Health Review Journal · doi:10.1108/13619322200700017 · Cited by 2 · see citing works
Baker, A. (2017) · Addiction · doi:10.1111/add.13723 · Cited by 2 · see citing works
“Although people with SMI are approximately as likely to want to quit as those in the general population [7], mental health staff tend not to support service consumers in smoking cessation [8], as they tend to lack knowledge about tobacco dependence and smoking’s relationship with mental ill-health [9].”
BackgroundLégislation anti-tabac en psychiatrie : une chance pour les patients ?
Michel, L., & Lang, J.-P. (2009) · L information psychiatrique · doi:10.1684/ipe.2009.0518 · Cited by 1 · see citing works
THE ROLE OF PSYCHIATRISTS IN TOBACCO DEPENDENCE TREATMENT
Nordin, A. S. A., Sellman, J. D., & Adamson, S. J. (2015) · Cited by 1 · see citing works
Attitudes towards a Complete Smoking Ban among Mental Health Hospital Employees in France
Korhonen, E.-S., Nordman, T., & Eriksson, K. (2015) · Archives of Nursing Practice and Care · doi:10.17352/2581-4265.000003 · Cited by 1 · see citing works
“Psychiatric staff seems to be particularly reluctant about smoke-free policies [25].”
BackgroundThe impact of smoke-free policies on inpatient psychiatric units : an ethnographic study
Grant, L. G. (2013) · cIRcle (University of British Columbia) · doi:10.14288/1.0073609
“Data collected in a U.K.-based survey study indicated that 1 in 10 staff on general inpatient units opposed smoking bans, whereas 1 in 3 on inpatient psychiatric units opposed such bans (McNally et al., 2006).”
BackgroundInfluentialQuitting smoking: Therapeutic in mental health treatment
Taylor, G. M. J., Greening, J., & Aveyard, P. N. (2014) · Pure (University of Bath)
Rothfus, M. A. (2013) · Library and Archives Canada (Government of Canada)
Olanbiwonnu, T. (2016) · TSpace (University of Toronto)
Treating Nicotine Dependence in Psychiatric Hospitals
Stockings, E. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813035-3.00058-7
Husni, M., Burhan, M., & Mazin, M. (2021) · European Journal of Clinical Medicine · doi:10.24018/clinicmed.2021.2.3.102
“102 Vol 2 | Issue 3 | July 2021 165 their general healthcare colleagues [6], although mental health patients are as a likely to want quit smoking and they”
BackgroundStein, K. F., Sawyer, K., Daryan, S., Allen, J. L., & Taylor, G. M. J. (2022) · medRxiv · doi:10.1101/2022.03.23.22272703
“There are many reasons for high smoking rates in this population, for example they are less likely to be prescribed smoking medicines (6), and it is widely believed that smoking cessation can worsen mental health (7, 8).”
BackgroundFaint, N., Cuesta‐Briand, B., & Coleman, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.868212 · Cited by 1 · see citing works
“Tobacco smoking has long been embedded within mental health service culture: “smoking rooms” have acted as social hubs for patients; smoking itself has provided structure and social activity for patients and staff alike; and cigarettes have been used to both placate or engage with patients (15, 16).”
Background
- Authors
- McNally, L., Oyefeso, A., Annan, J., Perryman, K., Bloor, R., Freeman, S., Wain, B., Andrews, H., Grimmer, M., Crisp, A., Oyebode, D., & Ghodse, A. H.
- Affiliations
- St George's, University of London (GB)
- Harplands Hospital (GB)
- Ipswich Hospital (GB)
- South West London and St George's Mental Health NHS Trust (GB)
- Corresponding author
- McNally, Lisa
- Venue
- Journal of Public Health
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-06-29
- Volume
- 28
- Issue
- 3
- Pages
- 192-196
- ISSN
- 0943-1853 (ISSN-L)
- 1741-3850
- 1741-3842
- OpenAlex
- W2107673032
- Cited by
- 96
- References
- 10
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 8 · 2021: 2 · 2020: 8 · 2019: 4 · 2018: 4 · 2017: 7 · 2016: 3 · 2015: 8 · 2014: 6 · 2013: 7 · 2012: 5
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- employee attitudes, smoking bans, smoke-free hospitals, mental health services, psychiatric staff, healthcare settings, policy implementation, NHS staff
- MeSH terms
- Smoking Prevention, Analysis of Variance, Attitude of Health Personnel, Hospitals, General, Hospitals, Psychiatric, Humans, Personnel, Hospital, Surveys and Questionnaires, Organizational Policy, Smoking Cessation
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