Workplace smoking restrictions in China: results from a six county survey
- Jiemin Ma1,
- Benjamin J Apelberg1,
- Erika Avila-Tang1,
- Gonghuan Yang2,
- Shaojun Ma2,
- Jonathan M Samet3,
- Frances A Stillman1
- 1Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- 2Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
- 3Institute for Global Health, University of Southern California, Los Angeles, California, USA
- Correspondence to Frances A Stillman, 627 N. Washington Street, Second Floor, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA;
Contributors JM wrote the paper, developed the questionnaire and analysed the data, BA provided analytical support, reviewed and assisted with manuscript, EA-T provided analytical support, GY developed the questionnaire and oversaw the project, SM collected the data, JS assisted in development of questionnaire, provided oversight of project, reviewed and provided assistance with manuscript development, FS conceptualised the manuscript and project and helped with writing the manuscript.
- Received 6 October 2009
- Accepted 13 May 2010
- Published Online First 25 August 2010
Objective To determine the coverage of smoking restriction policies in indoor workplaces in China and to assess the relationships between these restrictive policies and secondhand smoke (SHS) exposure and smoking behaviours.
Methods A cross-sectional household survey was conducted in six counties in Sichuan, Jiangxi and Henan provinces in 2004. Using a standardised questionnaire, information on demographic characteristics, knowledge, attitudes and behaviours related to smoking and SHS exposure was collected through face-to-face interviews by trained local investigators among 12 036 respondents. Of respondents, 2698 individuals worked mainly indoors and were included in data analysis.
Results Only 28.5% of respondents reported that indoor workplaces had a smoke-free policy. Even when respondents reported smoke-free policies, 41.1% smokers reported that they were non-compliant with policies and smoked at work. In addition, 32.0% of non-smokers reported being exposed to SHS at work despite smoke-free policies. Non-smokers who reported no smoking restriction policies were 3.7 times more likely to be exposed to SHS than those working in smoke-free workplaces (adjusted OR 3.7, 95% CI 1.3 to 10.1). On average, respondents complying with smoke-free policies smoked 3.8 fewer cigarettes than those reporting no policies in their workplaces at a marginally non-significant level (p=0.06) (adjusted mean difference −3.8, 95% CI −8.0 to 0.5).
Conclusions In China, few workplaces have implemented policies to restrict smoking, and, even in workplaces that have policies, workers report exposure to SHS while at their places of employment. Many workers report a lack of compliance with smoke-free policies. China needs better implementation of SHS policies to promote compliance. Working to improve implementation of smoke-free policies would promote cessation since Chinese smokers who were compliant with these efforts reported smoking fewer cigarettes per day.
- smoking restriction policy
- secondhand smoke
- environmental tobacco smoke
- public policy
Funding This work was supported by grants from the Fogarty International Center of the National Institutes of Health, USA (grant no. R01-HL-73699).
Competing interests None.
Ethics approval Ethics approval was obtained through the Johns Hopkins Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.