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The Link Between Smoking and Violence in Hospitals


Smoking in hospitals, a controversial subject that is now being studied in greater detail, not just for its health implications either.

In the UK, NHS hospitals have adopted a ‘smoke-free’ culture for many years now. Obviously, smoking in and around hospitals is banned, for good reason too. Of course, in the UK, smoking indoors in a public space is illegal, this law does include hospitals too which is part of the reason the ban came into action, however, the key reason for the smoking ban in hospitals is an obvious one, it’s about health.

The NHS just can’t be seen to be encouraging people to smoke, smoking is bad for your health and within the NHS alone, they are treating an awful lot of smoking-related health issues and problems. Smoking is a plague on the NHS and thus, hospitals just have to do everything they can prevent people from doing it while in their supervision.

If this is the case though, why are hospitals littered with people smoking outside?

It does seem as if the attempts to stamp out smoking within the NHS are in vain. Walk up to a hospital entrance and you will always see groups gathered outside smoking. Often, people in wheelchairs, with IV drips attached to them will be out the front, having a cigarette. Of course, smoking is a personal choice, so if they want to do it, I say go for it, but they should be aware of the health issues. Moreover, they should be conscious of the fact they are in a hospital for a reason and that smoking might not be helping with their condition or recovery. The NHS should be doing more to help get these messages across.

Is there more to it?

Many people argue that this is all a bit of a conspiracy. It is within the government’s interest to keep people smoking, right?

According to Statista, in the years 2015 – 2016, smoking tax amounted to £9.5 billion, in 2016 – 2017, smoking tax amounted to £8.9 billion and this year (2017 – 2018), smoking is expected to generate around £8.8 billion. Smoking is a lucrative industry that makes the government a lot of money. Now, consider that according to the NHS, the service has a budget of around £116.4 billion in the years 2015 – 2016. Taxation from smoking generates a lot of income that can be used to pump money back into the NHS.

It’s a catch 22, smoking brings money in, but it also comes with a cost.

According to the NHS:

In the years 2016 – 2017, there were 484,700 hospital admissions as a result of smoking (both cigarettes and electronic cigarettes). In 2016, the NHS registered 77,900 deaths as a direct result of smoking.

Now, the plot thickens even further

So, people smoking does benefit the government and helps generate much-needed funding. On the other hand, though, smoking is costing the NHS money too.

None of this matters though, once you consider how ‘letting’ people smoke in and around hospitals might be beneficial for the patients’ mental health.

According to Nationalelfservice.net:  

“Arguments span health, legal and human/civil rights domains. However, one key point you often hear against implementing smoke-free policies are fears about a potential increase in violence as a result.”

New research by Spaducci and others focuses on investigating how violence seems to be related to non-smoking policies in hospitals. The science is there, one of the significant effects of nicotine (the psychoactive component in tobacco) is a relaxing effect. Withdrawal from this causes issues, one of which can be heightened aggression, leading to violence.

Spaducci’s Research

The research spanned 11 studies to look at reported instances of physical violence, verbal violence and a combination of the two in research papers published in the United States between 1991 and 2014. The research papers had been published as a result of 7 cross-sectional studies and 4 cohort studies, all of which looked at violence in mental health settings as a direct result of not smoking. According to Nationalelfservice:

“Smoking has long been a currency on wards, given by staff to reward good behaviour; a trigger for disharmony when you have run out; or means for you to be bullied or threaten by other patients. In some places, the only way to get outside is during cigarette breaks. Banning smoking on wards in some regards is similar to banning drugs or alcohol, we know that these things continue regardless of the policies, and how rigorously the policies are implemented has its own perils and pitfalls. There remains the unanswered human rights questions if you are detained under the Mental Health Act is this another violation of your rights, of course, the same could be said of other legal substances.”


Across all 11 studies, when smoking was banned in the hospital setting, physical violence decreased in 1 study and physical violence increased in 2 studies (short term). The rest saw no change.

Across all 11 studies, when smoking was banned in the hospital setting, verbal violence decreased in 3 studies and verbal violence increased in 3 studies. The rest saw no change.

Across all 11 studies, when smoking was banned in the hospital setting, combined physical and verbal violence decreased in 3 studies and combined physical and verbal violence increased in 1 study. The rest saw no change.

“The observational studies focused on the short period of time following the introduction of the smoke-free policy changes. It may be that staff consistently implement the policy at these times. Patients have been made aware that things are changing and so are prepared. Systems have been put into place to provide additional smoking cessation expertise, and nicotine replacement therapies are available.”


“What these studies don’t tell us is what happens after this point; do staff become inconsistent, leave or are they replaced by agency/bank staff, do patient groups change, are cessation systems maintained? Is this compounded when staff leave the premises to smoke only to return to breathe their fumes over you?”


“I have heard of organisations after a period of implementation reverting back to smoking policies over safety fears. These fears may be related to concerns about violence increasing, but also other risks, for example, fires as patients hide lighters and smoke secretly. It is also clear that the role of vaping needs to be considered across the NHS; potentially safer, will this help resolve some of the issues associated with Nicotine Replacement Therapy (NRT).”

Our take on this

First of all, we should question the legitimacy of this research and its relevance to the NHS. Many of the studies researched are dated and unrelated to the NHS, or a generic hospital setting. Moreover, the findings don’t suggest that violence is heightened significantly when smoking is banned in these settings.

Overall, I don’t think the NHS need to worry about the further implications of banning smoking. In the UK it’s basically the norm now anyway. They do however need to focus on moving smoking away from their hospitals without putting their patients at further risk. Whilst they work this out, we also hope that the NHS continue to ensure they spread the message of why smoking is bad for you and why patients in hospital should try and refrain from smoking. Sadly, from a government level, they will never want smoking to be totally banned, however, it is in the interest of the NHS to make it as hard as possible to smoke when using their facilities.


Disclaimer – Content written for and on behalf of Healthnotepad.com is not professional medical advice and therefore cannot be taken as such. If you have a serious health problem or are affected by any of the topics covered on Healthnotepad.com, you could seek professional medical advice. Please be aware of other issues such as allergens that may come in to play when reviewing our posts. Always consult a doctor if you or a peer has genuine health concerns.

Nathan Bennett

I am a writer, journalist, food fanatic and psychology researcher with a big interest in the health and fitness industry. I have a specific interest in mental health and healthy eating as I believe that much of how we feel begins with how we eat. Whilst I believe traditional medicine is important, I also have a strong belief in natures own ability to heal and assist us in recovery.

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