Impact of a hospital smoking ban: Changes in tobacco use and employee attitudes

doi:10.1016/0306-4603(91)90050-R

Addictive Behaviors

Volume 16, Issue 6, 1991, Pages 419-426

https://doi.org/10.1016/0306-4603(91)90050-R Get rights and content

Abstract

The authors investigated the impact of a complete smoking ban on 349 employees of a cancer treatment center. A questionnaire administered approximately 4 months after the ban was initiated queried smokers on the impact of the ban on their smoking habits, their experience of withdrawal symptoms during the workday, and changes in work habits. A separate questionnaire asked nonsmokers about changes in the work environment. Results showed that few smokers quit while a majority decreased their consumption. Withdrawal symptoms were a problem in less than half the smokers, but those reporting signs of physical dependency on nicotine tended to smoke more before and after work and reported negative changes in work performance. Nonsmokers in general reported positive effects on the work environment.

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Exposure to workplace smoking bans and continuity of daily smoking patterns on workdays and weekends
2018, Addictive Behaviors
Citation Excerpt :
For example, as with other barriers to achieving preferred levels of consumption (e.g., filter vents, reduced tar and/or nicotine), individuals may alter their topography (Evans & Farrelly, 1998; Scherer & Lee, 2014) and smoke cigarettes “harder” on workdays when restrictions are lifted (i.e., during work breaks) (Chapman, Haddad, & Sindhusake, 1997), which could help to maintain nicotine above trough levels during restricted work periods. Alternatively, smokers could achieve preferred levels of consumption by changing when they smoke on workdays, by: (1) increased smoking before work (Baile, Gibertini, Ulschak, Snow-Antle, & Hann, 1991; Meade & Wald, 1977), or “pre-loading,” to help tolerate subsequent exposure to restrictions (at least, for a few hours, given nicotine's plasma half-life of approximately 2 h) (Benowitz, 1988, 2008); (2) increased smoking after work (Baile et al., 1991; Centers for Disease Control, 1990; Meade & Wald, 1977), which could equalize total consumption, but cannot undo any discomfort experienced by abstaining during business hours; and/or, (3) escaping restrictions and changing locations to smoke during business hours (Borland, Cappiello, & Owen, 1997; Borland & Owen, 1995), which could maintain preferred smoking rates and facilitate nicotine trough avoidance. To date, however, no studies have conducted a detailed assessment of the association between exposure to workplace bans and such compensatory behaviors.
Individuals may compensate for workplace smoking bans by smoking more before or after work, or escaping bans to smoke, but no studies have conducted a detailed, quantitative analysis of such compensatory behaviors using real-time data.
124 daily smokers documented smoking occasions over 3 weeks using ecological momentary assessment (EMA), and provided information on real-world exposure to smoking restrictions and type of workplace smoking policy (full, partial, or no bans). Mixed modeling and generalized estimating equations assessed effects of time of day, weekday (vs weekend), and workplace policy on mean cigarettes per hour (CPH) and reports of changing location to smoke.
Individuals were most likely to change locations to smoke during business hours, regardless of work policy, and frequency of EMA reports of restrictions at work was associated with increased likelihood of changing locations to smoke (OR = 1.11, 95% CI 1.05–1.16; p < 0.0001). Workplace smoking policy, time block, and weekday/weekend interacted to predict CPH (p < 0.01), such that individuals with partial work bans –but not those with full bans - smoked more at night (9 pm – bed) on weekdays compared to weekends.
There was little evidence that full bans interfered with subjects' smoking during business hours across weekdays and weekends. Smokers largely compensate for exposure to workplace smoking bans by escaping restrictions during business hours. Better understanding the effects of smoking bans on smoking behavior may help to improve their effectiveness and yield insights into determinants of smoking in more restrictive environments.
Smokefree Policies to Reduce Tobacco Use. A Systematic Review
2010, American Journal of Preventive Medicine
Citation Excerpt :
Fifty-seven studies were identified in 55 reports evaluating the impact of smokefree policies on one or more outcomes of interest.8,14,18,21–23,29–77 Twenty studies with limited quality of execution36,37,43–46,48,51–53,57,59,62–68,76 were not included in the final body of evidence. Eight articles78–85 provided additional information on studies already included in the review.
In 2001, a systematic review for the Guide to Community Preventive Services identified strong evidence of effectiveness of smoking bans and restrictions in reducing exposure to environmental (secondhand) tobacco smoke. As follow-up to that earlier review, the focus here was on the evidence on effectiveness of smokefree policies in reducing tobacco use. Smokefree policies implemented by worksites or communities prohibit smoking in workplaces and designated public areas. The conceptual approach was modified for this review; an updated search for evidence was conducted; and the available evidence was evaluated. Published articles that met quality criteria and evaluated changes in tobacco-use prevalence or cessation were included in the review. A total of 57 studies were identified in the period 1976 through June 2005 that met criteria to be candidates for review; of these, 37 met study design and quality of execution criteria to qualify for final assessment. Twenty-one studies measured absolute differences in tobacco-use prevalence with a median effect of −3.4 percentage points (interquartile interval: −6.3 to −1.4 percentage points). Eleven studies measured differences in tobacco-use cessation among tobacco users exposed to a smokefree policy compared with tobacco users not exposed to a smokefree policy. The median absolute change was an increase in cessation of 6.4 percentage points (interquartile interval: 1.3 to 7.9 percentage points). The qualifying studies provided sufficient evidence that smokefree policies reduce tobacco use among workers when implemented in worksites or by communities. Finally, a systematic economic review identified four studies that, overall, demonstrated economic benefits from a smokefree workplace policy. Additional research is needed to more fully evaluate the total economic effects of these policies.
Restrictive smoking policies in the workplace: Effects on smoking prevalence and cigarette consumption
1994, Preventive Medicine
Background. Thirty-two worksites participating in a randomized trial of worksite health promotion aimed at reducing smoking and obesity were categorized at baseline and 2 years later as having either restrictive or unrestrictive smoking policies. Between the two assessment points, 16 sites received health promotion interventions. Results. At baseline 15 sites had restrictive policies and 17 unrestrictive policies. Smoking restrictions were associated with significantly lower smoking prevalence and higher lifetime quit rates among ever smokers. They also were associated with more recent quit attempts and lower daily cigarette consumption, although these effects were not significant. Between baseline and follow-up, 9 of the 17 worksites that had few smoking restrictions at baseline became restrictive. Although neither baseline smoking policies nor changes in smoking policy predicted change in smoking prevalence or in the frequency of quit attempts, smokers in sites changing from unrestrictive to restrictive policies reported a significant reduction in daily cigarette consumption. Conclusions. The worksite health promotion program was successful in reducing smoking prevalence in intervention sites compared to controls. However, the existence of restrictive smoking policies neither helped nor hindered these intervention efforts. The present data are believed to support the idea that restrictive smoking policies have beneficial effects on the smoking habits of employees, but that the magnitude of this effect is modest.
Rethinking an Assessment of Nicotine Dependence: A Sex, Gender and Diversity Analysis of the Fagerstrom Test for Nicotine Dependence
2007, Journal of Smoking Cessation
Displacement imposition scale assesses reactions of cigarette and e-cigarette users impacted by a campus-wide smoking ban
2023, Journal of American College Health
Do smoking bans improve infant health? Evidence from U.S. Births: 1995-2009
2017, Eastern Economic Journal

View all citing articles on Scopus

^∗: The authors wish to thank the employees of the Moffitt Cancer Center for their cooperation and Ms. Anita Klamo for her assistance in preparation of the manuscript.

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Impact of a hospital smoking ban: Changes in tobacco use and employee attitudes

Abstract

Chest

Addictive Behaviors

Behavior Therapy

Additive Behaviors

Effects of passive smoking on angina pectoris

New England Journal of Medicine

Smoking on the job: The controversy heats up

Occupational Health and Safety

The impact of a total ban on smoking in the Johns Hopkins Children's Center

Journal of the American Medical Association

Effects of biochemical validation of self-reported cigarette smoking on treatment success and on misreporting abstinence

Health Psychology

Changes in smoking behavior after a myocardial infarction

Health Psychology

Non-smoking wives of heavy smokers have a higher risk of lung cancer: A study from Japan

British Medical Journal

Reducing smoking in hospitals: A time for action

Journal of the American Medical Association

The making of a smoke-free medical center

Journal of the American Medical Association