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The number of hospitalized patients who smoke fell to 18.4 percent in 2010, from 25 percent in 1995, a new study finds.

“It is encouraging that there has been improvement, but it’s discouraging that the nicotine replacement therapy has not been able to put more of a dent into this,” study author Susan Regan of Harvard Medical School in Boston told Reuters.

The study included 5,400 patients who smoked and were referred to a hospital tobacco treatment program between 2007 and 2010. The use of nicotine replacement therapy—including patches, gum, inhalers and lozenges—increased more than 12-fold between 1995 and 2010, the researchers noted.

Patients were less likely to smoke in the hospital if they were over 50 or had heart problems.

The nonprofit group that accredits hospitals, the Joint Commission, prohibits the facilities from allowing smoking in their buildings. However, many hospitals allow patients and staff to smoke outside the building. At Massachusetts General Hospital, where the study took place, patients are allowed to smoke at two shelters on the property.

“I think that if you really want to completely eliminate smoking, you have to make the (hospital) campus smoke free, but you’re also going to have to prevent patients from leaving the floor to smoke,” Regan said.

The findings are published in the Archives of Internal Medicine.

In a commentary accompanying the study, Dr. Steven Schroeder of the University of California, San Francisco, said, “Like other aspects of tobacco control, this study shows us how far we have come and how much more needs to be done. There is increasing pressure to remove the outdoor smoking areas that serve as a refuge for hospitalized patients and employees to sneak out for a smoke, representing a transition from smoke-free hospitals to smoke-free campuses.”

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