Association Between Temporary Employment and Current Smoking and Change in Smoking Behaviors: A Prospective Cohort Study From South Korea (2009-2018)

BACKGROUND

Previous studies have suggested that employment insecurity is associated with adverse health outcomes. We explored the association between temporary employment and smoking behaviors.

METHODS

We analyzed 11,795 workers (51,867 observations) from the Korea Health Panel Study (2009-2018). Employment types were categorized as regular, fixed-term, or daily, based on the duration of labor contract. The outcomes were current smoking status and changes in smoking behavior (initiation or cessation) in the following year. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The proportions of fixed-term and daily workers were 41.2% and 16.4% for women and 23.6% and 12.4% for men, respectively. Temporary employment was associated with increased odds of current smoking, while also demonstrating prospective associations with changes in smoking behaviors. For instance, in prospective analyses, male workers with fixed-term and daily employments were associated with a decreased likelihood of smoking cessation (OR 0.77; 95% CI, 0.65-0.91 for fixed-term employment and OR 0.66; 95% CI, 0.52-0.83 for daily employment) in the following year compared to those with regular employment. Moreover, those experiencing consecutive temporary employment was most inversely associated with smoking cessation in both men (OR 0.56; 95% CI, 0.44-0.71) and women (OR 0.37; 95% CI, 0.16-0.85) compared to those experiencing consecutive regular employment. However, no clear association between temporary employment and smoking initiation was observed in both men and women.

CONCLUSION

Temporary employment is directly associated with current smoking and inversely associated with smoking cessation. Policies are needed to improve job insecurity among temporary employees.

Effects of a supportive workplace environment on the success rate for smoking cessation camp

Background

This study was conducted to identify the success rate for smoking cessation over time after participation in a therapeutic smoking cessation camp, and to identify how participant characteristics, including a supportive workplace environment for smoking cessation (SWESC), affect the success rate for smoking cessation.

Methods

In all, 296 participants at smoking cessation camps in Ulsan between 2015 and 2020 were investigated. The success rates of smoking cessation after weeks 4, 6, 12, and 24 at camp were investigated. The participants were grouped as workers with an SWESC, and workers without an SWESC, and variables (age, education, household income, marital status, drinking, exercise, body mass index, morbidity, job, number of counseling sessions, cigarettes smoked per day and smoking initiation age) were investigated. Multiple logistic regression analysis was conducted at each time point. In addition, Cox regression analysis was performed to evaluate the variables affecting the success rate for smoking cessation over time.

Results

The smoking cessation success rate of workers with an SWESC at week 24 (90.7%) was higher than that for workers without an SWESC (60.5%). Multiple logistic regression was performed to determine the relationship between each variable and the success rates for smoking cessation at week 6, 12, and 24. SWESC was confirmed as significant (p < 0.05) variables for increased success rate for smoking cessation at all 3 time points. After adjusting for all variables, the Cox proportional hazards survival analysis showed a hazard ratio of 6.17 for SWESC (p < 0.001,; 95% confidence interval: 3.08-12.38).

Conclusions

At a professional treatment smoking cessation camp, participants with an SWESC showed a significantly higher success rate for smoking cessation. Supportive workplace environment for workers' health is expected to be an important factor for smoking cessation projects as well as other health promotion projects at workplace.

Simultaneous Measurement and Distribution Analysis of Urinary Nicotine, Cotinine, Trans-3'-Hydroxycotinine, Nornicotine, Anabasine, and Total Nicotine Equivalents in a Large Korean Population

Measurement of multiple nicotine metabolites and total nicotine equivalents (TNE) might be a more reliable strategy for tobacco exposure verification than measuring single urinary cotinine alone. We simultaneously measured nicotine, cotinine, 3-OH cotinine, nornicotine, and anabasine using 19,874 urine samples collected from the Korean National Health and Nutrition Examination Survey. Of all samples, 18.6% were positive for cotinine, 17.4% for nicotine, 17.3% for nornicotine, 17.6% for 3-OH cotinine, and 13.2% for anabasine. Of the cotinine negative samples, less than 0.3% were positive for all nicotine metabolites, but not for anabasine (5.7%). The agreement of the classification of smoking status by cotinine combined with nicotine metabolites was 0.982-0.994 (Cohen's kappa). TNE3 (the molar sum of urinary nicotine, cotinine, and 3-OH cotinine) was most strongly correlated with cotinine compared to the other nicotine metabolites; however, anabasine was less strongly correlated with other biomarkers. Among anabasine-positive samples, 30% were negative for nicotine or its metabolites, and 25% were undetectable. Our study shows that the single measurement of urinary cotinine is simple and has a comparable classification of smoking status to differentiate between current smokers and non-smokers relative to the measurement of multiple nicotine metabolites. However, measurement of multiple nicotine metabolites and TNE3 could be useful for monitoring exposure to low-level or secondhand smoke exposure and for determining individual differences in nicotine metabolism. Geometric or cultural factors should be considered for the differentiation of tobacco use from patients with nicotine replacement therapy by anabasine.

Diagnostic Performance Evaluation of the Novel Index Combining Urinary Cotinine and 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol in Smoking Status Verification and Usefulness for Trend Monitoring of Tobacco Smoking Exposure

During the last decade in Korea, urinary cotinine concentrations in non-current smokers have decreased, making it difficult to distinguish secondhand smoke (SHS) exposure from nonsmokers because of overlapping values between non-current smokers with and without SHS exposure. Additionally, the importance of smoking status verification to avoid misclassification is increasing with the increased use of e-cigarettes. We developed a novel index combining urinary cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and evaluated its diagnostic performance for the classification of smoking status using the KNHANES VII dataset. A total of 10,116 and 5575 Korean participants aged >19 years with measured urinary cotinine concentrations were enrolled in a training set and validation set, respectively. When using 4.0 as the cutoff value for distinguishing current smokers from non-current smokers, urinary cotinine∙NNAL showed a better diagnostic performance than urinary cotinine or urinary NNAL. Among e-cigarette users, urinary cotinine∙NNAL showed more accurate classification rates than urinary NNAL. Furthermore, urinary cotinine∙NNAL had measurable values in non-current smokers, whereas urinary cotinine had unmeasurable values in one-fourth of all participants. This study shows that urinary cotinine∙NNAL might be a useful biomarker for smoking status verification and trend monitoring of tobacco smoking exposure with increased use of e-cigarettes.

Effect of Second-Hand Smoke Exposure on Establishing Urinary Cotinine-Based Optimal Cut-Off Values for Smoking Status Classification in Korean Adults

Regulations for banning smoking in indoor public places and workplaces have increased worldwide in recent years. A consecutive Korean National Health and Nutrition Examination Survey (KNHANES) between 2008 and 2018 showed a trend toward significant decreases in self-reported tobacco smoke exposure and measured urinary cotinine concentrations. We established and compared each optimal cut-off value for assessing the effect of second-hand smoke (SHS) exposure on establishing urinary cotinine-based cut-off values for smoking status classification in a population setting controlled for racial and cultural diversity, using four KNHANES datasets consisting of the 2008, 2011, 2014, and 2018 surveys. A total of 18,229 Korean participants aged >19 years with measured urinary cotinine concentrations were enrolled. Self-reports of current smoking status showed that the prevalence of current smokers decreased from 22.9% to 18.2% between 2008 and 2018. During this period, the median value of urinary cotinine in nonsmokers decreased from 5.86 µg/L to 0.48 µg/L, whereas the median value showed no remarkable decrease in current smokers. The AUC-based optimal cut-off values of urinary cotinine concentration for distinguishing current smokers from nonsmokers decreased from 86.5 µg/L to 11.5 µg/L. Our study showed that decreased SHS exposure would result in decreased optimal cut-off values for distinguishing current smokers from nonsmokers. In addition, the study suggests that the range of urinary cotinine concentration to define SHS exposure for the trend monitoring of populationof SHS exposure is appropriate between 0.30 µg/L and 100 µg/L. In addition, our study showed the importance of determination of cotinine concentration, which would have allowed us to avoid mistakes in qualification to the study group in an increased use of e-cigarette setting.

Better air but not for all? Changes in second-hand smoke exposure at workplaces in 29 European countries over 10 years

BACKGROUND

As the largest study of its kind to date, this article aims to describe the scope, trends over time, socio-demographic risk groups and the association with different progressive regulations relating to workplace second-hand smoke (SHS) exposure in 29 European countries during a period of high regulatory action.

METHODS

Three waves of the European Working Conditions Surveys (2005, 2010 and 2015) were evaluated, including a total of 95 718 workers. The samples are representative for all employed residents of the 29 countries included. All interviews were conducted face-to-face at respondents' homes (computer-assisted personal interviews). SHS exposure among the overall working population of 29 countries-including smokers-was examined. Workplace regimes were grouped corresponding to the sub-scale 'workplace' as used in the Tobacco Control Scale.

RESULTS

Between 2005 and 2015, SHS exposure in the European countries declined from around 19.0% (95% CI 16.1-22.0) to 9.9% (8.3-11.5). High SHS-exposure was reported by workers with the lowest level of education [11.5% (9.7-13.2)], among high-skilled manual labourers [14.3% (12.1-16.4)] and among those without a standard employment contract [11.2% (9.3-13.1)]. The highest exposure was reported by workers in the food service industry [19.7% (16.8-22.6)]. Countries with less workplace-related smoking prevention regulations were found to have the highest overall levels of exposure.

CONCLUSION

This multinational series of cross-sectional surveys on the trends in passive smoking in the workplace have shown that countries with more comprehensive workplace smoking bans overall report lower levels of SHS exposure among their work force as compared with slow progressing countries.

Effects of work-related factors on self-reported smoking among female workers in call centers: a cross-sectional study

Objectives

This study conducted to investigate work-related factors in relation to smoking among women working in call centers in Gwangju, South Korea.

Methods

From 56 call centers (7320 employees), we selected 10 and conducted a survey using a structured questionnaire by randomly selecting 10% of workers from each center. A total of 387 subjects participated in this survey We analyzed for 375 respondents, after excluding men and those with missing responses. We analyzed the relationships of work-related factors such as emotional labor, workplace violence, employment type, annual salary, working hours, employment period with smoking, using multiple logistic regression analysis. Emotional labor and workplace violence were measured using the Korean Emotional Labor Scale (K-ELS) and Korean Workplace Violence Scale (K-WVS).

Results

The prevalence of current smoking among call center female workers was 13.6%. Univariate analysis showed that “Emotional disharmony and hurt”, “Experience of psychological and sexual violence from supervisors and co-workers” among items of K-ELS and K-WVS, working hours, annual salary correlated with smoking. After adjusting for emotional labor, workplace violence, employment type, annual salary, working hours, employment period, and age, only working hours show a significant association with smoking. Women who worked 40–49 h had 3.50 times (95% CI = 1.04–11.80) and worked more than 50 h had 8.68 times (95% CI = 1.89–39.78) greater odds of smoking as compared with women who worked less than 40 h.

Conclusions

Smoking was associated with working hours among female workers in call center. However, emotional labor and workplace violence did not show significant relationships with smoking.

Socio-demographic and clinical factors contributing to smoking cessation among men: a four-year follow up study of the Korean Health Panel Survey

Background

To examine factors contributing to smoking cessation among male smokers, we looked at how socio-demographic and clinical characteristics influence stopping smoking with passage of time.

Methods

Data from the Korea Health Panel during 2009–2012 were used. In 2009 a total of 2,941 smokers were followed up until 2012. Statistical analysis using a generalized linear mixed model was performed for all smokers, and a subgroup analysis was also performed to determine whether individual characteristics influence smoking cessation differently based on health condition.

Results

Male smokers who have married or graduated college or above were more likely to succeed in smoking cessation. Those with chronic disease(s) were also more likely to quit smoking than those without. Among those without chronic disease, higher education showed significant association with smoking cessation, however, being married or ever married showed significant association with smoking cessation among those with chronic disease.

Conclusions

The finding that higher education helped smokers without chronic disease succeed in smoking cessation suggests that a smoking cessation campaign should focus on those with lower education. In addition, quit smoking programs may be particularly helpful for male smokers with chronic disease(s) who have never married.

Effect of a smoke-free policy on staff attitudes and behaviours within an Australian metropolitan health service: a 3 year cross-sectional study

Objective In 2010, Peninsula Health (Vic., Australia), became smoke free as part of the locally developed smoking prevention and cessation strategy. The aim of the present study was to determine the effect of a smoke-free policy on smoking status and employee attitudes over a 3-year period. Methods Data were collected by three surveys 6 months before and 6 months and 3 years after policy introduction. Demographic data, smoking status and attitudes to the introduction of the smoke-free policy were collected for analysis. Results There were 3224 individual responses collected over three time points with similar demographics at each time. There were fewer employees smoking at 6 months (P=0.010) and 3 years (P<0.001) after implementation of the policy. There were more employees who felt positive towards the policy 3 years after its introduction (P=0.028). There were greater odds of an employee not identifying as a smoker after the policy was in place than before the policy was implemented. Conclusions The introduction of a smoke-free policy within a health service was an upstream health intervention that was well accepted by staff and appeared to have a positive effect on smoking behaviours. What is known about the topic? There are an increasing number of environmental changes that seek to decrease smoking behaviours. Bans within workplaces have a direct effect on employee smoking behaviour. What does this paper add? Some employee groups demonstrated the greater odds of smoking when a smoke-free policy was in place. Employees felt positive towards this policy. What are the implications for practitioners? This policy change supports environmental changes affecting individual health-related behaviours.

Minnesota's smokefree policies: impact on cessation program participants

BACKGROUND

Smokefree policies are enacted to protect individuals from secondhand smoke; however, these laws may have broader cessation effects.

PURPOSE

This study investigated the relationship between Minnesota's local and statewide smokefree policies and quitting outcomes among cessation program enrollees.

METHODS

Data were collected from 2006 to 2008 from two groups of participants (n=1644 pre-statewide law; n=1273 post-statewide law) and analyzed in 2009. Website enrollees were surveyed by Internet or telephone 6 months post-enrollment. Others were surveyed by telephone 7 months post-enrollment.

RESULTS

Those who enrolled in a cessation program after the statewide smokefree law were more likely to quit (p<0.05, relative risk [RR]=1.15) and were predicted to achieve a 30-day abstinence rate 4.1 percentage points greater than that achieved by those who quit pre-statewide law (30.9% vs 26.8%, respectively). Participants who quit post-statewide law were less likely to relapse and were predicted to have a relapse rate 6.4 percentage points below those who quit pre-statewide law (p<0.05, RR=0.87). Each additional year residing in or adjacent to a county with a local smokefree ordinance in place, up until the time of the statewide law, reduced the likelihood of achieving abstinence post-statewide law (p<0.001, RR=0.92) and increased the likelihood of relapse and the predicted relapse rate (p<0.05, RR=1.05).

CONCLUSIONS

Abstinence and relapse rates for those enrolling in cessation programs appeared more favorable after the implementation of Minnesota's statewide smokefree law, suggesting that smokefree policies may have a small but beneficial impact on cessation outcomes. Previous exposure to local smokefree ordinances may lessen this effect.

South Korean military service promotes smoking: a quasi-experimental design

PURPOSE

The South Korean (SK) government monopolizes the tobacco industry and is accused of pushing smoking on captive military personnel. However, estimating the association between military service and smoking is difficult, since military service is required for all SK men and the few civilian waivers are usually based on smoking determinants, e.g., social status.

MATERIALS AND METHODS

Using a quasi-experimental design we validly estimate the association between military service and smoking. Military service was assigned by immigration patterns to the United States, instead of an experimenter, by comparing Korean Americans who happened to immigrate before or after the age(s) of mandated service. Smoking promotion in the military was also described among SK veterans, to identify the probable mechanisms for veterans' smoking tendencies.

RESULTS

Veterans were 15% [95% confidence interval (CI), 4 to 27] more likely to ever-puff and 10% (95% CI, 0 to 23) more likely to ever-smoke cigarettes, compared to a similar group of civilians. Among veterans, 92% (95% CI, 89 to 95) recalled cigarettes were free, 30% (95% CI, 25 to 35) recalled smokers were given more work breaks and 38% (95% CI, 32 to 43) felt explicit "social pressure" to smoke. Free cigarettes was the strongest mechanism for veterans' smoking tendencies, e.g., veterans recalling free cigarette distribution were 16% (95% CI, 1 to 37) more likely to ever-smoke than veterans not recalling.

CONCLUSION

These patterns suggest military service is strongly associated with smoking, and differences between veterans and civilians smoking may carry over long after military service. Given military service remains entirely in government purview, actively changing military smoking policies may prove most efficacious. This highlights the importance of recent bans on military cigarette distribution, but policies eliminating other smoking encouragements described by veterans are necessary and could effectively reduce the smoking prevalence by as much as 10% in SK.

A cost-effectiveness analysis of India's 2008 prohibition of smoking in public places in Gujarat

Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India's Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the cost-effectiveness ratio ranges from $2 to $112 per LY gained and $37 to $386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.

The impact of graphic cigarette warning labels and smoke-free law on health awareness and thoughts of quitting in Taiwan

The present study evaluated the impact of Taiwan's graphic cigarette warning labels and smoke-free law on awareness of the health hazards of smoking and thoughts of quitting smoking. National representative samples of 1074 and 1094 people, respectively, were conducted successfully by telephone in July 2008 (pre-law) and March 2009 (post-law). Results reveal that the prevalence of thinking about the health hazards of smoking among smokers increased from 50.6% pre-law to 79.6% post-law, while the prevalence among non-smokers increased from 68.8 to 94.1% during the same period. The prevalence rates of smokers who reported thinking of quitting rose from 30.2% pre-law to 51.7% post-law. Multivariate analyses results indicated that the implementation of graphic warning labels and the smoke-free law significantly increased the odds of awareness about the health hazards of smoking [odds ratio (OR) = 6.39, 95% confidence interval (CI) = 4.84-8.44] and thoughts of quitting smoking (OR = 2.39, 95% CI = 1.48-3.87). In conclusion, the implementation of a smoke-free law in combination with graphic cigarette warning labels has been effective in increasing thoughts about the health hazards of smoking and quitting smoking.

Employee and employer support for workplace-based smoking cessation: results from an international survey

OBJECTIVES

Workplace smoking cessation programs can increase smoking cessation rates, improve employee health, reduce exposure to second-hand smoke, and decrease costs. To assist with the development of such programs, we conducted a Global Workplace Smoking Survey to collect information on workplace attitudes towards smoking cessation programs.

METHODS

Data were collected from 1,403 employers (smoking and non-smoking) and 3,525 smoking employees participating in surveys in 14 countries in Asia, Europe, and South America in 2007. Results were weighted to ensure that they were representative of smokers and employers at companies with the specified number of employees.

RESULTS

More than two-thirds of employers (69%) but less than half of employees (48%) indicated that their company should help employees with smoking cessation. Approximately two-thirds of employees and 81% of employers overall felt that smoke-free policies encourage cessation, but fewer individuals from Europe (vs. from Asia or South America) agreed with this. In companies with a smoke-free policy, 76% of employees and 80% of employers felt that their policy had been somewhat, very, or extremely effective in motivating employees to quit or reduce smoking. Employers and employees differed substantially regarding appropriate methods for encouraging cessation, with more employees favouring financial incentives and more employers favouring education.

CONCLUSIONS

Both employees and employers value smoke-free workplace programs and workplace cessation support activities, although many would like their companies to offer more support. These results will be useful for organizations exploring means of facilitating smoking cessation amongst employees.

Secondhand smoke at work

PURPOSE OF REVIEW

Secondhand smoke (SHS) exposure in the workplace remains common and has important acute and chronic health effects. The present study reviews the recent evidence linking workplace SHS exposure with poor health and the benefits of smoke-free workplace legislation.

RECENT FINDINGS

Workplace SHS exposure continues to occur in many parts of the United States and around the world. Occupational SHS exposure has been linked to serious chronic health effects including lung cancer, cardiovascular disease, chronic obstructive pulmonary disease, and poor general health. Smoke-free workplace laws rapidly reduce workplace SHS exposure and improve respiratory health including symptoms and lung function. Smoke-free workplace legislation is also expected to reduce the chronic health effects of passive smoking, including cardiopulmonary disease and lung cancer.

SUMMARY

Occupational exposure to SHS has serious negative health consequences and will shorten lifespan. Smoke-free workplace legislation should be universally adopted around the world.