This story originally appeared in UCLA Today, a discontinued publication.

Smooth start for smoking ban on health sciences campus

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When the UCLA Health System established last November two smoke-free zones that encompassed UCLA’s entire Westwood and Santa Monica health-science complexes of hospitals, buildings, parking lots and grounds, many staff and administrators held their collective breath.
 
banSome predicted the worst: Nicotine-deprived employees would take extended smoke breaks outside the zones, and some might even quit their jobs. Stressed-out patients would leave and take their business elsewhere, and visiting family members would rebel. Hospital revenue would fall. And, bottom line, the ban would be impossible to implement. Some even speculated that the ban might backfire and motivate some contrarians to start smoking.
 
But when the Nov. 17 start-up date came and went and the air cleared, none of these dire predictions became reality.
 
“It’s now been three months, and we have had, to my knowledge, no severe adverse events — nobody’s gone crazy,” said UCLA psychiatrist Dr. Timothy Fong, who is an addiction expert and one of the organizers of the health system initiative. “So far, it’s been very seamless. We’ve said these are the rules, and people have adapted.”
 
Paving the way to a smoke-free workplace
 
The smooth transition has much to do with months of advance planning; broad consultation with staff, administrators and patient advocacy groups early on; the formation of three committees covering staff and patient concerns and implementation; a series of emails that alerted people to the ban months ahead of time; and a robust educational campaign about the initiative and the availability of smoking-cessation resources, classes and counseling.
 
Organizers created a virtual Smoke-Free Resource Center, a one-stop website housing all information about the ban, maps of no-smoking areas, details on smoking cessation programs and other resources can be found. Presentations and training sessions helped employee groups understand how the ban would be implemented and enforced and how to handle any problems that might arise. An ongoing series of learn-at-lunches for employees continues to explore “quit smoking” issues.
 
Sarna Linda
Linda Sarna
Doctors, nurses and other medical staff volunteered their time to serve as Smoke-Free Champions to answer questions from employees, patients and the public. Anticipating that more patients would be requesting smoking-cessation medication, organizers even created pre-printed prescription forms for the convenience of doctors who want to help patients with withdrawal.
 
But the big challenge, noted Fong, “was just overcoming people’s misconceptions about what the transition period would be like and helping to manage anxieties about the change.
  
“Our No. 1 concern was patient safety — that they might become so uncomfortable they would leave the hospital,” Fong said. “Would we see people start becoming so agitated or frustrated that they might act out verbally or physically?”

Quite to the contrary, said Linda Sarna, a nursing professor internationally recognized for her work with promoting nursing involvement in tobacco control and her research on the quality of life and symptoms of patients with lung cancer. She holds the Lulu Wolf-Hassenplug Endowed Chair in Nursing.
 
“The world didn’t stop. People were able to get on with their lives,” said Sarna, who established the first national program to help nurses quit smoking and helped with the health system’s smoke-free campaign. "I think the initial bump in the road was that all of the nurses wanted to feel that they had the competence, knowledge and skills to be able to help people quit smoking. So there’s been a lot of education around that.”
 
Extending the no-butts border
 
The lessons learned from the experience will help in the planning of UCLA’s next venture: an initiative to ban smoking and tobacco chewing on the entire campus by 2014, part of a systemwide effort to ban smoking at all UC campuses.
 
UCLA administrators are forming a campuswide task force to discuss strategies for implementing the ban, with Sarna recently appointed to head it.
 
“We will most certainly be able to meet the 2014 deadline, if not earlier,” Sarna said of the campuswide ban that will include outdoor areas, athletic fields and parking lots. The sale and advertising of tobacco products will also be prohibited on campus. “Many campuses across the nation have already done this. We think that, with good planning, we can make this happen as smoothly and as quickly as possible. …  Our goal is to have a healthy environment where we can all live, work, teach and learn. And that means not having secondhand smoke here as a pollutant.”
 
Fong2
Dr. Timothy Fong
Wide-ranging involvement with representation from the entire campus community will be important, said Sarna, as well as broad communication with the campus early on. “It’s also important that we have the capacity to help people who are experiencing tobacco dependence. Through our health campus experience, we’ve identified a variety of resources.”
 
UC estimates that, systemwide, about 10 percent of its employees and 8 percent of its students smoke. Fong said a random survey showed that about 5 percent of hospital employees at UCLA smoke on a daily basis.
 
Under current state regulations, people are already prohibited from smoking in campus buildings and within 20 feet of the entrances and exits to those buildings. Before the UCLA health campus ban on smoking, that also held true for the Reagan UCLA Medical Center itself — except on the Resnick Neuropsychiatric Hospital outdoor deck, where patients who were hospitalized involuntarily or considered already under a lot of stress were allowed to smoke.
 
The new health campus not only bans this last stronghold for smokers, but also encompasses a large swath of the southeast campus outside the hospital perimeter (See map) that includes the Life Sciences Building, the new Terasaki Building and Tiverton House. A smoke-free zone was also created for the Santa Monica-UCLA Medical Center and Orthopaedic Hospital.
 
Education, not punishment
 
As planned for the systemwide ban, the UCLA Health System ban relies less on punishment and more on educating smokers about the dangers of lighting up and making them aware of resources to help them quit.

Punishment of smokers is not the goal, Fong said. So if smokers are seen lighting up in the zone, they are politely asked to stop by a security officer and/or given a card that explains they are in a smoke-free environment and thanks them for not smoking. The card also lists contact information for the California Smokers’ Helpline that provides free professional and confidential telephone counseling.

But since employees who smoke in the zone are violating a workplace policy, security can take down their names and report them to their supervisors, he explained, just as any violation of a workplace rule would be handled.
 
In the planning phase of the health campus smoking ban, organizers decided against handing out free smoking cessation aids to employees, who can get them through their health insurance or over the counter. Putting such items in campus vending machines where under-age teens might access them was also nixed.
 
The motivation to quit
 
So has the smoking ban motivated smokers to give tobacco the boot?
 
That’s still up in the air. According to Fong, the prohibition has not prompted large numbers of smokers to sign up for the two smoking-cessation clinics that are held on campus. And smokers are seen crossing the street to light up by the Facilities Management building or police station, or crossing Le Conte Avenue.
 
“We’ve heard reports of employees going to their cars to smoke,” Fong said.
 
That’s their choice, he said. “I’m not surprised that we haven’t seen an increase in demand for smoking cessation services. It just tells you that even if your boss changes the rules of your work environment, that doesn’t necessarily mean that you’ll be more motivated to stop smoking.”
 
But Sarna said it’s still too early to tell what the impact of the health campus ban will be on smokers. Employees, for example, may be trying to stop on their own instead of signing up for a campus program. “We know from other smoke-free workplaces and campuses that people do quit. It may get very annoying for them to find areas to smoke. We want to be there for them to provide support and to, frankly, diminish the suffering of people who might have nicotine withdrawal. We want to make sure that we have the capacity to offer treatment to these people.”
 
So far, Fong said he has received few complaints from smokers.                                            
 
“We haven’t heard from a lot of smokers that this is a bad thing to do,” Fong said. “People are aware that we are moving away as a society from smoking as being acceptable in public. But this is also about maintaining a professional environment. This is about the places where we work and spend a lot of time. People respect that.”
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Read UC President Mark Yudof’s letter about implementing a smoke-free environment on all UC campuses within the next 24 months. To read more on the UC-wide ban, go here.
Plan on attending a Lunch N’ Learn session from noon-1 p.m. on campus:
•    On March 13: Dr. Fong will talk about the UCLA Health System’s smoking ban during “The UCLA Smoke-Free Initiative: What every UCLA employee needs to know,” scheduled at the hospital, Room 8-8234.
•    On April 17: “How to get someone you know to quit smoking” in the Center for Health Sciences, Westwood Conference Room 14-214 U.        
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