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Implementing a tobacco-free environment

What does tobacco-free mean?

Tobacco-free is defined as any processed or unprocessed form of tobacco that may be smoked, inhaled, or chewed.

Tobacco or tobacco-related products and/or devices include all electronic and/or water vapor cigarettes, marijuana cigarettes or any other product or device that simulate the act of smoking.

A tobacco-free environment means:

  • Cigarettes, tobacco and tobacco-related products cannot be used, bought or sold anywhere on hospital grounds.
  • Tobacco products, lighters and matches are not allowed on inpatient units.
  • Inpatients should send these items home when they are admitted to the hospital. If this is not possible, they can be stored and returned when the patient is discharged.
  • Patients and visitors should not bring tobacco products, lighters or matches into the hospital or, at minimum, must keep them out of view and inaccessible to others.
  • Visitors must not provide patients with tobacco products, lighters or matches.

Regulations

As of January 1, 2016, the Smoke-Free Ontario Act and the Electronic Cigarettes Act regulations ban smoking (of both cigarettes and electronic cigarettes) on hospital grounds subject to certain exceptions that will be removed in two years. 

Effective January 1, 2018, all hospital grounds will be required to be 100% smoke-free including the removal of any Designated Smoking Areas (DSAs). 

Why tobacco-free and not just smoke-free?

Smoke-free policies allow clients to store cigarettes in lockers and to smoke in designated outdoor smoking areas. However:

  • People often continue to smoke outside of these designated smoking areas, exposing staff, clients and visitors to second-hand smoke.
  • Research in this area demonstrates that comprehensive tobacco bans are more likely to be successful than partial policies.
  • Tobacco-free policies provide greater clarity and are more consistent in their messaging, reducing amiguity about when and where tobacco products are allowed.
  • Tobacco-free policies address the harm caused by tobacco in forms other than cigarettes.

Case study: The CAMH experience

As one of the Canada's leading mental health care and addictions facilities, CAMH is committed to maintaining an environment where clients, staff and visitors can breathe freely and heal fully.

Why did CAMH make the change?

  • Smoking is the leading cause of disease and premature death among mental health patients. Research shows that tobacco-free psychiatric facilities are associated with a number of health and safety benefits to patient recovery.
  • Second-hand smoke also represents a serious danger to health for patients, staff and visitors.
  • Smoking in buildings increases our fire risk. Smoking in buildings / rooms, tobacco products and lighters / matches are fire and safety hazards.

Rolling out a tobacco-free environment is a journey. CAMH has been officially tobacco-free since 2014 and continues to optimize its processes and continue its change management initiatives. 

Evidence summary

Giovino, G. A. (2007). The tobacco epidemic in the United States. American Journal of Preventive Medicine, 33(6), S318-S326.

Williams, J. (2008). Eliminating tobacco use in mental health facilities: Patient's rights, public health, and policy issues. JAMA, 299(5), 571-573.

Mackowick, K. M., Lynch, M. J., Weinberger, A. H., & George, T. P. (2012). Treatment of tobacco dependence in people with mental health and addictive disorders. Current Psychiatry Reports, 14(5), 478-485.

Morozova, M., Rabin, R. A. and George, T. P. (2015). Co-morbid tobacco use disorder and depression: A re-evaluation of smoking cessation therapy in depressed smokers. The American Journal on Addictions, 24, 687–694.

Prochaska, J. (2010). Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? Drug and Alcohol Dependence, 110, 177-182.1