Almost thirty years have passed since the surgeon general of the United States released the first report on the effects of smoking (U.S. Department of Health, Education, and Welfare 1964). Over the ensuing years, further reports have expanded our knowledge of the widespread physiological effects of tobacco smoke and those at greatest risk (U.S. Department of Health, Education, and Welfare 1979; U.S. DHHS 1987, 1991, 1992; American Medical Association 1989). Subsequently, there has been a dramatic decrease in the number of smokers; more than thirty-six million Americans have quit smoking since the surgeon general's report (U.S. DHHS 1987, 7). Supporting this trend are the surgeon general's national health objectives for the year 2000 to achieve smoke-free work environments (Koop 1985). All of these trends contribute to current efforts to make hospitals smoke-free environments.