Background:
In Catalan hospitals, compliance with smoke-free regulation has been evaluated by direct (air markers of tobacco consumption) and indirect methods (surveys to healthcare workers); however, patients have never been asked about their insight on this matter. The objective is to describe the perception of hospitalized patients about compliance with indoor and outdoor smoke-free ban in hospitals.

Methods:
Cross-sectional study in 13 hospitals of the Catalan Network of Smoke-Free Hospitals (Catalonia, Spain) in 2015. The sample size considered the number of beds in each hospital (41-205 patients; 1047 patients in total). We included adult patients hospitalized >24 hours. A face-to-face questionnaire was conducted to collect information about patients (age, sex, reason for admission, smoking status) and smoke-free regulation (having received information about the smoke-free regulation, level of knowledge and perception of compliance). A descriptive analysis was performed and a logistic regression model was calculated to assess the association between the perception of compliance by patients and individual and hospital characteristics (type of hospital, care unit, workers' prevalence of tobacco use, etc.).

Results:
57.6% of the participants had seen information banners about the smoke-free ban; 4.8% of the participants reported having been verbally informed; 6.4% reported receiving written information. 72.8% of the participants perceived that people respected smoke-free ban in the perimeter of the hospital, but 3.0% had seen smoking indoors and 53.7% outdoors. 65.0% were aware of the current regulation indoors and outdoors. The belief in the compliance with smoke-free ban was higher among older participants. Former (OR=2.08, 95%CI 1.29-3.36) and never smokers (OR=2.49, 95%CI 1.53-4.03) were the ones who most believed in ban's compliance.

Conclusions:
In Catalan hospitals, the compliance with the smoke-free ban is high, according to hospitalized patients. Despite of this, there is room for improvement, especially in outdoor areas. The communication of smoke-free bans addressed to patients should be improved.