It used to be that patients were able to smoke in the hospital. I have vivid memories of clusters of men sharing cigarettes in the shabby bathroom at Boston City Hospital during the 1960s. It was not only the patients who smoked. Smoke breaks were common among the hospital staff, especially nurses; cigarettes were sold in hospital canteens, and many hospital directors in the 1970s and 1980s were chain smokers (I worked with 2 of them).
Step by step it became more difficult for hospitalized smokers to smoke. Hospitals stopped selling cigarettes in their canteens (in the case of Veterans Affairs, this sparked an ongoing fight with the US Congress1). The Joint Commission mandated in 1992 that hospitals be smoke free; smoking rates among health care workers—even nurses—plummeted2; and medications for smoking cessation became widely available.3 An important loophole in the 1992 Joint Commission regulations was the exemption of psychiatric hospitals. However, recently they have begun to restrict smoking as well, even without a regulatory mandate to do so; between 2005 and 2011, the proportion of state mental hospitals that outlawed smoking inside the hospital increased from 20% to 79%.4
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