Workplace Smoking Research Articles

The crossroads of work and home: linkages between smoke-free policies at work and household environments

BackgroundTobacco use causes over eight million global deaths annually, with seven million directly attributed to tobacco use and 1.2 million to second hand smoke (SHS). Smoke-free environments are crucial to counter SHS. Although India banned smoking in public places in 2008, SHS exposure remains high. Studies have noted that limiting smoking in workplaces, restaurants, etc., helps to reduce overall smoking and reduce SHS exposure. Under this background, the study explores the linkages between smoke-free workplaces and living in smoke-free homes in India.MethodsThe two rounds of the GATS India (2009-10 and 2016-17) have been used for the study. The study focuses on male tobacco smokers working indoors or outdoors or both indoors and outdoors. The sample for the study was 2,969 for GATS 1 and 2,801 for GATS 2. Dependent variables include living in a smoke-free home, while the independent variables were adherence to a smoke-free office policy and socio-demographic variables. The two rounds of the GATS data were pooled for analysis. Statistical analysis involves bivariate and multivariate analysis.ResultsFindings reveal that 41% of respondents worked in smoke-free workplaces in GATS 2. Nationally, smoke-free homes increased from 35% in 2009–2010 to 44% in 2016-17. Individuals with smoke-free workplaces were more likely to have smoke-free homes. The Southern region consistently exhibited the highest proportion of smoke-free homes. Urban areas and higher education correlated with increased smoke-free homes. Logistic regression analysis confirmed that workplace smoke-free status is a significant predictor of smoke-free homes. In GATS 2, respondents aged 30 years and above were less likely to have smoke-free homes, while education and Southern region residence positively influenced smoke-free homes.ConclusionsThe correlation between smoke-free workplaces and smoke-free homes is linked to stringent workplace no-smoking policies, potentially deterring individuals from smoking at home. Opportunities exist for the expansion and stringent implementation of the smoke-free policies among Indian working adults, leveraging the workplace as a key setting for evidence-based tobacco control. The study highlights positive trends in India’s smoke-free homes, crediting workplace policies. Effective policies, education, and regional strategies can advance smoke-free homes, stressing the pivotal role of workplace policies and advocating broader implementation.

Sociodemographic factors, health behavior, parental or workplace smoking, and adult asthma risk in the United States.

Although several studies have found a link between parental or workplace smoking and asthma risk, particularly in children and adolescents, only a few studies have found this link in adults. This study aimed to investigate the associations of sociodemographic factors, health behavior, and parental or workplace smoking with adult asthma risk in the United States (US). A secondary data analysis on 874 participants aged 25-45 was performed using data from the 2011-2014 National Survey of Midlife Development in the United States Refresher. Participants were divided into smokers and nonsmokers. Participants were further divided into groups A (a father or mother with a smoking history) and B (others in the house or colleagues in the workplace who had a smoking history). Findings from the FREQ procedure revealed that sociodemographic (female, black, school or college education, unmarried/divorced, and employed) and lifestyle (no alcohol intake, physically inactive, and obese) and clinical (diabetes and joint disease) factors were significantly associated with one- or more-fold odds of asthma among adult smokers than nonsmokers. Adult smokers in group A, particularly females, those with a high school or college education, physically inactive, and overweight or obese, had a higher risk of asthma than those in group B. Adult smokers' risk of developing asthma is increased in the US by having smoked with their parents, being a woman, being black, having a school or college education, being single or divorced, working, not drinking alcohol, being physically inactive, being obese, having diabetes, and having a joint disease.

Estimating the prevalence of and clarifying factors associated with multiple tobacco product use in Japan: a cross-sectional study in 2022.

BackgroundMultiple tobacco product (MTP) use is a public health concern due to their combined adverse health effects. MTP use may have increased since heated tobacco products (HTPs) became more prevalent in Japan. This study aimed to (1) estimate the recent prevalence of MTP use and clarify the associated factors compared to (2) non-smokers and (3) single-product users.MethodWe used data from an internet survey conducted in February 2022. The prevalence of MTP use in Japan was estimated using inverse probability-weighted scores from this survey and a nationwide survey by the Japanese government. Tobacco products include six types: cigarettes, HTPs, e-cigarettes, cigars, pipe/water pipes, and smokeless tobacco products. MTP use was defined using the outcome variable (no use, single-product use, and MTP use) based on these six types of use. Using multivariate logistic regression, we calculated the adjusted odds ratios and 95% confidence intervals (CI) to clarify factors associated with MTP use compared to non-smokers, adjusting demographic variables, psychological distress, self-rated health, and alcohol use. Using multivariate Poisson regression, we calculated the adjusted prevalence ratios (aPR) and 95%CI to clarify factors associated with MTP use among smokers, adjusting for these covariates and smoking-related factors like workplace and home smoking rules.ResultsWe analyzed 30,141 participants whose mean age was 47.8 years (standard deviation = 17.9), and 14,722 participants were male (48.8%). The estimated prevalence of MTP use was 6.8%. The most common combination of MTP use was cigarettes and HTPs. Compared to non-smokers, being younger, male, low education, poor psychological distress, poor self-rated health, and alcohol use were factors associated with MTP use. Among smokers, workplace smoking rules, such as a partial smoking ban and no smoking ban, were not associated with MTP use compared to the indoor smoking ban. However, participants with no home smoking ban were positively associated with MTP use compared to those with a ban on both cigarettes and HTPs at home (both cigarettes and HTPs allowed aPR=1.36, 95%CI 1.15 to 1.61, HTPs only allowed aPR=1.73, 95%CI 1.43 to 2.10).ConclusionMTP users may account for a high percentage of Japanese smokers.

Forensic Analysis of Lung Cancer from Secondhand Smoke Exposure of a Motel Worker

Background: In July 2018, Ms. PJM, a 50-year-old lifelong nonsmoker, was diagnosed with primary Stage IV lung adenocarcinoma with secondary metastasis to the brain, after being hospitalized for a fall in the motel where she worked, in Los Angeles, California. She had been employed as a maid cleaning rooms in this motel for 20 years, where she was exposed to secondhand and thirdhand tobacco smoke daily. Her death certificate, dated June 2021, declared metastatic lung cancer to be the cause of her death at age 53. Occupational disability and death claims filed by her attorney were contested by her employer. Aims: To conduct a forensic analysis using mathematical modeling to quantify Ms. PJM’s toxic secondhand and thirdhand smoke exposures, in order to estimate her risk of lung cancer from exposure to tobacco combustion products and other potential carcinogenic agents to which she might have been exposed. Methods: A quantitative analysis employing assessment of Hazard, Exposure, Dose, Dose-Response, and Risk plus a Discussion of Uncertainty. It is routinely used by U.S. federal regulatory agencies, including the Occupational Safety and Health Administration (OSHA), and the Environmental Protection Agency (EPA). Results: Ms. PJM’s modeled exposure to fine particulate matter from secondhand smoke ranged from the Hazardous to Significant Harm Levels of the EPA Air Quality Index for fine particles (PM2.5). Her modeled dose of serum cotinine ranged from the 90th to beyond the 95th percentile of nonsmokers’ dose, measured in a statistical sample of the U.S. nonsmoking population. Her estimated risk exceeds OSHA’s Significant Risk of Material Impairment of Health Level by a factor of three. She is estimated to have been exposed to the thirdhand smoke of at least 1.4 million cigarettes outgassing from room surfaces during her 20 years of labor. As for potential confounders, there were no known carcinogens in any of the cleaning agents she used; there is no evidence that she was exposed to asbestos, and she resided in a low-radon area of Los Angeles. Conclusions: As a result of her occupational exposure to secondhand and thirdhand smoke, Ms. PJM lost an estimated 33 years of life expectancy. The State of California has been remiss in failing to extend its workplace smoking ban to hotels and motels, leaving their workstaff at grave risk of the manifold diseases of passive smoking.

The knowledge, attitudes and behaviors of hospital nurses on smoking cessation interventions: a cross-sectional study

BackgroundSmoking is a major public health problem in Croatia. It is unknown to what extent nurses in Croatia use interventions for smoking cessation to help their patients. This study aimed to analyze the knowledge, attitudes and behaviors of hospital nurses on smoking cessation interventions.MethodsWe conducted a cross-sectional study in Zagreb, Croatia, in 2022 on a convenient sample of hospital nurses. We collected data with a questionnaire that included sociodemographic questions and questions about the frequency of implementation of 5 A’s (Ask, Advise, Assess, Assist, Arrange) interventions for smoking cessation during their work using the Helping Smokers Quit (HSQ) survey, participants’ attitudes and knowledge about smoking cessation skills and the smoking status of the nurses.ResultsThere were 824 nurses employed in the targeted departments; 258 nurses participated in the study (response rate: 31%). Among them, 43% responded that they always ask patients about their use of tobacco products. Only 2.7% indicated that they always help the patient to stop smoking. Very few (2%) attended any training in the past two years about helping patients to quit smoking, and 82% never had such training. 44% of the included nurses were smokers. Nurses who smoked stated more frequently than nonsmokers they should not be role models for their patients by avoiding smoking (P 0.001). Additionally, patients were less frequently questioned about their inability to stop smoking by nurses who smoked than nurses who did not smoke (P = 0.010).ConclusionEven though smoking cessation interventions delivered by nurses were proven effective, such interventions are used by a small number of surveyed nurses. A small number of nurses have received training to help them support smokers in quitting. The high smoking prevalence among nurses may impact their attitudes and the implementation of workplace smoking cessation efforts.

What have I got to lose? I’m here anyway”: a qualitative study assessing how reach and participation can be improved in workplace smoking cessation programmes

What have I got to lose? I’m here anyway”: a qualitative study assessing how reach and participation can be improved in workplace smoking cessation programmes

A qualitative study assessing how reach and participation can be improved in workplace smoking cessation programs.

Randomized controlled trials have demonstrated the effectiveness of workplace smoking cessation programs. However, with low participation rates reported, it is important to understand the barriers and facilitators for the reach and participation of employees in workplace smoking cessation programs. The objective of the present study is to uncover the needs of employees regarding reach and participation when implementing a workplace program to address smoking cessation. We carried out 19 semi-structured qualitative interviews in 2019 based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework with current and former smoking employees of organizations with ≥100 employees in the Netherlands. Some of the interviewees had experience with a cessation program. Data were analyzed using the Framework method. The main barriers according to employees were insufficient promotion of the cessation program, completing the program in the employee's own time and working night shifts and peak hours. Facilitators included being actively approached to participate by a colleague, positive reactions from colleagues about employee's participation in the program, providing the program on location and integrating the program as part of the organization's vitality policy. Effective workplace programs for smoking cessation can stimulate cessation but implementers often experience low participation rates. Our study presents recommendations to improve the recruitment and participation of employees in a workplace smoking cessation program, such as using active communication strategies, training managers to stimulate smoking employees to participate and making the program as accessible as possible by reimbursing time spent and offering the program at the workplace or nearby. Integrating the smoking cessation program into wider company vitality policy will also aid continued provision of the program.

Need for workplace smoking cessation program among public transit drivers: Evidence from a cross-sectional study in a metropolitan city of Western India.

Air pollution is a significant contributor to respiratory illness globally, and in India, evidence is scarce on whether smoking exacerbates this problem. We aimed at assessing if being a smoker among public transit drivers increased risk for respiratory illnesses and affected performance of pulmonary function tests in a cross-sectional study in a metropolitan city of Gujarat, western state of India. We conducted a cross-sectional study among public transit drivers (those who were smoking and not smoking). Administration staff who were not smoking were considered as control group. We collected socio-demographic and medical history including occupational history (N = 296). We collected details of respiratory symptoms with standard tools and assessed pulmonary function tests (PFT) using spirometry. Group differences and regression analyses were conducted in R software. We found that respiratory symptoms among public transit drivers who smoked were higher than those who did not smoke and healthy controls. In PFT diagnosis, drivers who smoke displayed two times higher prevalence of obstructive pattern compared to drivers who did not smoke. There was a significant reduction in the larger as well as the smaller airway functions, reflected in reduction of FEV1/FVC ratio (p < 0.001) and FEF25-75% (p < 0.001), respectively, among drivers who smoked compared to controls. Our results indicate that being a driver with a smoking history leads to a 3.1% greater decrease in the FEV1/FVC ratio and about half a litre reduction in FEF25-75% compared to the drivers who did not smoke. We suggest there is a high need for smoking cessation programmes for public transit drivers as they are at higher risk for respiratory illnesses and reduced pulmonary functions when smoking is added to the existing vehicular exposure.

Knowledge, attitudes and perceptions of workers in indoor bars, beer halls and discotheques towards exposure to second-hand smoking in the two cities in Swaziland

Second-hand smoking is a serious health hazard causing approximately 41000 deaths from lung cancer, respiratory infections, asthma, coronary heart disease and stroke globally each year. Evidence suggests that workers in bars, beer halls and discotheques are more exposed to second- hand smoking compared to other workers in general. Protection of these workers through enactment of smoke-free legislation and attitudes of these workers towards such legislation are key variables of compliance. This study aimed to describe the knowledge of the adverse effects of second-hand smoking, attitudes and perceptions of workers towards the practice. The results suggest that most workers knew what second-hand smoking was and that it could cause lung cancer, coronary heart disease and asthma but undermined the fact that continued exposure or exposure to low levels could lead to severe disease or death. Fifty-four percent of the respondents showed good knowledge and 36% showed fair knowledge of the adverse effects of exposure to second-hand smoke. Respondents mentioned lung cancer (100%), increased coughing (90%), asthma (60%) and heart disease (30%) as possible adverse effects. The knowledge was not different among workers who smoked and those who did not smoke (never smoked or ex- smokers) (p=0.1041). However, both smokers and non-smokers did not believe that exposure to second-hand smoke could lead to early death (p=0.8864). The suggestions that smoking should be banned in all indoor workplaces was accepted by non-smokers but rejected by smokers (p=0.0001). So was the suggestion of increasing tax on cigarettes (p&lt;0.0001). Legislation banning smoking in indoor workplaces is contained in the Swaziland Tobacco Products Control Act (2013) that is still waiting to be enforced and as such, indoor smoking is not banned in the country. Sixty-seven per cent of the participants were not aware of the existence of legislation aimed at protecting them against exposure to second-hand smoke in indoor workplaces. It is suggested that the enforcement of the Swaziland Tobacco Control Act (2013), which purports to impose a comprehensive ban of indoor smoking be speeded up so that indoor air quality could improve. Mechanisms to monitor adherence to the complete ban are likely to speed up improvement of the health of many indoor workers in bars, beer halls and discotheques that are exposed for lengthy periods. Enforcement of the Act should include creation of programmes to create awareness of the risks faced by the workers.

Workplace cessation support is associated with more abstinence in a workplace program in Hong Kong: A mixed-methods study.

We examined the association of workplace smoking cessation (SC) support from employers, in addition to SC interventions, and smoking abstinence. Smoking employees (≥1 cigarette daily, aged ≥18 years) from companies of various industries joined a workplace SC program in Hong Kong. Self-reported past 7-day point prevalence abstinence was measured at follow-up at 6 months. We assessed 14 types of workplace SC support with higher scores (range: 0-14) indicating greater support. Multivariable logistic regression examined the prospective association between workplace SC support and smoking abstinence, adjusting for intention to quit, nicotine dependence, self-efficacy of quitting, and sociodemographic characteristics. Average marginal effects were calculated to test if the association between overall workplace SC support and self-reported past 7-day PPA at follow-up at 6 months was modified by subgroups. We also interviewed employers from different companies to explore their perspectives of providing workplace SC support, and the data were analyzed by thematic analysis. In 383 participants who received a heath talk, a self-help SC booklet, and 15 text messages, greater workplace SC support was associated with smoking abstinence (AOR=1.32; 95% CI: 1.08-1.61), including support for smoke-free environment (AOR=1.51; 95% CI: 1.08-2.11) and for SC attempts/actions (AOR=1.93; 95% CI: 1.21-3.07). The association did not differ by sex, age, intention to quit, nicotine dependence, company size or company type. Qualitative interviews found that employers provided workplace SC support to establish a good company image, cost-benefit considerations were important to the types of workplace SC support provided, and lack of SC knowledge was a barrier to providing workplace SC support. Greater workplace SC support was associated with more abstinence in a workplace SC program.

Association of Childhood Respiratory Status with Adult Occupational Exposures in a Birth Cohort.

Rationale: People with better early-life respiratory health may be more likely to work in occupations with high workplace exposures in adult life compared with people with poor respiratory health. This may manifest as a healthy worker effect bias, potentially confounding the analysis of environmental exposure studies. Objectives: To evaluate associations between lung function in adolescence and occupational exposures at initial adult employment. Methods: The TCRS (Tucson Children's Respiratory Study) is a long-term prospective study of respiratory health beginning at birth. Associations between respiratory function at age 11 years and occupational exposures at first job at age 26 years were evaluated with logistic regression. We calculated percentage predicted values for forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1:FVC ratio, and forced expiratory flow from 25% to 75% of vital capacity at age 11. At the 26-year visit, participants self-reported occupational exposures to dust, smoke, and fumes/gas at first job in a standardized interview. Results: Forced expiratory flow from 25% to 75% of vital capacity and FEV1:FVC ratio at age 11 were positively associated with dust workplace exposures at the first job. Each 10% increase in percentage predicted prebronchodilator FEV1:FVC ratio was associated with 30% higher odds of workplace dust exposure (odds ratio for a 1% increase, 1.03 [95% confidence interval, 1.00-1.06; P = 0.045]). Similar associations were observed for FEV1 and FVC with workplace smoke exposures. We also observed modification by time at job: associations were stronger for those who remained in their jobs longer than 12 months. In addition, those with better function at age 11 were more likely to stay in their jobs longer than 12 months if their first jobs involved exposure to dust. Conclusions: Childhood lung function affects initial career choice. This study supports the premise of the healthy worker effect.

The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis.

Previous research has documented the effect of comprehensive smoking bans on preventing various adverse health outcomes in the years post-ban. In 2007, Denmark implemented a national smoking ban that prohibited indoor smoking in workplaces and public settings, although only partial restrictions applied in specific premises such as small bars, one-person offices, and in psychiatric units. We tested the hypothesis that the implementation of the national smoking ban was associated with a decrease in incidence of smoking-related morbidity in the Danish population compared to the pre-ban period. Interrupted time series analyses including the entire Danish population (≥30 years) was conducted. Information of hospitalizations and cause-specific mortality due to acute myocardial infarction, heart failure, hemorrhagic stroke, ischemic stroke, chronic obstructive pulmonary disease, cancer in bronchus and lung, cancer in lip, mouth, oral cavity, and pharynx, and bladder cancer were obtained from population-based registers. Poisson regression models accounting for seasonal variations and secular trends quantified immediate changes in incidence rates occurring at the time of the smoking ban as well as changes in the post-ban trend compared to pre-ban levels. Overall, we observed no consistent declines in incidence of cardiovascular diseases, chronic obstructive pulmonary disease, or the specific types of cancer in the post-ban period compared with the pre-ban period. No consistent reduction in incidence of smoking-related diseases was observed after the smoking ban was introduced in Denmark. This probably reflects that the Danish smoking ban included several exemptions, resulting in a less comprehensive ban compared to those introduced in other countries. In this study, we found that the Danish national smoking ban from 2007 did not consistently reduced the incidence of eight smoking-related outcomes in the post-ban period compared to pre-ban levels. We argue that due to the exemptions in the smoking ban, which for example allowed smoking in specific premises of the care and nursing sector, in one-person offices, and small bars, the ban was not sufficiently comprehensive to influence smoking behavior and thereof the incidence of smoking-related morbidity. Our findings highlight the importance of introducing comprehensive legislative measures to yield largest health benefits at a population level.

Prevalence And Predictors of Exposure to Second-Hand Smoke Among Never-Tobacco Smokers

Background: Exposure to Second-hand tobacco smoke (SHS) harms health. It is a risk factor for various diseases like asthma, hypertension, diabetes, heart disease and lung cancer. This study aimed to determine the prevalence and predictors of second-hand tobacco smoke among adult never-smokers. Methods: A cross-sectional study was conducted among 220 participants aged 18 years and above. A pre-tested questionnaire was used to elicit information regarding exposure to second-hand smoke at the home, workplace and various public places. The data was analysed using the Epi Info software for windows. Results: The second-hand smoke exposure at home and workplace was 11.4% and 19.1%, respectively. The SHS exposure at bus stops, public transport, government buildings and health care facilities were 33.3%, 13.0%, 7.6% and 3%, respectively. The in-home study participants with a current tobacco smoker, family member and/or friend had comparatively higher exposure to second-hand tobacco smoke. In the workplace and or public places, male study participants and illiterate individuals had higher exposure to second-hand tobacco smoke. Conclusion: The observed level of SHS exposure among non-smokers is a public health concern. Family members should not allow anyone to smoke in their home environment. The public health law prohibiting tobacco smoking in workplaces and public places needs further strengthening.

Factors associated with smoking behaviour changes during the COVID-19 pandemic in Japan: a 6-month follow-up study

BackgroundSmoking behaviour may have changed due to the COVID-19 pandemic, the April 2020 revised smoke-free policy and the high prevalence of heated tobacco product (HTP) use in Japan (10.9% in...

“Time-based” workplace smoking bans during working hours (including and excluding lunchtime) and combustible cigarette and heated tobacco product use: a cross-sectional analysis of the 2020 JASTIS study

Although some private companies have implemented “time-based” workplace smoking bans covering all working hours including lunchtime, little is known about their impact on tobacco use. We examined associations between workplace smoking bans during working hours (including and excluding lunchtime) versus no ban and workers’ combustible cigarette and heated tobacco product (HTP) use.We used data from the Japan “Society and New Tobacco” Internet Survey 2020 and in total 4,222 workers aged 20–74 were included in the analyses. Using inverse probability weighting, prevalence ratios (PRs) and 95% confidence interval (CI) for tobacco use were calculated according to “time-based” smoke-free policies: workplace smoking bans for working hours including lunchtime (lunchtime ban), workplace smoking ban for working hours excluding lunchtime (lunchtime allowed), and no ban for working hours (no ban).The PRs of “lunchtime ban” for workers’ use of combustible cigarettes and HTPs were lower than “no ban”: 0.43 (CI: 0.29, 0.63) for combustible cigarette use and 0.61 (CI: 0.41, 0.90) for HTPs use. Meanwhile, the PRs for “lunchtime allowed” was not significant: 0.84 (CI: 0.70, 1.01) for combustible cigarettes use and 1.15 (CI: 0.94, 1.40) for HTPs use.Workplace bans on smoking during working hours which include lunchtime may successfully reduce workers’ combustible cigarette and HTP use, but allowing their use during lunchtime may reduce the effectiveness of the ban. Not only conventional “place-based” smoke-free policies, but also “time-based” smoke-free policies are useful for tobacco control in the workplace.

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.

Health and economic impact of a smoking cessation program in Korean workplaces.

Smoking is a leading cause of diseases and death, with significant socioeconomic consequences. The purpose of this study was to evaluate the health and economic effectiveness of a workplace smoking cessation program. A total of 89 smokers from seven workplaces in Korea were the participants of the program. For 4 months, individual counseling based on the transtheoretical model (TTM) was conducted and interpersonal and organizational components were applied to encourage entire workplaces to encourage employee smoking cessation. The primary outcome was whether participants quit smoking or not. We also evaluated the changes in attitude and perceptions related to smoking cessation before and after the program and estimated the program's economic effects. Economic effects were defined as reductions in productivity losses and medical expenses. We calculated the return on investment (ROI) values representing the averted cost through the program compared to program cost. At the end of the program, 40.4% of participants quit smoking. Improvements were observed in TTM-based attitudes and perceptions. The mean reduction in productivity losses was estimated to be $187,609.94 for 2 yr and the mean reduction in medical expenses was $3,136.49 at 20 yr among seven workplaces. When accounting for these reductions, the ROI was 15.39 (ranging from -1.00 to 44.53). These effects were robust under various scenarios. The smoking cessation program should be expanded to a wider variety of workplaces. In the future, more sophisticated economic assessment methods should be developed and applied to facilitate workplace recruitment and attract management support.

Cohort profile for the Loma Linda University Health BREATHE programme: a model to study continuously incentivised employee smoking cessation

PurposeThe purpose of the Loma Linda University Health (LLUH) BREATHE cohort is to test the efficacy of a novel method of continuously incentivising participation in workplace smoking cessation on participation,...

Implementing tobacco-free policy in residential substance use disorders treatment: Practice changes among staff

IntroductionImplementing tobacco-free policies in substance use disorders (SUD) treatment may reduce tobacco-related, health disparities. This study examined adoption of tobacco-related policy and practices in six residential programs participating in a California-sponsored, 18-month, tobacco-free policy intervention. MethodsDirectors (N=6) completed surveys of tobacco-related policies before and after the intervention. Staff completed cross-sectional surveys assessing tobacco-related training, beliefs, practices, workplace smoking policy, tobacco cessation program services, and smoking status pre- (n=135) and post-intervention (n=144). ResultsDirector surveys indicated no programs had tobacco-free grounds, one provided tobacco-related staff training, and two provided nicotine replacement therapy (NRT) pre-intervention. At post-intervention, 5 programs had implemented tobacco-free grounds, 6 provided tobacco cessation training, and 3 provided NRT. Across all programs, staff were more likely to report smoke-free workplaces (AOR = 5.76, 95% CI1.14,29.18) post- versus pre-intervention. Staff positive beliefs towards addressing tobacco use were higher post-intervention (p<0.001). Odds of clinical staff reporting tobacco-related training participation (AOR = 19.63, 95% CI14.21,27.13) and program-level provision of NRT (AOR = 4.01, 95% CI 1.54, 10.43) increased post- versus pre-intervention. Clinical staff reporting they provided tobacco cessation services were also higher post-intervention (p= 0.045). There were no changes in smoking prevalence or quit intention among smoking staff. ConclusionA tobacco-free policy intervention in SUD treatment was associated with implementation of tobacco-free grounds, tobacco-related training among staff, more positive staff beliefs towards and delivery of tobacco cessation services to clients. The model may be improved with greater emphasis on staff policy awareness, facilitating availability of NRT, and reducing staff smoking.

More than a Ban on Smoking? Behavioural Spillovers of Smoking Bans in the Workplace

Are workplace smoking bans (WSBs) more than a ban on smoking? We study whether WSBs influence smoking cessation and exert behavioural spillover effects on (i) a number of health behaviours, and (ii) on individuals not directly affected by the bans. Drawing upon quasi-experimental evidence from Russia (a country where about half of the population smokes), which introduced a WBS (in addition to a smoking ban on public places), and adopting a difference-in-differences (DiD) strategy, which compares employed individuals (exposed to the work and public place ban) to those unemployed (exposed only to the ban in public places), we document three sets of findings. First, unlike previous studies (focusing on smoking bans in public places), we find robust evidence that WSBs increase smoking cessation in 2.9 percentage points (pp) among men. Second, we find that upon the WSB, quitters are less likely to use alcohol (6.7pp reduction among men and 3.5 pp among women), reduce their alcohol consumption (10 percent among men) and increase their physical activity (in 4.3 percentage points among men). WSBs are found to influence health behaviours of those not directly affected by the reform, such as never smokers. Our findings are consistent with a model of joint formation of health behaviours, and suggest of the needs to account for a wider set of spillover effects when estimating the welfare effect of WSBs.