Workplace smoking policies in Taiwan and their association with employees' smoking behaviours

BACKGROUND: The implementation of worksite smoking policies has shown significant effects on reducing employees' smoking consumption and protecting non-smoking workers. However, there are no data about workplace smoking policies in Taiwan. The purpose of this study was to document the status of worksite smoking policies in Taiwan and its potential impact on employees' smoking behaviours. METHODS: A two-stage investigation was conducted. The first stage was to examine the current status of workplace smoking policies and the second was to evaluate the relationship between workplace smoking policies and employees' smoking behaviours. After two follow-ups in each stage, 264 companies and 1141 employees returned their questionnaires. RESULTS: Workplace smoking policies were associated with types of businesses and size of workplaces. Only approximately half of manufacturing and service companies have implemented a prohibitive smoking policy. Large facilities (>750 employees) were more likely to implement a prohibitive policy (57%). Employees in workplaces with a prohibitive policy had lower prevalence of smoking and cigarette consumption, and less exposure to passive smoking. Although most smokers agreed with banning smoking in their work environment, no difference in interest in participating in cessation programs was found. CONCLUSIONS: Significant associations were found between workplace smoking policies and employees' smoking behaviours. Results of the study provide basic information for designing more refined smoking policies in the workplace in Taiwan.     

School tobacco policies in a tobacco-growing state

This study examined factors associated with tobacco-free policies and tobacco cessation in schools serving children in grades 6 to 12 in a tobacco-growing state using a cross-sectional telephone survey of school administrators from public and private middle and high schools (N = 691), representing 117 of the 120 Kentucky counties. Trained health department staff contacted 1028 schools; 691 (67%) participated in a phone survey, which lasted an average of 19 minutes. Variables of interest were indoor and outdoor smoking policies, fund-raising in Bingo halls, provision of cessation and prevention programs, owning or leasing a tobacco base, if the school received money from tobacco companies, type of school (public vs private), and school setting (urban vs rural). Only 20% of Kentucky schools reported comprehensive tobacco-free policies. Urban area schools were nearly twice as likely to have a tobacco-free campus than rural schools. Schools that did fund-raising in smoky Bingo halls were 30% less likely to have tobacco-free school policies. While few schools had a tobacco affiliation, those that received money from tobacco companies or grew tobacco were nearly 3 times as likely to provide cessation resources, compared to schools without tobacco affiliation. Rural schools were less likely to be tobacco free and provide cessation services. School-related, off-campus, extracurricular events might be considered as an element of tobacco-free school policy. Schools with tobacco affiliation may provide more cessation resources due to the increased prevalence of tobacco use in these areas.     

A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use

OBJECTIVES: In this cohort study, we assessed the impact of smoke-free work-site policies on smoking cessation behaviors. METHODS: Smokers were tracked as part of the Community Intervention Trial for Smoking Cessation. Telephone surveys were administered to 1967 employed smokers in 1993 and 2001. Data were gathered on personal and demographic characteristics, tobacco use behaviors, and restrictiveness of worksite smoking policies. RESULTS: People who worked in environments that changed to or maintained smoke-free policies between 1993 and 2001 were 1.9 times more likely (odds ratio [OR] = 1.92; 95% confidence interval [CI] = 1.11, 3.32) than people whose worksites did not do so to have stopped smoking by 2001. Continuing smokers decreased their average daily consumption by 2.57 cigarettes. People working in environments that had smoke-free policies in place in both 1993 and 2001 were 2.3 times more likely (OR=2.29; 95% CI=1.08, 4.45) than people not working in such environments to have quit by 2001, and continuing smokers reported a decline in average daily consumption of 3.85 cigarettes. CONCLUSIONS: Smoke-free worksite policies help employees reduce their cigarette consumption and stop smoking.     

拒烟自我效能、吸烟合理化信念与戒烟意愿的关联——基于上海336名男性吸烟者调查问卷的分析

目的探索影响吸烟者戒烟意愿的因素,为开展有针对性的戒烟干预提供参考。方法采用目的抽样方法从上海市4个居民社区和3家公司中招募吸烟者进行线上问卷调查,问卷调查内容包括一般人口学特征、戒烟意愿、吸烟状态、吸烟成瘾性、烟草危害认知、拒烟自我效能、吸烟合理化信念等信息。采用独立样本t检验、χ2检验以及多因素logistic回归分析进行统计学分析。结果共回收有效问卷336份。吸烟者的年龄为（37.1±10.2）岁,58.3%的文化水平为大专、本科及以上,平均每日吸烟量为（11.46±7.22）支,吸烟者中属于轻度尼古丁依赖者较多（58.3%）,计划在未来6个月内戒烟者248名（73.8%）。与低拒烟自我效能者相比,高拒烟自我效能的吸烟者具有戒烟意愿的可能性更大（OR=2.406,95%CI:1.357~4.267）;低吸烟合理化信念的吸烟者较高吸烟合理化信念者更有可能具有戒烟意愿（OR=2.112,95%CI:1.167~3.821）。结论吸烟者拒烟自我效能和吸烟合理化信念可对其戒烟意愿分别产生积极和消极的影响,开展控烟工作时可以关注吸烟者拒烟自我效能的提升和吸烟合理化信念的纠正,从而提高吸烟者的戒烟意愿。     

The impact of workplace smoking ordinances in California on smoking cessation

OBJECTIVES: The effect of local workplace smoking laws in California was assessed to determine whether such laws increase smoking cessation. METHODS: Workplace smoking ordinance data from 1990 were appended to 1990 California Tobacco Survey data from 4680 adult indoor workers who were current cigarette smokers or reported smoking in the 6 months before the survey. Ordinance effects on cigarette smoking and worksite policy were estimated by using multiple logistic regression controlling for sociodemographic variables. RESULTS: Smokers who worked in localities with a strong workplace ordinance (compared with no workplace ordinance) were more likely to report the existence of a worksite smoking policy (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.2, 2.2) and to report quitting smoking in the prior 6 months (OR = 1.5; 95% CI = 1.1, 1.7). In communities with strong ordinances, an estimated 26.4% of smokers quit smoking within 6 months of the survey and were abstinent at the time of the survey, compared with an estimated 19.1% in communities with no ordinance. CONCLUSIONS: Workplace smoking ordinances increased smoking cessation among employed smokers, indicating that these laws may benefit smokers as well as nonsmokers.     

Impact of a smoke-free workplace policy in a company

OBJECTIVE: To assess the impact of a smoke-free workplace policy in a company. METHOD: The impact of the implementation of a smoke-free workplace policy was assessed between October 2001 and February 2003 in a company with 184 employees. Two surveys of the entire staff were performed, one before the implementation of the new policy and the other 14 months after. RESULTS: Both passive exposure to tobacco smoke and tobacco consumption among smokers decreased. The proportion of workers free of tobacco smoke exposure at their workplace increased from 32% to 84% (p < 0.001) and, among smokers, the mean daily consumption of cigarettes was reduced by 7.3 cigarettes (p = 0.049). CONCLUSIONS: Demarkation of areas where smoking is allowed not only reduces passive exposure to tobacco smoke at the workplace but also seems to encourage smokers to quit smoking or to reduce tobacco consumption.     

Workplace smoking ban effects on unhappy smokers

Economists usually draw a distinction between smokers. They distinguish 'happy addicts' à la Becker-Murphy from 'unhappy addicts' who state that smoking is a mistake and call for some help to quit. When evaluating tobacco control policies, it might be important to distinguish their effects on those two types of population. Indeed, such policies are welfare improving only if they help unhappy addicts to quit. We investigate the effect of the French workplace smoking ban on a sample of presumably 'unhappy addicts', smokers who consult tobacco cessation services. We show that the ban caused an increase in the demand for such services, and that this increase was larger in cold and rainy areas. It also induced an increase in the percentage of successful attempts to quit. Workplace smoking bans might be welfare improving since they seem to help 'unhappy addicts' to reconcile their behavior with their preferences.     

Is Some Provider Advice on Smoking Cessation Better Than No Advice? An Instrumental Variable Analysis of the 2001 National Health Interview Survey

RESEARCH OBJECTIVE: To estimate the effect of provider advice in routine clinical contacts on patient smoking cessation outcome. DATA SOURCE: The Sample Adult File from the 2001 National Health Interview Survey. We focus on adult patients who were either current smokers or quit during the last 12 months and had some contact with the health care providers or facilities they most often went to for acute or preventive care. STUDY DESIGN: We estimate a joint model of self-reported smoking cessation and ever receiving advice to quit during medical visits in the past 12 months. Because providers are more likely to advise heavier smokers and/or patients already diagnosed with smoking-related conditions, we use provider advice for diet/nutrition and for physical activity reported by the same patient as instrumental variables for smoking cessation advice to mitigate the selection bias. We conduct additional analyses to examine the robustness of our estimate against the various scenarios by which the exclusion restriction of the instrumental variables may fail. PRINCIPAL FINDINGS: Provider advice doubles the chances of success in (self-reported) smoking cessation by their patients. The probability of quitting by the end of the 12-month reference period increased from 6.9 to 14.7 percent, an effect that is of both statistical (p < .001) and clinical significance. CONCLUSIONS: Provider advice delivered in routine practice settings has a substantial effect on the success rate of smoking cessation among smoking patients. Providing advice consistently to all smoking patients, compared with routine care, is more effective than doubling the federal excise tax and, in the longer run, likely to outperform some of the other tobacco control policies such as banning smoking in private workplaces.     

Changes in smoking associated with hospitalization: quit rates, predictive variables, and intervention implications

BACKGROUND. Hospitalization can provide one of the most opportune times to prompt smoking cessation. This study determined the frequency of various smoking cessation related behaviors occurring during and following hospitalization and identified variables associated with these outcomes. METHODS. A sample of 526 HMO members who smoked prior to hospitalization and were hospitalized for nonpregnancy related, nonterminal conditions were surveyed to assess the natural history of smoking cessation associated with hospitalization. RESULTS. Three events were studied: not smoking while hospitalized (51% of subjects), attempting to quit following hospitalization (37%), and smoking status one year after hospitalization (16% abstinent). Similar factors were associated with not smoking in the hospital and quit attempts: older persons and patients with circulatory/respiratory diagnoses were only half as likely to smoke in the hospital as other patients and twice as likely to try to quit. Different variables predicted smoking status at follow-up: heavier smokers were significantly more likely to stop (26% cessation) than light or moderate smokers (10% and 11% cessation, respectively). DISCUSSION. The hospital may be an effective setting for smoking cessation programs, especially those aimed at heavy smokers. Research is needed to determine whether smokefree hospital policies alter smoking rates following hospitalization.     

Tobacco denormalization and industry beliefs among smokers from four countries

BACKGROUND: Tobacco denormalization is an important concept for understanding smoking behavior. The present study sought to assess beliefs about the tobacco industry and the social acceptability of smoking among nationally representative samples of adult smokers from four countries, and to assess the relationship of these measures to cessation behavior and tobacco-control policy. DESIGN: A longitudinal survey of 9058 adult smokers from Canada (n = 2214), the United States (n = 2138), the United Kingdom (n = 2401), and Australia (n = 2305), was conducted in October-December 2002 and again in June and August 2003 (75% follow-up rate). The analyses were conducted in 2005. RESULTS: The findings indicate that few smokers perceive approval for their smoking, and most hold relatively antagonistic beliefs toward the tobacco industry. For example, 80% of smokers reported that society disapproves of smoking, and more than three quarters reported that tobacco companies cannot be trusted to tell the truth. Social and industry denormalization were independently associated with intentions to quit smoking. Baseline levels of social denormalization were associated with abstinence at the 8-month follow-up, as were changes in industry denormalization beliefs between baseline and follow-up. Anti-industry beliefs at baseline did not predict abstinence at follow-up. A similar pattern of findings was observed across all four countries. In addition, social denormalization and anti-industry beliefs were significantly associated with tobacco-control policies, such as noticing health warnings on packages and greater workplace smoking restrictions. CONCLUSIONS: Tobacco denormalization constructs were independently linked to cessation-related outcomes among adults from four countries. Tobacco-industry denormalization themes in mass media campaigns may help to reduce tobacco use above and beyond more traditional communications that target social norms.     

Tobacco smoking in hotel workers and the necessity to promote non-smoking policy at the workplace

This investigation aimed at evaluating the prevalence of active smokers in hotel workers to underline the need for a non-smoking campaign at the workplace. Data on smoking habit were collected in a questionnaire which included 398 subjects of whom 170 were men and 228 women aged in average 29 and 35 years, respectively. Seventy-six men and 134 women declared themselves regular tobacco smokers. In average, they started to smoke at the age of 17 and 18, respectively and had been smoking for 21 and 16 years, respectively. Although the number of smokers was high, it is encouraging that 29% of men and of 51% women tried and did not succeed in quitting smoking, whereas 30% of men and 12% of women did quit smoking. The authors advocate reducing tobacco use and controlling environmental tobacco smoke exposure at the workplace, which should include a non-smoking company policy, implementation of smoking cessation programmes, social support programmes, trade union support, as well as the assistance of health professionals during regular check-ups.     

The impact of cigarette warning labels and smoke-free bylaws on smoking cessation: evidence from former smokers

BACKGROUND: To effectively address the health burden of tobacco use, tobacco control programs must find ways of motivating smokers to quit. The present study examined the extent to which former smokers' motivation to quit was influenced by two tobacco control policies recently introduced in the Waterloo Region: a local smoke-free bylaw and graphic cigarette warning labels. METHODS: A random digit-dial telephone survey was conducted with 191 former smokers in southwestern Ontario, Canada in October 2001. Former smokers who had quit in the previous three years rated the factors that influenced their decision to quit and helped them to remain abstinent. RESULTS: Thirty-six percent of former smokers cited smoke-free policies as a motivation to quit smoking. Former smokers who quit following the introduction of a total smoke-free bylaw were 3.06 (CI95 = 1.02-9.19) times more likely to cite smoking bylaws as a motivation to quit, compared to former smokers who quit prior to the bylaw. A total of 31% participants also reported that cigarette warning labels had motivated them to quit. Former smokers who quit following the introduction of the new graphic warning labels were 2.78 (CI9 = 1.20-5.94) times more likely to cite the warnings as a quitting influence than former smokers who quit prior to their introduction. Finally, 38% of all former smokers surveyed reported that smoke-free policies helped them remain abstinent and 27% reported that warning labels helped them do so. CONCLUSION: More stringent smoke-free and labelling policies were associated with a greater impact upon motivations to quit.     

Smokers' expectations to quit smoking

We investigate the effectiveness of different smoking policies on smokers' expectations to quit smoking using a choice experiment on a sample of smokers identified within the World Health Organization (WHO) MONICA Project. Our results indicate that restricted availability, increased cigarette prices, cessation subsidies and regulations at restaurants, bars and cafes increase the expected probability of smoking cessation. Regulations at work places do not seem to have any effect. The results also show the significant role of limited self-control; smokers who have the intent to quit smoking are more likely to quit smoking if a stricter regulation is implemented. Further, smokers who have received advice from their children to quit smoking or who perceive the health risks as considerable, are more likely to expect to quit smoking.     

Tobacco use patterns and attitudes among teens being seen for routine primary care

PURPOSE: To describe the tobacco-related attitudes, behaviors, and needs of smoking and nonsmoking teens being seen for routine pediatric care and to identify predictors of tobacco use. DESIGN: Cross-sectional survey of adolescent primary care patients who completed self-administered questionnaires in medical office waiting rooms while waiting for routine care visits. SETTING: A group-practice HMO in the Pacific Northwest. SUBJECTS: A sample of 2526 teenagers, ages 14 to 17, who consented to receive health promotion interventions as a part of a randomized trial in seven pediatric and family practice offices. MEASURES: A 38-item questionnaire assessed tobacco use history, attitudes, quit attempts, and stage of acquisition or cessation along with gender, age, race/ethnicity, body mass index, educational plans, frequency of exercise, attempts to lose weight, and depressed mood. RESULTS: Sixty-seven percent of teens approached (2526 of 3747) consented to complete a questionnaire and receive tobacco- or diet-related interventions as a part of their medical visit. About 23% of teen patients reported smoking at least one cigarette in the last month, although only 14% described themselves as current "smokers." Most current smokers (84%) smoked at least 20 days in the last month. Logistic regression predictors of smoking included older age, Native American ethnicity, lower educational aspirations, lower body mass index, smoking among half or more friends, smokers at home, and a positive depression screen. Among ever-regular smokers, most were in the action (28%), preparation (21%), or contemplation (22%) readiness to quit smoking stages, and 77% of current smokers had made one or more serious quit attempts in the last year. CONCLUSIONS: Most teens in these medical facilities consented to receive tobacco and diet interventions, and most self-described current smokers were contemplating or preparing to quit. Medical visits provide attractive opportunities for tobacco intervention, but messages should be tailored based on the patient's tobacco status and stage of acquisition or cessation.     

甘肃省15～69岁现在吸烟者戒烟意愿及影响因素

  目的  了解甘肃省现在吸烟者的戒烟意愿以及影响因素,为烟草防控工作提供科学依据。  方法  采用多阶段抽样方法,随机抽取15~69岁现在吸烟者作为调查对象。采用《全国居民吸烟情况调查问卷》开展面对面调查,分析不同特征现在吸烟者的戒烟意愿,采用Logistic回归分析模型分析现在吸烟者戒烟意愿的影响因素。  结果  甘肃省现在吸烟者的戒烟意愿为16.4%（95%CI:15.5%~17.3%）,农村地区（OR=1.199,95%CI:1.022~1.408,P=0.026）、家中禁止吸烟（OR=1.767,95%CI:1.273~2.454,P=0.001）、12个月内就医时医务人员劝阻吸烟（OR=1.599,95%CI:1.359~1.842,P < 0.001）、去过戒烟门诊（OR=3.089,95%CI:2.031~4.698,P < 0.001）、初中、高中、大专及以上文化程度（OR=1.383,95%CI:1.101~1.736;OR=1.627,95%CI:1.252~2.116;OR=1.374,95%CI:1.009~1.873,均有P < 0.05）、高烟草危害知识得分为1~,3~,5~6（OR=1.248,95%CI:1.030~1.514;OR=1.574,95%CI:1.289~1.922;OR=2.288,95%CI:1.879~2.786,均有P < 0.05）是现在吸烟者戒烟意愿的促进因素;年龄20~、30~岁组以及烟龄20~、30~年是现在吸烟者戒烟意愿的阻碍因素。  结论  甘肃省现在吸烟者戒烟意愿总体不高,今后应进一步在全社会普及烟草危害知识,加强医务人员戒烟服务能力培训,在诊疗过程中开展戒烟服务,同时应鼓励和支持医疗机构加快戒烟门诊建设。     

山东省医学院校教师烟草流行现况研究

目的了解山东省医学院校教师烟草流行水平、对烟草危害健康知识的掌握情况、对吸烟行为的劝阻及学校控烟环境等,为进一步制定并实施控烟干预措施提供依据。方法从山东省9所医学院校中随机抽取两所,在各学校分别采用完全随机抽样方法,运用横断面调查方法,由被调查者自行填写统一发放的调查问卷。采用SPSS 13.0进行数据录入和统计分析,根据资料类型及分布特征选择相应指标如率、构成比进行统计描述,并应用χ2检验进行统计学分析,P<0.05为差异有统计学意义。结果在本研究中,医学院校教师尝试吸烟率为35.60%,现吸烟率为16.90%,男性教师现吸烟率高于女性教师。对吸烟被动吸烟危害健康相关知识的全部正确认识率为5.67%,不同性别教师的掌握情况差异无统计学意义。认为医学院校教师有同等的吸烟权利的百分比为67.59%,男性的赞成率高于女性;认为医学院校教师应带头拒绝吸烟的百分比为80.81%,男性的赞成率低于女性。12.35%的教师在过去30d中曾在校园看到烟草广告;分别有43.36%和52.33%的教师曾在办公室和教学楼看到过别人吸烟。结论医学院校教师吸烟率低于一般人群,但知识掌握程度较低,仍存在室内吸烟问题,学校控烟力度不够,应尽快加强职业教育及健康教育,提高其控烟意识,为其在今后的工作岗位上开展控烟活动及增强医学生的控烟教育打下坚实基础。     

Motives for smoking cessation are associated with stage of readiness to quit smoking and sociodemographics among German industrial employees

PURPOSE: To test the relationships among particular motives for smoking cessation, stage of readiness to quit (preparation or contemplation), and sociodemographic characteristics. DESIGN: A cross-sectional study to examine attitudes toward and use of health promotion at the worksite, using a self-administered questionnaire. SETTING: Two German metal companies. SUBJECTS: Of 1641 responding employees (response rate 65% in company A and 44% in company B), 360 smokers who intended to quit immediately (n = 105) or in the near future (n = 255) were analyzed. MEASURES: The questionnaire comprised of sociodemographic characteristics, smoking behavior, smoking history, readiness to quit smoking, motives to quit, such as coworkers' complaints and health-related or financial concerns. Chi-squared tests and multiple logistic regression analyses were performed. RESULTS: Health-related reasons (94%) predominated financial (27%) or image-related (14%) reasons for smoking cessation. Participants in the cessation preparation group were more likely to report an awareness of being addicted (79.6% vs. 58.2%; p < .001) and the negative public image (22.5% vs. 11.6%; p < .01) as reasons for quitting compared with those in the contemplation group. In multivariable regression models, the motives for smoking cessation, including reduced performance, family's and coworkers' complaints, pregnancy/children, and negative public image, but not health-related and financial concerns, differed significantly by gender, age, marital status, education, and occupational status. CONCLUSIONS: Motives for smoking cessation vary according to the individual's level of readiness to quit and sociodemographic background.     

The use of nicotine-replacement therapy by hospitalized smokers

BACKGROUND: No-smoking policies are mandatory in U.S. hospitals. Consequently, smokers who are hospitalized must temporarily stop smoking. Nicotine-replacement therapy (NRT) could help hospitalized smokers relieve nicotine withdrawal symptoms, comply with no-smoking policies, and sustain tobacco abstinence after discharge. The extent of NRT use in the hospital setting is unknown. We describe the prevalence and patterns of NRT use in hospitalized smokers. DESIGN: Prospective observational study within a randomized smoking-intervention trial. SETTING/PARTICIPANTS: Six hundred fifty adult smokers admitted to the medical and surgical services of a large urban teaching hospital that prohibits smoking in all indoor areas. Follow-up was at 6 months. MAIN OUTCOME MEASURE: Inpatient pharmacy records of nicotine patch or gum use. RESULTS: Only 34 of 650 smokers (5.2%) received NRT during their hospital stay, including only 9.6% of smokers who reported difficulty refraining from smoking while hospitalized and 9.0% of hospitalized smokers with nicotine withdrawal. NRT was more likely to be prescribed to patients with nicotine withdrawal (OR 2.23; 95% CI: 1.01, 4.90), a higher daily cigarette consumption (OR 1.04; 95% CI: 1.01, 1.06), and a longer hospitalization (OR 1.05; 95% CI: 1.00, 1.10). NRT use was independent of a patient's intention to quit smoking after discharge and was not associated with smoking cessation 1 and 6 months after discharge. CONCLUSIONS: NRT was rarely used in this hospital, even among those who could have benefited from it to treat nicotine-withdrawal symptoms. When NRT was used, relief of nicotine withdrawal, rather than assistance with smoking cessation, appeared to be the primary goal. Greater use of NRT could benefit the estimated 6.5 million smokers who are hospitalized annually by reducing nicotine withdrawal, encouraging smoking cessation, and ensuring compliance with hospital no-smoking policies.     

Impact of patient characteristics on physician's smoking cessation strategies

BACKGROUND: The effectiveness of smoking cessation interventions may be influenced by a variety of patient characteristics, including level of nicotine addiction and readiness to change. We conducted this study to examine the relationship between these characteristics and the frequency of physician-initiated smoking cessation interventions. METHODS: We identified smokers seen during office visits to 1 of 38 primary care physicians in rural Kansas. Trained students observed the frequency and nature of doctor-patient discussions related to tobacco. Telephone surveys were conducted with these patients 1 to 3 days after the office visit. RESULTS: We completed observations and telephone surveys on 259 smokers. Tobacco-related discussions occurred during 66% of doctor-patient encounters. Although discussions overall were unrelated to a patient's readiness to quit, specific assistance with smoking cessation was offered less often to precontemplators (15%) than to contemplators (31%) or those preparing to quit (37%) (P < 0.05). While bupropion was discussed with 23% of smokers, nicotine replacement therapy was discussed with 12% and was unrelated to markers of nicotine addiction. CONCLUSIONS: Current efforts to promote smoking cessation are only marginally related to patient characteristics. Doctors are missing many opportunities to effectively intervene with patients who are contemplating smoking cessation or preparing to quit.