1. p<0.0003 Study Design An evaluation of the policy’s affect on employee knowledge, attitudes, and practices; on staffing; and consumer response was undertaken to provide feedback to administrators, inform decisions of similar institutions, and to contribute to the literature. The evaluation included: -Pre/Post cross sectional survey of employees (n=1400; response rates of 64% pre and 65% post) -Employee turnover analysis -Consumer use and satisfaction analysis -Focus groups and key informant interviews 07/01- 07/02 Employee and Consumer Response to a Smoke-Free Hospital Campus Policy J. Gary Wheeler, MD * ; LeaVonne Pulley, PhD ‡ ; Holly C. Felix, PhD ‡ ; Zoran Bursac, PhD ‡ ; Nadia Siddiqui, MPH § ; M. Kate Stewart, MD ‡ ; Glen Mays, PhD ‡ ; C. Heath Gauss, MS ‡ ; and Jan Richter, EdD ‡ Affiliations: *College of Medicine, University of Arkansas for Medical Sciences and AR Children’s Hospital, Little Rock, AR ‡ Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR § Center for Health Equality, Drexel University, Philadelphia, PA Contact Information: Holly C. Felix, PhD; UAMS COPH; 4301 West Markham Slot 820; Little Rock, AR 72205; felixholly@uams.edu. Diffusion of Innovation The response of UAMS employees and consumers to the outdoor smoking ban provided evidence for the development of statewide legislation. In January 2005, the Arkansas General Assembly passed Act 134 of 2005, An Act to Prohibit the Use of Tobacco Products in and on the Grounds of All Medical Facilities in Arkansas. Results Employee Knowledge, Attitudes, and Behavior Background In an effort to provide a healthier environment for patients, employees, students and visitors, and to set a good example for similar institutions, the University of Arkansas for Medical Sciences (UAMS) implemented an outdoor smoking ban on July 4, 2004. The outdoor smoking ban applied to all patients, employees, contractors, and visitors; and to all UAMS owned and leased property (including vehicles). [NOTE: Patients who obtain a written statement from their physicians are permitted to smoke on campus in an outdoor smoking hut.] See the state legislation at http://www.arkleg.state.ar.us/ftproot/acts/2005/public/Act134.pdf. Employee Turnover Analysis Consumer Use and Satisfaction Analysis Likely to leave as result of policy Had to walk through ETS to enter/exit UAMS buildings p<0.0003 Employee Knowledge, Attitudes and Behavior Support the policy Believe policy makes UAMS healthier, safer workplace Conclusions Policy decreased exposure to ETS and decreased tobacco use Detractors “pleasantly surprised” with implementation ease No impact on employee turnover rates No impact on consumer use or satisfaction Cleaner workplace Limited enforcement concerns Pre-Post- Licensed Bed Occupancy Rate57%58% Staffed Bed Occupancy Rate87%88% Patient Bed Days6,9597,071 Average Daily Census228.2232.6 No measurable difference between pre- and post-Press-Ganey survey scores related to staff sensitivity to inconveniences, staff attitudes toward visitors, and accommodations and comfort for visitors Focus Groups and Key Informant Interviews Pre-Implementation Concerns: Decreased patients, increased employee turnover, enforcement challenges Post-Implementation Comments: “Pleasantly surprised” at ease of implementation, which has “not been an issue;” UAMS seen as a courageous leader; cleaner campus; increased awareness of ETS harms; few enforcement concerns Change in terminations from same month, previous year 07/02- 07/03 07/03- 07/04 No evidence that retention or recruitment changed systematically after smoke-free policy No evidence that health care workers responded differently than other employees Pre Post p<0.0065 p<0.0028