Effects of the Implementation of a Smoke-Free Policy in a Medical Center

doi:10.1378/chest.102.5.1531

Chest

Volume 102, Issue 5, November 1992, Pages 1531-1536

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The implementation of a smoke-free policy in this medical center was associated with a decrease in the prevalence of regular cigarette smoking from 16.7 percent to 13.8 percent and a smoking cessation rate of 22.5 percent among regular smokers over the 2½ years since the policy was announced. This decrease in prevalence is the result of both smoking cessation among existing employees and less frequent regular smoking among new employees. At two-year follow-up, the policy was overwhelmingly endorsed by medical center staff overall but was viewed less favorably by those who continued to smoke. Nevertheless, over the 2½ years, many of these smokers have been in the action stage of cessation (37.1 percent made a serious attempt to stop smoking, 20.7 percent had used nicotine polacrilex in a smoking-cessation effort, and 13.8 percent had attended a formal cessation program). The implementation of a smoke-free policy has made a significant contribution toward providing a healthful work environment and toward encouraging nonsmoking behavior in staff and patients.

Section snippets

METHODS

For the current survey, 27 questions that probed several areas were used. These questions addressed general attitudes regarding the policy, impact on job productivity, and effects on smoking behavior. Smoking status was determined by asking the respondents to describe their current use (June 1989) and to recall their use of cigarettes at time points in the past: (1) policy announcement, August 1986; (2) policy implementation, June 1987; (3) six months postimplementation, January 1987.

The survey

RESULTS

Of the 15,966 questionnaires distributed, 10,579 were returned with usable information, for an overall response rate of 66.3 percent. The response rates were significantly different among staff groupings: consultant staff, 77.6 percent; paramedical staff, 72.4 percent; and hospital staff, 56.0 percent. Information that would allow a more refined analysis of response rates was not collected.

The consultant staff represented 7.0 percent of the respondents, the paramedical staff 59.6 percent, and

DISCUSSION

Although not a goal of the smoke-free policy, we observed a 22.5 percent smoking cessation rate among regular smokers and a decrease in the prevalence of regular cigarette smoking from 16.7 percent to 13.8 percent over the 2½ years since announcement of the policy. Other institutions that have implemented a smoke-free worksite have observed a decrease in the prevalence of smoking among employees. For example, after the Harvard School of Public Health banned smoking at the worksite in 1986, the

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Cited by (26)

Three-year follow-up of attitudes and smoking behaviour among hospital nurses following enactment of France's national smoke-free workplace law
2012, International Journal of Nursing Studies
Citation Excerpt :
Regarding health care facilities, smoking areas are no longer allowed as notified in the circular of December 8, 2006 (Official Journal of the French Republic no. 16, 2007). Several studies have evaluated the short-term (Heloma et al., 2001; Martínez-Sánchez et al., 2009; Mullally et al., 2009) or the long-term impact (Heloma and Jaakkola, 2003; Offord et al., 1992; Zaloshnja et al., 2010) of the implementation of smoke-free workplace legislation on smoking behaviour. With regards to before bans were introduced, most studies reported that workplace smoking bans were associated with reduction in smoking prevalence in the short (Heloma et al., 2001; Martínez-Sánchez et al., 2009) or long term (Offord et al., 1992).
This study evaluated among hospital nurses the smoking status, knowledge and attitudes regarding smoking cessation services, and smoking behaviour 3 years after the implementation of smoke-free workplace law (decree no. 2006-1386).
A descriptive study was undertaken in a public referral hospital in the South of France. Between February and April 2010, a questionnaire was distributed to the nurses. Data on demographic information, smoking status, behaviour and attitudes regarding smoking addiction, and knowledge regarding smoking cessation services were collected. Changes in nurses’ smoking habits were studied through a former study conducted in this hospital a year after the law had come into effect.
Three years after the enactment of the smoking ban, 30% (30% in 2008) reported themselves as current smokers, 26% (25% in 2008) as ex-smokers and 44% (45% in 2008) as non-smokers. Among smokers, 72% (68% in 2008) declared they had decreased tobacco consumption during working hours and 50% (29% in 2008) daily cigarette consumption. The majority of nurses (88%) supported the smoke-free law. A higher percentage of smokers than non smokers have knowledge of smoking cessation services. The smoking prevalence among hospital nurses seemed to have remained constant between 2008 and 2010 despite a better compliance with the law.
France's national smoke-free workplace law is associated with a reduction in tobacco consumption and exposure to second-hand smoke in nurses but not smoking prevalence. The other measures of the MPOWER package have to be reinforced.
Smokefree Policies to Reduce Tobacco Use. A Systematic Review
2010, American Journal of Preventive Medicine
Citation Excerpt :
The median result was a reduction in tobacco use of 3.4 percentage points (interquartile interval: –6.3 to –1.4 percentage points). In ten studies,22,30,35,40,47,54,58,72,74,77 the absolute percentage point differences were reported as significant. Twenty studies in 18 reports14,18,21–23,30,31,35,47,54,56,58,61,69,72–74,77 provided sufficient information to permit a calculation of relative percentage difference or change in the prevalence of tobacco use.
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.
Evaluation of a workplace anti-smoking program at a company with 640 employees
2002, Archivos de Bronconeumologia
El conocimiento del riesgo que supone para los no fumadores la inhalación de aire contaminado con humo de tabaco ha motivado el desarrollo de intervenciones sobre tabaquismo en el medio laboral, aunque en nuestro entorno son todavía escasas. El objetivo de nuestro estudio es conocer la eficacia de una intervención sobre tabaquismo entre los trabajadores de una empresa, según los cambios existentes en la prevalencia pre y postintervención en el grupo estudiado
Se realizó una encuesta preintervención sobre tabaquismo (prevalencia y actitudes) en una empresa de 640 empleados (el 92% varones y el 8% mujeres); a lo largo de los nueves meses siguientes se desarrolló la intervención dentro de la empresa durante el horario laboral; posterior-mente se repitió la encuesta (postintervención) con el objetivo de evaluar su efectividad basándose en los cambios existentes. Se realizó un estudio de datos apareados en los trabajadores que contestaron ambas encuestas
Contestaron la encuesta preintervención 388 empleados (60%), 357 varones (92%), 31 mujeres (8%); edad media, 48,4 (desviación estándar [DE], 9,36). La prevalencia de tabaquismo fue del 55%, incluyendo fumadores a diario, esporádicos y de otras labores de tabaco; media de cigarrillos/día, 17,86 (DE, 2,45); grado de dependencia a la nicotina (test de Fagerström), media, 3,3 (DE, 2,8) sobre 10. Contestaron la encuesta preintervención 206 empleados (el 32% del total); en los trabajadores que contestaron ambas encuestas (83) mediante estudio de datos apareados se observó una disminución de la prevalencia de fumadores del 4% y del número de cigarrillos/día (17,4 preintervención y 16,4 postintervención); estas diferencias no fueron estadísti-camente significativas
El entorno laboral constituye un medio adecuado, infrautilizado en la actualidad, para realizar intervenciones sobre tabaquismo y contribuir así a mejorar la salud de la población trabajadora
Awareness of the health risks of passive smoking for non-smokers has led to the development of work-place interventions for smokers, although they are still few in our setting. The objective of this study was to evaluate the efficacy of an anti-smoking program among the workers of a company, in function of changes in the pre and post-intervention prevalence of smoking in the study population
A pre-intervention questionnaire on smoking (prevalence and attitudes) was administered at a company with 640 employees (92% men, 8% women). An anti-smoking program was carried out inside the company during working hours over the next nine months. The questionnaire was then repeated (post-intervention) in order to evaluate its efficacy based on changes. For employees who answered both questionnaires, paired variables were analyzed
The pre-intervention questionnaire was answered by 388 employees (60%), 357 men (92%) and 31 women (8%); their mean age was 48.4 years (SD 9.36). The prevalence of smoking was 55%, including daily smokers, sporadic smokers and others. The mean number of cigarettes per day was 17.86 (SD 2.45). The mean level of nicotine dependence measured by the Fagerström test was 3.3 (SD 2.8) out of 10. The post-intervention questionnaire was answered by 206 employees (32%). Among employees who answered both questionnaires (83), analysis of paired data showed a decrease in the prevalence of smoking of 4% and in the number of ci-garettes per day from 17.4 (pre-intervention) to 16.4 (post-intervention). The differences were not statistically significant
Although the workplace is an appropriate setting for anti-smoking interventions that would contribute to improving the health of smokers, such programs are currently underutilized
Attitudes of Olmsted County, Minnesota, residents about tobacco smoke in restaurants and bars
2001, Mayo Clinic Proceedings
To determine the attitudes of Olmsted County, Minnesota, adults about environmental tobacco smoke in restaurants, bars, and nightclubs.
In this population survey, 2014 adults were contacted by random digit dial methods between February 28 and May 5, 2000, and asked to participate in a telephone survey; 1224 (61%) consented.
For the 57% (95% confidence interval [CI], 54%-60%) of the study population that reported exposure to environmental tobacco smoke, the most frequently reported sites of exposure were restaurants (44% [95% CI, 41%-48%]), work (21% [95% CI, 18%-24%]), and bars (19% [95% CI, 16%-22%]). Seventy-two percent (95% CI, 69%-74%) of respondents said that they would select a smoke-free restaurant over one where smoking is permitted, and 70% (95% CI, 67%-72%) said that they would select a smoke-free bar over one where smoking is permitted. The majority of respondents said that they would not dine out or visit bars or nightclubs more often or less often if all restaurants, bars, and nightclubs were smoke-free.
Olmsted County residents prefer smoke-free restaurants, bars, and nightclubs.
Comparison of attitudes toward smoking of smoking and non-smoking employees of the Federal University of Sao Paulo, Brasil
1999, Archivos de Bronconeumologia
Estudiar aspectos puntuales de un programa de prevención del tabaquismo en la Universidad de São Paulo, mencionando la actitud y el pensamiento de los funcionarios fumadores y no fumadores, a fin de obtener una propuesta mayoritaria para injerto de un programa antitabaquismo en la institución.
Fue aplicado un cuestionario confidencial autoexplicativo con 51 preguntas de múltiples opciones y se obtuvieron respuesta en 2.613 (48,6%) de los funcionarios, profesores, residentes, enfermeras y alumnos.
Del total de participantes en el estudio eran fumadores 438 (16,8%) y ex fumadores 456 (17,5%). El inicio del tabaquismo se dio entre los 11 y los 20 años en el 84% de los casos. Las edades donde prevaleció el mayor número de fumadores fue entre 31 a 40 años, siendo por encima de los 60 años mayor la prevalencia para ex fumadores. Los individuos que fuman en el trabajo representan el 78%. Fumadores y no fumadores han relatado algún tipo de rechazo en relación al humo del cigarrillo, principalmente el olor en las ropas y en el cabello (62,7% de respuestas de fumadores frente a 59% de respuestas de no fumadores, NS). En el grupo de no fumadores, el 37,5% se decantó por la prohibición total del humo en el ambiente de trabajo frente al 10% de los fumadores (p < 0,05). Por otro lado, el 82,8% de los fumadores concordaron restringir locales específicos para el humo, frente al 59% de las opiniones de los no fumadores (p < 0,05).
Creemos que pesquisas como éstas deban ser realizadas en todas las instituciones, especialmente en áreas de salud, a fin de que la implementación de políticas restrictivas al uso de tabaco tenga éxito y sea respaldada por la mayoría de los funcionarios fumadores o no. En fases preliminares, sobre la base de nuestros resultados, se aconsejó crear locales restringidos para los fumadores y, posteriormente, con el desarrollo de la campaña institucional antitabaquismo, se llegó a la prohibición total del tabaco en el ambiente de trabajo.
To study the attitudes toward smoking of employees of the Federal University of Sao Paulo as a step toward implanting a consensualized anti-smoking program for the institution.
We designed and distributed anonymous, self-completed questionnaires with 51 multiple-choice questions, whieh were returned by 2,613 (48.6%) employees, professors, medieal residents, nurses and students.
Four hundred thirty-eight (16.8% of the population) of the respondents were smokers and 456 (17.5%) were non-smokers. For 84% smoking started between the ages of 11 and 20 years. Most smokers were between 31 and 40 years of age, and the prevalence of ex-smokers was highest in respondents over the age of 60. Seventy-eight percent of the smokers smoked at work. Both smokers and non-smokers reported some tvpe of discomfort caused by cigarette smoke, mainly smell in clothes and hair (62.7% of smokers versus 59% of non-smokers, NS). The proportion who opted for a totally smoke-free environment w as 37.5% among non-smokers and 10% among smokers (p<0.05). Restrictions on smoking in specific places, on the other hand, met with the approval of 82.8% of smokers and 59% of non-smokers (p<0.05).
We believe that surveys such as this one should be carried out at all institutions, particularly in health care centers, in order to assure that smoking restriction policies are suceessful and receive the support of most employees, whether they smoke or not. Our data suggest the advisability of creating rstricted-smoking zones in the early phase of an institutional anti-smoking campaign designed to lead to a totally smoke-free workplace environment.
Workplace interventions for smoking cessation
2014, Cochrane Database of Systematic Reviews

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: Manuscript received August 19, 1991; revision accepted March 24, 1992.

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Chest

Clinical InvestigationsEffects of the Implementation of a Smoke-Free Policy in a Medical Center

Section snippets

METHODS

RESULTS

DISCUSSION

Chest

Mayo Clin Proc

Mayo Clin Proc

Indian health service facilities become smoke-free

JAMA

Are veterans really different? the feasibility of smoke-free VA hospitals

JAMA

The impact of a total ban on smoking in the Johns Hopkin's Childrens Center

JAMA

Ending smoking at the Johns Hopkins medical institutions: an evaluation of smoking prevalence and indoor air pollution

JAMA

Clinical Investigations
Effects of the Implementation of a Smoke-Free Policy in a Medical Center