Smoke-free Workplace Policies Research Articles

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities.

Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics. Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness. Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness. Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience. Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to promote recall and loss-framed content (ie, dangers of SHS) to prompt emotion. Further, gain-framed messages that are localized to the rural community may be especially effective. Findings support designing smoke-free campaigns in rural communities with the audience in mind by tailoring messages to age, sex, and education level.

Tobacco control policies and activities in Aboriginal community-controlled health services.

To describe tobacco control policies and activities at a nationally representative sample of Aboriginal community-controlled health services (ACCHSs). The Talking About The Smokes (TATS) project used a quota sampling design to recruit 34 ACCHSs around Australia. Between April 2012 and October 2013, a representative at each ACCHS completed a survey about the service's tobacco control policies and activities. Questions about support for smoke-free policies were also included in the TATS project survey of 2435 Aboriginal and Torres Strait Islander members of the communities served by the ACCHSs. ACCHS tobacco control policies and activities. Thirty-two surveys were completed, covering 34 sites. Most ACCHSs (24/32) prioritised tobacco control "a great deal" or "a fair amount", and all services had smoke-free workplace policies. Most had staff working on tobacco control and had provided tobacco control training within the past year. A range of quit-smoking information and activities had been provided for clients and the community, as well as extra smoking cessation support for staff. There was strong support for smoke-free ACCHSs from within the Aboriginal communities, with 87% of non-smokers, 85% of ex-smokers and 77% of daily smokers supporting a complete ban on smoking inside and around ACCHS buildings. The high level of commitment and experience within ACCHSs provides a strong base to sustain further tobacco control measures to reduce the very high smoking prevalence in Aboriginal and Torres Strait Islander populations.

Are Partial Workplace Smoking Bans as Effective as Complete Smoking Bans? A National Population-Based Study of Smoke-Free Policy Among Japanese Employees.

Although complete workplace smoking bans are generally recommended rather than partial bans, the latter are widespread in many countries, especially Japan. Our objective was to compare complete workplace smoking bans and partial bans for associations with employee smoking and secondhand smoke (SHS)-related discomfort/ill-health. We also evaluated complete bans versus no ban and partial bans versus no ban. Eleven thousand ninety eligible employees (weighted number: 34 353 241) aged 20-64 years in 2011 (response rate: 62.5%) were analyzed using a nationally-representative, population-based cross-sectional study. Adjusted prevalence ratios for self-reported current smoking and SHS-related discomfort/ill-health according to workplace smoke-free policies were calculated, using conventional regression and propensity score (PS) weighting (targeting population of average treatment effect among both treated [TET] and untreated [TEU]). Both conventional regressions and PS weighting analyses showed complete bans were significantly associated with lower prevalence of current smoking and perceived SHS-related discomfort/ill-health among nonsmokers than partial or no ban. In contrast, partial bans were not significantly associated with either outcome compared with no ban. Using several PS trimming levels, we found interesting differences between TET and TEU in a comparison between partial and no ban: that is, significant associations in TET estimations, but none in TEU estimations. Although complete smoking bans were associated with lower levels of employee smoking and SHS-related discomfort/ill-health compared with no smoking ban, partial bans were not. Findings from PS weighting of TEU suggest that partial workplace bans may not be any more effective for Japanese employees than no ban. Therefore, complete bans may be strongly recommended for future implementation, but careful interpretation of the data is necessary because of the cross-sectional study design.

Smoke-Free Workplaces Are Associated with Protection from Second-Hand Smoke at Homes in Nigeria: Evidence for Population-Level Decisions.

The evidence suggests that smoke-free workplace policies may change social norms towards exposing others to second-hand smoke at home. The aim of the study was to assess whether being employed in a smoke-free workplace (SFWP) is associated with living in a smoke-free home (SFH). We used the data from the Global Adult Tobacco Survey conducted in Nigeria in 2012, in which 9,765 individuals were interviewed including 1,856 persons who worked indoors. The percentage of Nigerians employed in SFWP that reported living in a SFH was higher compared to those employed in a workplace where smoking occurred (95% versus 73%). Working in a SFWP was associated with a significantly higher likelihood of living in a SFH (OR = 5.3; p < 0.001). Urban inhabitants indicated more frequently that they lived in SFH compared to rural residents (OR = 2.0; p = 0.006). The odds of living in a SFH were significantly higher among nonsmokers and nonsmokeless tobacco users compared to smokers and smokeless tobacco users (OR = 28.8; p < 0.001; OR = 7.0; p < 0.001). These findings support the need for implementation of comprehensive smoke-free policies in Nigeria that result in substantial health benefits.

Exposure to secondhand smoke and attitudes toward smoke-free workplaces among employed U.S. adults: findings from the National Adult Tobacco Survey.

This study assessed the prevalence and correlates of secondhand smoke (SHS) exposure and attitudes toward smoke-free workplaces among employed U.S. adults. Data came from the 2009-2010 National Adult Tobacco Survey, a landline and cellular telephone survey of adults aged ≥18 years in the United States and the District of Columbia. National and state estimates of past 7-day workplace SHS exposure and attitudes toward indoor and outdoor smoke-free workplaces were assessed among employed adults. National estimates were calculated by sex, age, race/ethnicity, education, annual household income, sexual orientation, U.S. region, and smoking status. Among employed adults who did not smoke cigarettes, 20.4% reported past 7-day SHS exposure at their workplace (state range: 12.4% [Maine] to 30.8% [Nevada]). Nationally, prevalence of exposure was higher among males, those aged 18-44 years, non-Hispanic Blacks, Hispanics, and non-Hispanic American Indians/Alaska natives compared to non-Hispanic Whites, those with less education and income, those in the western United States, and those with no smoke-free workplace policy. Among all employed adults, 83.8% and 23.2% believed smoking should never be allowed in indoor and outdoor areas of workplaces, respectively. One-fifth of employed U.S. adult nonsmokers are exposed to SHS in the workplace, and disparities in exposure exist across states and subpopulations. Most employed adults believe indoor areas of workplaces should be smoke free, and nearly one-quarter believe outdoor areas should be smoke free. Efforts to protect employees from SHS exposure and to educate the public about the dangers of SHS and benefits of smoke-free workplaces could be beneficial.

Tobacco Control Policies and Their Impacts. Past, Present, and Future

The 1964 Surgeon General's report on smoking and health concluded that "Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action." The adoption of remedial actions over the next half century produced what is arguably the most important public health triumph of that period in the United States and in other developed nations. At the heart of the remedial actions were governmental policies. By raising cigarette price, taxation is especially effective at reducing smoking, encouraging some smokers to quit and others to reduce their daily consumption, while also discouraging the initiation of smoking by children. Smoke-free workplace policies have dramatically reduced workers' exposure to the toxins in cigarette smoke, smoking, employers' costs, and the incidence of acute myocardial infarctions. Other policies have also helped diminish the toll of smoking. The successes of tobacco control notwithstanding, future progress will occur slowly unless society finds new, possibly radical "endgame" strategies to hasten the arrival of a smoke-free society.

Evaluation of a community-based tobacco control intervention in five remote north Queensland Indigenous communities

This study aimed to assess the impact of a complex community-based tobacco control program in eight remote north Queensland Indigenous communities with high rates of tobacco use. A community-based tobacco intervention trial was conducted over one year in five intervention sites and three control sites in far north Queensland with predominantly Aboriginal and Torres Strait Islander populations. The intervention was composed of six components: a school-based education program ‘Smokin’ No Way’, ‘SmokeCheck’ tobacco brief intervention training for health workers, assistance to develop workplace smoke-free policies, an Event Support Program, ‘Smoke Rings’ support group and enforcement of tobacco sales legislation. Household surveys of self-reported tobacco use were conducted at baseline and one year after the interventions, along with interviews with key individuals and organisations, to assess intervention implementation. It was found that there was a modest effect on self-reported daily tobacco use and mean number of cigarettes smoked weekly after 12 months in intervention communities. There were non-significant declines in self-reported smoking and mean cigarettes smoked per week in aggregated control communities. Independent evaluation of fidelity of implementation found major shortcomings in actual program delivery. To enhance success of future interventions, fidelity of implementation should be ensured and a longer implementation period utilised.

Tobacco control challenges in East Asia: proposals for change in the world's largest epidemic region

East Asia is one of the world's largest tobacco epidemic regions. Although several international studies have evaluated the status of tobacco control in this region, the findings have not been...

Implementation of a smoke-free policy in a high secure mental health inpatient facility: staff survey to describe experience and attitudes.

BackgroundIn 2008, a new forensic hospital was opened as a totally smoke-free facility. This study describes the attitudes and experience of mental health professionals working in the high secure mental health facility three years after it was opened. It is part of a larger evaluation describing the experience of current and discharged hospital patients.MethodsQuantitative data was collected using a survey of hospital staff (N = 111) with a 50% response rate. The survey collected demographic and smoking data to describe staff responses to statements relating to hospital smoking policy, patient care and staff support.ResultsAmong staff surveyed, 13% were current smokers and 41% were ex-smokers (10% quit after commencing employment in the smoke-free hospital). Most (88%) preferred to work in a smoke-free environment, although this was significantly lower in smokers compared to non-smokers (39% vs. 95%). While most staff felt that the smoke-free environment had a positive impact on the health of patients (86%) and on themselves (79%), smokers were significantly less likely to agree. Just over half (57%) of staff surveyed agreed that patient care was easier in a totally smoke-free environment, although less smokers agreed compared to non-smokers. Staff who smoked were also significantly less likely to indicate they had sufficient support working in a smoke-free environment, compared to non-smokers (15% vs. 38%).ConclusionsThe staff surveyed supported the smoke-free workplace policy; most agreed that patient care was easier and that the policy did not lead to an increase in patient aggression. Implementation of a total smoking ban can result in positive health outcomes for patients and staff, and may influence some staff to quit. Staff who smoke have a less positive experience of the policy and require additional support.

Smokefree Home Rules Adoption by Smokers and Nonsmokers: Minnesota, 1999–2010

Smokefree workplace policies have successfully limited indoor exposure to secondhand smoke. However, exposure still exists in other indoor locations, most notably in the home. This paper examines change in the public's awareness of secondhand smoke harm, exposure to secondhand smoke, and prevalence of smokefree home rules between 1999 and 2010 in Minnesota. The Minnesota Adult Tobacco Survey is a statewide, cross-sectional, random-digit-dial telephone-based survey. The survey measures tobacco use, behaviors, attitudes, and beliefs among adults aged 18 and older in 1999, 2003, 2007, and 2010. Analysis was conducted in 2011. There was a significant decrease in self-reported exposure to secondhand smoke among all nonsmokers in Minnesota from 2003 (60.9%) to 2010 (37.7%) (p<0.05). The prevalence of smokefree home rules adoption among all Minnesotans increased significantly between each time point: 1999 (64.5%); 2003 (74.8%); 2007 (83.2%); 2010 (87.2%) (p<0.05). Although smokers tended to adopt smokefree home rules at rates lower than nonsmokers, the percentage of smokefree home rules among smokers nearly doubled between 1999 (31.4%) and 2010 (58.1%) (p<0.05). Over 10 years, Minnesotans reported a significant decline in exposure to secondhand smoke and a significant increase in voluntary smokefree home rules. Such a trend is notable as virtually all public tobacco control efforts were aimed at raising awareness and support for smokefree policies within workplaces. These findings demonstrate positive changes in social norms and suggest that behavior change in public settings might also be translated into practice in private settings.

The impact of state preemption of local smoking restrictions on public health protections and changes in social norms.

Introduction. Preemption is a legislative or judicial arrangement in which a higher level of government precludes lower levels of government from exercising authority over a topic. In the area of smoke-free policy, preemption typically takes the form of a state law that prevents communities from adopting local smoking restrictions. Background. A broad consensus exists among tobacco control practitioners that preemption adversely impacts tobacco control efforts. This paper examines the effect of state provisions preempting local smoking restrictions in enclosed public places and workplaces. Methods. Multiple data sources were used to assess the impact of state preemptive laws on the proportion of indoor workers covered by smoke-free workplace policies and public support for smoke-free policies. We controlled for potential confounding variables. Results. State preemptive laws were associated with fewer local ordinances restricting smoking, a reduced level of worker protection from secondhand smoke, and reduced support for smoke-free policies among current smokers. Discussion. State preemptive laws have several effects that could impede progress in secondhand smoke protections and broader tobacco control efforts. Conclusion. Practitioners and advocates working on other public health issues should familiarize themselves with the benefits of local policy making and the potential impact of preemption.

Having a yarn about smoking: Using action research to develop a ‘no smoking’ policy within an Aboriginal Health Organisation

Objectives This article reports on a culturally appropriate process of development of a smoke-free workplace policy within the peak Aboriginal Controlled Community Health Organisation in Victoria, Australia. Smoking is acknowledged as being responsible for at least 20% of all deaths in Aboriginal communities in Australia, and many Aboriginal health workers smoke. Methods The smoke-free workplace policy was developed using the iterative, discursive and experience-based methodology of Participatory Action Research, combined with the culturally embedded concept of ‘having a yarn’. Results Staff members initially identified smoking as a topic to be avoided within workplace discussions. This was due, in part, to grief (everyone had suffered a smoking-related bereavement). Further, there was anxiety that discussing smoking would result in culturally difficult conflict. The use of yarning opened up a safe space for discussion and debate, enabling development of a policy that was accepted across the organisation. Conclusions Within Aboriginal organisations, it is not sufficient to focus on the outcomes of policy development. Rather, due attention must be paid to the process employed in development of policy, particularly when that policy is directly related to an emotionally and communally weighted topic such as smoking.

Smoking studies produce new findings regarding breast and lung cancer link

Three recent studies explored how smoking is related to certain breast and lung cancer risks. In the first study, postmenopausal women who were current or former smokers were found to have a 16% higher risk of developing breast cancer than never-smokers.1 The study also found that women who had extensive exposure to passive smoking, either as children or adults, had an excess risk of developing breast cancer. Although previous studies have indicated a link between smoking and breast cancer, passive smoking risk remains controversial. Researchers, led byJuhua Luo, MD, of West Virginia University in Morgantown, and Karen Margolis, MD, of Health-Partners Research Foundation in Minneapolis, Minnesota, used data from the 1993-1998 Women's Health Initiative Observational Study to determine links between smoking, passive smoking, and breast cancer They analyzed data from nearly 80,000 women between the ages of 50 and 79 years across 40 clinical centers nationwide, identifying a total of 3250 cases of invasive breast cancer diagnosed over 10 years. Participants were asked a variety of questions, including whether they had ever smoked, at what age they began smoking, how many cigarettes they smoked each day, and at what age they quit smoking. They also were asked if they had lived in smoking households as children or adults and whether they had worked in smoking environments. Researchers found that smokers had a 16% increased risk of developing breast cancer after menopause; former smokers had a 9% increased risk. Those women who had smoked for 50 years or more had the highest risk compared with lifetime nonsmokers. Women who started smoking as teenagers also had a particularly high risk. The increased risk continued for 20 years after a person had stopped smoking. Nonsmoking women who had been exposed to extensive passive smoking had a 32% excess risk of breast cancer “Extensive” was defined as more than 10 years' exposure in childhood, more than 20 years' exposure as an adult at home, and more than 10 years' exposure as an adult at work. However, because their analysis of secondhand smoke was limited to the most extensive passive smoking category, the authors say more research is needed to confirm these findings. In another study by Kenneth Piazza, MD, MPH, and Andrew Hyland, PhD, at Roswell Park Cancer Institute in Buffalo, New York, smoke free homes and workplaces were linked to reductions in breast cancer incidence and mortality rates.2 The study found a statistically significant decrease in breast cancer mortality, particularly among younger premenopausal women, as the number of smoke- free homes and workplaces increased. An estimated 20% of the change in breast cancer mortality rates was due to changes in smoke-free home and workplace policies. Similar to the first group of researchers, Drs. Piazza and Hyland cited the lack of definitive evidence regarding passive smoke and risk of breast cancer However, the study also found that states with higher percentages of women working and living in smoke-free environments had lower breast cancer rates. In a third study, researchers found that many longtime smokers quit spontaneously shortly before their lung cancer was diagnosed.3 As a result, they speculate that sudden smoking cessation may be a symptom of lung cancer The study found that most patients who quit did so before noticing any cancer symptoms. They also often quit with no difficulty, despite having tried to quit unsuccessfully in the past, notes lead author Barbara Campling, MD, a medical oncologist at Thomas Jefferson University in Philadelphia, Pennsylvania. Researchers interviewed 115 lung cancer patients from the Philadelphia Veterans Affairs Medical Center, all of whom had been smokers. Of these, 55 patients (48%) had quit smoking before diagnosis and only 6 (11%) of these patients had experienced symptoms before they quit. The patients who quit were as dependent on nicotine as those who continued to smoke, yet 31% said they quit without difficulty. Investigators compared these results with those found in patients with prostate cancer and heart attack survivors. In the patients with lung cancer, the median time elapsed between quitting smoking and lung cancer diagnosis was 2.7 years. The interval between quitting and the event was 24.3 years for patients with prostate cancer and 10 years for heart attack survivors. Dr. Campling and colleagues speculated that smoking cessation may be caused by tumor secretion of a substance that interferes with nicotine addiction. She cautions that these results should not be misinterpreted to suggest that heavy smokers should continue smoking; they still should be strongly encouraged to quit.

Environmental Tobacco Smoke Exposure Among Korean Workers: National Working Condition Survey

PP-30-106 Background/Aims: We investigated worker's environmental tobacco smoke (ETS) exposures by industry type and socioeconomic variables. Methods: The study population comprised 10,043 workers who participated in Korea National Working Condition Survey in 2006. Interviewers visited randomly selected households and interviewed every worker. Chi-square tests and multiple logistic regression models were used for the analysis Results: ETS exposure of men (23%) was twice that of women (12%). High ETS exposure occurred in construction (39.5%), machinery (34.1%), entertainment (30.3%), transportation (29.8%), and electric/electronics (27.7%) population. Low exposure was reported in education/science (3%), finance (6%), religion (7%), health (7%) and communication (7%) jobs. Non-regular job was more likely exposed to ETS than did regular job (OR: 1.33, 95% CI: 1.11, 1.59). Longer working hours (above 45 hours) were associated with ETS exposure (OR: 1.38, 95% CI: 1.19, 1.59). Smoking (OR: 1.16, 95% CI: 0.99, 1.36) and drinking alcohol (OR: 1.38, 95% CI: 1.13, 1.68) were also associated with higher exposure. Especially among women, ETS exposure showed greater association with smoking (OR: 2.5, 95% CI: 1.48, 4.3) and drinking (OR: 2.51, 95% CI: 1.48, 4.25). Higher income (above 3000$/month vs. below 1000$/month, OR: 0.48, 95% CI: 0.34, 0.69), higher education (graduate school vs. middle school, OR: 0.55, 95% CI: 0.34, 0.91), and lager company (above 1000 employees vs. below 100 employees, OR: 0.61, 95% CI: 0.49, 0.76) were predictors for lower ETS exposure. Conclusion: Since 1995, even though smoke-free workplace policy has been gradually strengthened in South Korea, the protection of workers from ETS exposures still has a large room for improvement. Blue-collar and service workers are more likely than other types of workers to be exposed to ETS in the workplace. ETS exposure also showed inequality by socioeconomic position (education, occupational class, employment status, and household income). Additional measures are needed to increase the number of smoke-free workplaces.

Workplace smoking policies and their association with male employees' smoking behaviours: a cross-sectional survey in one company in China

ObjectivesThe present work sought to evaluate different worksite smoking control policies and their associations with employees' smoking behaviours and attitudes among Chinese male workers.MethodsThis was a cross-sectional survey with a...

Use of mentholated cigarettes: what can we learn from national data sets?

Use of mentholated cigarettes: what can we learn from national data sets?

Menthol smoking, smoke‐free policies and cessation services

This study examined whether menthol cigarette smoking is related to exposure to smoke-free home and work-place policies, availability of cessation services at work and knowledge of cessation resources among current smokers. Secondary analysis was conducted using logistic regression of cross-sectional data. The 2003 and 2006/07 Tobacco Use Supplement (TUS) to the Current Population Survey, administered by the National Cancer Institute, the Centers for Disease Control and Prevention (CDC) and the Census Bureau, formed the basis for this investigation. A total of 66,145 current smokers who participated in the TUS CPS administrations in 2003 and 2006/07. Demographic characteristics (gender, race/ethnicity, age, education, income), smoking frequency, menthol cigarette use, status of smoking bans in the work-place and at home, availability of cessation services at work and knowledge of quitting resources were assessed. Among all current smokers with an indoor job, with no smoke-free restrictions at either work or home as the reference, those who smoked menthol cigarettes were about one-third as likely to have a smoke-free policy at both work and home [odds ratio (OR) = 0.32; 95% confidence interval (CI): 0.27-0.38]. In the comparison of those with an indoor smoke-free policy at work only versus those with no restrictions, menthol status was a risk factor for not having a work-place restriction (OR = 0.79; 95% CI: 0.67-0.93); similarly, within this sample, menthol use was a risk factor for not having a home restriction (OR = 0.38; 95% CI: 0.31-0.46). Among all current smokers, the use of menthol cigarettes was a risk factor for not having a smoking restriction at home (OR = 0.93; 95% CI: 0.88-0.98). Menthol smoking was not related to availability of cessation services offered at work or knowledge of cessation services. This study suggests that menthol smoking is associated with lack of policy protection from second-hand smoke exposure. Policymakers and tobacco control professionals should monitor tobacco control efforts to ensure that policies and interventions reach all menthol smokers.

Effect of Smoke-Free Home and Workplace Policies on Second-Hand Smoke Exposure Levels in Children: An Evidence Summary

Second-hand smoke (SHS) is a major avoidable cause of developmental and respiratory disease and premature death among children worldwide. SHS is a ‘Class A’ carcinogen, and there is no safe level of SHS exposure. Almost 700 million children worldwide are exposed daily to SHS at home. This article reviews and summarizes evidence based on available studies that report on ‘voluntary’ home smoking restrictions and their effects on SHS exposure levels in children aged 0–17 years. All potentially relevant publications within a 10-year period (January 2000–April 2010) were identified (n = 19 full-text articles) through comprehensive database searches. In general, voluntary household smoking restrictions reported a significant reduction in childhood SHS exposure ranging between 20–50% reductions, using both self-reported and biological measures. Mandated comprehensive workplace and enclosed public smoke-free policies also suggested an apparent benefit in some specific pediatric health encounters, namely, decreased preterm birth risks and reduced emergency hospital visits owing to asthma.

Coverage by smoke‐free workplace policies by race/ethnicity and health outcomes

PurposeThe present research has three goals: to examine the prevalence of smoke‐free workplace policies; to examine how coverage by a smoke‐free workplace policy differs among racial/ethnic groups; and to examine the impact of smoke‐free workplace policy (SFWP) coverage on health outcomes.Design/methodology/approachThe research uses secondary analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1998‐2006.FindingsIt was found that SFWP coverage is below government goals – especially for Hispanic workers and that SFWP coverage was associated with health outcomes.Research limitations/implicationsThe relatively slow progress in coverage by smoke‐free workplace policies during the last eight years suggests the possibility that a ceiling has been reached in smoke‐free workplace policy coverage. Limitations include factors that might negatively influence SFWP reporting (e.g. lack of knowledge about SFWP; language barriers), availability of data after 2006, and a cross‐sectional design for health outcomes.Practical implicationsThe findings suggest that there is health value in SFWP, but that coverage is not at 100 percent and a federal‐level mandate might be necessary to reach that level. In situations where customers are allowed to smoke, it may be more difficult to justify and enforce a smoke‐free workplace policy.Originality/valueThis is the first study to examine SFWP coverage by race over time. This study allows for examination of progress toward published SFWP goals.

Changes in the SF-8 scores among healthy non-smoking school teachers after the enforcement of a smoke-free school policy: a comparison by passive smoke status

BackgroundThe effects of the enforcement of a smoke-free workplace policy on health-related quality of life (HRQOL) among a healthy population are poorly understood. The present study was undertaken to examine the effects of the enforcement of a smoke-free school policy on HRQOL among healthy non-smoking schoolteachers with respect to their exposure to passive smoke.MethodsTwo self-reported questionnaire surveys were conducted, the first before and the second after the enforcement of a total smoke-free public school policy in Nara City. A total of 1534 teachers were invited from 62 schools, and their HRQOL was assessed using six domains extracted from the Medical Outcomes Survey Short Form-8 questionnaire (SF-8): general health perception (GH), role functioning-physical (RP), vitality (VT), social functioning (SF), mental health (MH), and role functioning-emotional (RE). The participants were divided into two groups according to their exposure to environmental tobacco smoke (ETS) at baseline: participants not exposed to ETS at school (non-smokers), and participants exposed to ETS at school (passive smokers). Changes in each SF-8 score were evaluated using paired t-tests for each group, and their inter-group differences were evaluated using multiple linear regression analyses adjusted for sex, age, school type, managerial position, and attitude towards a smoke-free policy.ResultsAfter ineligible subjects were excluded, 689 teachers were included in the analyses. The number of non-smokers and passive smokers was 447 and 242, respectively. Significant changes in SF-8 scores were observed for MH (0.9; 95% confidence interval [CI], 0.2-1.5) and RE (0.7; 95% CI, 0.0-1.3) in non-smokers, and GH (2.2; 95% CI, 1.2-3.1), VT (1.8; 95% CI, 0.9-2.7), SF (2.7; 95% CI, 1.6-3.8), MH (2.0; 95% CI, 1.0-2.9), and RE (2.0; 95% CI, 1.2-2.8) in passive smokers. In the multiple linear regression analyses, the net changes in the category scores of GH (1.8; 95% CI, 0.7-2.9), VT (1.4, 95% CI, 0.3-2.5), SF (2.5; 95% CI, 1.1-3.9), MH (1.2; 95% CI, 0.1-2.4) and RE (1.6; 95% CI, 0.5-2.7) in passive smokers significantly exceeded those in non-smokers.ConclusionsA smoke-free school policy would improve the HRQOL of healthy non-smoking teachers who are exposed to ETS.