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Compliance with the smoke-free public places legislation in Nepal: A cross-sectional study from Biratnagar Metropolitan City. PLoS One 2022; 17:e0264895. [PMID: 35263360 PMCID: PMC8906589 DOI: 10.1371/journal.pone.0264895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Smoke-free legislation banning tobacco smoking in public places was implemented across Nepal in 2014 with the ambition to reduce the impact of second-hand smoking. As part of a comprehensive policy package on tobacco control, the implementation of the legislation has seen a marked reduction in tobacco consumption. Yet there remains uncertainty about the level of compliance with smoke-free public places. Objectives This study assesses the compliance with smoke-free laws in public places and the factors associated with active smoking in public places in Biratnagar Metropolitan City, Nepal. Methods A cross-sectional study was conducted in the Biratnagar metropolitan city in Province 1 of Nepal from July to December 2019. A total of 725 public places within the metropolitan city were surveyed using a structured survey tool. Active smoking was the primary outcome of the study which was defined as smoking by any person during the data collection time at the designated public place. Results The overall compliance with smoke-free legislation was 56.4%. The highest compliance (75.0%) was observed in Government office buildings. The lowest compliance was observed in eateries, entertainment, and shopping venues (26.3%). There was a statistically significant association between active smoking and the presence of ‘no smoking’ notices appended at the entrance and the odds of active smoking in eateries, entertainment, hospitality, shopping venues, transportations and transits was higher compared to education and health care institutions. None of the ‘no smoking’ notices displayed fully adhered to the contents as prescribed by the law. Conclusion As more than half of the public places complied with the requirements of the legislation, there was satisfactory overall compliance with the smoke-free public places law in this study. The public venues (eateries, shopping venues and transportations) that are more frequently visited and have a high turnover of the public have lower compliance with the legislation. The content of the message in the ‘no smoking’ notices needs close attention to adhere to the legal requirements.
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Al-Jayyousi GF, Kurdi R, Alsaei S, Al-Kaabi H, Alrushdi AJ, Abdul Rahim HF. Students' perceptions of a university 'No Smoking' policy and barriers to implementation: a cross- sectional study. BMJ Open 2021; 11:e043691. [PMID: 34108159 PMCID: PMC8191599 DOI: 10.1136/bmjopen-2020-043691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Effective policies are an important tool for reducing tobacco use. We examine student perceptions of the existing no-smoking policy in the country's largest national university and identify perceived barriers to its implementation. We explore student support for a 100% tobacco-free campus policy. DESIGN We conducted a cross-sectional survey using a self-administered on-line questionnaire. SETTING This study was conducted at Qatar University (QU), the largest national institution of higher education in Qatar. PARTICIPANTS A total of 199 students participated out of a stratified random sample of students aged ≥18 years with active registration in the Spring 2020 semester. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed students' knowledge of and attitudes towards QU's current no-smoking policy, the perceived barriers to its implementation, and support for a 100% tobacco-free policy. RESULTS Only 26% (95% CI 19.97 to 32.03) and 16.6% (95% CI 11.70 to 22.49) of respondents correctly identified the current policy on traditional and electronic cigarettes, respectively. Less than 30% of respondents held positive attitudes towards policy enforcement, and more male respondents reported positive attitudes towards compliance than women. Support for a 100% tobacco-free policy was at 77.2%, but it was significantly lower among tobacco users compared with non-users (35.9% and 91.8%, respectively; p<0.001). Failure to establish clear penalties, opposition from smoking students, and lack of cessation services were perceived as major barriers to implementation. CONCLUSIONS Clear and comprehensive tobacco-free policies are important tools for creating environments conducive to rejecting smoking and seeking cessation support. The findings underscore the need to increase awareness about the policy, advocate for clear penalties for violations, and promote cessation services on campus. Qualitative research is needed to further understand perceived barriers to successful enforcement of the policy.
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Affiliation(s)
- Ghadir Fakhri Al-Jayyousi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
| | - Rana Kurdi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
| | - Shahd Alsaei
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
| | - Haya Al-Kaabi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
| | - Al Jaziya Alrushdi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
| | - Hanan F Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Ad Dawhah, Qatar
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Goel S, Sharma D, Gupta R, Mahajan V. Compliance with smoke-free legislation and smoking behaviour: observational field study from Punjab, India. Tob Control 2017; 27:407-413. [PMID: 28798264 PMCID: PMC6047142 DOI: 10.1136/tobaccocontrol-2016-053559] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 11/04/2022]
Abstract
Background Indian smoke-free legislation requires prohibition of smoking at public places and owners of public places to display ‘no smoking’ signages. Aims and objectives The study aims to assess the compliance of public places with smoke-free legislation and determine the factors associated with active smoking in public places. Methodology This was a cross-sectional analytic observational quantitative survey conducted by a team of trained field investigators using a structured observational checklist across 6875 public places in Punjab state of India. The study was carried out over a period of 3 years. Results A total of 6875 public places across 22 districts of Punjab were observed. The overall compliance to smoke-free law in Punjab was 83.8%. The highest overall compliance was observed in healthcare facilities (89.6%) and least in transit stations (78.8%). Less active smoking was observed in public places where display of ‘no smoking’ signage compliant with smoke-free law of India was present (adjusted OR 0.6). Further, there was a positive association between active smoking and places where the owner of public places smoked (OR 5.2, CI 2.5 to 11.1). Conclusion More than 80% of the public places in a jurisdiction in north India were compliant with the smoke-free legislation of India. ‘No smoking’ signages displayed as per legislation have an effect on curbing smoking behaviours at public places. It is recommended that policymakers should focus more on implementing the smoke-free law at transit sites and structured training sessions should be organised for owners of workplaces.
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Affiliation(s)
- Sonu Goel
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Sharma
- Department of Community Medicine, Government Medical College, Chandigarh, India
| | - Rakesh Gupta
- Department of Health and Family Welfare, Government of Punjab, Punjab, India
| | - Vini Mahajan
- Department of Health and Family Welfare, Government of Punjab, Punjab, India
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Vardavas CI, Agaku I, Patelarou E, Anagnostopoulos N, Nakou C, Dramba V, Giourgouli G, Argyropoulou P, Antoniadis A, Gourgoulianis K, Ourda D, Lazuras L, Bertic M, Lionis C, Connolly G, Behrakis P. Ashtrays and signage as determinants of a smoke-free legislation's success. PLoS One 2013; 8:e72945. [PMID: 24023795 PMCID: PMC3762932 DOI: 10.1371/journal.pone.0072945] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/21/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Successful smoke-free legislation is dependent on political will, enforcement and societal support. We report the success and pitfalls of a non-enforced nationwide smoke-free legislation in Greece, as well as ways in which compliance and enforcement-related factors, including ashtrays and signage, may impact indoor secondhand smoke (SHS) concentrations. Methods A follow-up study of venues (n = 150, at baseline, n = 75 at 2-year follow-up) in Greece assessed indoor particulate matter with a diameter less than 2.5 micrometers (PM2.5) concentrations attributable to SHS smoke every six months for two years (n = 455 venue/measurements). Results Following the implementation of the 2010 smoke-free legislation, mean PM2.5 concentrations attributable to SHS fell from 175.3 µg/m3 pre-ban to 84.52 µg/m3 immediately post-ban, increasing over subsequent waves (103.8 µg/m3 and 158.2 µg/m3 respectively). Controlling for potential influential factors such as ventilation, time of day, day of week, city and venue type, all post-ban measurements were still lower than during the pre-ban period (Wave 2 beta: −118.7, Wave 3 beta: −87.6, and Wave 4 beta: −69.9). Outdoor or indoor signage banning smoking was not found to affect SHS concentrations (beta: −10.9, p = 0.667 and beta: −18.1, p = 0.464 respectively). However, ashtray or ashtray equivalents were strong determinants of the existence of indoor SHS (beta: +67 µg/m3, p = 0.017). Conclusions While the public may be supportive of smoke-free legislation, adherence may decline rapidly if enforcement is limited or nonexistent. Moreover, enforcement agencies should also focus on the comprehensive removal of ashtray equivalents that could act as cues for smoking within a venue.
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Affiliation(s)
- Constantine I. Vardavas
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
- * E-mail:
| | - Israel Agaku
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Evridiki Patelarou
- Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
| | | | - Chrysanthi Nakou
- Department of Medicine, Aristotelio University of Thessaloniki, Thessaloniki, Greece
| | - Vassiliki Dramba
- Department of Pulmonary Medicine, General Hospital of Serres, Serres, Greece
| | - Gianna Giourgouli
- Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece
| | | | - Antonis Antoniadis
- Department of Pulmonary Medicine, General Hospital of Serres, Serres, Greece
| | | | - Despoina Ourda
- South Eastern European Research Center, Thessaloniki, Greece
| | - Lambros Lazuras
- South Eastern European Research Center, Thessaloniki, Greece
| | - Monique Bertic
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Christos Lionis
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Gregory Connolly
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Panagiotis Behrakis
- Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
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Serra C, Bonfill X, Pladevall Vila M, Cabezas Pena C. WITHDRAWN: Interventions for preventing tobacco smoking in public places. Cochrane Database Syst Rev 2008; 2008:CD001294. [PMID: 18646069 PMCID: PMC10734372 DOI: 10.1002/14651858.cd001294.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Consol Serra
- Department of Health and Experimental SciencesUnit of Research in Occupational HealthPompeu Fabra UniversityDr Aiguader, 80BarcelonaSpain08003
| | - Xavier Bonfill
- Hospital de la Santa Creu i Sant PauSpanish Cochrane Centre, Department of Epidemiologyc/ Sant Antoni M. Claret, 167BarcelonaCataloniaSpain08025
| | | | - Carmen Cabezas Pena
- Health DepartmentSubdireccio General de Salut PublicaRoc Boronat 81‐9508005 BarcelonaCataloniaSpain
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López MJ, Pérez-Ríos M, Schiaffino A, Nebot M, Montes A, Ariza C, García M, Juárez O, Moncada A, Fernández E. Mortality attributable to passive smoking in Spain, 2002. Tob Control 2008; 16:373-7. [PMID: 18048612 DOI: 10.1136/tc.2006.019679] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Exposure to environmental tobacco smoke (ETS) is associated with a variety of health effects, including lung cancer and ischaemic heart disease. The objective of this study was to estimate the number of deaths caused by exposure to ETS among non-smokers in Spain during the year 2002 METHODS Prevalence of ETS exposure among never smokers was gathered from three region based health interview surveys. The relative risks of lung cancer and ischaemic heart diseases were selected from three meta-analyses. Population attributable risk (PAR) was computed using a range of prevalences (minimum-maximum). The number of deaths attributable to ETS was calculated by applying PARs to mortality not attributable to active smoking in 2002. The analyses were stratified by sex, age and source of exposure (home, workplace and both combined). In addition, a sensitivity analysis was performed for different scenarios. RESULTS Among men, deaths attributable to ETS ranged from 408 to 1703. From 247 to 1434 of these deaths would be caused by the exposure only at home, 136-196 by exposure only in the workplace and 25-73 by exposure at both home and the workplace. Among women, the number of attributable deaths ranged from 820 to 1534. Between 807 and 1477 of these deaths would be caused by exposure only at home, 9-32 by exposure only in the workplace and 4-25 by exposure both at home and in the workplace. CONCLUSION Exposure to ETS at home and at work in Spain could be responsible for 1228-3237 of deaths from lung cancer and ischaemic heart disease. These data confirm that passive smoking is an important public health problem in Spain that needs urgent attention.
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Affiliation(s)
- M J López
- Evaluation and Intervention Methods Unit, Public Health Agency of Barcelona, Barcelona, Spain.
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Twose J, Schiaffino A, García M, Borras JM, Fernández E. Correlates of exposure to second-hand smoke in an urban Mediterranean population. BMC Public Health 2007; 7:194. [PMID: 17683585 PMCID: PMC1963452 DOI: 10.1186/1471-2458-7-194] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 08/05/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe the socio-demographic factors associated with exposure to second-hand smoke (SHS) in different settings (home, leisure, and workplace). METHODS We analysed cross-sectional data on self-reported SHS exposure in 1059 non-daily smokers interviewed in the Cornellà Health Interview Survey Follow-up Study in 2002. We calculated age-adjusted prevalence rates and prevalence rate ratios of SHS exposure at home, at the workplace, during leisure time, and in any of these settings. RESULTS The age-standardized prevalence rate of SHS exposure in any setting was 69.5% in men and 62.9% in women. Among men, 25.9% reported passive smoking at home, 55.1% during leisure time, and 34.0% at the workplace. Among women, prevalence rates in these settings were 34.1%, 44.3% and 30.1%, respectively. Overall exposure to SHS decreased with age in both men and women. In men, SHS exposure was related to marital status, physical activity, smoking, and alcohol intake. In women, SHS exposure was related to educational level, marital status, occupational status, self-perceived health, smoking-related illness, and alcohol intake. CONCLUSION The prevalence of SHS exposure in this population was high. The strongest association with exposure were found for age and occupational status in men, and age and educational level in women.
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Affiliation(s)
- Jorge Twose
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Spain
- Organització Catalana de Transplantaments
| | - Anna Schiaffino
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Montse García
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Josep Maria Borras
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
- Department of Clinical Sciences, Universitat de Barcelona, Spain
| | - Esteve Fernández
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Spain
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Germain D, Wakefield M, Durkin S. Non-smokers' responses when smokers light up: a population-based study. Prev Med 2007; 45:21-5. [PMID: 17509677 DOI: 10.1016/j.ypmed.2007.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 03/26/2007] [Accepted: 03/28/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study examines the extent to which the 'common courtesy approach' is adopted by non-smokers when in the presence of smokers, in the state of Victoria, Australia, where restrictions on smoking in public places are relatively comprehensive. METHOD 4,765 non-smokers aged 18 years and over were surveyed over two representative population telephone-administered surveys of randomly sampled Victorians conducted in 2004 and 2005. RESULTS Only 5.5% of non-smokers said they would ask a person to stop smoking if they lit up a cigarette nearby. The majority of non-smokers (74.7%) reported they would move away and 16.4% said they would do nothing. When asked what they would do if, in a public place, someone next to them asked if they minded whether they smoked, 48.8% of non-smokers reported they would say they would prefer it if they didn't smoke, while 28.0% reported that they would tell the person they don't mind when they would prefer that person not smoke. Overall, 46.7% of non-smokers indicated they would consent to be exposed to second-hand smoke if someone asked them this question. CONCLUSIONS Our findings underline the importance of smoke-free policies in protecting a significant proportion of the non-smoker population, who remain unlikely to protect themselves individually.
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Affiliation(s)
- Daniella Germain
- Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, 1 Rathdowne Street, Carlton Victoria 3053, Australia
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López MJ, Nebot M, Sallés J, Serrahima E, Centrich F, Juárez O, Ariza C. [Measurement of exposure to environmental tobacco smoke in education centers, health centers, transport facilities and leisure places]. GACETA SANITARIA 2005; 18:451-7. [PMID: 15625043 DOI: 10.1016/s0213-9111(04)72032-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe levels of exposure to environmental tobacco smoke (ETS) in various public places in Barcelona (Spain). MATERIAL AND METHOD Vapor-phase nicotine was measured with passive samplers containing a sodium bisulfate treated filter with a 37 mm diameter. The places sampled were primary and secondary schools, hospitals, primary care centers, train stations, subways, universities, airports, restaurants and discotheques. RESULTS Primary and secondary schools and health centers had the lowest levels of ETS exposure, with mean concentrations of less than 1 microg/m3. The mean values found in transport and universities were 2.16 microg/m3 in train stations, 3.30 microg/m3 in subways, 4.30 microg/m3 in airports and 4.97 microg/m3 in universities. The highest concentrations were found in restaurants and discotheques, with mean values of 12.36 microg/m3 in restaurants and 130.65 microg/m3 in discotheques. All samples taken from primary and secondary schools, airports, subways, restaurants and discotheques contained ETS. Likewise, 90% of the samples taken from train stations and 96% of those from universities contained ETS. Seventy-nine percent of the samples from hospitals and 58% of those from primary care centers contained ETS. CONCLUSIONS The results confirm that passive smoking is an important public health problem in Spain and that greater efforts are needed to enforce smoke-free policies in public spaces and workplaces.
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Affiliation(s)
- María J López
- Servei de Promoció de la Salut, Agència de Salut Pública de Barcelona, Barcelona, Spain.
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Rodríguez-Artalejo F, Lafuente Urdinguio P, Guallar-Castillón P, Garteizaurrekoa Dublang P, Sáinz Martínez O, Díez Azcárate JI, Foj Alemán M, Banegas JR. One year effectiveness of an individualised smoking cessation intervention at the workplace: a randomised controlled trial. Occup Environ Med 2003; 60:358-63. [PMID: 12709522 PMCID: PMC1740534 DOI: 10.1136/oem.60.5.358] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To assess the effectiveness of a smoking cessation intervention at the workplace. The intervention was adapted to smokers' tobacco dependence, and included minimal structured counselling at the first visit (5-8 minutes), nicotine patches for three months, and three sessions of counselling for reinforcement of abstinence (2-3 minutes) over a three month period. METHODS Open randomised trial with two groups: the intervention group, and the control group which was subjected to standard clinical practice, consisting of short (30 seconds to one minute) sporadic sessions of unstructured medical antismoking advice. The trial was carried out among 217 smokers of both sexes, aged 20-63 years, motivated to quit smoking and without contraindications for nicotine patches, who were employees at a public transport company and at two worksites of an electric company. The main outcome measure was self reported tobacco abstinence confirmed by carbon monoxide in expired air </=10 ppm. Analysis was performed according to intention-to-treat. RESULTS The rate of continuous abstinence at 12 months was 20.2% for the intervention versus 8.7% for the control group (OR: 2.58; 95% CI: 1.13 to 5.90; p = 0.025). In subgroup analyses, effectiveness of the intervention did not vary substantially with age, tobacco dependence, number of cigarettes smoked per day, number of years of tobacco consumption, degree of desire to quit smoking, time spent with smokers, subjective health, and presence of tobacco related symptoms. Weight gain at 12 months was similar for both groups (1.69 kg in the intervention v 2.01 kg in the control group; p = 0.21). CONCLUSIONS A simple and easily generalisable intervention at the workplace is effective to achieve long term smoking cessation. In a setting similar to ours, nine subjects would have to be treated for three months for one to achieve continuous abstinence for 12 months.
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Affiliation(s)
- F Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Spain.
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11
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Longo DR, Johnson JC, Kruse RL, Brownson RC, Hewett JE. A prospective investigation of the impact of smoking bans on tobacco cessation and relapse. Tob Control 2001; 10:267-72. [PMID: 11544392 PMCID: PMC1747578 DOI: 10.1136/tc.10.3.267] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine the long term impact of workplace smoking bans on employee smoking cessation and relapse. Over three years we studied a total of 1033 current or former smokers (intervention group) employed in smoke-free hospitals and 816 current or former smokers (comparison group) employed in non-smoke-free workplaces. The design of this natural experiment is a prospective cohort study. We randomly selected both hospitals and employees from 12 strata based on hospital size and state tobacco regulations, and sampled employees in the same communities. Main outcome measures were post-ban quit ratio and relapse rate. RESEARCH DESIGN Between groups comparisons were conducted using the Cochran-Mantel-Haenszel statistic for general association, stratified Cox proportional hazards models, and the CMH analysis of variance statistic based on ranks. McNemar's test and the sign test were used to test for changes over time within each group. RESULTS Differences in the post-ban quit ratio were observed between intervention and comparison groups (p < or = 0.02). For employees whose bans were implemented at least seven years before survey, the post-ban quit ratio was estimated at 0.256, compared with 0.142 for employees in non-smoke-free workplaces (p = 0.02). After controlling for a variety of factors, time to quit smoking was shorter for the hospital employees (p < 0.001), with an overall relative risk of quitting of 2.3. Contrary to expectations, relapse rates were similar between the groups. CONCLUSION Employees in workplaces with smoking bans have higher rates of smoking cessation than employees where smoking is permitted, but relapse is similar between these two groups of employees. The results of this investigation have international applicability for policy makers, clinicians, employers, and employees. Countries should review smoking policies in workplaces in light of their own smoking patterns and efforts to deal with environmental tobacco smoke.
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Affiliation(s)
- D R Longo
- Center for Family Medicine Science in the Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, Columbia, Missouri 65212, USA.
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Serra C, Cabezas C, Bonfill X, Pladevall-Vila M. Interventions for preventing tobacco smoking in public places. Cochrane Database Syst Rev 2000:CD001294. [PMID: 10908490 DOI: 10.1002/14651858.cd001294] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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, EMBASE, HEALTHSTAR, PAIS, and CDP File (National Centre for Chronic Disease Prevention and Health Promotion, CDC) "Smoking and Health database". 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 before and after studies and interrupted time series, and uncontrolled before and after studies. 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 the study was abstracted by one reviewer and checked by two others. Studies were combined using qualitative narrative synthesis. MAIN RESULTS Eleven of 22 studies reporting information about interventions to reduce smoking in public places met all the inclusion criteria. All included studies were uncontrolled before and after studies. The most effective strategies used comprehensive, multicomponent 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. REVIEWER'S CONCLUSIONS Carefully planned and resourced, multicomponent strategies effectively reduced smoking within public places. Less comprehensive strategies were less effective. All the studies used relatively weak experimental designs. Most studies were done in the USA, and 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.
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Affiliation(s)
- C Serra
- Spanish Cochrane Centre, Institut Universitari Fundació Parc Taulí, Parc Taulí s/n, Sabadell, Barcelona, Spain, 08208.
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