Diffusion of 100% tobacco-free hospital campus policies in North Carolina

In 1992, the Joint Commission on Accreditation of Healthcare Organizations required all accredited U.S. hospitals to adopt policies prohibiting smoking within their facilities. With U.S. hospitals having eliminated indoor smoking, an increasing number have begun adopting tobacco-free hospital campus (TFHC)policies. TFHC policies offer protection from secondhand smoke exposure to patients, employees, and visitors; may motivate tobacco users to quit; and, may lead to increased availability of and access to cessation services.

In 2006, the North Carolina Hospital Association and NC Prevention Partners, with support from The Duke Endowment, created the Healthy Hospital Initiative, to assist NC hospitals in adopting 100% TFHC policies. The goal of the HHI is to have 100% of NC's hospitals implement TFHC policies by June 2009. As of January 2008, 75% of NC hospitals have passed tobacco-free campus policies.

In two years, the rate of 100% TFHC policy adoption increased seven-fold. This rapid rate of policy adoption demonstrates the effectiveness of HHI's intervention strategies, including the use of statewide opinion leaders to provide individualized technical assistance, public education, advocacy, distribution of model policies, establishment of a peer network of hospital administrators and personnel, and dissemination of policy successes. Dissemination activities are grounded in diffusion of innovation models and include a website with information about rates of policy adoption, copies of new policies, press releases, newsletters, and maps illustrating policy adoption statewide. These efforts have informed and simultaneously influenced hospital administrators and decision-makers to adopt these policies, as the rapid rate of policy adoption demonstrates.