Problem/Objective: In 2005, the Arkansas state legislature passed Act 134, groundbreaking legislation prohibiting smoking on the grounds of all medical facilities in Arkansas. The Act became effective October 1, 2005. With a dearth of literature to guide the implementation of such policies, information from the statewide implementation of smoke-free policies in medical facilities has the potential to assist hospitals, administrators, policy-makers, and legislators.

Methods: Arkansas Hospital Association member CEOs were surveyed immediately after Act 134 was passed in April/May 2005 and 1-year after the effective date in October 2006. Surveys assessed perceived levels of agreement, support, and resistance from employees, patients, visitors, physicians, and board members as well as difficulty with enforcement, cost, greatest challenges and other factors.

Results: Out of 113 original member facilities, 76 responded to the pre-implementation survey and 68 to the post-implementation survey. Policies were implemented in all appropriate facilities. Paired samples t-tests indicate that CEOs were fairly accurate in assessing levels of agreement, support, and resistance. However, they underestimated the level of support experienced post-implementation from employees, patients, physicians, and the board while overestimating the level of resistance from employees, visitors, and the board. The average cost was significantly less than anticipated.

Conclusions: Legislated smoke-free medical facility policies are successful. Hospitals tend to overestimate the level of difficulty with implementation and underestimate available support. Many hospitals creatively solved a number of challenges in order to comply with Act 134.