BACKGROUND-AIM:
Smoking cessation interventions in hospitals are recommended to reduce tobacco-related morbidity and mortality. In Catalonia, the Catalan Network of Smoke-free Hospitals (XCHsF) —including 89 of 91 acute hospitals— has promoted cessation services since 2000. This study assesses the availability and implementation of cessation resources and practices across the hospitals in the network, relating this to the level of project implementation and accreditation.

METHODS:
A cross-sectional study was conducted using an ad hoc online questionnaire sent to the coordinators of the “smoke-free hospital” project of each hospital. It covered the following variables: (1) hospital characteristics (years of membership, number of workers, number of beds, Self-Audit Questionnaire (SAQ) score, hospital regime and the level of accreditation: member, bronze, silver, gold); (2) availability of cessation interventions for inpatients, outpatients, visitors, and staff; and (3) provision of clinical resources (protocols, records, trained professionals, pharmacological treatments). Descriptive analyses summarized services overall and by accreditation level. Chi-square or Fisher’s exact tests were used for categorical variables, and trends across accreditation levels were evaluated with Cochran–Armitage (binary) and Cuzick (continuous) tests.

RESULTS:
A total of 76 hospitals completed the questionnaire, with a median membership of 17 years in the network, which increased with accreditation level. Overall, 78% provided cessation services for inpatients, but availability varied: 40% of member hospitals, 93% of bronze, 89% of silver and all gold hospitals (p<0.001). Staff smoking-cessation services ranged from 50% in member hospitals to 100% in silver and gold hospitals (p=0.005). Overall, outpatient and visitor services were much lower (38% and 6.5% respectively), though silver and gold hospitals consistently showed higher provision of cessation services compared to lower accreditation level hospitals (trend among outpatient p=0.039). Pharmacological treatments for smoking cessation were widely available: 72% offered medication in all inpatients wards, with full availability in 100% of gold hospitals, compared with 78% of silver, 86% of bronze, and 30% of member hospitals (p=0.003). Intervention protocols followed the same gradient, with higher implementation and updated protocols in silver and gold centers.

CONCLUSIONS:
Most Catalan hospitals offer cessation services for inpatients and staff, but access for outpatients and visitors remains limited. Pharmacological treatments are broadly available, especially in higher-accredited hospitals. Strengthening cessation services provision in lower-accredited hospitals could ensure more equitable access at the population level.