Secondhand smoke exposure in the workplace

Population-level estimates of workplace exposure to secondhand smoke in Canada

OBJECTIVES

Secondhand smoke (SHS) is a known lung carcinogen that is also associated with cardiovascular disease and premature death. An important source of exposure to SHS is the workplace. In the past, efforts have been made to reduce workplace SHS exposure across Canada, with corresponding benefits to public health. This study estimated the number of workers exposed to SHS in Canada in 2006 and 2016 and their level of exposure.

METHODS

The proportion of workers exposed to SHS and the proportion of workers reporting specific workplace smoking restrictions by occupation and province, acquired from the 2007-2009 and 2010-2012 Canadian Tobacco Use Monitoring Surveys, were applied to 2006 and 2016 Canadian census data to estimate population-level exposure. Workers were assigned to exposure levels (possible, moderate, high) using workplace smoking restrictions. Only moderately and highly exposed workers were considered exposed.

RESULTS

The number of exposed workers decreased by 20% from 520,000 in 2006 to 418,000 in 2016. Workers were equally split between moderate and high exposure groups. Trades, transport and equipment operators, and workers in primary industry had the highest rates of overall exposure. The proportion of workers exposed varied by province, with the lowest rates in Ontario (approximately 2% in both years), and the highest in Saskatchewan in 2006 (6%) and Newfoundland in 2016 (4%).

CONCLUSION

Workplace SHS exposure persists. The findings can help prioritize high-risk groups for interventions and inform studies of the burden of occupational disease. Further characterization of exposure is needed to better inform enforcement and prevention.

Support for a Campus Tobacco-Free Policy among Non- Smokers: Findings from a Developing Country

BACKGROUND

A tobacco-free workplace policy is identified as an effective means to reduce tobacco use and protect people from second-hand smoke; however, the number of tobacco-free policies (TFP) remains very low in workplaces in Malaysia. This study explored the factors affecting support for a tobacco-free policy on two healthcare campuses in Malaysia, prior to the implementation of TFP.

MATERIALS AND METHODS

This cross- sectional study was conducted among 286 non-smokers from two healthcare training centres and two nearby colleges in Malaysia from January 2015 to April 2015. A standardized questionnaire was administered via staff and student emails. The questionnaire collected information on sociodemographic characteristics, support for a tobacco-free policy and perceived respiratory and sensory symptoms due to tobacco exposure. Bivariate and multivariate logistic regression analyses were performed to estimate the independent effects of supporting a tobacco-free campus.

RESULTS

The percentage of individuals supporting completely tobacco-free facilities was 83.2% (N=238), as opposed to 16.7% (N=48) in support of partially tobacco-free facilities. Compared to the supporters of partially tobacco-free facilities, non-smokers who supported completely tobacco-free health facilities were more likely to be female, have higher education levels, to be very concerned about the effects of other people smoking on their health and to perceive a tobacco-free policy as very important. In addition, they perceived that tobacco smoke bothered them at work by causing headaches and coughs and, in the past 4 weeks, had experienced difficulty breathing. In the multivariate model, after adjusting for sociodemographic characteristics and other factors, only experiencing coughs and headaches increased the odds of supporting a completely tobacco-free campus, up to 2.5- and 1.9-fold, respectively.

CONCLUSIONS

Coughs and headaches due to other people smoking at work enhances support for a completely tobacco-free campus among non-smokers.

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association

BACKGROUND

Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.

METHODS AND RESULTS

For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies.

CONCLUSIONS

This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Tobacco advertising, environmental smoking bans, and smoking in Chinese urban areas

OBJECTIVES

To evaluate whether cigarette smoking in Chinese urban areas was respectively associated with exposure to tobacco advertising and smoking bans in households, workplaces, and public places.

METHODS

Participants were 4735 urban residents aged 15 years and older, who were identified through multi-stage quota-sampling conducted in six Chinese cities. Data were collected on individual sociodemographics and smoking status, and regional tobacco control measures. The sample was characterized in terms of smoking prevalence, and multilevel logistic models were employed to analyze the association between smoking and tobacco advertising and environmental smoking restrictions, respectively.

RESULTS

Smoking prevalence was 30%. Multilevel logistic regression analysis showed that smoking was positively associated with exposure to tobacco advertising, and negatively associated with workplace and household smoking bans.

CONCLUSIONS

The association of smoking with both tobacco advertising and environmental smoking bans further justifies implementation of comprehensive smoking interventions and tobacco control programs in China.

The role of worksite and home smoking bans in smoking cessation among U.S. employed adult female smokers

PURPOSE

Examine the association of work and home smoking bans with quitting behaviors among employed female smokers in the United States.

DESIGN

Secondary analyses using cross-sectional data from the 2006/2007 Tobacco Use Supplement to the Current Population Survey.

SUBJECTS

Nationally representative sample of 7610 U.S. employed female smokers, aged 18 to 64 years, who reported working indoors. Setting . N/A.

METHODS

Multivariate logistic regression analyses were conducted to examine the association of smoking ban policies (complete work and home bans, complete work ban only, complete home ban only, and no complete work or home ban) with intention to quit in the next 30 days, at least one quit attempt in the past year, and sustained abstinence of at least 3 months in the past year.

RESULTS

Twenty-nine percent of women reported complete work and home smoking bans. Smoking bans were not associated with intention to quit and were marginally associated with sustained abstinence. Regardless of intention to quit, women with complete work and home bans were significantly more likely than those without complete work and home bans to report quit attempts. Among women with no intention to quit, the odds of having a quit attempt were significantly higher among women who had a complete home ban only compared with women without complete work and home bans.

CONCLUSIONS

Efforts to promote quitting behaviors among employed female smokers may be facilitated by increasing rates of complete smoking bans at both work and home settings.

Exposure to secondhand smoke in Finnish workplaces and compliance with national smoke-free workplace legislation

Aims: The present study examined time trends and associations in exposure to secondhand smoke (SHS) at work in Finland in 1985—2008 and compliance with national smoke-free workplace legislation that has been enforced since 1995. Methods: The study population comprised respondents of nationally representative annual postal surveys from 1985 to 2008. The differences in the prevalence of SHS-exposed respondents were measured with particular reference to workplace size and workplace smoking arrangements. Results: From 1985 to 2008 daily exposure to SHS at work decreased in all workplaces. The annual decrease was largest in 1994—95 when the smoke-free workplace legislation was enacted. The proportion of exposed employees in workplaces with designated smoking rooms was two-fold compared to employees in workplaces where no one smoked, and this ratio remained unchanged between 1995 and 2008. Employees in small workplaces were exposed most and exposure to SHS was lowest in the largest workplaces. Conclusions: Totally smoke-free workplaces give better protection against the exposure to SHS than workplaces with designated smoking areas. We urge a law reform that does not allow any designated smoking rooms indoors. In the prevention of SHS exposure, special attention should be directed to small workplaces.

Quantification of ETS exposure in hospitality workers who have never smoked

BACKGROUND

Environmental Tobacco Smoke (ETS) was classified as human carcinogen (K1) by the German Research Council in 1998. According to epidemiological studies, the relative risk especially for lung cancer might be twice as high in persons who have never smoked but who are in the highest exposure category, for example hospitality workers. In order to implement these results in the German regulations on occupational illnesses, a valid method is needed to retrospectively assess the cumulative ETS exposure in the hospitality environment.

METHODS

A literature-based review was carried out to locate a method that can be used for the German hospitality sector. Studies assessing ETS exposure using biological markers (for example urinary cotinine, DNA adducts) or questionnaires were excluded. Biological markers are not considered relevant as they assess exposure only over the last hours, weeks or months. Self-reported exposure based on questionnaires also does not seem adequate for medico-legal purposes. Therefore, retrospective exposure assessment should be based on mathematical models to approximate past exposure.

RESULTS

For this purpose a validated model developed by Repace and Lowrey was considered appropriate. It offers the possibility of retrospectively assessing exposure with existing parameters (such as environmental dimensions, average number of smokers, ventilation characteristics and duration of exposure). The relative risk of lung cancer can then be estimated based on the individual cumulative exposure of the worker.

CONCLUSION

In conclusion, having adapted it to the German hospitality sector, an existing mathematical model appears to be capable of approximating the cumulative exposure. However, the level of uncertainty of these approximations has to be taken into account, especially for diseases with a long latency period such as lung cancer.

Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption

BACKGROUND

Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and smoking behaviour of those populations they affect.

OBJECTIVES

To assess the extent to which legislation-based smoking bans or restrictions reduce exposure to SHS, help people who smoke to reduce tobacco consumption or lower smoking prevalence and affect the health of those in areas which have a ban or restriction in place.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL, Conference Paper Index, and reference lists and bibliographies of included studies. We also checked websites of various organisations. Date of most recent search; July 1st 2009.

SELECTION CRITERIA

We considered studies that reported legislative smoking bans and restrictions affecting populations. The minimum standard was having a ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. We included randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before and after studies, interrupted-time series as defined by the Cochrane Effective Practice and Organization of Care Group, and uncontrolled pre- and post-ban data.

DATA COLLECTION AND ANALYSIS

Characteristics and content of the interventions, participants, outcomes and methods of the included studies were extracted by one author and checked by a second. Because of heterogeneity in the design and content of the studies, we did not attempt a meta-analysis. We evaluated the studies using qualitative narrative synthesis.

MAIN RESULTS

There were 50 studies included in this review. Thirty-one studies reported exposure to secondhand smoke (SHS) with 19 studies measuring it using biomarkers. There was consistent evidence that smoking bans reduced exposure to SHS in workplaces, restaurants, pubs and in public places. There was a greater reduction in exposure to SHS in hospitality workers compared to the general population. We failed to detect any difference in self-reported exposure to SHS in cars. There was no change in either the prevalence or duration of reported exposure to SHS in the home as a result of implementing legislative bans. Twenty-three studies reported measures of active smoking, often as a co-variable rather than an end-point in itself, with no consistent evidence of a reduction in smoking prevalence attributable to the ban. Total tobacco consumption was reduced in studies where prevalence declined. Twenty-five studies reported health indicators as an outcome. Self-reported respiratory and sensory symptoms were measured in 12 studies, with lung function measured in five of them. There was consistent evidence of a reduction in hospital admissions for cardiac events as well as an improvement in some health indicators after the ban.

AUTHORS' CONCLUSIONS

Introduction of a legislative smoking ban does lead to a reduction in exposure to passive smoking. Hospitality workers experienced a greater reduction in exposure to SHS after implementing the ban compared to the general population. There is limited evidence about the impact on active smoking but the trend is downwards. There is some evidence of an improvement in health outcomes. The strongest evidence is the reduction seen in admissions for acute coronary syndrome. There is an increase in support for and compliance with smoking bans after the legislation.

Smokefree policies to reduce tobacco use. A systematic review

In 2001, a systematic review for the Guide to Community Preventive Services identified strong evidence of effectiveness of smoking bans and restrictions in reducing exposure to environmental (secondhand) tobacco smoke. As follow-up to that earlier review, the focus here was on the evidence on effectiveness of smokefree policies in reducing tobacco use. Smokefree policies implemented by worksites or communities prohibit smoking in workplaces and designated public areas. The conceptual approach was modified for this review; an updated search for evidence was conducted; and the available evidence was evaluated. Published articles that met quality criteria and evaluated changes in tobacco-use prevalence or cessation were included in the review. A total of 57 studies were identified in the period 1976 through June 2005 that met criteria to be candidates for review; of these, 37 met study design and quality of execution criteria to qualify for final assessment. Twenty-one studies measured absolute differences in tobacco-use prevalence with a median effect of -3.4 percentage points (interquartile interval: -6.3 to -1.4 percentage points). Eleven studies measured differences in tobacco-use cessation among tobacco users exposed to a smokefree policy compared with tobacco users not exposed to a smokefree policy. The median absolute change was an increase in cessation of 6.4 percentage points (interquartile interval: 1.3 to 7.9 percentage points). The qualifying studies provided sufficient evidence that smokefree policies reduce tobacco use among workers when implemented in worksites or by communities. Finally, a systematic economic review identified four studies that, overall, demonstrated economic benefits from a smokefree workplace policy. Additional research is needed to more fully evaluate the total economic effects of these policies.

WITHDRAWN: Interventions for preventing tobacco smoking in public places

BACKGROUND

Environmental tobacco smoke is a health hazard. Reducing exposure to tobacco smoke in public places is a widespread public health goal. There is, however, considerable variation in the extent to which this goal has been achieved in different settings and societies. There is therefore a need to identify effective strategies for reducing tobacco consumption in public places.

OBJECTIVES

To evaluate the effectiveness of interventions to reduce tobacco consumption in public places.

SEARCH STRATEGY

We searched the Tobacco Addiction Review Group trials register, MEDLINE and EMBASE in March 2006. We handsearched a key journal and abstracts from international conferences on tobacco. We checked the bibliographies of identified studies and reviews for additional references.

SELECTION CRITERIA

We considered randomized and controlled trials, controlled and uncontrolled before-and-after studies and interrupted time series. The main outcome of interest was levels and measures of compliance with bans and restrictions. We considered strategies aimed at populations, including education campaigns, written material, non-smoking and warning signs, and comprehensive strategies. We also considered strategies aimed at individual smokers.

DATA COLLECTION AND ANALYSIS

Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of each study was abstracted by one reviewer and checked by two others. Studies were combined using qualitative narrative synthesis.

MAIN RESULTS

Twenty of 25 studies reporting information about interventions to reduce smoking in public places met all the inclusion criteria. Three were controlled before-and-after studies and 17 were uncontrolled before-and-after studies. The most effective strategies used comprehensive, multi-component approaches to implement policies banning smoking within institutions. Less comprehensive strategies, such as posted warnings and educational material, had a moderate effect. Five studies showed that prompting individual smokers had an immediate effect, but such strategies are unlikely to be acceptable as a public health intervention.

AUTHORS' CONCLUSIONS

Carefully planned and resourced, multi-component strategies effectively reduced smoking within public places. Less comprehensive strategies were less effective. Most studies were done in the USA and, despite increasing evidence from Europe, there is a need to identify ways in which these strategies can be adopted and used in countries with different attitudes to tobacco use. Future studies should also consider the use of more rigorous experimental designs.

Secondhand tobacco smoke exposure, nicotine dependence, and smoking cessation

OBJECTIVE

To explore the association among the number of sources of secondhand tobacco smoke (SHS) exposure, nicotine dependence (ND), and smoking cessation.

DESIGN

A secondary analysis of cross-sectional data. Responses for the main study were obtained in 2001 from a controlled trial of the Quit and Win Tobacco Free Contest in Kentucky.

SAMPLE

822 current smokers.

MEASUREMENTS

Demographic variables (age, gender, educational status, income, and ethnicity) the number of sources of SHS exposure, smoking frequency, length of abstinence from smoking, age of smoking initiation, smoking cessation attempts, intentions to quit smoking, and ND.

RESULTS

The number of sources of SHS exposure was associated with higher ND and smoking frequency, and related to low intentions and attempts to quit smoking. The number of sources of SHS exposure contributed to 11% of the variance in the final ND model, after accounting for control and potential mediating variables.

CONCLUSIONS

The number of sources of SHS exposure may be an important factor influencing ND and intentions and attempts to quit smoking. Further studies are needed to explore the association between SHS exposure and ND among smokers to guide treatment and policy development.

Smoking policies in small worksites in Minnesota

PURPOSE

To examine correlates of smoking policies in a stratified sample of small worksites in Minnesota and to determine knowledge and attitudes of the owners and managers regarding the Minnesota Clean Indoor Air Act (MCIAA) rules that newly applied to their businesses.

DESIGN

Cross-sectional survey.

SETTING

Minnesota offices and factories/warehouses with 5 to 50 employees. Subjects. Owners or managers of offices and factories/warehouses; sample size = 233; response rate = 66%.

MEASURES

Existence and strength of worksite smoking policies.

ANALYSIS

Comparison of factories/warehouses and offices in metropolitan and greater Minnesota using chi square and linear and logistic regression analyses.

RESULTS

Approximately two-thirds of the worksites claimed to have a smoking policy, but only 26% of the total sample had a policy in writing. Worksites that offered health insurance to their employees were more likely to have a written policy (p < .0001), as were offices in the metro area compared with other worksites (p = .003). Policies of both types of outstate worksites were stronger compared with those at metro sites, and offices had stronger policies than factories and warehouses in the metro area. Only about one-third of the businesses had heard of the MCIAA rule changes.

CONCLUSION

Most small businesses in Minnesota do not have a smoking policy in writing and thus their employees are at risk of exposure to secondhand smoke at work.

Environmental and Economic Evaluation of the Massachusetts Smoke-free Workplace Law

An environmental and economic evaluation of the smoke-free law in Massachusetts provides a broad appreciation of how a state-wide smoking ban affects the health of patrons and workers as well as the industries that are commonly concerned about the effects of smoking bans on business. The aim of this study is to evaluate environmental and economic effects of the statewide Massachusetts statewide Smoke-Free Workplace Law. Before and after the smoking ban, air quality testing was conducted in a sample (n = 27) of hospitality venues and state-wide economic changes were assessed. Compliance, in terms of patronage was measured by person-counts. Environmental outcomes were respirable suspended particles (RSP) less than 2.5 microns in diameter (PM2.5). Economic outcomes were meals tax collections, employment in the food services and drinking places and accommodations industries. On average, levels of respirable suspended particles (RSPs) less than 2.5 microns in diameter (PM2.5) decreased 93% in these venues after the Massachusetts Smoke-free Workplace Law went into effect. No statistically significant changes were observed among the economic indicators. This evaluation demonstrates that the state-wide Massachusetts law has effectively improved indoor air quality in a sample of Massachusetts venues and has not negatively affected several economic indicators.