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Robson, Debbie, Spaducci, Gilda, McNeill, Ann, Stewart, Duncan, Craig, Tom J. K., Yates, Mary and Szatkowski, Lisa (2017) Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis. Lancet Psychiatry, 4 (7). pp. 540-546. ISSN 2215-0366
Background:
Smoke-free policies are important to protect health and reduce health inequalities. A major barrier to policy implementation in psychiatric hospitals is staff concern that physical violence will increase. We aimed to assess the effect of implementing a comprehensive smoke-free policy on rates of physical assaults in a large UK mental health organisation.
Methods:
We conducted an interrupted time series analysis of incident reports of physical assault 30 months before and 12 months after the implementation of the policy using a quasi-Poisson generalised additive mixed model.
Findings:
There were 4,550 physical assaults over the study period; 4.9% of which were smoking-related. When adjusted for temporal and seasonal trends and key confounders, there was a 39% reduction in the number of physical assaults per month following the policy introduction compared to beforehand (Incidence Rate Ratio 0.61, 95% CI 0.53-0.70, p<0.001).
Interpretation:
The introduction of a comprehensive smoke-free policy in a large psychiatric organisation appeared to reduce the incidence of physical assaults. Adequately resourced smoke–free policies could be part of broader violence reduction strategies in psychiatric settings.
Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0.
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