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Open Access Open Badges Research article

Implementation, barriers and challenges of smoke-free policies in hospitals in Egypt

Ghada Nasr Radwan1*, Christopher A Loffredo2, Rasha Aziz1, Nagah Abdel-Aziz1 and Nargis Labib1

Author Affiliations

1 Department of Public Health, Cairo University, Cairo, Egypt

2 Lombardi Cancer Center, Georgetown University, Washington DC, USA

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BMC Research Notes 2012, 5:568  doi:10.1186/1756-0500-5-568

Published: 15 October 2012



Tobacco use is a serious public health challenge in North Africa, and health professionals play a vital role in tobacco control. In Egypt, limited data are available on the knowledge and attitudes of health care providers regarding tobacco control policies. Such data are especially relevant due to Egypt’s tobacco control laws, adopted in 2007, prohibiting smoking in hospitals and other public places. This study surveyed 49 senior administrative staff, 267 physicians, 254 nurses, and 109 administrative employees working in El-Kasr El-Aini Hospital in Cairo, assessing their knowledge and attitudes regarding Egypt’s tobacco control laws and barriers to their effective implementation in health care facilities. We also investigated the hospital’s compliance with smoke-free policies.


The majority (>90%) of the hospital workers knew that exposure to second-hand smoke is harmful to health. Physicians and nurses had a more favorable attitude towards the smoking ban when compared to administrative employees. Hospital staff identified the following barriers to successfully implementing the smoking ban: lax enforcement of tobacco control laws, the lack of penalties for violators, the lack of cessation programs, and the prevalence of smoking among physicians.


Overall, smoke-free policies were poorly enforced in this large teaching hospital in Cairo, Egypt. Interventions to address the identified barriers to their implementation could include the provision of cessation training and services as well as effective communication programs to educate health care workers at all levels regarding the dangers of second-hand smoke exposure and effective measures for protection.

Health care staff; FCTC; Smoke-free policies