Tobacco Control Regulations Research Articles

Biological monitoring of exposure to benzene in water pipe smokers of rural Western Uttar Pradesh (India)

Aim: Present study was performed to investigate the possible human exposure to benzene through water pipe smoking, if any, in the selected rural population of Western Uttar Pradesh. Methodology: Urine samples from water pipe smokers of both the sexes were collected and analyzed for urinary concentration of phenol, creatinine and malondialdehyde employing standard methods. Results: The results showed that tobacco used by selected rural population contained traces of benzene in the range of 2.75 to 9.682µl ml-1. Analysis of urine samples for phenol, a major metabolite of benzene, showed its increased concentrations in water pipe smokers than non smokers. Further, the effects of age and gender differences on the excretion of phenol were also recorded. Female water pipe smokers were found to be more vulnerable to benzene exposure than male smokers. Intriguingly, alcoholic water pipe smokers were less vulnerable than the non-alcoholic smokers. Interpretation: It is concluded that respiratory, cardiac and haematological disorders caused by water pipe smoking might be attributed to long term benzene exposure amongst water pipe smokers. Large scale epidemiological studies are warranted in Indian rural population considering WHO (Framework Convention on Tobacco Control) regulations of water pipe smoking and tobacco products. Key words: Biological monitoring, Benzene, Oxidative stress, Phenol, Tobacco, Waterpipe smoking

Five years of discourse related to Indonesia tobacco control reform: a content analysis of online media coverage

BackgroundIn 2017, Indonesia initiated the amendment of its 11-year-old tobacco control regulation (PP 109/2012) to reduce smoking among youth, but the process was stalled. The proposed changes in the regulation...

Evaluation of a Regional Tobacco Control Program (Greater Manchester's Making Smoking History) on Quitting and Smoking in England 2014-2022: A Time-Series Analysis.

This study aimed to assess the impact of Greater Manchester's Making Smoking History program-a region-wide smoking cessation programs launched in January 2018-on key smoking and quitting outcomes. Data were from a nationally representative monthly survey, 2014-2022 (n = 171 281). We used interrupted time-series analyses (Autoregressive Integrated Moving Average [ARIMA] and generalized additive models [GAM]) to examine regional differences between Greater Manchester and the rest of England, before and during the program's first five years. Outcomes were rates of quit attempts and overall quits among smokers, quit success rates among smokers who tried to quit (preregistered outcomes), and current smoking prevalence among adults (unregistered outcome). Results showed mixed effects of the program on quitting. Primary ARIMA models showed comparative reductions in quit success rates (change in quarterly difference between regions = -11.03%; 95% CI -18.96; -3.11) and overall quit rates in Greater Manchester compared with the rest of England (-2.56%; 95% CI -4.95; -0.18), and no significant change in the difference in the quit attempt rate (+2.95%; 95% CI -11.64; 17.54). These results were not consistently observed across sensitivity analyses or GAM analyses. Exploratory ARIMA models consistently showed smoking prevalence in Greater Manchester declined more quickly than in the rest of England following the initiation of the program (-2.14%; 95% CI -4.02; -0.27). The first five years of Greater Manchester's Making Smoking History program did not appear to be associated with substantial increases in quitting activity. However, exploratory analyses showed a significant reduction in the regional smoking rate, over and above changes in the rest of England over the same period. Taken together, these results show a relative decline in smoking prevalence in Greater Manchester but equivocal data on quitting, introducing some uncertainty. It is possible the program has reduced smoking prevalence in the absence of any substantial change in quitting activity by changing norms around smoking and reducing uptake, or by reducing the rate of late relapse. It is also possible that an undetected effect on quitting outcomes has still contributed to the program's impact on reducing prevalence to some degree. It will be important to evaluate the overall impact of the program over a longer timeframe.

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

ObjectiveTo assess the impact of tobacco control regulations and policy implementation on smoking cessation tendencies in cigarette users born between 1982 and 1991 in Chile.DesignLongitudinal cross-sectional study.SettingNational level.ParticipantsData from the...

Changes in Compliance With Bans on Tobacco Product Display and Advertising at Traditional and Modern Point-of-Sale Retailers in Depok, Indonesia, 2019-2021.

Banning Point-of-Sale (POS) advertising and product display is an important tobacco control strategy. Depok, Indonesia enacted some regional tobacco control policies regulating the POS environment in 2021. This study examined changes in compliance before and after the implementation of these policies as of 2021. Data collectors visited 180 modern retailers (hyper/supermarkets/convenience stores) and 147 traditional retailers (warungs) in 2019. The same retailers were revisited in 2021. Data collectors assessed compliance with tobacco product display, and advertising regulations at POS, including if products were displayed in spaces to target minors (near candy or at a child's eye level). Data were analyzed using McNemar and Mann-Whitney U tests. From 2019 to 2021, in modern retailers, tobacco product display (95.6% vs. 52.2%) and product advertising (36.1% vs. 3.9%) were significantly reduced (p < .001). In traditional retailers, tobacco product display (94.6% in 2019, 91.2% in 2021, p > .05) and product advertising (87.1% in 2019, 87.8% in 2021, p > .05) remained common during both data collection periods. Tobacco products were commonly displayed in spaces to target minors in both modern retailers (43.3% in 2019, 34.4% in 2021, p > .05) and traditional retailers (90.5% in 2019, 83.0% in 2021, p > .05). Compliance with bans on tobacco product advertising and display at modern retailers improved significantly from 2019 to 2021; however, most modern retailers continue to display tobacco products in 2021. Traditional retailers remain largely noncompliant. Tobacco products are commonly displayed in areas that target minors. The enforcement of regional regulations should be strengthened, particularly among traditional retailers. In Depok, Indonesia, tobacco advertising and product display bans have been implemented; however, more work is needed to support compliance. Enforcement efforts, such as those carried out by civil police, can focus on tobacco product display bans in traditional and modern retailers, and traditional retailers need additional support to remove tobacco product advertising. Retailers may receive money from the tobacco industry for these advertisements. Creative solutions may include supporting retailers in finding alternative advertising revenue.

Identification and Characterization of Illegal Sales of Cannabis and Nicotine Delivery Products on Telegram Messaging Platform.

Unregulated and potentially illegal sales of tobacco, nicotine, and cannabis products have been detected on various social media platforms, e-commerce sites, online retailers, and the dark web. New end-to-end encrypted messaging services are popular among online users and present opportunities for marketing, trading, and selling of these products. The purpose of this study was to identify and characterize tobacco, nicotine, and cannabis selling activity on the messaging platform Telegram. The study was conducted in three phases: (1) identifying keywords related to tobacco, nicotine, and cannabis products for purposes of detecting Telegram groups and channel messages; (2) automated data collection from public Telegram groups; and (3) manual annotation and classification of messages engaged in marketing and selling products to consumers. Four keywords were identified ("Nicotine," "Vape," "Cannabis," and "Smoke") that yielded 20 Telegram groups with 262 506 active subscribers. Total volume of channel messages was 43 963 unique messages that included 3094 (7.04%) marketing/selling messages. The most commonly sold products in these groups were cannabis-derived products (83.25%, n = 2576), followed by tobacco/nicotine-derived products (6.46%, n = 200), and other illicit drugs (0.77%, n = 24). A variety of marketing tactics and a mix of seller accounts were observed, though most appeared to be individual suppliers. Telegram is an online messaging application that allows for custom group creation and global connectivity, but also includes unregulated activities associated with the sale of cannabis and nicotine delivery products. Greater attention is needed to conduct monitoring and enforcement on these emerging platforms for unregulated and potentially illegal cannabis and nicotine product sales direct-to-consumer. Based on study results, Telegram represents an emerging platform that enables a robust cannabis and nicotine-selling marketplace. As local, state, and national tobacco control regulations continue to advance sales restrictions and bans at the retail level, easily accessible and unregulated Internet-based channels must be further assessed to ensure that they do not act as conduits for exposure and access to unregulated or illegal cannabis and nicotine products.

Capacity of enforcers and level of enforcement of the Tobacco Control Act 2015 in Kampala, Uganda.

Tobacco use is a leading cause of preventable deaths worldwide. Uganda enacted the Tobacco Control Act (TCA) 2015 to domesticate implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) regulations. This study assessed the capacity to enforce the TCA and associated factors, as well as the level and barriers to its enforcement in Kampala, Uganda. A cross-sectional study using both quantitative and qualitative methods was employed. A structured questionnaire was used for quantitative data collection, and a WHO adapted capacity assessment open-ended guide was used for key informant interviews. Multivariable logistic regression was used to obtain odds ratios and 95% confidence intervals for the independent predictors for capacity to enforce the TCA. A total of 162 respondents from 5 institutions and six key informants were involved in the study. Findings established that only 23% (37/162) of the enforcers had the capacity to enforce the TCA. Male enforcers [OR = 0.16, 95% CI (0.05-0.55)], those who did not know when the law was enacted [OR = 0.19, 95% CI (0.07-0.52)], those with no plans to enforce the law [OR = 0.22, 95% CI (0.05-0.93)], and older enforcers (aged 31-40 years) [OR = 0.27, 95% CI (0.09-0.81)] were less likely to have the capacity to enforce the TCA. The level of enforcement of the TCA was mainly low to moderate for most of the institutions mandated to enforce it. Lack of knowledge about the law amongst the enforcers and general public, and inadequate funds were reported as major barriers to enforcement of the TCA. The capacity to enforce the TCA in Kampala was low. There is potential to enhance the capacity of enforcers through further dissemination of the Act, as well as sensitization of enforcers, institutional managers, and the general public about the legislation.

Recruitment of Young Adults: Lessons Learned From Research on Rural E-Cigarette Use and Cessation.

Electronic nicotine delivery system (ENDS) use continues to grow in rural areas of the United States. In particular, young adults (18-24 years) in rural areas are a hard-to-reach population in regard to understanding the growing ENDS use trend. The purpose of this article was to describe recruitment strategies that were used for a series of ENDS-relevant projects for young adults in rural areas, report recruitment yields from these strategies, and provide methodological considerations to aid researchers in improving recruitment. We used descriptive statistical methods to characterize recruitment yields (responses to screening vs initial invites, and number of individuals who fully met eligibility criteria vs responses to screening) from 2 ENDS studies that focused on 3 main recruitment strategies, including student directories, leadership offices (eg, Student Affairs), and regional tobacco control support networks (eg, Area Health Education Centers) for reaching young adults in rural communities. The recruitment yield rates varied and ranged from 2% to 14% depending on strategy with leadership offices resulting in the highest recruitment yield. Methodological considerations by strategy are described in detail. Results of this study can be used to inform tailored recruitment strategies to increase the representation of rural young adults in ENDS or other tobacco research.

Factors associated with successful purchase of cigarettes among students aged 11-17 years who made a purchase attempt in The Gambia: Evidence from the 2017 Global Youth Tobacco Survey.

Access to tobacco plays a strong role in smoking initiation among youth. This study aimed to quantify successful purchase of cigarettes and assess the factors associated with cigarette purchase access among students aged 11-17 years in The Gambia. We used the 2017 Global Youth Tobacco Survey (GYTS) of 12585 students, aged 11-17 years from The Gambia. The analysis was restricted to 2951 students aged 11-17 years who bought and/or attempted to buy cigarettes within the past 30 days regardless of smoking status. Our outcome was purchasing access, defined as successfully purchasing cigarettes within the past 30 days. We report a weighted prevalence of successful purchase attempt. Multivariable logistic regression assessed the factors associated with successful purchase of cigarettes and was adjusted for non-response and the complex survey design. Most students (59.4%, 95% CI: 55.4-63.3) who attempted to purchase cigarettes were successful, most of whom were boys (61.3%, 95% CI: 57.8-64.6). However, there was no significant difference in successful attempts to purchase cigarettes between boys (59.3%, 95% CI: 54.2-64.2) and girls (59.4%, 95% CI: 55.4-63.3). Older age (AOR=2.45; 95% CI: 1.25-4.78), higher school grade (AOR=1.53; 95% CI: 1.09-2.16) and current cigarettes smoking (AOR=1.41; 95% CI: 1.08-1.85) were significantly associated with successful attempt to purchase cigarettes. Sex, parents' smoking status and students' weekly pocket money were not associated with successful cigarettes purchase attempt. Among students who currently smoke cigarettes, 55.6% (95% CI: 47.7-63.2) bought them from a store, shop, street vendor, or canteen; 12.2% (95% CI: 8.3-17.5) obtained them from someone else, and 6.7% (95% CI: 4.4-10.0) used other means the last time they smoked. Students in The Gambia can purchase cigarettes without much hinderance despite the restrictions. Our research findings can guide the implementation of policies, programs, and public health strategies including more efforts toward implementing tobacco control laws and regulations that protect children from exposure and use of all forms of tobacco products.

Effect of a two-phase tobacco control regulation on incidence from ischemic stroke and hemorrhagic stroke, Shenzhen, China, 2007-2016.

The Shenzhen government is widely considered to be most efficiently implementing smoke-free legislation in China. We evaluated and compared the impact of Shenzhen's two-phase smoke-free regulation on the incidence rates for ischemic and hemorrhagic stroke. An interrupted time series design was used to capture immediate and annual incidence changes from 2007 to 2016 for both ischemic and hemorrhagic stroke due to two-phase smoke-free regulation in Shenzhen, China, by using a generalized additive model. The first phase, implemented on 9 March 2010, required five main public places to be smoke-free. In the second phase, the comprehensive law was expanded to the whole city on 1 March 2014. The regulation implementation during phase I was associated with a strong immediate decline in the incidence rate of ischemic stroke (-14.2%, 95% CI: -19.6 - -8.4) and hemorrhagic stroke (-10.1%, 95% CI: -18.2 - -1.2), but without showing the annual changes (p>0.05). Following the implementation of the comprehensive law, the gradual annual effect showed a significant change in ischemic stroke, with a 6.3% (95% CI: 8.9 - -3.6) reduction. Neither the immediate nor gradual decreases in hemorrhagic stroke incidences associated with the comprehensive regulation were statistically significant during phase II (p>0.05). Subgroup analyses indicate that a much larger health effect of the regulation during phase I was greater among those aged ≥65 years than among those aged 35-64 years. Shenzhen's two-phase smoke-free regulation was well implemented. Even though the regulation did not extend to the whole city, the immediate health benefits on the incidence rates of ischemic stroke and hemorrhagic stroke could be seen. However, the health benefits brought by the implementation of comprehensive smoke-free legislation were attenuated by previous smoke-free regulations in five main public places, which were more evident in hemorrhagic stroke.

How Do National Laws Filter Down to the Local? Tobacco Control Regulations and Smoke Free Areas in a Decentralised Indonesia

The proliferation of provinces and districts in Indonesia since 1998 has led to an array of new local laws across the country. This study focuses on how laws made at the national level become enacted at the local level. We offer a cross-comparison of three case studies of the implementation of smoke-free area regulations, as mandated by Government Regulation No. 109/2012. We investigate this process in Aceh province and the cities of Bandung and Malang, exploring the process of law creation and the context that influences it. We find that local political dynamics shaped unique regulations and outline how these differences manifested, both in the law-making process and in its outcomes. We also reflect on the decentralised law-making system, arguing that top-down diffusion of policy is problematic, with the case studies raising concerns in terms of inconsistencies due to localised variations, as well as inefficiencies and tobacco industry influence.

Impact of National Tobacco Control Policy on Rates of Hospital Admission for Pneumonia: When Compliance Matters.

A number of studies claim that tobacco control (TC) regulations are associated with reductions in smoking-related hospitalisation rates, but very few have estimated the impact of TC laws (TCL) at both countrywide and regional levels, and none of them have studied the impact of TCL in relation to compliance with TC regulations. This study evaluates the effects of Russian TCL on hospital admission (HA) rates for pneumonia countrywide and in 10 Russian regions and the extent of these effects in connection with the compliance with TCL. Methods: HA rates for pneumonia from 2005-2019 were analysed to compare the periods before and after the adoption of TCL in 2013. An interrupted time series design and a Poisson regression model were used to estimate the immediate and long-term effects of TCL on pneumonia annual hospitalisation rates after the TCL adoption, compared with the pre-law period. The 10 Russian regions were compared using the TCL implementation scale (TCIS) developed on the basis of the results of the Russian TC policy evaluation survey; Spearman's rank correlation and linear regression models were employed. Results showed a 14.3% reduction in HA rates for pneumonia (RR 0.88; p = 0.01) after the adoption of TCL in Russia with significant long-term effect after 2013 (RR 0.86; p = 0.006). Regions with better enforcement of TCL exhibited greater reductions in pneumonia HA rates (rsp = -0.55; p = 0.04); (β = -4.21; p = 0.02). Conclusions: TCL resulted in a sustained reduction in pneumonia hospitalisation rates, but these effects, varying by region, may depend on the scale of the TCL enforcement.

Discourse on Human Rights Issues and Public Policy Context: Prospect of Indonesia Tobacco Control Regulation

The efforts on tobacco control are based on two main philosophies which are focused on human rights and the economy. This is observed for every country that is willing to reduce tobacco consumption and slightly ensure prosperity at the same time. It is being discussed in the international community that some countries are not a party to FCTC (Framework Convention on Tobacco Control) but have a domestic regulatory system for tobacco or are committed to implementing other obligations based on international norms at the minimum. This research specifically examined institutions and rules besides politics and judiciary enforcement in tobacco control regulation through the application of comparative and system approaches within the legal political context and a qualitative method. It was discovered that Indonesia has the ability to deliberate domestic regulatory systems to combat and reduce tobacco use despite the strong interference by tobacco industries and markets that are approaching legislatures, politicians, or executive apparatus to create different institutional interests. This usually leads to a mixture of verdict and judgment for the judiciary and legal enforcement.

Global burden and trends of lung cancer incidence and mortality.

Lung cancer has been the leading cause of cancer-related deaths worldwide for many years. This study aimed to investigate the global patterns and trends of lung cancer. Lung cancer incidence and mortality were derived from the GLOBOCAN 2020 database. Continuous data from Cancer Incidence in Five Continents Time Trends were used to analyze the temporal trends from 2000 to 2012 using Joinpoint regression, and average annual percent changes were calculated. The association between the Human Development Index and lung cancer incidence and mortality was assessed by linear regression. An estimated 2.2 million new lung cancer cases and 1.8 million lung cancer-related deaths occurred in 2020. The age-standardized incidence rate (ASIR) ranged from 36.8 per 100,000 in Demark to 5.9 per 100,000 in Mexico. The age-standardized mortality rate (ASMR) varied from 32.8 per 100,000 in Poland to 4.9 per 100,000 in Mexico. Both ASIR and ASMR were approximately twice higher in men than in women. The ASIR of lung cancer showed a downward trend in the United States of America (USA) between 2000 and 2012, and was more prominent in men. The age-specific incidence rates of lung cancer for ages of 50 to 59 years showed an upward trend in China for both men and women. The burden of lung cancer is still unsatisfactory, especially in developing countries like China. Considering the effectiveness of tobacco control and screening in developed countries, such as the USA, there is a need to strengthen health education, accelerate the establishment of tobacco control policies and regulations, and improve early cancer screening awareness to reduce the future burden of lung cancer.

Communicative Processes Underlying DIY eJuice Mixing Among Young Adult International ENDS Users

ABSTRACT The use of electronic nicotine delivery systems (ENDS) is increasing around the world, with contemporary trends outpacing scientific understanding of the health implications. Such trends include do-it-yourself eJuice mixing (DIY eJuice), which involves the unregulated homemade mixing of fogging agents, nicotine salts, and flavorants to create personalized liquid for ENDS products. The purpose of this study was to employ a grounded theory approach to gather formative data on the communicative processes surrounding the behavior of DIY eJuice mixing among international, young adult ENDS users. Participants were recruited locally for mini focus group discussions via SONA (n = 4) and internationally for an open-ended survey via Prolific (n = 138). Questions explored experiences with the online DIY eJuice community, motivations for mixing, information seeking strategies, flavor preferences, and perceived benefits of mixing. Thematic analysis and flow sketching revealed the underlying processes of social cognitive theory to explain the communicative processes of DIY eJuice mixing behaviors. Specifically, environmental determinants emerged in the form of online and social influences; personal determinants in the form of curiosity and control; and behavioral determinants following a benefits/barriers analysis, particularly regarding cost. These findings provide theoretical implications for the role of health communication constructs in understanding contemporary trends in ENDS use and practical implications for tobacco prevention messaging and tobacco control regulations.

Multiple streams approach to tobacco control policymaking in the capital city of the world's largest tobacco consuming country.

The aim of this study was to analyse the policymaking process of Beijing tobacco control regulations based on a multiple streams framework to provide a reference for other cities, at the national level and for the international community to promote the development of tobacco control policy. Twenty-one documents related to tobacco control in Beijing were collected, nine informants were interviewed and the interview data were analysed by a thematic framework method. It was found that indicators, feedback and a focus event in the problem stream drew the attention of policymakers and the society for tobacco control. In 2011, Ying Songnian, a representative of the Beijing Municipal People's Congress, put forward tobacco control legislation, which was just in time for the legislative reform of the Congress. The proposal was studied by the Congress, and a strategy of 'social co-governance' was founded. In the political stream, the government actively promoted tobacco control and social organizations extensively participated in it. In 2013, the General Office of the Central Committee of the Chinese Communist Party and the General Office of the State Council issued a notice on matters related to leading cadres taking the lead in banning smoking in public places, which opened a policy window for decision-makers who were hesitatant. The issue of tobacco control was successfully put on the policy agenda and contributed to the introduction of the Beijing Municipal Regulations on Smoking Control. Development of the factors in problem stream, policy stream and political stream promoted the setting up of the tobacco control policy agenda in Beijing. It is suggested that more cities should learn from the experience of Beijing, seize the opportunity of the ideological change of the ruling party, actively identify the problems, mobilize and advocate for representatives and introduce the concept of 'social co-governance' to promote tobacco control legislation.

Experts’ views on how to design a tobacco control fund in the UK

ObjectiveTo explore expert views on the potential value, and approaches to establishing and administering a tobacco control fund in the UK.DesignSemistructured interviews and follow-up discussion groups.SubjectsTwenty-four UK and international experts...

Who Are the Local Policy Innovators? Cluster Analysis of Municipal Tobacco Control Policies in Massachusetts.

Tobacco use is a leading cause of preventable death, yet it is challenging to establish public policy to reduce tobacco use. Massachusetts has been a national leader in tobacco control, and its policy-making patterns can be informative to the country. To identify factors associated with the adoption of tobacco policy within 351 Massachusetts municipalities. We obtained the 2019 Massachusetts municipality-level tobacco control policy information from Massachusetts' Tobacco Automated Fact Sheet Information system and compiled it with data from American Community Survey, Massachusetts Municipal Association, and Massachusetts state government's Web sites. We used k -means clustering method to identify statistical clustering patterns and hotspot analysis (Getis-Ord Gi*) and Local Indicators of Spatial Association to identify geographic clustering patterns. We then performed multinomial logistic regression to identify factors associated with policy clusters. Massachusetts. Three hundred fifty-one municipalities in Massachusetts. Policy clusters-groups of municipalities with similar tobacco control policy behaviors. Based on the k -means analyses, we identified 3 clusters in Massachusetts municipal tobacco control policy behaviors: 54% (N = 191) of municipalities were "Policy Leaders" with a high adoption rate of the 6 tobacco control policies; 18% (N = 63) were "Peer-Influenced Actors" focused on tobacco purchase restrictions for individuals younger than 21 years; and 28% (N = 97) were "Policy Non-Actors," with no tobacco control policies in place. Policy Leaders were geographically clustered in larger cities and the MetroWest region. Policy Non-Actors were clustered in rural areas of Western and Central Massachusetts. Larger municipal population size, higher municipal tax income, and higher percentages of residents voting Democratic were associated with higher policy adoption activities. Local variation in the adoption of tobacco policies may exacerbate inequities in tobacco use and population health. Opportunities remain to implement additional tobacco control regulations at the local level to promote public health.

Advancement of Tobacco Control in Ghana: Barriers &amp; Opportunities – A Brief Situation Report

Adequate tobacco control in the wake of the ongoing COVID-19 pandemic cannot be overemphasized. As a Lower Middle-Income Country (LMIC) with peculiar needs, Ghana can strengthen her tobacco control regime by advancing country-specific and resilient programmes. The Food and Drugs Authority (FDA) in partnership with WHO embarked on a national project to sensitize law enforcement officers on the existing tobacco control provisions whilst identifying control barriers peculiar to the various regional groupings. The main outcome of this meeting was the development of a tobacco control enforcement plan which defined the framework for regional participation in tobacco control. The next phase of this project is the sustainability of the regional tobacco control units and the exploration of the inclusion of traditional leadership in tobacco control policy implementation. FDA recognizes that there is an important role of Traditional Authorities, Law enforcement agencies and other state agencies as tobacco control advocates. Keywords: Ghana, Tobacco, enforcement, control

Factors associated with secondhand smoke exposure among non-smoking employees in the workplace: A cross-sectional study in Qingdao, China.

ObjectiveThis study was conducted to describe secondhand smoke (SHS) exposure among non-smoking employees in the workplace, and identify factors related to SHS exposure in Qingdao.MethodsThe study participants covered key non-smoking places stipulated in the “Qingdao City Smoking Control Regulations,” which included three categories: restaurants, bars, and office buildings. Airborne nicotine concentration in the workplace and saliva cotinine concentration of employees were measured. The questionnaire included employees’ demographic factors, smoke-free measures in the workplace, employers’ tobacco hazard knowledge, and attitudes towards smoke-free policy.ResultsA total of 222 non-smoking employees and 46 non-smoking employers were included in the study. The median concentrations of airborne nicotine and salivary cotinine were 0.389 μg/m3 and 0.575 ng/mL, respectively. Educational status, average number of workplace smokers per day, exposure time to SHS in the workplace, and whether smoking and non-smoking areas were divided significantly related to airborne nicotine concentration. Age, educational status, exposure time to SHS in the workplace, tobacco control training and publicity, and whether the employers support the “Qingdao Tobacco Control Regulation” were significantly related to salivary cotinine concentration.ConclusionsDespite the implementation of the “Qingdao Smoking Control Regulations” in 2013, the workplace remains an important location for SHS exposure. Interventions such as raising workers’ awareness of the risks associated with SHS exposure through health education and developing smoking prevention and cessation programs to reduce SHS exposure in the workplace are urgently needed.