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Subjects were given the questionnaire and were asked to complete it and place it in an envelope or dispose of it. Respondents were asked whether they had challenged a patient, visitor or member of staff smoking on the hospital site and, if not, whether they would in future.Respondents were asked to offer reasons why they would not challenge staff, patients or visitors to stop smoking.

Fear of aggression was the most commonly reported reason for not challenging smokers.

Most medical and nursing staff report that they do not enforce NHS smoke-free regulations and do not challenge smokers on NHS sites.

Over 50% of medical and nursing staff reported that they would not challenge patients, staff or visitors smoking on NHS trust site.

There was a trend for employees to be more likely to challenge patients than visitors, and to be more likely to challenge visitors than other staff.

This is due to many real and perceived barriers including fear of aggression.

Overcoming these barriers is an important area of research to guide successful implementation of future smoking policy.Personal smoking history, job title and age were requested for each subject.People who had challenged smokers in the past were assumed to be likely to challenge smokers in future and therefore they were grouped together to identify planned future behavior.Approximately 24% of the UK population continues to smoke cigarettes despite widespread knowledge of negative health effects.Smoking is implicated in 120 000 premature deaths in the UK every year.A Fifty-one (60%) respondents reported awareness of other members of staff smoking on site.

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