Workplace smoking related absenteeism and productivity costs in Taiwan

Economic costs attributable to modifiable risk factors: an analysis of 24 million urban residents in China

BACKGROUND

Estimating the economic burden of modifiable risk factors is crucial for allocating scarce healthcare resources to improve population health. We quantified the economic burden attributable to modifiable risk factors in an urban area of China.

METHODS

Our Shanghai Municipal Health Commission dataset covered 2.2 million inpatient admissions for adults (age ≥ 20) in public and private hospitals in 2015 (1,327,187 admissions) and 2020 (837,482 admissions). We used a prevalence-based cost-of-illness approach by applying population attributable fraction (PAF) estimates for each modifiable risk factor from the Global Burden of Diseases Study (GBD) to estimate attributable costs. We adopted a societal perspective for cost estimates, comprising direct healthcare costs and productivity losses from absenteeism and premature mortality. Future costs were discounted at 3% and adjusted to 2020 prices.

RESULTS

In 2020, the total societal cost attributable to modifiable risk factors in Shanghai was US$7.9 billion (95% uncertainty interval [UI]: 4.6-12.4b), mostly from productivity losses (67.9%). Two health conditions constituted most of the attributable societal cost: cancer (51.6% [30.2-60.2]) and cardiovascular disease (31.2% [24.6-50.7]). Three modifiable risk factors accounted for half of the total attributable societal cost: tobacco (23.7% [16.4-30.5]), alcohol (13.3% [8.2-19.7]), and dietary risks (12.2% [7.5-17.7]). The economic burden varied by age and sex; most of the societal costs were from males (77.7%), primarily driven by their tobacco and alcohol use. The largest contributor to societal costs was alcohol for age 20-44, and tobacco for age 45 + . Despite the COVID-19 pandemic, the pattern of major modifiable risk factors remained stable from 2015 to 2020 albeit with notable increases in attributable healthcare costs from cancers and productivity losses from cardiovascular diseases.

CONCLUSIONS

The substantial economic burden of diseases attributable to modifiable risk factors necessitates targeted policy interventions. Priority areas are reducing tobacco and alcohol consumption and improving dietary habits that together constitute half of the total attributable costs. Tailored interventions targeting specific age and sex groups are crucial; namely tobacco in middle-aged/older males and alcohol in younger males.

Productivity costs of lifelong smoking-the Northern Finland Birth Cohort 1966 study

BACKGROUND

Smoking is one of the leading causes of impaired health and mortality. Loss of paid and unpaid work and replacements due to morbidity and mortality result in productivity costs. Our aim was to investigate the productivity costs of lifelong smoking trajectories and cumulative exposure using advanced human capital method (HCM) and friction cost method (FCM).

METHODS

Within the Northern Finland Birth Cohort 1966 (NFBC1966), 10 650 persons were followed from antenatal period to age 55 years. The life course of smoking behaviour was assessed with trajectory modelling and cumulative exposure with pack-years. Productivity costs were estimated with advanced HCM and FCM models by using detailed, national register-based data on care, disability, mortality, education, taxation, occupation and labour market. A two-part regression model was used to predict productivity costs associated with lifelong smoking and cumulative exposure.

RESULTS

Of the six distinct smoking trajectories, lifetime smokers had the highest productivity costs followed by late starters, late adult quitters, young adult quitters and youth smokers. Never-smokers had the lowest productivity costs. The higher the number of pack-years, the higher the productivity costs. Uniform patterns were found in both men and women and when estimated with HCM and FCM. The findings were independent of other health behaviours.

CONCLUSIONS

Cumulative exposure to smoking is more crucial to productivity costs than starting or ending age of smoking. This suggests that the harmful effects of smoking depend on dose and duration of smoking and are irrespective of age when smoking occurred.

Gender disparities in lost productivity resulting from non-communicable diseases in Mexico, 2005-2021

Background

Non-communicable diseases (NCDs) cause long-term impacts on health and can substantially affect people's ability to work. Little is known about how such impacts vary by gender, particularly in low- and middle-income countries (LMICs), where productivity losses may affect economic development. This study assessed the long-term productivity loss caused by major NCDs among adult women and men (20-76 years) in Mexico because of premature death and hospitalisations, between 2005 and 2021.

Methods

We conducted an economic valuation based on the Human Capital Approach. We obtained population-based data from the National Employment Survey from 2005 to 2021 to estimate the expected productivity according to age and gender using a two-part model. We utilised expected productivity based on wage rates to calculate the productivity loss, employing Mexican official mortality registries and hospital discharge microdata for the same period. To assess the variability in our estimations, we performed sensitivity analyses under two different scenarios.

Results

Premature mortality by cancers, diabetes, chronic cardiovascular diseases (CVD), chronic respiratory diseases (CRD) and chronic kidney disease (CKD) caused a productivity loss of 102.6 billion international US dollars (Intl. USD) from 2.8 million premature deaths. Seventy-three percent of this productivity loss was observed among men. Cancers caused 38.3% of the productivity loss (mainly among women), diabetes 38.1, CVD 15.1, CRD 3.2, and CKD 5.3%. Regarding hospitalisations, the estimated productivity loss was 729.7 million Intl. USD from 54.2 million days of hospitalisation. Men faced 65.4 and women 34.6% of these costs. Cancers caused 41.3% of the productivity loss mainly by women, followed by diabetes (22.1%), CKD (20.4%), CVD (13.6%) and CRD (2.6%).

Conclusions

Major NCDs impose substantial costs from lost productivity in Mexico and these tend to be higher amongst men, while for some diseases the economic burden is higher for women. This should be considered to inform policymakers to design effective gender-sensitive health and social protection interventions to tackle the burden of NCDs.

A Comparison of the Validities of Traditional Chinese Versions of the Work Productivity and Activity Impairment Questionnaire: General Health and the World Health Organization's Health and Work Performance Questionnaire

There is a lack of valid instruments for measuring productivity loss due to illness. This study aimed to compare the validities of traditional Chinese versions of the Work Productivity and Activity Impairment: General Health (C-WPAI:GH) and the World Health Organization's Health and Work Performance Questionnaire (C-WHO-HPQ), and to define the factors associated with productivity loss. We conducted a cross-sectional study of 165 Taiwanese employees in technology companies. Spearman's correlation coefficients and ANOVAs were used to test the validities of the C-WPAI:GH and C-WHO-HPQ. Bayesian model averaging was used for multiple linear regression to define the factors related to productivity loss. The C-WPAI:GH had acceptable validities for assessing the productivity loss of Taiwanese employees. The C-WHO-HPQ had acceptable content validity and concurrent criterion validity. However, the construct validity of the C-WHO-HPQ was insufficient (less than 75% of results were consistent with our hypotheses). Absenteeism in the C-WPAI:GH was associated with education, physical functioning and job satisfaction. There were significant associations of bodily pain, social functioning and general health with presenteeism, overall work impairment and activity impairment in the C-WPAI:GH. A linear correlation was found between education and activity impairment in the C-WPAI:GH. The C-WPAI:GH can be used to evaluate productivity loss due to illness.

Associations of sustained smoking and smoking cessation with work-related outcomes: a longitudinal analysis

Purpose

The aim of this study was to assess the association between sustained smoking and quitting with work-related outcomes among older workers.

Methods

We categorized a sample of older employees into non-smokers, sustained smokers and quitters. Multivariable regression models were used to test longitudinal associations of sustained smoking and smoking cessation with sickness absence, productivity loss and work ability.

Results

We included 3612 non-smokers, 673 sustained smokers and 246 quitters. Comparing sustained smokers to non-smokers, we found higher (but not statistically significant) sickness absence for sustained smokers [1.01, 95% confidence interval (CI) − 0.16–2.17]. We did not find differences in productivity loss (OR 0.82, 95% CI 0.60–1.13) and work ability (0.05, 95% CI −0.05–0.15). For employees with a relatively high physical health at baseline, comparing quitters to sustained smokers, we found higher (but not statistically significant) productivity loss for quitters (OR 2.23, 95% CI 0.94–5.31), and no difference in sickness absence (0.10, 95% CI − 2.67–2.87), and work ability (− 0.10, 95% CI −  0.36–0.16). For employees with a relatively low physical health at baseline, comparing quitters to sustained smokers, we found a statistically significant lower work ability (− 0.31, 95% CI − 0.57–0.05), and no difference in sickness absence (2.53, 95% CI − 1.29–6.34) and productivity loss (OR 1.26, 95% CI 0.66–2.39).

Conclusions

We found no evidence that sustained smokers have less favorable work-related outcomes than non-smokers or that quitters have more favorable work-related outcomes than sustained smokers. The benefits of smoking cessation for employers might take a longer time to develop.

Smoking and school absenteeism among 15- to 16-year-old adolescents: a cross-section analysis on 36 European countries

Background

Schools have a crucial role to play in preventing youth smoking. However, the well-known long-term health consequences of youth smoking may be insufficient to convince education stakeholders to devote efforts to implement school-based programmes. However, if youth smoking were to have short-term consequences, this evidence could prompt education stakeholders’ action. In this article, we investigate the link between smoking and school absenteeism.

Methods

We used data from the 2011 wave of the European School Survey Project on Alcohol and Other Drugs, on adolescents aged 15–16. We applied logistic models to assess the risk of more than 3 missed school days, by cause, as function of smoking intensity, adjusting for age, sex, socioeconomic status, academic performance, parental involvement and other risk behaviours (alcohol and cannabis consumption). Consistency was assessed by replicating the analyses for each sex and age group and further adjusting for depression and self-esteem.

Results

Smoking more than five cigarettes per day was significantly linked to school absenteeism, with a 55% excess risk of missing more than 3 school days per month due to illness (OR = 1.55, 95% CI 1.46–1.64), and a more than two times excess risk due to skipping (OR = 2.29; 95% CI 2.16–2.43). These findings were consistent across age and sex groups.

Conclusion

We observed an association between smoking intensity and absenteeism among youth in Europe. This implies that, to the extent that this association is causal, school tobacco control policies may reduce the short-term consequences of smoking on adolescents’ education and health.

Factors Contributing to Nurse Productivity in Public Hospitals in Surabaya, Indonesia

This study aimed at examining the factors that contribute to nursing productivity in public hospitals in Surabaya. Data relating to the respondents' characteristics and their productivity were collected using a questionnaire incorporating the Behaviorally Anchored Rating Scale. The samples were drawn from 31 nurses form the emergency room (ER) and 29 nurses from the intensive care unit (ICU) wards of a public hospital in Surabaya, Indonesia, of whom, 52 nurses participated voluntarily and indicated their willingness to respond by signing an informed consent form. The chi-square and Fisher's exact test was used to determine associations between the determinants (demographic characteristics, lifestyle and nutritional status) and productivity and the strength of association was identified by using logistic regression. The results from this study found that gender had borderline significant and duration of work experience had a significant association with nurse productivity. Therefore, gender and duration of working experience are factors which should be taken into consideration when managing human resources working in ERs and ICUs while basic nursing competencies are clearly also important factors in maintaining productivity.

Cost-effectiveness and cost-utility analysis of a work-place smoking cessation intervention with and without financial incentives

AIMS

To perform an economic evaluation of a work-place smoking cessation group training programme with incentives compared with a training programme without incentives.

DESIGN

A trial-based cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a societal perspective and an employer's perspective.

SETTING

Sixty-one companies in the Netherlands.

PARTICIPANTS

A total of 604 tobacco-smoking employees.

INTERVENTION AND COMPARATOR

A 7-week work-place smoking cessation group training programme. The intervention group earned gift vouchers of €350 for 12 months' continuous abstinence. The comparator group received no incentives.

MEASUREMENTS

Online questionnaires were administered to assess quality of life (EQ-5D-5 L) and resource use during the 14-month follow-up period (2-month training period plus 12-month abstinence period). For the CEA the primary outcome measure was carbon monoxide (CO)-validated continuous abstinence; for the CUA the primary outcome was quality-adjusted life years (QALY). Bootstrapping and sensitivity analyses were performed to account for uncertainty. Incremental cost-effectiveness ratio (ICER) tables were used to determine cost-effectiveness from a life-time perspective.

FINDINGS

Of the participants in the intervention group, 41.1% had quit smoking compared with 26.4% in the control group. From a societal perspective with a 14-month follow-up period, the ICER per quitter for an intervention with financial incentives compared with no incentives was €11 546. From an employer's perspective, the ICER was €5686. There was no significant difference in QALYs between the intervention and control group within the 14-month follow-up period. The intervention was dominated by the comparator in the primary analysis at a threshold of €20 000 per QALY. In the sensitivity analysis, these results were uncertain. A life-time perspective showed an ICER of €1249 (95% confidence interval = €850-2387) per QALY.

CONCLUSIONS

Financial incentives may be cost-effective in increasing quitting smoking, particularly from a life-time perspective.

Estimation of the impacts of substance use on workplace productivity: a hybrid human capital and prevalence-based approach applied to Canada

OBJECTIVE

Policy makers require evidence-based estimates of the economic costs of substance use-attributable lost productivity to set strategies aimed at reducing substance use-related harms. Building on a study by Rehm et al. (2006), we provide estimates of workplace costs using updated methods and data sources.

METHODS

We estimated substance use-attributable productivity losses due to premature mortality, long-term disability, and presenteeism/absenteeism in Canada between 2007 and 2014. Lost productivity was estimated using a hybrid prevalence and incidence approach. Substance use prevalence data were drawn from three national self-report surveys. Premature mortality data were from the Canadian Vital Statistics Death Database, and long-term disability and workplace interference data were from the Canadian Community Health Survey.

RESULTS

In 2014, the total cost of lost productivity due to substance use was $15.7 billion, or approximately $440 per Canadian, an increase of 8% from 2007. Substances responsible for the greatest economic costs were alcohol (38% of per capita costs), tobacco (37%), opioids (12%), other central nervous system (CNS) depressants (4%), other CNS stimulants (3%), cannabis (2%), cocaine (2%), and finally other psychoactive substances (2%).

CONCLUSION

In 2014, alcohol and tobacco represent three quarters of substance use-related lost productivity costs in Canada, followed by opioids. These costs provide a valuable baseline that can be used to assess the impact of future substance use policy, practice, and other interventions, especially important given Canada's opioid crisis and recent cannabis legalization.

[Tobacco and work]

INTRODUCTION

Health indicators published over more than 15 years in France show differences in the prevalence of smoking in relation to activity status and socio-professional categories. However, the relationship between smoking and work is not limited to this.

BACKGROUND

Smoking by employees is traditionally regarded as entailing additional costs for businesses, but the actual costs of smoking in the workplace are difficult to assess. Co-exposure to tobacco and the toxic substances encountered in work areas carries an increased risk of developing lung disease, broncho-pulmonary cancer and chronic obstructive pulmonary disease in particular. The workplace can also be an area of exposure to passive smoking that affects employees unequally. In France, the use of tobacco and e-cigarettes in the workplace has been regulated since 2006 and 2016, respectively.

OUTLOOK

Workplace smoking cessation programs and smoking bans seem to encourage cessation of smoking. Smoking cessation advice by occupational physicians could work in the same manner. Subjects exposed to occupational carcinogens and tobacco could benefit from low-dose CT screening after a trial period to validate this approach.

CONCLUSION

Workplaces can be areas for the prevention and cessation of smoking.

Impact of a Smoking Cessation Quitline in Vietnam: Evidence Base and Future Directions

Smoking is considered the most critical modifiable factor with regard to lung cancer and remains a public health concern in many countries, including Vietnam, which is among those countries with the highest tobacco consumption rates in the world. This study has examined the impact of national telephone counselling for smoking cessation and has identified the factors associated with the impact of the quitline among male callers in Vietnam. A randomized cross-sectional survey of 469 smokers who sought smoking cessation services via the national quitline was performed from September 2015 to May 2016. The primary outcomes were measured by a self-reported quit rate at the time of assessment, 7 day point prevalence abstinence (PA), 6 month prolonged PA, service satisfaction, and level of motivation. Among the participants, 31.6% were abstinent, and 5.1% of participants successfully stopped smoking and did not need to seek quitline support. Most of the clients were satisfied with the quality of service (88.5%), felt more confident about quitting (74.3%), and took early action via their first quit attempt (81.7%); 18.3% reported a more than 7 day abstinence period at the time of survey. The primary reasons for smoking relapse were surrounding smoking environments (51.6%) and craving symptoms (44.1%). Future smoking cessation efforts should focus on improving the quality of quitline services, client satisfaction, and developing a tailored program and counseling targeting smokers with specific characteristics, especially ones experiencing chronic diseases.

The Relationship between Health Literacy and Stages of Change in Smoking Behavior among Employees of Educational Health Centers of Tabriz University of Medical Sciences (2016)

Background:

Health literacy has been considered as a predictor of starting, maintaining, and stop smoking. However, such relations have not been well documented in previous texts. Therefore, the purpose of this study was to investigate the relation between health literacy and changes in the behavior of smoking in Tabriz University of Medical Sciences.

Methods:

In this correlational descriptive study, a total of 297 employees of Tabriz health centers were examined. To collect data, a demographic-social questionnaire, Iranian Health Literacy Questionnaire, and DiClemente's behavior change questionnaire were used. Besides, SPSS 13 software (significance level = 0.05) was employed to analyze the data.

Results:

The average health literacy rate of participants was 70, and most respondents had adequate health literacy. Nearly 41.1% were in the precontemplation phase which is one of the stages of behavior change. There was a positive and significant statistical relation between behavior change variable with all health literacy areas (except the scope of understanding) and total health literacy score (P = 0.011 and r = 0.147). The results of ordinal regression analysis demonstrated that there is a significant positive relationship between the score of health literacy and behavioral change (b = 0.019, 95% confidence interval = (0.010–0.029), P < 0.001).

Conclusions:

Improving the level of health literacy can lead to change people's behavior in relation to tobacco consumption. However, due to the lack of relevant texts, there is a need for further studies in this field.

Factors Associated with Cigarette Smoking and Motivation to Quit among Street Food Sellers in Vietnam

Since 2013, smoke-free signs in public places, including in restaurants and food stores, have been introduced in Vietnam, aiming to prevent passive smoking. Although extensive research has been carried out on second-hand smoking among clients in public places (e.g., hospitals, restaurants) in Vietnam, no single study exists which captures the current practice of smoking among street food outlets. This study aims to estimate the prevalence of smoking and identify factors associated with smoking status and cessation motivation amongst food sellers in Vietnam. A cross-sectional study involving 1733 food providers at outlets was conducted in 29 districts in Hanoi capital, Vietnam, in 2015. The prevalence of smoking amongst food sellers was determined to be 8.5% (25% for men and 0.8% for women). The enforcement of the smoke-free policy remains modest, since only 7.9% observed outlets complied with the law, providing a room designated for smokers. Although approximately 80% of the participants were aware of the indoor smoke-free regulations in public places, such as restaurants and food stores, 40.2% of smokers reported no intention of quitting smoking. A percentage of 37.6% of current smokers reported that despite having intentions to quit, they did not receive any form of support for smoking cessation. Being male and having hazardous drinking habits and a poor quality of life were all factors that were significantly associated with smoking status. Additionally, having awareness of smoking’s adverse effects and being frequently supervised by the authority were associated with a greater motivation to quit. This study highlights the importance of an accompanying education and smoking cessation program in addition to the frequent inspection and reinforcement of smoke-free policy in food stores. This research extends on our knowledge of smoking prevalence and its factors related to smoking events and motivation to quit among street food outlets. Overall, this study strengthens the idea that more government efforts towards preventing passive smoking and smoking cessation education are necessary in restaurants and other street food outlets.

Relationship Between Exposure to Second-Hand Smoke in the Workplace and Occupational Injury in the Republic of Korea

Background

Most studies in the field of smoking exposure in the workplace linked to occupational safety have only focused on active smoking. Few studies have reported that exposure to second-hand smoke in the workplace is a possible factor increasing the risk of occupational injury without considering occupational characteristics. The aim of this study was to determine the association between occupational injury and level of exposure to second-hand smoke at the workplace among Korean workers, after taking into account occupational characteristics.

Method

Using data from the third Korean Working Conditions Survey, levels of exposure to second-hand smoke were categorized as none, moderate, and high. We investigated the influence of exposure to second-hand smoke on occupational injury using logistic regression analysis with stratification by sex, smoking status, smoke-free policy in the workplace, and occupational characteristics. Occupational characteristics (occupational classification, working schedule, length of working day, and co-exposure to occupational hazards in the workplace) were stratified and analyzed using logistic regression models to estimate the risk of occupational injury linked to exposure to second-hand smoke.

Results

Among all participants, there was a significant dose-dependent association between risk of occupational injury and level of exposure level to second-hand smoke. After stratification by sex and smoking status, there was a significant association between risk of occupational injury and exposure level to second-hand smoke. Moreover, there was a significant relationship between exposure to second-hand smoke in the workplace and occupational injury, depending on the smoking-free policy at workplace (odds ratio [OR] in completely non-smoking workplace, 4.23; OR in non-smoking workplace with separate smoking area, 2.98; OR in smoking workplace 2.84). Additionally, there was a significant relationship between risk of occupational injury and exposure to second-hand smoke after stratification by occupational classification, working schedule, long working hours, and co-exposure to hazards in the workplace.

Discussion

There was a dose-response relationship between occupational injury and exposure to second-hand smoke, even after stratification to reduce the impact of various potential confounders and after taking into account occupational characteristics. These findings provide greater insight into the effects of exposure to second-hand smoke on the working population and may direct further research and policy-making in this field.

Factors Predicting the Provision of Smoking Cessation Services Among Occupational Health Nurses in Thailand

The purpose of this study was to identify factors predicting occupational health nurses' provision of smoking cessation services. Data were collected via a self-administered questionnaire distributed to 254 occupational health nurses in Thailand. Analysis by structural equation modeling revealed that self-efficacy directly and positively influenced smoking cessation services, and mediated the relationship between workplace factors, nurse factors, and smoking cessation services. The final model had good fit to the data, accounting for 20.4% and 38.0% of the variance in self-efficacy and smoking cessation services, respectively. The findings show that self-efficacy is a mediator that influences provision of smoking cessation services by occupational health nurses. Interventions to enhance nurses' self-efficacy in providing smoking cessation services are expected to promote provision of smoking cessation services to workers.

Relationship of airflow limitation severity with work productivity reduction and sick leave in a Japanese working population

BACKGROUND

The aim of this study was to reveal the association between airflow limitation (AL) severity and reduction with work productivity as well as use of sick leave among Japanese workers.

METHODS

This cross-sectional study included 1,378 workers who underwent a lung function test during a health checkup at the Japanese Red Cross Kumamoto Health Care Center. AL was defined as forced expiratory volume in 1 second/forced vital capacity of <0.7. Workers completed a questionnaire on productivity loss at work and sick leave. The quality and quantity of productivity loss at work were measured on a ten-point scale indicating how much work was actually performed on the previous workday. Participants were asked how many days in the past 12 months they were unable to work because of health problems. Logistic regression analysis was used to assess the associations between AL severity and the quality and quantity of productivity loss at work as well as use of sick leave.

RESULTS

Compared with workers without AL, workers with moderate-to-severe AL showed a significant productivity loss (quality: odds ratio [OR] =2.04, 95% confidence interval [CI]: 1.12-3.71, P=0.02 and quantity: OR =2.19, 95% CI: 1.20-4.00, P=0.011) and use of sick leave (OR =2.69, 95% CI: 1.33-5.44, P=0.006) after adjusting for sex, age, body mass index, smoking status, hypertension, hyperglycemia, dyslipidemia, sleep duration, work hours per day, and workplace smoking environment.

CONCLUSION

AL severity was significantly associated with work productivity loss and use of sick leave. Our findings suggested that early intervention in the subjects with AL at the workforce might be beneficial for promoting work ability.

Effect of Workplace Counseling Interventions Launched by Workplace Health Promotion and Tobacco Control Centers in Taiwan: An Evaluation Based on the Ottawa Charter

Workplace health promotion (WHP) is important to prevent work-related diseases, reduce workplace hazards, and improve personal health of the workers. Health promotion projects were launched through the centers of WHP funded by the Taiwan Bureau of Health Promotion since 2003. Hence, the aim of this study is to evaluate the impact of WHP programs intervention from 2003 to 2007. The intervention group consisted of 838 business entities which had ever undergone counseling of the three centers in northern, central, and southern Taiwan from 2003 to 2007. The control group was composed of 1000 business entities randomly selected from the business directories of the Ministry of Economic Affairs, Taiwan. The questionnaire survey included general company profiles and the assessment of workplace health according to the five action areas of the Ottawa Charter for Health Promotion. We have received 447 (53.3%) questionnaires from the intervention group and 97 questionnaires from the control group. The intervention group was more effective in using the external resources and medical consultation, and they had better follow-up rates of the abnormal results of annual health examinations. Compared to the control group, the intervention group had a significantly decreased smoking rate in 246 companies (61.2%) and a reduced second-hand smoke exposure in 323 companies (78.6%) (p<0.001). By means of the intervention of WHP programs, we can enhance the awareness of the enterprises and the employees to improve worksite health and to create a healthy work environment.

Impact of Work Environments and Occupational Hazards on Smoking Intensity in Korean Workers

The purpose of this study was to investigate the influence of work environments and occupational hazards on smoking intensity by occupation type in Korean workers. This study used the data from the Fourth Korea National Health and Nutrition Examination Survey in 2009. The sample of this study included 3,769 adults who were aged 18 years or older and had an occupation of office work, sales, or manufacturing. After controlling for sociodemographic characteristics, the generalized linear models revealed that office workers and the sales force who had smoking co-workers at the workplace were more likely to smoke than those who did not. A dirty workplace and exposure to occupational noise were significant factors increasing the smoking intensity for manufacturers. A smoking cessation program considering physical work environments and co-workers' support should be developed for Korean workers.

Cancer Attributable to Asbestos Exposure in Shipbreaking Workers: A Matched-Cohort Study

Purpose

Long-term follow-up studies of asbestos-related cancer in shipbreaking workers are lacking. This study examines the relationship between cancer incidence and asbestos exposure among former Taiwan shipbreaking workers.

Methods

A total of 4,427 shipbreaking workers and 22,135 population-based matched controls were successfully followed in this study. The study cohort was linked to the Taiwan Cancer Registry for new cancer cases. The adjusted hazard ratio (aHR) for cancer was calculated for the shipbreaking workers with Total Exposure Potential Scores (TEP) for asbestos.

Results

Follow-up generated 109,932 person-years, with 940 deaths and 436 cancer cases, among 4,427 shipbreaking workers from 1985 to 2008. The high asbestos exposure group also had a statistically significant increase in the risk of overall cancer (aHR= 1.71; 95% CI: 1.42-2.05), esophagus cancer (aHR= 2.31; 95% CI: 1.00-5.41), liver and intrahepatic bile duct cancer (aHR= 1.60; 95% CI: 1.08-2.36), and trachea, bronchus, and lung cancer (aHR= 3.08; 95% CI: 1.80-5.25). Mesothelioma cases were found in the high asbestos exposure group. Moreover, overall cancer, esophagus cancer, and trachea, bronchus, and lung cancer were seen in a dose-dependent relationship with asbestos exposure.

Conclusions

This study presented the elevated trend of asbestos exposure with cancer incidence for overall cancer, esophagus cancer, and trachea, bronchus, and lung cancer among shipbreaking workers. Those workers previously exposed to asbestos should receive persistent monitoring in order to early detect adverse health outcomes.

Privatization of solid waste collection services: Lessons from Gaborone

Formal privatization of solid waste collection activities has often been flagged as a suitable intervention for some of the challenges of solid waste management experienced by developing countries. Proponents of outsourcing collection to the private sector argue that in contrast to the public sector, it is more effective and efficient in delivering services. This essay is a comparative case study of efficiency and effectiveness attributes between the public and the formal private sector, in relation to the collection of commercial waste in Gaborone. The paper is based on analysis of secondary data and key informant interviews. It was found that while, the private sector performed comparatively well in most of the chosen indicators of efficiency and effectiveness, the public sector also had areas where it had a competitive advantage. For instance, the private sector used the collection crew more efficiently, while the public sector was found to have a more reliable workforce. The study recommends that, while formal private sector participation in waste collection has some positive effects in terms of quality of service rendered, in most developing countries, it has to be enhanced by building sufficient capacity within the public sector on information about services contracted out and evaluation of performance criteria within the contracting process.

The role of betel-quid chewing in smoking cessation among workers in Taiwan

BACKGROUND

Current smokers exhibit a higher rate of betel-quid chewing than non-smokers. However, little is known regarding the extent to which betel-quid chewing may affect attempts to quit smoking and smoking cessation. The aim of the present study is to examine the association between betel-quid chewing and patterns of quitting smoking. Specifically, we explore whether betel-quid chewing is associated with (1) current smokers who have never attempted to quit versus those who have attempted to quit and have failed, those who are in the process of quitting, and successful cessation smokers, and (2) current smokers who have attempted to quit and have failed versus those who have successfully quit smoking.

METHODS

A telephone survey of 7,215 workers was conducted and obtained an 88.6% response rate. In the survey, the respondents' smoking and betel-quid chewing statuses were recorded and a list of covariates was assessed.

RESULTS

After controlling for the effect of the covariates, betel-quid chewing was found to be more highly associated with current smokers who have never attempted to quit, compared to current smokers who are in the process of quitting (OR = 12.72; 95% CI = 1.05-154.26), successful cessation smokers (OR = 3.62; 95% CI = 2.32-5.65), and smokers who have attempted to quit and have failed (OR = 1.37; 95% CI = 1.06-1.77), respectively. In addition, betel-quid chewing is more highly associated with a failure to quit smoking than with successfully quitting smoking (OR = 3.46; 95% CI = 2.17-5.51).

CONCLUSION

The findings support four plausible reasons why betel-quid chewing may dissuade smokers from quitting. These reasons highlight additional avenues for potentially reducing the smoking population in workplaces, such as considering work contexts and social norms, and product sales in smoking-cessation campaigns.

Cancer incidence of Taiwanese shipbreaking workers who have been potentially exposed to asbestos

BACKGROUND

Shipbreaking remains one of the most dangerous jobs worldwide. Shipbreaking workers are exposed to many hazardous chemicals, especially asbestos. Unfortunately, long-term follow-up studies of cancer incidence patterns in shipbreaking workers are lacking. This study examines whether there is an increased risk of cancer among male shipbreaking workers over a 24-year follow-up period.

METHODS

4155 male shipbreaking worker's information was retrospectively collected from Kaohsiung's Shipbreaking Workers Union database from 1985. The study cohort was linked to the Taiwan Cancer Registry from 1985 to 2008 for new cancer cases. The expected number of cancers for shipbreaking workers was calculated by using the age (5-year intervals) and calendar time-specific annual rates of cancer incidence with reference to the general population of Taiwan from 1985 to 2008. Standardized incidence ratios (SIRs) were calculated as relative risk estimates. The hazard ratio (HR) for cancer was calculated for the shipbreaking workers with Total Exposure Potential Scores for asbestos.

RESULTS

After consideration of a 5-year latency period, an elevated incidence of overall cancer (N=368; SIR=1.13 (1.01-1.25)), oral cavity cancer (N=83; SIR=1.99 (1.58-2.46)), and trachea, bronchus, and lung cancers (N=53; SIR=1.36 (1.02-1.78)) was found among male shipbreaking employees. Moreover, mesothelioma cases were found in those who had the occupation of flame cutter. The high asbestos exposure group was associated with an increased SIR of developing overall cancer and oral cancer, whether we considered a 5-year or 10-year latency period.

CONCLUSION

Asbestos-related diseases, including lung cancer and mesothelioma, were seen in excess in these shipbreaking workers and some cases appeared to have a dose-dependent relationship. Preventative measures among male shipbreaking workers should be researched further.

Smoke-free policies and non-smokers' reactions to SHS exposure in small and medium enterprises

INTRODUCTION

Non-smoker employees can significantly improve the existing smoke-free policies in the workplace by asserting their right for smoke-free air and confronting smoker colleagues. The aim of the study was to assess the psychological and social drivers of non-smokers' readiness to assert their right for smoke-free air in the workplace.

MATERIALS AND METHODS

Twenty-six small-and-medium enterprises (SME) with diverse background were randomly selected, and 284 employees agreed to participate in the study. Our study focused on the responses of 85 non-smokers (M age = 34 years, SD = 7.98, 84.2% worked in indoor offices). A cross-sectional design was used and participants completed a structured anonymous questionnaire assessing background and demographic characteristics, and psychosocial predictors of assertiveness intentions.

RESULTS

Although more than half of non-smokers reported they were often/almost always bothered by exposure to SHS, roughly one third of them reported having asked their colleagues not to smoke at work. Regression analysis showed that the effects of distal predictors (i.e. annoyance due to SHS exposure) were mediated by past behaviour, attitudes (protection motivation beliefs), social norms, and self-efficacy.

CONCLUSIONS

Health beliefs related to SHS exposure, and concerns about workplace health and job performance, social norms and self-efficacy can increase the assertiveness of non-smokers in workplace settings. Related campaigns should focus on communicating normative messages and self-efficacy training to empower non-smoker employees to act assertively towards protecting their smoke-free rights.

Re-examining the price sensitivity of demand for cigarettes with quantile regression

Existing studies suggest that teenagers, young adults, and individuals of low socioeconomic status are more sensitive to changes in cigarette prices. However, little is known as to whether there are differences in price sensitivity between heavy and light smokers. To examine this gap, the present study uses quantile regression to estimate price sensitivity of demand for smokers with different levels of tobacco consumption. We conducted a national personal interview survey in Taiwan and the results showed price sensitivity is positively associated with the level of cigarette consumption. The data indicate that pricing strategies are more likely to notably reduce cigarette consumption for heavy smokers. Our findings suggest policymakers can meet target control for cigarette consumption by effectively adjusting market prices of cigarettes.

Estimating the cost of a smoking employee

OBJECTIVE

We attempted to estimate the excess annual costs that a US private employer may attribute to employing an individual who smokes tobacco as compared to a non-smoking employee.

DESIGN

Reviewing and synthesising previous literature estimating certain discrete costs associated with smoking employees, we developed a cost estimation approach that approximates the total of such costs for U.S. employers. We examined absenteeism, presenteesim, smoking breaks, healthcare costs and pension benefits for smokers.

RESULTS

Our best estimate of the annual excess cost to employ a smoker is $5816. This estimate should be taken as a general indicator of the extent of excess costs, not as a predictive point value.

CONCLUSIONS

Employees who smoke impose significant excess costs on private employers. The results of this study may help inform employer decisions about tobacco-related policies.

Mortality among shipbreaking workers in Taiwan--a retrospective cohort study from 1985 to 2008

BACKGROUND

Shipbreaking workers are typically exposed to a wide range of hazardous chemicals. However, long-term follow-up studies of their mortality patterns are lacking. This study examined mortality among shipbreaking workers over a 24-year follow-up period.

METHODS

A total of 4,962 shipbreaking workers were recruited from the database of the Kaohsiung Shipbreaking Workers Union. The data were then linked to the Taiwan National Death Registry from 1985 to 2008. The mortality ratios-standardized for age and calendar years-(SMRs) for various causes of deaths were calculated with reference to the general population of Taiwan.

RESULTS

Among men workers, a statistically significant increased SMR was observed for all causes (SMR = 1.28), all cancers (SMR = 1.26; particularly noteworthy for lesions of oral and nasopharyngeal: SMR 2.03, liver: SMR 4.63, and lung: SMR 1.36), cirrhosis of the liver (SMR = 1.32), and accidents (SMR = 1.91). A statistically significant increase in mortality was observed for respiratory system cancer (SMR = 1.87) and lung cancer (SMR = 1.91) among workers with a longer duration of employment (≥7 years). The result also showed that among shipbreaking workers who were still alive, two people had mesothelioma and 10 people have asbestosis.

CONCLUSIONS

Those employed in shipbreaking industries experienced an increase in mortality from all causes. The increased SMR for lung cancer was probably related to asbestos, metals, and welding fume exposure.

Smoking and absence from work: systematic review and meta-analysis of occupational studies

AIMS

This study aimed to assess the association between smoking and absenteeism in working adults.

METHODS

A systematic review and meta-analysis was performed by electronic database searches in MEDLINE, EMBASE, CAB Abstracts, PubMed, Science Direct and National Health Service Economic Evaluation Database (February 2012). Longitudinal, prospective cohorts or retrospective cohorts were included in the review. Summary effect estimates were calculated using random-effects meta-analysis. Heterogeneity was assessed by I(2) and publication bias was investigated.

RESULTS

A total of 29 longitudinal or cohort studies were included. Compared with non-smokers, current smokers had a 33% increase in risk of absenteeism [95% confidence interval (CI): 1.25-1.41; I(2)  = 62.7%; 17 studies]. Current smokers were absent for an average of 2.74 more days per year compared with non-smokers (95% CI: 1.54-3.95; I(2)  = 89.6%; 13 studies). Compared with never smokers, ex-smokers had a 14% increase in risk of absenteeism (95% CI: 1.08-1.21; I(2)  = 62.4%; eight studies); however, no increase in duration of absence could be detected. Current smokers also had a 19% increase in risk of absenteeism compared with ex-smokers (95% CI: 1.09-1.32, P < 0.01, eight studies). There was no evidence of publication bias. The total cost of absenteeism due to smoking in the United Kingdom was estimated to be £1.4 billion in 2011.

CONCLUSIONS

Quitting smoking appears to reduce absenteeism and result in substantial cost-savings for employers.

Aplicação de um programa de cessação do tabagismo com rodoviários urbanos

O presente relato tem como objetivo descrever a aplicação de um programa de cessação do tabagismo realizado em uma empresa de transporte coletivo urbano que implantou a política do ambiente livre do fumo. Pretende-se contribuir apresentando um modelo de intervenção de abordagem cognitivocomportamental possível de ser implantado no contexto organizacional. Método: o programa foi realizado em três etapas: levantamento no número de fumantes (n=90; 13% do universo total de funcionários), avaliação do nível de dependência de nicotina (n=30; 33% dos fumantes) e realização dos grupos de cessação do tabagismo, dos quais participaram 16 fumantes (18%). Os grupos aconteceram em quatro encontros semanais, com duração de duas horas cada, sendo que, após trinta dias, foi realizado um encontro de manutenção. Resultados: o programa demonstrou boa eficácia, pois, dos 16 fumantes que participaram, 7 atingiram a abstinência e 9 reduziram o consumo. Conclusão: os psicólogos podem ser agentes comprometidos em manter um ambiente livre de fumo e prevenir os efeitos do tabagismo nas organizações utilizando intervenções cognitivo-comportamentais como a descrita.

The Associations Between Smoking and Occupational Categories

The implementation of smoke-free policies for workplaces and their impacts have been far from satisfactory. We investigated smoking prevalence in various occupations using data (n = 9283) from the Korea National Health and Nutrition Examination Survey collected from 2008 to 2010. Young adults who were working in the occupation categories of “service and sales,” “skilled agricultural, fishery, and forest workers,” and “crafts and machine operation” for men and “service and sales” for women showed 1.8 to 7.1 and 3.7 times higher ( P < .05) smoking prevalence compared with the reference (managers and professionals), respectively, and the highest prevalence among the 7 occupational categories that were studied. Drinking and stress level were positively associated with being current smokers. We provide quantitative evidence supporting clinicians and policy makers wishing to establish smoking-cessation programs in workplaces for young adults in South Korea, and evidence supporting the improvement of prevention by the concomitant reduction of risk factors.

An economic analysis of tobacco elimination policies in Turkey

OBJECTIVE

We aim to evaluate the costs and benefits of various tobacco elimination policies, specifically, an immediate taxation option and eight tax-combined long-term cessation programs.

METHODS

We combine demographic projections for the period 2012-2050 with incidence and mortality rates of four major cigarette related diseases, price elasticity of cigarette demand and unit costs of nonprice measures to reduce demand in order to estimate the net present discounted values of policy alternatives.

RESULTS

The tax-combined cessation programs yield lower net costs to households and the society when they phase out smoking earlier. However, immediate taxation option is found to be superior, for both households and the society, to all tax-combined cessation programs irrespective of the duration of intervention. While all policies are estimated to yield significant reductions in the expected number of smoking related diseases and deaths, a class-based 20-year intervention is found to be the most effective program.

CONCLUSIONS

Although immediate taxation policy and tax-combined class-based 20-year intervention program emerge as the best tobacco elimination policies for the society, more research is needed on assessing the cost-effectiveness, applicability and social desirability of these alternatives and on designing additional policies to overcome their limitations.

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.

The cross-effects of cigarette and betel nut consumption in Taiwan: have tax increases made a difference?

This paper empirically identifies cross-price elasticities of betel nut and cigarette consumption in Taiwan based on the Central Bureau of Statistics demand model. It compares reduction of cigarette consumption as a result of the proposed Betel Nut Health Tax with reduction of betel nut consumption as a result of the Tobacco Health and Welfare Taxes levied in 2002 and 2006, in order to determine which tax is most effective. Results from a simulated comparative analysis indicate that the Betel Nut Health Tax reduces cigarette consumption to a much greater extent than the Tobacco Health and Welfare Taxes reduce betel nut consumption.

Effect of cigarette taxes on the consumption of cigarettes, alcohol, tea and coffee in Taiwan

OBJECTIVES

To analyse whether a health tax of 10 New Taiwan Dollars (NT$) (US$0.3) imposed on cigarettes in 2009 will help to reduce cigarette consumption, and whether or not the cigarette tax will affect consumption of alcohol, coffee and tea.

STUDY DESIGN

Time series data for consumption and retail prices of tobacco, alcohol, tea and coffee were collected and analysed for the period 1973-2007.

METHODS

To establish the Central Bureau of Statistics demand function to estimate the overall demand price elasticities of cigarettes, alcohol, tea and coffee, a seemingly unrelated regression analysis was used. The independent variables were annual consumption of cigarettes, alcohol, tea and coffee. The dependent variables were prices of and expenditures on cigarettes, alcohol, tea and coffee.

RESULTS

The estimated own-price elasticities for cigarettes and alcohol are close to -0.726. The own-price elasticities for tea and coffee are less than those for cigarettes and alcohol. Hence, it is predicted that the NT$10 health tax on cigarettes will reduce cigarette consumption by a significant 13.19%. Analysis of cross-price elasticity reveals that alcohol is complementary to cigarettes.

CONCLUSIONS

Taxation is an effective smoking control policy tool that not only helps to reduce consumption of cigarettes, but also reduces consumption of alcoholic beverages.

Auricular acupressure combined with multimedia instruction or alone for quitting smoking in young adults: A quasi-experimental study

BACKGROUND

Smoking plays a disease-related risk factor and is however the principal cause of preventable death. Many studies support the use of combined rather than single interventions to stop smoking.

OBJECTIVE

This study aimed to evaluate the effects of auricular acupressure combined with multimedia instruction in comparison with auricular acupressure alone on smoking cessation in young adults.

METHOD

A quasi-experimental research design was used and participants were assigned to experimental groups according to their preference. Group 1 received the 10-week program with auricular acupressure plus multimedia instruction; Group 2 received auricular acupressure alone. Thirty-two participants were in each group were recruited from universities in Taiwan. The physical and psychological data were collected right before and after the program.

RESULTS

This study demonstrated the effects of smoking cessation on physical and psychological factors in each group. Statistical between-group differences existed in psychological factors of smoking cessation self-efficacy and nicotine dependence, but not in physical factors of carbon monoxide and cotinine.

CONCLUSIONS

This study adds to the body of research on the benefits of using auricular acupressure combined with or without multimedia instruction for smoking cessation in adolescents. The combined intervention was more effective especially in increasing smoking cessation self-efficacy and decreasing nicotine dependence. Further study is suggested adding control groups such as placebo in order to understand a single effect of smoking cessation.

Beliefs regarding smoking in the workplace: results from the Global Workplace Smoking Survey

OBJECTIVES

To collect global information on attitudes of employers and employees toward workplace smoking and cessation.

METHODS

The Global Workplace Smoking Survey collected data from employers (smoking and non-smoking) and smoking employees in 14 countries in 2007.

RESULTS

A total of 3,525 employees (all smokers) and 1,403 employers (smokers and non-smokers) participated in the survey. While the majority of employees and employers felt that workplace smoking was unacceptable, this was indicated by a greater proportion of employers than employees, particularly in Europe and Asia (92 and 93% of employers vs. 61 and 71% of employees, respectively). Only 29% of employees believed that smoking has negative financial impacts on their company compared to 46% of employers. While almost three-quarters of employees agreed that all workplaces should be smoke-free, agreement was greater among employers (87%).

CONCLUSIONS

Our results indicate a broad lack of support for workplace smoking among employers and smoking employees, although employers were more likely to stress negative financial consequences and advantages of smoke-free workplaces. These results suggest directions for subsequent programs to reduce workplace smoking by assisting smoking cessation.

Local governments' dependence on tobacco tax revenue: a deterrent to tobacco control in the Republic of Korea

OBJECTIVE

To investigate, in the Republic of Korea, whether local governments' participation in an anti-smoking programme supported by the National Health Promotion Fund in 2002-2003 was related to the percentage of local tax revenue comprised by the tobacco consumption tax (TCT).

METHODS

Using financial and administrative data on 163 municipalities, the authors estimated logit models of local governments' participation in the anti-smoking programme as a function of the proportion of local tax revenue that came from the TCT and a set of control variables, namely local socioeconomic characteristics and the size of the staff in the local public health centre (PHC).

FINDINGS

Local governments that derived a greater percentage of their local tax revenue from the TCT, particularly those that ranked in the upper fourth in terms of this percentage, were less likely to participate in the anti-smoking programme. Insufficient staff in the PHC was also found to be associated with lower participation in the anti-smoking programme.

CONCLUSION

Local governments' dependence on revenue from the TCT may be a deterrent to tobacco control in the Republic of Korea.

The urban poor's economic profile of tobacco use

OBJECTIVES

Low-income minority tobacco users are price sensitive and are more likely to quit when tobacco prices go up. No prior research documents economic characteristics of low-income tobacco users. The study investigates economic profile of tobacco use among urban low-income African Americans.

METHODS

In this baseline study (n = 338), tobacco users and nonusers were compared, and their economic conditions of tobacco use including (current and past) employment barriers were examined.

RESULTS

The study results demonstrate that tobacco use status appeared to be associated with employment barriers among low income populations. Controlling for other independent variables in the multivariate logistic regression model, previous criminal activity, planning to move out, and female gender were found to be linked to labor force status.

CONCLUSIONS

More research efforts on how indigent tobacco-using individuals develop their employment skills and become economically independent are needed.

The synergistic effect of cigarette taxes on the consumption of cigarettes, alcohol and betel nuts

BACKGROUND

Consumption of cigarettes and alcoholic beverages creates serious health consequences for individuals and overwhelming financial burdens for governments around the world. In Asia, a third stimulant--betel nuts--increases this burden exponentially. For example, individuals who simultaneously smoke, chew betel nuts and drink alcohol are approximately 123 times more likely to develop oral, pharyngeal and laryngeal cancer than are those who do not. To discourage consumption of cigarettes, the government of Taiwan has imposed three taxes over the last two decades. It now wishes to lower consumption of betel nuts. To assist in this effort, our study poses two questions: 1) Will the imposition of an NT$10 Health Tax on cigarettes effectively reduce cigarette consumption? and 2) Will this cigarette tax also reduce consumption of alcoholic beverages and betel nuts? To answer these questions, we analyze the effect of the NT$10 tax on overall cigarette consumption as well as the cross price elasticities of cigarettes, betel nuts, and alcoholic beverages.

METHODS

To establish the Central Bureau of Statistics demand function, we used cigarette, betel nut, and alcoholic beverage price and sales volume data for the years 1972-2002. To estimate the overall demand price elasticity of cigarettes, betel nuts, and alcoholic beverages, we used a seemingly unrelated regression analysis.

RESULTS

We find that the NT$10 health tax on cigarettes will reduce cigarette consumption by a significant 27.22%. We also find that cigarettes, betel nuts, and alcoholic beverages have similar inherent price elasticities of -0.6571, -0.5871, and -0.6261 respectively. Because of this complementary relationship, the NT$10 health tax on cigarettes will reduce betel nut consumption by 20.07% and alcohol consumption by 7.5%.

CONCLUSION

The assessment of a health tax on cigarettes as a smoking control policy tool yields a win-win outcome for both government and consumers because it not only reduces cigarette consumption, but it also reduces betel nut and alcoholic beverage consumption due to a synergistic relationship. Revenues generated by the tax can be used to fund city and county smoking control programs as well as to meet the health insurance system's current financial shortfall.

The health behaviors of the older US worker

BACKGROUND

As the US workforce ages, lifestyle factors will increasingly affect their health, yet little information is available on their prevalence in older working populations.

METHODS

Using the nationally representative 1997-2003 National Health Interview Survey (NHIS), reported current smoking, risky drinking and leisure-time physical activity behaviors of older workers (> or =65 years) were compared with older non-workers. These behaviors were evaluated by age, gender, race, ethnicity, and occupation, as well as prototype "healthy" and "risky" persons.

RESULTS

The study population of 4,946 older US workers and 38,313 older non-workers represented an estimated 3.9 million older workers and 28.9 million older non-workers annually. Relative to older non-workers, older workers reported more current smoking and risky drinking, but higher levels of leisure-time physical activity with variations by subpopulations.

CONCLUSIONS

Less than 4% of the older US worker population reported overall healthy behaviors. Certain occupations and other subpopulations can be targeted for age-appropriate behavioral interventions.

Effect of smoking status on productivity loss

OBJECTIVE

The objective of this study was to describe health-related productivity losses in nonsmokers, former smokers, and current smokers using a large, cross-sectional database of U.S. employees.

METHODS

Volunteers completed the Wellness Inventory, an instrument measuring productivity losses related to 11 health conditions affecting employee health. Results are aggregated, dollarized, and reported by smoking group.

RESULTS

Current smokers missed more days of work and experienced more unproductive time at work compared with former smokers and nonsmokers. The average annual cost for lost productivity for nonsmokers was 2623 dollars/year compared with 3246 dollars/year for former smokers and 4430 dollars/year for current smokers. More than half the costs were due to unproductive time at work.

CONCLUSION

Current smokers incurred the highest productivity losses, which translated into higher costs to employers for current smokers. Costs were lower for former smokers and nonsmokers.

Cigarette smoking and poverty in China

Drawing on the 1998 China national health services survey data, this study estimated the poverty impact of two smoking-related expenses: excessive medical spending attributable to smoking and direct spending on cigarettes. The excessive medical spending attributable to smoking is estimated using a regression model of medical expenditure with smoking status (current smoker, former smoker, never smoker) as part of the explanatory variables, controlling for people's demographic and socioeconomic characteristics. The poverty impact is measured by the changes in the poverty head count, after smoking-related expenses are subtracted from income. We found that the excessive medical spending attributable to smoking may have caused the poverty rate to increase by 1.5% for the urban population and by 0.7% for the rural population. To a greater magnitude, the poverty headcount in urban and rural areas increased by 6.4% and 1.9%, respectively, due to the direct household spending on cigarettes. Combined, the excessive medical spending attributable to smoking and consumption spending on cigarettes are estimated to be responsible for impoverishing 30.5 million urban residents and 23.7 million rural residents in China. Smoking related expenses pushed a significant proportion of low-income families into poverty in China. Therefore, reducing the smoking rate appears to be not only a public health strategy, but also a poverty reduction strategy.

Economic gains and health benefits from a new cigarette tax scheme in Taiwan: a simulation using the CGE model

Background

This study evaluates the impact of an increase in cigarette tax in Taiwan in terms of the effects it has on the overall economy and the health benefits that it brings.

Methods

The multisector computable general equilibrium (CGE) model was used to simulate the impact of reduced cigarette consumption resulting from a new tax scheme on the entire economy gains and on health benefits.

Results

The results predict that because of the new tax scheme, there should be a marked reduction in cigarette consumption but a notable increase in health benefits that include saving between 28,125 and 56,250 lives. This could save NT$1.222~2.445 billion (where US$1 = NT$34.6) annually in life-threatening, cigarette-related health insurance expenses which exceeds the projected decrease of NT$1.275 billion in Gross Domestic Product (GDP) because of reduced consumption and therefore tax revenue.

Conclusion

Overall, the increased cigarette excise tax will be beneficial in terms of both the health of the general public and the economy as a whole.

Smoking behaviour in Taiwan, 2001

PURPOSE

To examine smoking behaviours in Taiwan and compare those behaviours to those in the USA.

METHODS

Using the National Health Interview Survey (NHIS) of Taiwan (2001), a survey of over 20 000 participants, frequencies were calculated for smoking, ex-smoking, quantity smoked, and exposure to environmental tobacco smoke (ETS). Breakdowns by age, sex, and socioeconomic status were also calculated.

RESULTS

The ratio of male to female smoking rates was 10.9 to 1 among adults (46.8%/4.3%), but 3.6 to 1 among underage teenagers (14.3%/4.0%). The proportion of underage to adult smokers was three times higher for girls than for boys. Smoking prevalence substantially increased during and after high school years, and peaked in those aged 30-39 years. Smoking rates of high school age adolescents increased more than threefold if they did not attend school or if they finished their education after high school. Low income and less educated smokers smoked at nearly twice the rate of high income and better educated smokers. The smoker/ex-smoker ratio was close to 7. Male daily smokers smoked on average 17 cigarettes/day, and females, 11. Half of the total population, especially infants and women of childbearing age, were exposed to ETS at home.

CONCLUSIONS

Taiwan has particularly high male smoking prevalence and much lower female prevalence. The low female prevalence is likely to increase if the current sex ratio of smoking by underage youth continues. The low quit rate among males, the high ETS exposure of females and young children at home, and the sharp increase in smoking rates when students leave school, are of particular concern. These observations on smoking behaviour can provide valuable insights to assist policymakers and health educators in formulating strategies and allocating resources in tobacco control.