In the outdoor smoking shelter at Lexington's Central Baptist Hospital hangs a banner: "Say Yes to Fresh. Fresh Air. Fresh Breath. Fresh Start."
Heather Kelly, seated in a wheelchair in her hospital gown and hooked to an IV, smoked a cigarette. She has already heard the news the banner announces: "One month to a tobacco-free hospital campus."
Come next month, smoking or the use of any tobacco product won't be allowed anywhere on the grounds of a facility owned by Central Baptist, UK HealthCare or the Saint Joseph Health System.
At the medical facilities where the policy goes into effect by Nov. 20 — the day recognized annually as the Great American Smokeout — officials are getting the word out and helping as many people as possible to quit now.
Health care officials said they are not forcing employees or anyone else to quit using tobacco products. But given the risks of smoking, it doesn't make sense for a health care facility to allow it, they said.
Kelly, who lives in Nicholasville, said she is going to quit smoking anyway.
"I've cut way down," she said. "But it's hard to go cold turkey."
But she frets that the new policy will negatively affect her father.
"My father won't come to the hospital if he can't smoke," she said.
At least 52 of Kentucky's 126 hospitals have banned smoking or will by Jan. 1, as part of the Kentucky Hospital Association's Tobacco-free Healthcare Collaborative.
Smoke-free hospital interiors have been around since about 1992, but the new initiative will send users of tobacco products off hospital property altogether. No hanging out and smoking in the parking lot, just beyond the hospital entrance or anywhere else on the grounds.
Smoke-free hospital campuses are a national trend. A 2007 Arkansas study found that a campuswide smoke-free policy had no detrimental effect on employee or consumer attitudes and behaviors.
But no one is denying that the facilities enacting the policy face some tough times in Kentucky — a state that has a history of high tobacco use. Twenty-nine percent of Kentuckians smoke; the national average is 21 percent.
The local hospitals say they have a plan to help patients deal with nicotine withdrawal.
"When patients inform us that they use tobacco, we can provide appropriate medical care and support for withdrawal symptoms," said Amanda Nelson, a spokeswoman for UK HealthCare.
Gift shops and pharmacies at the hospitals will have plenty of nicotine replacement products on hand for visitors.
And employees are being offered classes and one-on-one support.
Linda Justice, who works in housekeeping at Central Baptist, says the policy means that she will quit smoking by Nov. 20.
"That's the plan," she said. "I've already got the prescription medication to stop smoking. I quit for 11 months once, but started back. My father had lung cancer. You'd think I wouldn't smoke."
Safety was a concern for Heather Kelly's niece Raven Chancey, who smoked with her aunt when she visited her at Central Baptist.
"You shouldn't have to walk across the street," she said.
At UK, officials will meet Oct. 29 with nearby property and business owners who fear they could look out on their lawns and find cigarette butts or smokers who have been shooed away from the hospital. Saint Joseph is sending letters to area residents and businesses.
"We are not unsympathetic to people who smoke at a stressful time, said Ruth Ann Childers, a spokeswoman for Central Baptist. "But it's a proven health risk."
At Central Baptist, officials offered employees free smoking cessation products if they attended a 12-week Freedom from Smoking class.
Marie Doss, a food-service manager who smoked one to two packs a day for 47 years, says the upcoming ban prompted her to take classes at Central Baptist and to start taking a prescription drug to help her quit. Doss has stopped smoking altogether.
"I really didn't think I'd be able to do it," she said.
Jeff Murphy, a spokesman for Saint Joseph Health System, which owns seven Central Kentucky hospitals, said that 200 employees are enrolled in a stop-smoking program.
"We are doing it for the health of our employees and patients," Murphy said. No employee who smokes will be forced to quit. But he said those who smoke won't get longer breaks so they can go off campus.
Elizabeth Cobb, vice president for health policy at the Kentucky Hospital Association, said hospitals that have already initiated the policy are receiving a lot of support from their communities and staff.
But, Cobb acknowledged, "It's a challenge to make sure people are complying with the policy."
At UK HealthCare, employees could be disciplined if they violate the policy, and security employees will help enforce it, said Murray Clark, associate vice president for Health Affairs.
Edsel Rawlings, a patient at UK HealthCare Good Samaritan, was smoking outside during a recent hospital stay.
But Rawlings said that if he's hospitalized when the smoke-free campus policy goes into effect, it might be a good thing.
"It would make me cut down. Anything along those lines would be positive," Rawlings said.