Were you ever allowed to smoke in a hospital? The surprising history of tobacco in healthcare

September 30, 2025 •

3 min read

For decades, smoking was a common sight within hospital walls, with nurses, doctors, and patients often lighting up indoors. The thought of this today is jarring, and the short answer to the question, "Were you ever allowed to smoke in a hospital?" is a resounding yes, in a past era with dramatically different health attitudes.

Quick Summary

Hospitals once permitted and even sold tobacco products to patients and staff, a practice that disappeared following health reports and accreditation mandates in the early 1990s.

Key Points

A Common Sight: Decades ago, it was normal for doctors, nurses, and patients to smoke inside hospitals, reflecting broader societal acceptance.
Changing Attitudes: Growing medical evidence, particularly from the 1964 Surgeon General's report, fueled a shift in public and medical opinion against smoking.
Risks of Secondhand Smoke: The recognition of severe health risks from secondhand smoke, including heart disease and cancer, was a major catalyst for policy change in healthcare settings.
Key Mandate: A 1991 mandate by the Joint Commission required all accredited U.S. hospitals to be smoke-free by December 31, 1993, driving widespread policy adoption.
Psychiatric Exceptions Ended: While some psychiatric units initially resisted bans, evidence showed that implementing smoke-free policies did not increase aggression and was beneficial for patient health.
Comprehensive Policies: Modern hospital policies prohibit all forms of tobacco use, including electronic cigarettes, anywhere on hospital property.
Cessation Support: Hospitals now provide nicotine replacement therapy and other cessation support to help patients manage withdrawal symptoms during their stay.

A Different Era: Tobacco in Mid-Century Healthcare

Prior to the 1980s, smoking was widely accepted in hospitals, with both medical professionals and patients smoking freely indoors. Some hospitals provided ashtrays and sold cigarettes in gift shops. This was consistent with societal norms of the time, and some healthcare workers even appeared in cigarette advertisements.

Experienced healthcare staff recall a time when smoking was permitted at nurses' stations and in patient rooms. Special arrangements were sometimes made for patients on oxygen to smoke. For certain psychiatric patients, smoking was considered a right, and some units supplied cigarettes. Smoking was prevalent throughout hospitals, including staff areas, waiting rooms, and even intensive care units.

The Turning Point: Growing Health Concerns and Evidence

The shift began with increasing evidence of smoking's health risks. The 1964 Surgeon General's report was a key event, though policy changes were gradual. Growing awareness of the dangers of secondhand smoke, which causes heart disease and lung cancer in non-smokers, further highlighted the conflict between smoking and a healing environment. Secondhand smoke posed significant risks to hospital staff.

Public opinion changed, and the anti-smoking movement grew. Clean indoor air laws and the ban on airline smoking in the late 1980s increased pressure on hospitals to go smoke-free.

Factors Influencing the Change

Several factors contributed to the end of smoking in hospitals:

Medical Evidence: Overwhelming scientific proof of the harms of smoking and secondhand smoke.
Accreditation Standards: The Joint Commission mandated smoke-free facilities for accreditation.
Employee Health and Safety: The need to protect hospital employees from secondhand smoke.
Public Image and Perception: Hospitals sought to align their image with health promotion.
Liability Concerns: Risks associated with exposing non-smokers to secondhand smoke.

The Implementation of Smoke-Free Hospital Policies

The major change occurred in the early 1990s. In 1991, the Joint Commission announced that accredited hospitals had to be smoke-free by December 31, 1993. This mandate was the primary driver for hospitals to adopt strict no-smoking policies nationwide. By 1994, most U.S. hospitals complied.

Hospitals implemented various strategies to enforce these policies:

Clear Communication: Informing patients and visitors of the policy through signage and upon admission.
Cessation Support: Offering nicotine replacement therapy (NRT) to help patients manage withdrawal.
Removing Infrastructure: Eliminating ashtrays and designated smoking areas.
Staff Training: Training staff to enforce the policy with patients and visitors.
Campus-wide Bans: Extending the prohibition to all hospital grounds, including parking areas.

Comparison of Hospital Smoking Policies


Feature	Pre-1990s (Example: 1970s)	Modern Day (Post-1993)
General Policy	Widely permitted, with designated smoking lounges or patient rooms.	Strict, campus-wide bans on all tobacco and e-cigarette products.
Staff Smoking	Common practice in nursing stations and break rooms.	Prohibited on hospital property; failure to comply can result in disciplinary action.
Patient Access	Patients could smoke in their rooms or designated areas; hospitals sometimes sold cigarettes.	Patients are expected to abstain; NRT is offered for nicotine addiction management.
Availability of Tobacco	Cigarette vending machines and gift shop sales were common.	No tobacco products are sold or provided on campus.
Exposure to Secondhand Smoke	High risk for patients, staff, and visitors, including those with respiratory issues.	Minimized by comprehensive smoke-free policies.

Challenges and Nuances: The Case of Psychiatric Units

Implementing bans in psychiatric units presented unique challenges, as some staff feared patient agitation or withdrawal. Historically, some exceptions were made, with smoking sometimes seen as a way to build rapport or a patient's right.

However, research indicated that smoke-free policies in psychiatric settings did not increase aggression and improved patient health. Courts did not uphold a "right to smoke" for psychiatric patients, prioritizing the health of all individuals in the hospital.

A Radical Transformation in Healthcare

The move to prohibit smoking in hospitals signifies a major public health achievement, showing how medical evidence, public pressure, and regulation can alter established practices. Today, smoke-free hospitals are essential for patient care, staff well-being, and public health. This history underscores the progress made in aligning healthcare practices with its core mission.

Visit the CDC's site for more information on tobacco control and smoking prevention to learn about current initiatives and resources.

Frequently Asked Questions

Yes, smoking was commonly allowed in hospitals for many decades. Before the 1990s, it was normal for patients, staff, and visitors to smoke inside hospital buildings and even in patient rooms.

The nationwide ban on smoking inside U.S. hospitals was effectively implemented after the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated smoke-free facilities by December 31, 1993.

Hospitals banned smoking due to overwhelming medical evidence about the harm of both smoking and secondhand smoke. Accreditation mandates, concern for employee and patient health, and changing public perception all played a role in the decision.

Yes, although some psychiatric units initially received exceptions, the smoke-free policy was extended to cover them as well. Studies later confirmed that such bans did not lead to increased aggression and provided significant health benefits to patients.

After the bans, patients who were smokers were offered nicotine replacement therapy (NRT) to manage withdrawal symptoms. Smoking was no longer permitted, and patients were required to abstain.

No, modern smoke-free policies at hospitals prohibit all forms of smoking and tobacco use on campus, which includes e-cigarettes and vaping devices.

Smoking on hospital property is generally prohibited by policy. While not necessarily a criminal offense, it is a violation of hospital rules and can lead to being asked to leave the premises by security.