Alcohol drinking as a mediator of the influence of smoking prevalence on second-hand smoke exposure in workplaces: a mediation analysis

Haoxiang Lin,Chun Chang,Zhao Liu

doi:10.1186/s13011-020-00307-0

Haoxiang Lin, Chun Chang + Show 1 more

Open Access

https://doi.org/10.1186/s13011-020-00307-0

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Abstract

ObjectiveBoth alcohol drinking and second-hand smoke (SHS) exposure have shown a strong association with smoking behaviour. This study uses mediation analysis to clarify the process underlying the relationship between smoking prevalence and SHS exposure and the extent to which this relationship is mediated by alcohol use in the workplace.MethodA total of 14,195 employees from 81 companies in China participated in this survey. Mediation analysis was used to establish the mediation effect of alcohol drinking. Structural equation modelling (SEM) was used to evaluate the role of alcohol drinking when a smoke-free (SF) workplace policy was imposed.ResultsFor males, approximately 6.3% of the effects on SHS exposure were mediated through the channel of alcohol use. For females, this channel mediated 14.1% of the total effects. SF policy was negatively associated with smoking prevalence and SHS exposure. The indirect effect of the SF policy on reducing SHS exposure by controlling smoking behaviour was significant. For smokers, worksite smoking bans were negatively associated with the smoking amount and drinking behaviour, and the indirect effect of this policy on promoting smokers’ intention to quit by reducing the smoking amount and controlling drinking behaviour was significant.ConclusionThis study confirmed that alcohol drinking is among the channels that mediate the association between smoking prevalence and SHS exposure in workplaces. Our results also find a spillover effect of SF workplace policy and call for effective interventions for alcohol use, which may influence the outcomes of SF policy implementation.

Highlights

Both alcohol drinking and second-hand smoke (SHS) exposure have shown a strong association with smoking behaviour
This study confirmed that alcohol drinking is among the channels that mediate the association between smoking prevalence and SHS exposure in workplaces
What this paper adds Using the Asia Best Workplace Mainland China (ABWMC) data, this study finds that alcohol drinking is among the channels that mediate the association between smoking prevalence and SHS exposure in workplaces

Summary

Introduction

Both alcohol drinking and second-hand smoke (SHS) exposure have shown a strong association with smoking behaviour. Smoking and alcohol drinking have a positive correlation, and a higher level of smoking prevalence in an area is related to a higher level of SHS exposure than that reported by non-smokers [1,2,3]. The extent to which adjustment for alcohol use modifies the association between smoking and SHS exposure remains uncertain. Most studies that have investigated the effects of alcohol drinking on smoking-related behaviours have relied on a general view, and few have assessed the effects in particular settings, such as workplaces [4, 5]. Because of the sustained increase in working hours in the past half century and the high prevalence of smoking and alcohol use in China, the link between smoking and drinking behaviour and workplace SHS exposure has become increasingly important for public health and policy makers. A very recent study found that the prevalence of alcohol consumption was 45.84% for young Chinese people (drinkers’ referred to those who have either drunk more than half a cup of alcohol at least once in the past 12 months or those who have drunk any quantity of alcohol at least twice in the past 12 months), suggesting an increase in alcohol use among young people [10]

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