Does the workplace-smoking ban eliminate differences in risk for environmental tobacco smoke exposure at work?
Introduction
There is abundant evidence for the health hazards of exposure to environmental tobacco smoke (ETS), including increased risk for lung cancer, other cancers, coronary heart disease (CHD), respiratory diseases (such as chronic obstructive pulmonary disease (CODP) and asthma), stroke, and complications of pregnancy such as low birth weight and pre-term delivery [1], [2], [3], [4], [5], [6], [7]. The main locations for ETS exposure are workplaces and private homes [8], [9], [10]. Emmons et al. reported that, in the absence of workplace-smoking bans, approximately 50% of the exposure was at the workplace [11]. Hammond found that 29% of the workers were exposed only at work, while 12% were exposed only at home [12].
One of the most effective public health policies to reduce ETS exposure of non-smokers is the implementation of smoking restrictions or total bans at workplaces and public places [2], [3], [13], [14], [15]. In 2007 approximately 50% of the countries in Europe installed anti-smoking laws for workplaces; other countries have limited or no worksite smoking restrictions [16]. In the Netherlands a full workplace-smoking ban has been in place for all worksites (except in bars, cafes and restaurants) since January 2004. Employers are allowed to provide designated smoking rooms.
An effective implementation of the workplace-smoking ban would imply that after the ban there would be no systematic differences in exposure of non-smokers to ETS at the workplace. This would also mean that the ban would lead to a greater reduction in exposure to ETS among those at higher risk before the ban. Most ETS evaluation studies focused on specific categories of workers like hospitality workers or healthcare staff [10], [17], [18], [19], [20], [21], [22], or related the level of worksite smoking policy with ETS exposure [23], [24], [25], [26], [27]. Studies in the USA [28], [29], New Zealand [30], UK/Ireland [31], Scotland [32], Spain [33] and Finland [34], evaluated the impact of a national or state-wide workplace-smoking ban on all types of employees. All seven studies revealed significant reductions of ETS exposure at work after implementation of worksite bans [28], [29], [30], [31], [32], [33], [34]. However, only one of these studies examined the effects in risk groups most exposed to ETS before the ban and thus at the highest risk of acquiring ETS-related health problems [30]. In the present study, we analyze whether the workplace-smoking ban reduced exposure to ETS among all non-smoking employees. However, we also focus more specifically on whether some categories of employees are still at elevated risk for exposure to ETS after the ban. Previous studies suggest that high ETS exposure at work is related to younger age, lower education, blue collar workers and being male [23], [26], [30], [35]. Therefore, we expected that the impact of the ban will be stronger in younger employees, employees with lower education, and male employees. Moreover we expected that, among employees who work more hours, the differences before and after the ban would be larger, because they spend more of their time in an environment that was changed by the introduction of the smoking ban. Specific for the Netherlands is that government-related agencies implemented a workplace-smoking ban as early as 1990. Assuming that this ban had an effect, it is likely that the 2004 national workplace-smoking ban has had less effect on employees working at government-related agencies.
Section snippets
Study design and setting
The Continuous Survey of Smoking Habits (CSSH) monitors smoking prevalence and smoking habits in the Dutch population. Each week 200 respondents are randomly selected from a database of 140,000 respondents representative for the Dutch population aged 15 years and older. To ensure the representativeness, the sample is weighted to region, urbanisation, gender, age, household, education and activity. The subjects were approached by Internet to fill in a questionnaire. For the present study, data
Impact of the ban on the general working population
The first research question addressed the impact of the workplace-smoking ban on self-reported ETS exposure in the general working population. Fig. 1 presents the percentages of employees reporting ‘being exposed to ETS at work’. Despite rather large fluctuations per week in the proportion of employees reporting to be exposed, the figure shows that after the ban a smaller proportion of the employees reported to be exposed to ETS. In the weeks before the ban 70.7% of the employees reported being
Discussion
The first conclusion of this study is that the workplace-smoking ban in the Netherlands has led to a decrease in the proportion of employees reporting to be exposed to ETS; however, it should be noted that even after the ban the proportion of non-smoking workers reporting to be exposed (51.9%) is still rather high. The decrease also occurred in groups, which before the ban had an elevated risk for exposure to ETS. However, we did not see the expected stronger effect among groups of employees
Conclusions
The Dutch workplace-smoking ban led to a decrease in ETS exposure. However, also after the ban still 52% of the employees report to be exposed to ETS during work, although less frequently than before the ban. It would be worthwhile to explore the specific conditions that influence the effectiveness of the ban to protect the non-smoking workers. Furthermore, it is also clear that the groups at elevated risk (male and low-educated employees) are still more often exposed to smoking colleagues
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