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MAJOR REVIEW ARTICLES
1. A
review of the health impact of smoking control at the workplace;
Eriksen MP, Gottlieb NH; American Journal of Health Promotion; 13
(2); pp. 83-104;
November/December
1998
Format:
Review Article
Abstract
(abbreviated):
Summary
of Important Findings: Smoking cessation group programs were found
to be more effective than
minimal treatment programs, although less intensive treatment,
when combines with high participation rates, can influence the
total population.
Tobacco policies were found to reduce cigarette consumption at
workand worksite environmental tobacco smoke (ETS) exposure.
Conclusions:
The literature is rated suggestive for group and incentive
interventions; indicative for
minimal interventions, competitions, and medical interventions;
and acceptable for the testing
of incremental effects. Because of the lack of experimental
control, the smoking policy literature is rated weak; although
there is strong consistency in
results for reduced cigarette consumption and decreased exposure
to ETS at work.
2.
Environmental Tobacco Smoke in Public Places and Workplaces:
Current Knowledge and
Implications for Policy; McBride C, McWiliam D, Mecredy D, Mowat
DL; Toronto: Ontario Tobacco Research Unit; (Literature Reviews
Series No. 7);1996
Format:
Review Article
Abstract:
This
literature review explores the facts and issues related to the
development of municipal bylaws
regulating smoking in workplaces and public places. A number of
factors are examined including the
health effects of environmental tobacco smoke (ETS),
public opinion about ETS and tobacco control measures, current
legislation on passive smoking,
municipal tobacco control, ventilation and cleaning systems,
impact on business and tourism,
enforcement, and smokers’ rights. Research suggests
that there is strong public support for smoke-free bylaws and that
they do not adversely affect
business or tourism. Given current knowledge about the health
hazards of ETS, it is clear that
prohibitions on smoking in all public places and workplaces
provide the optimal protection of worker and public health.
3.
Changes in employee smoking behavior after implementation of
restrictive smoking policies; Olive
KE, Ballard JA; Southern Medical Journal 89 (7),
pp. 699-706; July 1996.
Format:
Review Article
Abstract:
How do
restricted smoking policies affect the smoking behavior of
employees? At two federal
hospitals, 2,700 employees completed written surveys after implementation
of restrictive smoking policies. At one hospital, smokers reported
less smoking at work (down 2.0
cigarettes a day at 6 months, 1.7 at 12) without compensatory
smoking. At the other, no significant changes in smoking behavior
were reported. However, at both
hospitals, some baseline smokers quit smoking. At 6
months, 9% had quit at one hospital and 8% at the other. Analyses
were done using these two
studies and 17 published studies. In 11 of 11 studies, consumption
at work decreased, and in 12 of 14,
total daily consumption decreased. Regression analysis
indicated that the number of smokers who quit smoking after policy
implementation increases over time at
rates exceeding those normally expected in the
population. Smoking policies appear to effect a reduction in total
cigarette consumption and an
increase in the number of smokers who quit.
Conclusions
(abbreviated):
[O]n
comparison with our estimates of baseline smoking cessation rates,
we do believe that the weight
of the literature supports the hypothesis that restrictive smoking
policies contribute to increased smoking cessation…. Restrictive
smoking policies have increasing impact on the lives of Americans.
Our research suggests that such
policies may have impact beyond the workplace and are conducive
to a healthy workforce. Moreover, we believe such policies are
important in our hospitals to
convey to patients the negative health consequences of
smoking.Patients expect health care professionals to model healthy
behavior. Patients are mostly
supportive of hospital restrictive smoking policies, and the
majority of smoking patients
are willing to comply with such policies. We believe current US
standards requiring such policies are
appropriate, make an important statement, and contribute
to a healthier society.
4. Do
workplace smoking bans reduce smoking?; Evans WN, Farrelly MC,
Montgomery E; Working Paper 5567;
National Bureau of Economic Research, Inc.; May
1996
Format:
Monograph/Working Paper
Abstract:
In recent
years there has been a heightened public concern over the
potentially harmful effects of
environmental tobacco smoke (ETS). In response, smoking has
been banned on many jobs. Using data
from the 1991 and 1993 National Health Interview
Survey and smoking supplements to the September 1992 and May 1993
Current Population Survey, we
investigate whether these workplace policies reduce smoking
prevalence and smoking intensity among workers. Our estimates
suggest that workplace bans
reduce smoking prevalence by 5 percentage points and average
daily consumption among smokers by 10
percent. The impact of the ban is greatest for
those with longer work weeks. Although workers with better health
habits are more likely to work
at establishments with workplace smoking bans, estimates from
bivariate probit and two-stage least
square equations suggest that these estimates are
not subject to an omitted variables bias. The rapid increase in
workplace bans can explain all
of the recent sharp fall in smoking among workers relative to
non-workers.
5.
Worksite and community intervention for tobacco control; Gruman J,
Lynn W; in Nicotine addiction:
Principles and management. New York: Oxford University Press,
1993; pp. 396-411.
Format:
Book Chapter
Conclusion:
The
lengthy and complex group of factors that have been identified as
determinants of smoking
initiation, smoking, and quitting set forth a formidable challenge
for those engaged in planning
interventions to bring one of the twentieth century’s most
serious health problems under control.
It is neither practical nor realistic to believe that
any single approach or method will have a significant impact on
population- wide smoking
prevalence. The precedent for effective action has been set
through numerous system-wide
public health interventions in such areas as tuberculosis control,
maternal and child health, HIV disease, and occupational health.
It is time for tobacco use to
draw upon this tradition and to be accorded top priority as a
public health challenge.
6. Smoking
control at the workplace; Fielding JE; Ann. Rev. Pub. Health Vol.
12, pp. 209-234; 1991
Format:
Review Article
Conclusion:
During
the 1980s, a profound change occurred in the response of employers
to smoking among employees.
Increasing epidemiological data on the adverse effects of
ETS have been coupled with repeated demonstrations that smokers
cost employers more, both
directly and indirectly, than nonsmokers. Weight of scientific
evidence, combined with increasingly
prevalent legal restrictions on smoking in private
and public workplaces, has led employers to take more aggressive
approaches to discourage smoking and
encourage employees who quit to remain abstinent.Traditional
smoking cessation classes, self-help materials, and one-on-one
counseling, which together reached a
small percentage of smokers, have been complemented
by increasingly restrictive smoking policies that discourage
worksite smoking and sometimes
ban smoking on employer support, including that of a significant
percentage of smokers. Various activities have been associated
with declines in the percentage
of smokers in the population, but the independent effects of
restrictive smoking policies on smoking prevalence have not yet
been elucidated. The most
important trend among management and workers in private and public
workplaces is the shift from
acceptance of smoking and the primacy of the rights of the
smoker to discouragement of smoking. Intensive efforts to
discourage tobacco use and to
establish nonsmoking as normative behavior at the worksite have
been commonplace. Should
present trends continue, smoking prohibition in the worksite
could be common within the next
decade.
7.
Smoking cessation programs in the workplace: Review and recommendations
for occupational health nurses; Strasser PB; AAOHN Journal;
39 (9), pp. 432-438; September 1991
Format:
Review Article
Summary
Seventeen
studies of worksite smoking cessation were examined. Although the
review was limited, the conclusions
are supported by a recent meta-analysis of worksite
smoking research. Fisher (1990) determined that although worksite
smoking cessation programs do produce
significantly higher quit rates than control and
current conditions, poor research methodologies along with
multifaceted program approaches
make it difficult to identify one or two strategies that will
predict success for smokers who
attempt to quit (Fisher, 1990). If,
as research suggests, there is no “magic bullet” to offer
smokers who want to quit, then
occupational health nurses have a unique opportunity to design
programs for the specific needs
of the workers in their practice. Many nurses are in a setting
where they can closely evaluate which
treatment approaches seem to be effective and
modify interventions appropriately, In addition, occupation;
health nurses have advantage of
being able to intervene over time, which may be more effective
than a single, discrete
program. As the social climate
becomes less supportive of smoking, more and more smokers are
looking for assistance to quit. Programs in the workplace carried
out by occupational health
nurses are a logical choice to provide this help. Fisher (1988)
reported 70% of workers participating
in worksite programs indicated they would not
have sought another program if one had not been offered at work.
Published reports of nurses’
involvement in worksite smoking cessation programs are
sparse. Jordan Marsh (1988) reports that occupational health
nurses are much less involved
than physicians in counseling smokers. Occupational health nurses
should be at the forefront of the
effort, seizing the opportunity to spearhead smoking
cessation efforts at the workplace. The benefits from such efforts
will affect worker health
directly and business costs indirectly. What better way for
occupational health nurses to prove
their worth to business and obtain personal satisfaction
than to help individual workers improve their health status?
8. Work
site smoking cessation: A meta-analysis of long-term quit rates
from controlled studies; Fisher
KJ, Glasgow RE, Terborg JR; Journal of Occupational Medicine;
32 (5), pp. 429-439; May 1990
Format:
Review Article
Abstract:
Meta-analytic
techniques were applied to 20 controlled studies of work site
cessation yielding a total of
34 comparisons of long-term (average = 12 months) quit rate
(QR). An overall weighted mean effect
size (ES) of .21 ? .07 was found, indicating a modest
but significant overall effect (P < .01). The weighted average
follow-up QR from all
interventions was 13%. Based on previous research, characteristics
associated with interventions, work
sites, employees, and research methodology were
identified as potential moderator variables. Apart from
methodological variables,
interventions conducted in smaller work sites (ES = .45 ? .17),
which lasted 2 to 6 hours (ES =
.28 ? .07) were associated with the largest effect sizes. We
were also interested in absolute quit rates. After controlling for
methodological quality,
programs that included a cessation group component (partial r=
-.42), and that shared company
and employee time (partial r = -.48), as well as the above variables
had the strongest associations with QR. Implications for public
health policy and future
research are discussed.
Conclusion
(abbreviated):
In
summary, the best-evidence criteria of Slavin proved to be a
useful basis on which to select
studies for a meta-analysis of work site smoking cessation. The
primary analysis answered conclusively
that work site interventions significantly influence
QR. Interventions that used at least part of employees’ own
time, were more intense,
contained cessation groups, and were conducted in smaller organizations
were associated with higher QR. Work site programs appear to be
particularly effective in assisting
heavier smokers to quit. These factors, however, explained
only some of the variability in outcome. Patterns of the
relationships between variables
were clarified when methodological factors were controlled.
Finally, the modest but significant
and conservatively defined long-term QR of 13%, generated
from 20 controlled studies, can be regarded as a quantitative
assessment of the impact of
these interventions, a benchmark against which future WSC investigations
can be compared.
CANADIAN
SURVEYS AND TRENDS
1. Which
workers smoke?; Gaudette LA, Richardson A, Huang S; Health Reports:10(3);
pp. 35-45; Winter 1998
Format:
Journal Article
Main
Results:
In
1994/95, 28% of full-time workers were daily smokers, and about a
third of them smoked 25 or more
cigarettes a day. Smoking prevalence and intensity were lowest
among white-collar workers and highest
among blue-collar workers. Since 1978/79, there
has been an overall decline in smoking prevalence, and since 1986,
a decline in smoking intensity
among all workers except those in outdoor blue-collar occupations.
About 6 in 10 full-time workers who smoked daily encountered
restrictions at work.
Implications:
The
1994/95 National Population Health Survey shows that smokers who
reported workplace restrictions
were less likely to smoke heavily and more likely to have tried
to cut down. However, these results
cannot be used to conclude that the presence of
bans caused reductions in smoking. In fact, workers reporting
restrictions were no more
likely to have tried to quit than workers who reported no
restrictions. Smoking
restrictions are only one factor that may influence workers who
smoke. Smoking has been
associated with stress caused by high job strain. It may be a
coping strategy to deal with work
involving high demands and low levels of autonomy….
Women in clerical occupations, who have a below-average quit rate,
fit these stress patterns. High
job strain can also be expected from the assembly-line nature,
tight supervision and boredom associated with many indoor
blue-collar occupations. As
well, some blue-collar occupations entail a degree of danger.
Workers in such jobs may perceive
smoking to be a relatively innocuous risk compared
with other serious hazards that they confront. Social
factors are also important. Many blue-collar workers seem to be
committed smokers who may be
receiving support from peer groups to continue smoking, and
may be more likely to socialize in
places with less stringent smoking restrictions.
2.
Relationship of organizational characteristics of Canadian
workplaces to anti-smoking
initiatives; Frankish CJ, Johnson JL, Ratner PA, Lovato CY;
Preventive Medicine; 26; pp. 248-256;
1997
Format:
Journal Article
Results:
One-half
of workplaces reported some kind of smoking-related initiative.
Most of the initiatives
were smoking policies; only 11.7% of workplaces provided smoking
cessation
programs. The number of employees and the number of other
lifestyle and
occupational health and safety programs available are most
predictive of smoking-related
programs.
Conclusion: If
Canadians are going to achieve a smoke-free society, greater
efforts to assist smokers
to quit will be necessary. The workplace provides an excellent
opportunity for such
efforts. Health promotion advocates must communicate the cost
savings and other
benefits to employers garnered from workplace smoking reduction
efforts.
3. The
role of information, policy & programs in worksite smoking
control; Frankish
CJ, Johnson J; Lovato C, Green L, Ratner P, Best A; Institute of
Health Promotion
Research; 1995
Format:
Report for The Canadian Fitness & Lifestyle Research Institute
and Health Canada
Recommendations
(abbreviated):
[General
recommendations regarding smoking control in work settings]
Canadian
employers have not had the same level of motivation to provide
health promotion
programs for their employees as have American employers who face
paying
the medical bills or the increased insurance premiums if their
employees fall ill. One
result of this disparity in motivation is the underdevelopment in
the Canadian context
of workplace tobacco control…. We recommend government
leadership in providing
tax incentives and technical support for employers to offer
worksite smoking
cessation programs in conjunction with smoke-free workplace
policies and more
comprehensive health promotion programs. The more comprehensive
programs
need to address not only the behaviour of employees (e.g., coping
with stress),
but also the working conditions (e.g., sources of stress, other
aspects of workplace
air quality besides smoking). We recommend a national task force
with government,
academic, business, and labour representation to do a cost-benefit
study and
develop a business case. COMMIT
offers the best demonstration to date of the role for workplace
programs within a
comprehensive community-based strategy…. Meta-analysis of
controlled studies
supports their effectiveness in terms of smoking cessation… as
do recent state-wide
evaluation data from California…. The California data are particularly
compelling:
between 1990 and 1993 (during the intensive state-wide tobacco
control
program), the number of smoke-free workplaces almost doubled.
Maintaining
a smokefree work area was associated with a 14% reduction in
smoking prevalence….
4.
Smoking cessation initiatives in the workplace; The Conference
Board of Canada;
1995
Format:
Report
Highlights
(abbreviated):
?
Employee health and wellness appears to be relatively important
among participating
organizations.
? The
level of assistance provided to employees for smoking cessation is
another indicator
of the importance of employee health and wellness.
? Most
smoking cessation initiatives are fully-funded by organizations
and are usually
stand-alone in nature.
? Various
studies have identified important health and productivity issues
arising from
having employees leave their work areas to smoke.
? Only 3
per cent of responding organizations conduct evaluations of their
programs.
? A
smoke-free environment can be a key motivator for smokers wishing
to quit.
? Notable
gender differences were identified in the survey in terms of
smoking behaviour,
desire to quit and perceived barriers to success.
? The
types of formal workplace programs offered are somewhat
inconsistent with employee
preferences.
? Some
employers expressed a need for additional resources in terms of
more information
on the hazards of smoking, community resources available and
programs
targeted at heavy smokers.
5.
Workplace smoking: Trends, issues and strategies; Lowe GS; Health
Canada; October
1995
Format:
Discussion Paper
Conclusion:
Having
reviewed the current state of research on workplace smoking
restrictions and evaluated
existing legislation, we can now suggest future research and
policy directions
for Canada. While Canada has made considerable progress in
reducing workplace
ETS exposure, the goals of the NSTRTU have been achieved in only a
few industries
and occupations. Blue-collar occupations and huge areas of the
service sector
have smoking rates well above average. Small firms, which employ
the majority
of Canadian workers, are less affected by smoking regulations.
Moreover, total
bans on ETS are not yet the standard for regulation. Generally,
workers comply with
smoking legislation or policies. However, achieving greater
reductions in ETS exposure
will require enforcement strategies aimed at non-conforming
groups. In
integrated ETS reduction strategy must involve government,
employers, unions and
public health organizations. Uniform minimum standards are also
essential and should be
established at the provincial level. However, most progress in
achieving smoke-free
workplaces is now occurring at the municipal level. The use of
enhanced OHS
legislation may also be a useful strategy to reduce ETS in
high-exposure worksites.
6.
Workplace smoking policies and public reaction in Alberta: An
analysis of the 1990
Alberta survey; Krahn H, van Roosmalen E; Health and Welfare
Canada;
1990
Format:
Report Conclusions
(abbreviated):
?
Workplace smoking policies have become much more common, with a
substantial
majority of workers protected by some type of policy.
? As
workplace smoking policies have become more common, the strong
support for them
which was observed in earlier studies has remained. In general,
the principle
that the rights of non-smokers must be protected appears to be the
norm.
? A small
minority of workers continue to violate “no smoking” policies,
but they face a
reasonably high chance of being asked to comply by another small
minority
of co-workers.
?
Although residents of larger urban centres are somewhat less
likely to smoke, and while
workplace smoking policies are somewhat less common in rural and
small
town settings, rural and urban residents appear to be equally
receptive to “no
smoking” policies.
CESSATION
1.
Employee stress levels and the intention to participate in a
worksite smoking
cessation program; Chen W-F, Heaney CA; Journal of Behavioral
Medicine;
20(4); pp. 351-364; 1997.
Format:
Journal Article
Abstract:
This
study examines the nature and extend of the relationship between
stress levels and
intentions to participate in a worksite smoking cessation program
among male current
smokers (n=220) employed in an automobile manufacturing plant. A
plantwide
survey was conducted which measured job stress, nonjob stress,
smoking behavior,
and intent to participate. The results of polychotomous logistic
regressions suggest
that among the current smokers in this plant, job and nonjob
stress were positively
associated with workers’ intentions to participate in a worksite
smoking cessation
program. Thus, contrary to the popular notion that stress
diminishes the motivation
to quit, employees under high levels of stress may be most
receptive to educational
interventions intended to persuade smokers to commit to quitting.
2.
Smoking-specific weight gain concerns and smoking cessation in a
working
population; Jeffery RW, Boles SM, Strycker LA, Glasgow RE; Health
Psychology;
61(5); pp. 487-489; 1997
Format:
Journal Article
Abstract:
Smoking
cessation rates, progression in stage of change for smoking
cessation, and serious
quit attempts were examined over 2 years in a cohort of 242 men
and women
smokers (mean age 39.7 years, mean body mass index [BMI] 26.3) as
a function
of expressing concern about gaining weight because of quitting
smoking. Participants
were employees of 25 companies who were in a worksite health
promotion
program aimed at reducing risk factors for cardiovascular disease.
Multivariate
odds ratios (controlled for age, education, job class, sex, and
BMI) for quitting
smoking, attempting to quit smoking, and progressing in stage of
change for
smoking cessation as a function of weight concern were not
significant. Interactions
between sex and weight concern, and BMI and weight concern were
also not
significant. These findings, in a working, predominantly
blue-collar population,
and those of other studies, suggest that concern about gaining
weight is, at
best, a weak predictor of change in smoking behavior among most
workers.
3. A
worksite smoking intervention: A 2 year assessment of groups,
incentives
and self-help; Jason LA, Salina DA, McMahon SD, Hedeker D,
Stockton M. Health
Education Research; 12(1); pp. 129-138; 1997
Format:
Journal Article
Conclusions:
The costs
of smoking to our society ($100 billion annually) are enormous.
When the costs and
the benefits of these three worksite programs are considered, all
three are highly
cost-effective…. However, given the convergent nature of the
data and the expense
involved in the implementation of the group intervention, the self-help and
incentive
interventions could be considered relatively more cost-effective
than the group intervention at long-term follow-up. Yet, each intervention has
unique benefits
that should be considered. Media interventions and self-help
groups represent
effective methods of reaching thousands of smokers. The media has
the additional
benefit of raising the awareness and sensitivity of the general
public to the
difficulties involved in quitting smoking. Incentives may increase
response rates and
participation rates. Groups may help participants identify coping
strategies that are
specifically effective for them, and provide an environment where they can
prepare,
practice and support each other. Smokers may benefit from access
to a variety
of intervention methods, as different approaches may appeal to
different individuals.
4. Health
and economic implications of a work-site smoking-cessation program:
A simulation analysis; Warner KE, Smith RJ, Smith DG, Fries BE.
Journal
of Occupational and Environmental Medicine 38 (10); pp. 981-992;
October 1996
Format:
Journal Article
Abstract:
In this
article, we examine the health and economic implications of a
workplace smoking-cessation
program by using a simulation model that includes, among its
novel
features, consideration of long-term as well as short-term
implications and evaluation
of the effects of employee turnover on benefits derived by both
the firm and the
broader community. As a result of employee turnover, approximately
half of the
program-generated benefits are realized by the community outside
the firm. Still,
smoking cessation is a very sound economic investment for the
firm, and is particularly
profitable when long-term benefits are included, with an eventual
benefit-cost
ratio of 8.75. Saving life-years at a cost of $894 each, the
program is more
cost-effective than most of the conventional medical care covered
by the firm’s insurance.
Nevertheless, the intervention successfully addresses only a
fraction of the costs
that smoking imposes on the firm.
Principal
conclusions (abbreviated):
? The
most important, if not necessarily most intriguing, conclusion of
this study is that our
findings are consistent with the conventional wisdom that a
work-site smoking
cessation program will generate economic benefits that exceed the
program’s
cost. Indeed, in the base case analysis, each of the four areas of
economic benefit – medical care, absenteeism, on-the-job productivity,
and life insurance
– eventually yields financial returns that more than cover
program cost….
? The
analysis confirms another piece of conventional wisdom, namely,
that a smoking-cessation
program is a cost-effective investment in employee health. The cost
per life-year saved of $894 is consistent with the findings from
other cost-effectiveness
analyses of smoking cessation…
? One of
the more intriguing conclusions from our analysis is that previous
studies may have
systematically and considerably underestimated the magnitude of
the eventual
net financial benefit associated with workplace health promotion
at the same time
that they overestimated benefits and underestimated costs during
the short-run
time periods they evaluated….
? This
analysis suggests that a work-site smoking-cessation program,
well-funded and
realistic in its expectations with regard to successful quitting,
is a distinct economic
winner, for both the firm that runs the program and for the
broader community
within which the firm is located. In concluding, however, we
emphasize
that we have never believed that a health-promotion program must
yield a
positive financial return to justify its existence. Firms
interested in their employees’
welfare should see an intervention such as the one studied here to
be an
extraordinary investment in their employees’ health: this
work-site wellness
intervention grants employees additional years of life at a cost
well below
that of nearly all of the medical interventions the firm covers
through its conventional
health insurance. We consider the fact that the program also
generates
a handsome economic return a very welcome bonus.
5.
Effectiveness of nicotine patches in a workplace smoking cessation
program:
An eleven-month follow-up study; Mankani SK, Garabrant DH, Homa
DM.
Journal of Occupational and Environmental Medicine 38 (2); pp.
184-189; February
1996
Format:
Journal Article
Abstract:
Transdermal
nicotine patches are widely prescribed as part of smoking
cessation programs,
but their efficacy beyond 6 months is not well established. We
evaluated the
efficacy of a 70-day treatment regimen among 75 subjects in an
industrial setting
where follow-up was conducted for 11 months. The median time free
of cigarettes
was 73 days, and the overall smoking abstinence rate was 9% after
11 months of
follow-up. Smoking abstinence was significantly higher among those
subjects
who completed the full course of treatment than among those who
did not (25 vs.
6%, respectively). Smoking abstinence was also higher among
subjects who started
smoking after age 17 than among those who started at younger ages
and was
higher among mail than female subjects. We conclude that
transdermal nicotine patches
are of limited efficacy in achieving long-term smoking cessation
and that the relative
costs and benefits of this treatment are not adequately specified.
6.
Assessing a smoking cessation intervention involving groups,
incentives, and
self-help manuals; Jason LA, McMahon SD, Salina D, Hedeker D,
Stockton M, Dunson K,
Kimball P. Behavior Therapy 26, 393-408; 1995
Format:
Journal Article
Abstract:
A
media-based worksite smoking cessation program was evaluated.
Participants in each
worksite received a television program and one of three
conditions: 1) self-help manuals
alone, 2) self-help manuals and incentives, or 3) maintenance
manuals, incentives,
support groups, and cognitive behavioral strategies for quitting
smoking. During
the 6 months following the initial media and group meeting
intervention phase, 14
booster meetings were held for participants who had received
support groups.
The quit-rate among participants who received manuals, incentives
and groups
was significantly higher than the quit rate among participants who
received the
manuals and incentives, or just the manuals. The results indicate
that the combination
of cognitive behavioral techniques and social support may
represent an effective
worksite smoking cessation intervention. The significant effect of
the group condition
12 months following initial quit efforts is particularly
promising.
7. Is a
telephone helpline of value to the workplace smoker?; Amos A,
White DA, Elton
RA. Occupational Medicine 45 (5);234-238; 1995
Format:
Journal Article
Abstract:
This
paper reports the findings of the evaluation of a national smokers’
helpline which was
set up by British Telecom (BT) for its employees. The helpline
formed part of a
new comprehensive smoking policy for all BT staff. Over 1000
employees, more than
3.0% of all smokers, phoned the helpline during the first three
months of its
operation. Two-thirds of callers tried to quit smoking after
calling the helpline, and a
quarter were still successful three months later. One in six
callers reduced the number of
cigarettes that they smoked on working days. While the helpline
and other
cessation support services were evaluated positively by callers,
it appears that helplines
only appeal to a small minority of smokers. However, they do seem
to be an
effective mechanism for a nationwide company to identify those
smokers who want
support, and a useful means of centralizing the administration of
support services.
They are potentially a cost-effective option for larger employers.
8.
Reducing smoking at the workplace: Implementing a smoking ban and
hypnotherapy;
Sorensen G, Beder B, Prible CR, Pinney J. Journal of Occupational
and
Environmental Medicine 37 (4);453-460; April 1995
Format:
Journal Article
Abstract:
Smoking
cessation programs may be an important component in the
implementation of
worksite smoking policies. This study examines the impact of
worksite smoking policies.
This study examines the impact of a smoke-free policy and the
effectiveness
of an accompanying hypnotherapy smoking cessation program. Participants
in the 90-minute smoking cessation seminar were surveyed 12 months
after the
program was implemented (n=2642; response rate=76%). Seventy-one
percent
of the smokers participated in the hypnotherapy program. Fifteen
percent of survey
respondents quit and remained continuously abstinent. A survey to
assess attitudes
toward the policy was conducted 1 year after policy implementation
(n=1256;
response rate=64%). Satisfaction was especially high among those
reporting
high compliance with the policy. These results suggest that
hypnotherapy may be an
attractive alternative smoking cessation method, particularly when
used in
conjunction with a smoke-free worksite policy that offers added
incentive for smokers
to think about quitting.
9.
Smoking and the workplace: Realities and solutions; Henningfield
JE, Ramström,
Husten CG, Givino GA, Zhu BP, Barling J, Weber C, Kelloway EK,
Strecher
VJ, Jarvis MJ, Weiss J. Journal of Smoking-related Disease 94 (5):
Suppl. 1; 261-270;
1994
Format:
Journal Article
Abstract:
Smoking
imposes important costs on employers in terms of increased
healthcare expenses
and lost productivity due to absenteeism. However, smoking
cessation programmes
in the workplace may achieve substantial cost savings and
productivity benefits,
as indicated by new data showing that workers who have stopped
smoking for at
least a year lose significantly fewer work days and have
significantly less morbidity
than those who continue to smoke. Moreover, morbidity, absenteeism
and use of
healthcare resources will eventually be comparable between former
smokers and
individuals who never smoked. The workplace seems an almost ideal setting for
smoking
cessation intervention, particularly if restrictive smoking
policies are in place,
and may also be especially good for reaching blue-collar and
unskilled workers.
Smoking cessation treatment is more cost-effective than many other
accepted
medical practices, such as pharmacological treatment of
hypertension or hypercholesterolaemia.
For smokers with strong nicotine dependence, interventions that
include nicotine replacement appear to be clearly more
cost-beneficial than non-pharmacological
therapies alone. Programmes tailored to a smoker’s own ideas
about the
benefits and drawbacks of quitting offer a promising new approach to
intervention.
Further trials are necessary to establish the optimal form of
intervention
and to assess the value of nicotine replacement in the workplace
setting.
10.
Smoking cessation at the workplace: Conceptual and practical
considerations;
Abrams D, Emmons KM, Linnan L, Biener L. In Interventions for
Smokers:
An International Perspective; Baltimore: Wilkins & Wilkins;
pp. 127-169; 1994.
Format:
Book Chapter
Conclusions
(abbreviated):
[I]nterventions
directed at defined populations increasingly have adopted a
broadening
theoretical model due to an integration of individual and public
health perspectives.
In some ways, worksites are an ideal “laboratory” in which to
examine this
integration since they are at an intermediate level of social
complexity between the individual and the community/population extremes of a continuum of
social structure….
Despite advances in understanding smoking behavior (from both a
biological
and a societal perspective), there remains a significant gap
between the individual
biobehavioral and public health disciplines. It is important for
scientists focusing
on the individual perspective to be more cognizant of the public
health- population
perspective and vice versa…. Worksite intervention and research
can provide
one opportunity for a detailed study of complex interactions between the
individual
and the organizational environment. Such research can inform
investigators
about mechanisms of change and about cost-effective operating
principles
for public health-focused interventions in general.
11. The
impact of incentives and competitions on participation and quit
rates in
worksite smoking cessation programs; Matson DM, Lee JW, Hopp JW.
American
Journal of Health Promotion; 7(4); pp. 270-280, 295
Format:
Review Article
Abstract
(abbreviated):
Purpose:
The purpose of this review is to determine whether incentive-based
programs
conducted at worksites increased participation and long-term
smoking cessation
rates. Conclusions:
It appears that incentives/competition may be useful for
increasing participation
and smoking reduction. Further research needs to be conducted to
determine
whether incentives and/or competition enhance long-term quit
rates, and what are the most effective types of incentive procedures.
12.
Promoting smoking cessation at the workplace: Results of a
randomized controlled
intervention study; Sorensen G, Lando H, Pechacek TF. Journal of
Occupational
Medicine; 35(2); pp. 121-126; February 1993
Format:
Journal Article
Abstract:
This
paper presents results from a preliminary short-term work-site
intervention study
aimed at smoking cessation. The 3-month intervention included
consultation for
employers on the adoption of a nonsmoking policy, training for
nonsmokers to provide
assistance to smokers attempting to quit, and cessation classes
for smokers. Eight
work sites from Bloomington, Minnesota were recruited to the study
and randomly
assigned to an intervention or comparison condition after a
baseline survey of
all employees. To assess the effect of the intervention, smokers
were surveyed
1 and 6 months after the intervention was completed. At the
1-month follow-up,
the overall quit rate in the intervention group was 12% compared
to 5% in the
control group (P>.05). At the 6-month follow-up, 12% of smokers
in the intervention
group reported quitting, compared to 9% in the control group
(P>.05). Co-worker
support for quitting was higher in the intervention group compared
to the comparison
group. Cessation was highest overall among smokers whose
co-workers frequently
asked them not to smoke and among those who worked with a high
proportion
of nonsmokers. These results indicate that a short-term,
multifaceted smoking
cessation program implemented in work sites can affect smoking
cessation rates as
well as the work-site norms about smoking.
13.
Worksite smoking control, discouragement, and cessation; Dawley
LT,HH, Glasgow RE, Rice J, Correa P. The International Journal of the
;
28(8): pp. 719-733; 1993
Format:
Journal Article
Abstract:
Smoking
control, discouragement, and cessation were investigated at three
comparable
chemical plants. One plant was randomly assigned to smoking
cessation only
while the other two plants were assigned to a comprehensive
program of smoking
control, discouragement, and cessation. Three weeks later, smoking
cessation
was provided at all three sites. Results are consistent with a
previous investigation
of the comprehensive program carried out at two oil refineries.
Not only was
there a greater rate of participation in the smoking cessation
program with the
comprehensive program, 4 months after completion of smoking
cessation treatment
revealed significant changes on all outcome variables in the
expected direction
and suggest the superiority of a comprehensive program of smoking
control,
discouragement, and cessation over cessation alone.
14.
Implementing a year-long, worksite-based incentive program for
smoking cessation;
Glasgow RE, Hollis JF, Pettigrew L, Foster L, Givi MJ, Morrisette
G. American
Journal of Health Promotion; 5(3); pp. 192-199; January/February
1991
Format:
Journal Article
Abstract
(abbreviated):
Background:
There have been few reports of the process of implementing ongoing
worksite
health promotion programs. This article describes the
implementation of a year-long
smoking cessation program in nine worksites employing a total of
approximately
700 smokers. Results:
The program produced high participation rates (29% of smokers
joined the program)
and moderate cessation rates among participants (during the last
half of the
program, monthly cessation rates averaged 20%). There was marked
variability across
worksites on both participation and cessation, and qualitative
features of organizations
associated with outcome are discussed.
15.
Cessation and relapse in a year-long workplace quit-smoking
contest; Sloan RP,
Dimberg L, Welkowitz LA, Kristiansen MA. Preventive Medicine; 19;
pp. 414-423;
1990
Format:
Journal Article
Abstract:
In an
attempt to increase the impact of smoking cessation activities,
some recent studies
have examined the use of contests and competitions. The study
reported here
evaluates a year-long multiple-lottery quit-smoking contest at
Volvo Flygmotor, the Volvo
aircraft engine manufacturing company in Trollhattan, Sweden.
Lotteries were held
at 1, 6 and 12 months after the contest began. By quitting for at
least 1 month,
enrollees were eligible no win cash prizes. Maintaining nonsmoking
status from a
previous lottery automatically qualified enrollees for the next
one. Smoking status
was established by self-report, expired carbon monoxide, and
saliva cotinine. Seventy-three
employees, representing approximately 10% of the company’s
smokers,
entered the contest during the initial 2-week enrollment period.
Point prevalence
1-month and 6-month cessation rates were 64.4 and 49.3%
respectively. Continuous
abstinence 6-month and 1-year rates were 45.2 and 32.8%
respectively. Psychological,
home, work and smoking history variables generally were not
related to
cessation or relapse.
COMMUNITY
WORKSITE INTERVENTIONS
1.
Promoting worksite smoking control policies and actions: The
Community Intervention
Trial for Smoking Cessation (COMMIT) experience; Glasgow RE,
Sorensen G, Giffen C, Shipley RH, Corbett K, Lynn W; Preventive
Medicine; 25; 186-194;
1996
Format:
Journal Article
Abstract
(abbreviated):
Background:
As an important aspect of the COMMIT trial, worksite
smoking-control consultations
and supports were provided to employers in 11 diverse, moderate-
sized
communities. After a 4-year intervention period (1989 – 1992),
impacts on worksite
policies, support resources for smokers, and employee perceptions
were assessed
in these communities and in 11 matched Comparison communities.
Results:
Overall, 44% of the worksites surveyed reported having smokefree
policies, with no
differences between Intervention and Comparison communities.
Thirty- seven
percent of Intervention community worksites reported offering
smoking cessation
resources or assistance for employees during the period of the
study, compared
to 31% of Comparison community worksites (P=0.04). Employees in
Intervention
communities, relative to those in Comparison communities, reported
greater
awareness of stop-smoking resource, but equivalent increases in worksite
smoking
bans.
Conclusion:
Although the level of worksite smoking-cessation activities was
higher in Intervention
than in Comparison communities, there remains a substantial need
to increase
the level of such activities and to integrate such activities with
restrictive smoking
policies.
2.
Learnings from the Brantford COMMIT project: A summary of
community intervention
strategies for the worksite; Brantford COMMIT, Program Training
and
Consultation Centre of the Ontario Tobacco Strategy; February 1994
Format:
Project Report/Guide
Summary
of contents:
Includes
descriptions of program strategies and sample resources used by
the Brantford
COMMIT project relating to worksite activities. These strategies
include:
?
Worksite consultations;
?
Worksite smoking policy network binder;
? Smoking
policy workshop;
? Between
worksite challenges;
? Power
breakfast – sick building syndrome; and
?
Smoke-free worksite day.
Each
strategy includes objectives, description, and target groups as
well as a summary
of key learnings gained from Brantford COMMIT’s presentation of
the strategy.
Estimated time and cost estimates for strategies are also included.
LABOUR
ISSUES
1.
Finding common ground: How public health can work with organized
labor to
protect workers from environmental tobacco smoke; National Association
for Public Health Policy; Journal of Public Health Policy; 18(4);
pp. 453-464; 1997
Format:
Journal Article
Summary:
Tobacco
is not and does not have to be a high priority for all segments of
organized labor,
but public health advocates should continue to promote the issue
and find segments
which are open to collaborative efforts to protect workers’
health. Even in those
unions representing workers for whom smoking and ETS pose a lower health
risk
relative to other workplace toxins, smoking policy remains a
strategic issue for at least
two reasons. First, supporting efforts to control ETS exposure is
an issue of service
to non-smoking union members, and likewise, bargaining for smoking
cessation
programs is a service to members who smoke. Second, it is in the union’s
interest
to engage with management through collective bargaining to develop
smoking
policies, rather than to allow management to unilaterally propose
and/or implement
policies. To remain a strong voice in the worksite, labor needs to
defend its
unions and members from misdirected and overzealous actions.
Within
the context of the diversity of opinions from within labor and
public health, this
policy statement aims to identify our common ground and recommend
ways to collaborate
in protecting worker health. Specifically, we recommend that the
public health
community take the following actions: 1) assist unions with
smoking cessation
services that meet the needs of labor, 2) support labor’s
efforts to negotiate
smoking policies within the context of collective bargaining, 3)
include labor in
tobacco control coalitions, 4) advocate for regulatory initiatives
that include ETS as
part of an overall indoor air quality strategy, 5) focus attention
on preventing smoking
among children of union members, and 6) develop strategies with
labor to benefit
from savings that employers achieve under smoking restrictions or
bans. Smoking
and exposure to second-hand smoke represent a threat to the health
of workers.
Given that the public health and labor movements have a mutual
interest in
protecting worker health, it makes sense for these two groups to
join together on tobacco
control policy-making in the worksite.
2. Labor
positions on worksite tobacco control policies: A review of
arbitration
cases; Sorensen G, Youngstrom R, MacLachlan C, Gibson SJ, Emmons
K,
Johnston D, Levenstein C; Journal of Public Health Policy; 18(4);
pp. 433-453; 1997
Format:
Review Article
Abstract:
Although
worksite smoking restrictions have become increasingly common in
recent years,
organized labor has generally not been involved in the adoption of
these policies;
some evidence suggests that unions often oppose the adoption of
worksite smoking
policies. To contribute to an understanding of labor’s role in
tobacco control policies,
this paper reports the results of a review of 85 arbitration cases
and 5 cases of unfair
labor practices charges published between 1986 and 1994. In most
of the cases
reviewed, management unilaterally imposed a new smoking policy,
which the union
then grieved. Union opposition to the policy generally focused on
the process by which
the policy was adopted, rather than the content of the policy; the
concern was that management has breached its duty to bargain with the union
regarding the adoption
of the policy. These results underline the importance of joint
labor- management
actions on worksite tobacco control policies.
3. No
smoking! The arbitration of smoking restricting policies; Petersen
DJ; Dispute
Resolution Journal; 50(1); pp. 44-50; January 1995
Format:
Journal Article
Conclusion
(abbreviated):
A review
of 42 published arbitration awards convincingly demonstrates that
there are few
absolutes when it comes to the establishment of rules restricting
smoking in the
workplace, at least in a unionized setting. It is significant that
though the NRLB considers
smoking to be a term or condition of employment, some arbitrators view
smoking
as a privilege, one that can be unilaterally revoked, rather than
a mandatory
subject for bargaining. There
also appears to be sharp disagreement among arbitrators regarding
the role of past
practices for preventing the adoption of smoking restriction rules….
One area
of apparent widespread arbitrage agreement involves management’s
right to
unilaterally establish reasonable work rules restricting or
banning smoking, absent contractual
limitations…. An
employer, faced with the prospect of amending or establishing a
smoking restriction
rule, would be wise to approach it with caution in view of the
variability of arbitral
thought in this controversial area.
4.
Arbitrating a smoking ban: A management perspective; Douglas FL;
Dispute Resolution
Journal; 48(4); pp. 38-44; December 1993
Format:
Journal Article
Conclusion:
A
smoke-free policy will no doubt result in inconvenience and a loss
of comfort to employees
who previously enjoyed the privilege of smoking “anywhere”
inside. The relatively
slight impact upon a smoker’s personal choice to smoke does not
tip the scales
when balanced against the compelling interests of the employer.
Planning how to
implement a smoking policy should not be overlooked. If an
employer cannot articulate
the underlying reasons for a change in a smoking policy, it is
doubtful that the same
employer can articulate its policy to an arbitrator.
5. Unions
and Workplace Smoking Policy; Lowe GS, Neale DJ; Kingston, ON:
Industrial
Relations Centre, Queen’s University, 1992
Format:
Monograph
Executive
Summary:
Over the
past decade, environmental tobacco smoke (ETS) has been identified
as a major
public health hazard. This directly impacts on the workplace and
on union-management
relations.
This
study draws on three major sources of information:
?
Published literature on workplace ETS and smoking policies
?
Unpublished literature from unions, health promotion
organizations, employers, etc.;
?
Interviews with over 30 union representatives and officials of
health promotion organizations.
The issue
of workplace ETS and union involvement in policy-making is
addressed from the
perspective of union-management and union-government relations.
The following
areas are covered:
?
Variations in workplace smoking behaviour and attitudes towards
workplace smoking;
? The
costs of workplace smoking;
?
Legislation regulating workplace smoking and specific union
responses to legislation;
?
Policies from labour organizations, including the CLC, OFL, CUPE,
PSAC, CCU, CAIMAW,
USWA, CAW and others;
? Three
grievance cases that set important legal precedents and
precipitated policy and
legislation;
? Seven
case studies of union action that resulted in company workplace
smoking policies;
?
Recommendations on an effective smoking policy. Because
this research is exploratory, no attempt was made to draw a
representative sample of
all unions in Canada. Rather, the focus was on major public and
private sector
unions with full-time occupational health officials. This approach
rested on the assumption
that these unions would reflect major developments and trends
regarding
the ETS issue within the labour movement as a whole.
LEGAL
ISSUES
1.
Employer liability for workplace environmental tobacco smoke: Get
out of the fog;
Vallone, MA; Valparaiso University Law Review; 30; 1996
Format:
Journal Article
Conclusion:
The
negative effects of ETS on nonsmokers can no longer be denied. The
courts are attempting
to remedy ETS-related injuries using a variety of methods. This is
causing
confusion for employees seeking relief. Further, ETS litigation
has the potential
of creating a massive class of cases for the court system to
handle. Moreover,
the current methods of redressing ETS-related workplace injuries
are inadequate.
Therefore, the need to provide these injured individuals with an
efficient and just
remedy has arrived. In addressing this concern, all potential
effects any remedial
action will have on society as a whole should be considered.
Amending the current
workers’ compensation laws to include a remedy for ETS harms
will minimize the
burden on the courts, will lessen the employers’ costs, and will
provide injured employees
an effective remedy.
2. An
assessment of the current legal climate concerning smoking in the
workplace;
Fox JC; Saint Louis University Public Law Review; 13(2); 1994
Format:
Journal Article
Conclusion:
Considered
in their entirety, relevant federal and state statutes and case
law provide little
support for the efforts of antismokers to impose their views
concerning smoking
on employers and fellow workers. In all jurisdictions, employers
have an obligation
to provide employees with a safe and healthful working
environment. But that general duty is concerned with the full spectrum of indoor air
quality issues and requires
employers to consider, among other things, whether their
facilities are receiving
adequate ventilation and whether the ventilation system is being
properly maintained.
A limited number of decisions have been sympathetic to the
complaints of
individual employees claiming a hypersensitivity to co-worker
smoking. The remedy
typically found to be appropriate in those cases has been a
rearrangement of desks
or work stations, plus occasionally, other measures falling under
the general
rubric of “reasonable accommodation.” In the
final analysis, decisions concerning smoking in the workplace –
to the extent not
dictated by a state statute or county or municipal ordinance –
are most appropriately
left to the good sense and common courtesy of smoking and nonsmoking
employees, subject to applicable laws and regulations. The decided
cases
make clear that employers need not ban smoking to minimize the
risk of claims by
– or liability to – nonsmoking employees. The key is a policy
that provides employees
with an adequately ventilated working environment and does not
force objecting
nonsmokers to share their immediate workspace on a sustained basis
with smoking
colleagues.
3.
Second-hand smoke and the law; in S.W.W.E.A.P. (Smoking in the
Workplace Windsor-Essex
Action Program) Workplace No Smoking Policy Facilitator’s Guide;
McDowell
J, SWWEAP; 1996
Format:
Guide Chapter
Summary:
Briefly
summarizes Canadian federal , Ontario provincial, and Windsor
municipal laws
governing the issue of smoking in the workplace. Includes:
? The
Non-Smokers’ Health Act
? Smoking
in the Workplace Act (1991)
? Tobacco
Control Act (TCA) Ontario (1994)
? City of
Windsor By-law (1995)
Also
includes information on health and safety laws relating to
smoking, how to refuse
unsafe work, and summaries of workplace lawsuits related to
smoking.
OUTCOMES
1.
Relationship of worksite smoking policy to changes in employee
tobacco use:
Findings from COMMIT; Glasgow RE, Cummings KM, Hyland A; Tobacco
Control;
6(Suppl. 2); S44-S48; 1997
Format:
Journal Article
Abstract
(abbreviated):
Objective:
To report data on the impact of worksite smoking policies on
employee smoking
behaviour from a large and heterogeneous sample of smokers and
worksites
in 22 different communities across North America participating in
the COMMIT
trial.
Results:
After controlling for potential confounding factors, regressing
analyses revealed
that employees who worked in a smoke-free worksite were over 25%
more likely to
make a serious quit attempt between 1988 and 1993, and over 25%
more likely to
achieve cessation than those who worked in a worksite that
permitted smoking.
Among continuing smokers, employees in smoke-free worksites
consumed an
average of 2 ¾ fewer cigarettes per day compared with those who
worked in places
with a non-restrictive smoking policy. A smoke-free worksite
policy was not associated
with a greater likelihood of using smokeless tobacco.
Conclusion:
These data from one of the largest and longest smoking cessation
studies
to date, add support to the conclusion that smoke-free worksite
policies help employees
to reduce or discontinue use of tobacco.
2.
Worksite characteristics and changes in worksite tobacco-control
initiatives:
Results from the COMMIT study; Sorensen G, Glasgow RE, Topor
M,
Corbett K; Journal of Occupational and Environmental Medicine;
39(6); 520-526; June 1997
Format:
Journal Article
Abstract:
Few
studies have prospectively examined the characteristics associated
with worksite
adoption of tobacco-control initiatives. Data were collected as
apart of the Community
Intervention Trial (COMMIT) for Smoking Cessation, which conducted
interventions
in 11 communities. This smoking cessation intervention was based
on community
organization principles and delivered through multiple community
channels,
including worksites, health care providers, the media, and
cessation resources.
This article reports results from telephone interviews of
intervention community
worksites having 50 or more employees, conducted at baseline and
the end of
the intervention period. Among worksites that responded to both
baseline and final
surveys, 83% had not adopted a smoke-free policy at baseline, and
61% did not
offer any cessation aid or quitting resources at baseline. By the
final survey, 34$ of
those with no smoking ban at baseline had become smoke-free, and
36^ of those
offering no cessation assistance at baseline were offering
cessation resources at the
follow-up. The prevalence of policy adoption was higher among
worksites employing
more female employees and offering other health-promotion
activities; manufacturing
businesses were significantly less likely than businesses other
than service
and wholesale/retail businesses to adopt policies. Adoption of
cessation programs
was significantly more likely among worksites employing 100 to 249
orkers,
compared with those employing 50 to 99 workers; those
predominantly employing
men; those offering other types of health-promotion activities;
and those with a
higher rate of turnover. These results provide important
information about the
characteristics of worksites likely to engage in tobacco-control
efforts. Health educators
and others may choose to target those worksites most ready for
adoption of
tobacco control policies and programs, as indicated by these
findings.
3.
Workplace smoking policy and changes in smoking behaviour in
California:
A suggested association; Patten CA, Gilpin E, Cavin SW, Pierce JP;
Tobacco
Control; 4; pp. 36-41; 1995
Format:
Journal Article
Abstract
(abbreviated):
Objective:
To examine the association between changes in smoking behaviour
and changes
in workplace smoking policies in California, USA. Subjects:
Longitudinal sample of 1844 California adult indoor workers
interviewed in 1990 and
1992. Respondents were classified into one of four groups
according to whether
they worked in a smoke-free work area in neither 1990 nor 1992
(group 1), in 1992
only (group 2), in 1990 and in 1992 (group 3), or in 1990 only
(group 4).
Results:
Smoking prevalence changed from 1990 to 1992 as a function of
change in workplace
smoking policy. In group 3 there was a percentage decrease of
11.4%, but only
a 5.9% decrease in group 2. For group 4, smoking prevalence showed
a percentage
increase of 50.9%, whereas group 1 was unchanged. Although these
individual
effects were not statistically significant, the ?2 analysis for
the overall change in
smoking status among those who were current smokers in either 1990
or 1992
suggested there was an association (p<0.06). The largest
decrease in cigarette
consumption (1.4 cigarettes/day) was found for group 2. Group 4
increased
their daily cigarette consumption by about four cigarettes per
day, and 38.0% of
these workers did not report smoking in 1990, but reported smoking
in 1992.
Multivariate analysis indicated that those who change from working
in an area under a
smoke-free policy to no restrictions are highly unlikely to
decrease their cigarette
consumption.
Conclusion:
Workplace smoking policies that are maintained may encourage
changes
in smoking behaviour. Smoking prevalence and cigarette consumption
may increase
when workers move from a workplace that prohibits smoking in the
work area to
one that allows work area smoking.
4.
Effects of a restricted work-site smoking policy on employees who
smoke; Brigham
J, Gross J, Stitzer JL, Felch LJ; American Journal of Public
Health; 85(5); 773-778;
May 1994
Format:
Journal Article
Abstract
(abbreviated):
Objectives:
This study evaluated the biological and subjective consequences
observed
in individual smokers after implementation of a work-place
smoking-restriction
policy.
Results:
Smokers at the restricted site had verified smoking reduction
(mean = four cigarettes
per day) and significantly reduced nicotine and carbon monoxide
during the work
shift. There were increases in ratings of some common withdrawal
symptoms
(Cravings/urges, concentration difficulties, increased eating,
depression). No
evidence of compensatory smoking during nonwork hours was found.
Overall tobacco
exposure, as measured in saliva cotinine, showed a nonsignificant
15% decline. Conclusions:
Workplace smoking restriction markedly altered smoking patterns
(i.e., reduced
daytime smoking) and reduced cotinine levels to an amount
consistent with cigarette
reduction. Thus, work-site smoking restriction may promote
meaningful, albeit
limited, reductions in tobacco exposure and consequent health
risks.
5.
Smoking regulations at the workplace and smoking behavior: A study
from
southern Germany; Brenner H, Fleischle B; Preventive Medicine; 23;
230-234; 1994