“We Are Watching”: The effectiveness of implementing novel anti-smoking signage on hospital property

Objective: Poor adherence to smoke-free policies on hospital property is an ongoing challenge. This study introduced novel anti-smoking signage onto hospital property with the aim of evaluating its effectiveness on reducing the incidence of smoking in designated areas.Methods: This prospective ecological study used cigarette butt count as a proxy to measure smoking prevalence at a single hospital’s three exit sites between October–December 2013. A pre-analysis of cigarette butt count at each site was conducted and the site with the highest count was selected for intervention; the two remaining sites were controls. The intervention signs featured a pair of stern male eyes with a forward gaze with “Don’t Smoke” written in black font and “We Are Watching” in red font below. Pre- and post-intervention cigarette butt counts were collected over 18 days and 14 days respectively. Climate was included in the analysis.Results: The number of cigarette butts decreased at the intervention site across 11 of the 14 post- intervention monitored days (29.8% decrease). Cigarette butt counts increased across both control sites (32.9% and 58.8%). One-way ANOVA revealed a significant interaction (p = .000) between location and pre-/post-intervention periods. A two-way ANOVA evaluating location, intervention period, and climate temperature change (± 10 degrees Celsius) revealed statistical significance (p < .05). Interaction between location and climate was not significant.Conclusions: This study demonstrated a decrease in cigarette butts at the hospital exit where the “watching eyes” signs were implemented. Simple, low-cost anti-smoking interventions such as this may assist in creating healthier, smoke-free environments on hospital properties.