Implementing and enforcing a smoke-free policy and by-law on hospital grounds at Central Coast Local Health District

Issue addressed Smoking by patients, staff and visitors on the grounds of Central Coast Local Health District (CCLHD). Methods NSW Health introduced a smoke-free buildings and vehicles policy in 1988. A smoke-free grounds policy was implemented in 1999, and a smoke-free by-law adopted by CCLHD in 2013, making smoking on CCLHD grounds an offence. Smoking in high-profile areas near hospital entrances was counted regularly since 2000. Several methods for communicating, monitoring and enforcing these smoke-free interventions have been adopted, including signage, Public Address announcements and enforcement patrols to ensure by-law compliance and to issue fines where required. Compliance with the smoke-free interventions has been supported with the availability of Nicotine Replacement Therapy for patients and visitors. Results When monitoring counts first commenced in 2000, smoking rates in high-profile areas were 8.1% at Gosford Hospital and 11.1% at Wyong Hospital. Counts conducted in 2018 indicated a substantial improvement, with the smoking rate in high-profile areas reducing to 0.25% at Gosford Hospital and 0.5% at Wyong Hospital. Smoking rates in high-profile areas have held steady at approximately 0.3% since 2014, after the by-law was implemented. Conclusions The introduction of the smoke-free by-law added extra impetus to efforts to reduce smoking on CCLHD hospital grounds by providing the option to fine people who breach the by-law. Smoking in high-profile areas has declined substantially since 2011, and is minimal since the establishment of the smoke-free by-law. So what? The experiences of CCLHD in implementing the smoke-free by-law may provide insights for other health services looking to use a similar intervention at their facilities. There are also methodological lessons for other organisations looking to communicate, monitor and enforce smoke-free policies, without enforcing fines.