Making hospitals in China smoke-free: a prospective study of implementing the new standard

Nicotine Tob Res. 2013 Dec;15(12):2076-80. doi: 10.1093/ntr/ntt098. Epub 2013 Sep 6.


Objectives: In the run-up to all Chinese health care facilities becoming smoke-free, the feasibility of the new standard was assessed by monitoring its implementation in a sample of Chinese hospitals.

Methods: Forty-one hospitals across 20 provinces were asked to ban smoking inside the hospital and provide advice and referral to stop-smoking treatment. Smoking status of more than 24,000 members of staff at 21 hospitals was surveyed at baseline (April 2009) and at follow-up (October 2010). Surveys monitored implementation of several specific aspects of the new standard to identify potential barriers to nationwide implementation.

Results: All hospitals managed to implement the ban and most set up smoking cessation clinics. Routine recording of patients' smoking status proved more difficult to implement. The hospitals improved significantly in 8 out of 11 monitored policy parameters. Smoking prevalence among staff decreased from 14.8% to 10.7% (p < .001), suggesting an important collateral benefit of making hospitals smoke-free. Outdoor smoking areas facilitated the indoor ban. Staff education emerged as the key priority.

Conclusions: The smoke-free standard is feasible even in a country with a widespread acceptance of smoking inside health facilities. Several challenges need to be addressed when the new standard is disseminated across China.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • China
  • Data Collection
  • Female
  • Health Plan Implementation
  • Hospitals / standards*
  • Humans
  • Male
  • Medical Staff, Hospital / statistics & numerical data
  • Organizational Policy
  • Pilot Projects
  • Prevalence
  • Prospective Studies
  • Smoke-Free Policy*
  • Smoking / legislation & jurisprudence
  • Smoking Cessation / legislation & jurisprudence
  • Smoking Cessation / statistics & numerical data*
  • Smoking Prevention*
  • Tobacco Smoke Pollution / legislation & jurisprudence
  • Tobacco Smoke Pollution / prevention & control*


  • Tobacco Smoke Pollution