Secondhand smoke in psychiatric units: patient and staff misperceptions

Tob Control. 2015 Oct;24(e3):e212-20. doi: 10.1136/tobaccocontrol-2014-051585. Epub 2014 Sep 19.


Background: Mental health units have usually been exempted from complete smoke-free policies. The aim of this study was to compare the self-reported level of exposure to secondhand smoke (SHS) of patients and staff in psychiatric units to objective measures, and examine preference for different types of smoking bans.

Methods: Cross-sectional survey about ban preferences and self-reported exposure to SHS by means of a self-administered questionnaire administered to patients and staff from 65 inpatient psychiatric units in Catalonia (95.5% of all units). We measured air concentrations of particulate matter ≤ 2.5 μm (PM2.5 in µg/m(3)) as a marker of SHS in these units.

Results: 600 patients and 575 professionals completed the questionnaire. 78.7% of them were objectively exposed to SHS (PM2.5>10 μm/m(3)) but 56.9% of patients and 33.6% of staff believed they were not exposed at all and 41.6% of patients and 28.4% of staff believed the environment was not at all unhealthy. Nurses had a higher smoking prevalence than psychiatrists (35.8% vs 17.2%; p<0.001), and nurses had a higher perception of being moderately highly exposed to SHS (40.3% vs 26.2%; p<0.001). PM2.5 levels were significantly different depending on the type of smoking ban implemented but unrelated to the perception of SHS levels by both patients and staff. Only 29.3% of staff and 14.1% of patients strongly supported total smoking bans.

Conclusions: Patients and staff have substantial misperceptions about the extent of their exposure to SHS and low awareness about the harmful environment in which they stay/work. This might have an influence on the preference for less restrictive smoke-free bans. It is particularly noteworthy that less that one-third of mental health staff supported smoke-free units, suggesting an urgent need for further education about the harmful health effects of SHS.

Keywords: Health Services; Priority/special populations; Public policy; Secondhand smoke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Air Pollution, Indoor* / analysis
  • Cross-Sectional Studies
  • Environmental Exposure* / analysis
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel
  • Humans
  • Male
  • Middle Aged
  • Particulate Matter / analysis
  • Patients
  • Psychiatric Department, Hospital*
  • Smoke-Free Policy*
  • Smoking* / epidemiology
  • Spain / epidemiology
  • Surveys and Questionnaires
  • Tobacco Smoke Pollution* / analysis
  • Young Adult


  • Particulate Matter
  • Tobacco Smoke Pollution