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The efficacy of smoking ban policy at the workplace on secondhand smoking: systematic review and meta-analysis

Rashiden I, Ahmad Tajuddin NANB, Yee A, Zhen STE, Bin Amir Nordin AS

Environ Sci Pollut Res Int, 2020 Aug;27(24):29856-29866.
PMID: 32483718 DOI: 10.1007/s11356-020-09407-7

Exposure to secondhand smoke (SHS) in the workplace has led many workplaces to set up smoke-free policies to protect non-smoking employees. Although smoke-free workplaces are pervasive, the intensity of the practice is questionable. The purpose of this review is to identify the pooled prevalence estimate of secondhand smoke at smoke-free workplaces and the factors associated with SHS exposure at the workplace despite existing smoke-free policies. Fourteen studies (total 7458 employees) were identified from Pubmed, ScienceDirect, Cinahl, Scopus, and Web of Science from inception to December 2017. Results indicate that despite the existence of smoke-free policies at the workplace, 14 studies reported exposure to secondhand smoke. The pooled prevalence of the SHS exposure was 0.29 (95% CI = 0.23 to 0.36) (P smoke at the smoke-free workplace. While most of the selected studies show the exposure of SHS within the smoking ban workplace, only two studies reported no exposure to secondhand smoke after implementation of smoke-free policies. Although the smoking ban policy at the workplace has been introduced, there are still a number of employees being affected by secondhand smoke. This indicates that there is still a gap of knowledge, attitude, and practice of non-smokers in strengthening the smoke-free policy at the workplace.

Matched MeSH terms: Smoke-Free Policy*
Fulltext The support for smoke free policy and how it is influenced by tolerance to smoking - experience of a developing country

Rashid A, Manan AA, Yahya N, Ibrahim L

PLoS One, 2014;9(10):e109429.
PMID: 25338116 DOI: 10.1371/journal.pone.0109429

This cross sectional survey was conducted to determine the support in making Penang UNESCO World Heritage Site (GTWHS) smoke free and to determine the influence of tolerance towards smoking on this support. This is the first phase in making Penang, Malaysia a smoke free state. A multistage sampling process was done to select a sample of respondents to represent the population of GTWHS. Attitude towards smoking was assessed using tolerance as a proxy. A total of 3,268 members of the community participated in the survey. A big majority (n = 2969; 90.9%) of the respondents supported the initiative. Support was lowest among the owners and residents/tenants, higher age groups, the Chinese, men, respondents who had poor knowledge of the places gazetted as smoke free, and respondents with poor knowledge of the health effects on smokers and on passive smokers. The odds (both adjusted and unadjusted) of not supporting the initiative was high among those tolerant to smoking in public areas. Tolerance towards smoking was associated with 80.3% risk of non-support in the respondents who were tolerant to smoking and a 57.2% risk in the population. Health promotion and education concerning the harm of tobacco smoke in Malaysia, which has mainly targeted smokers, must change. Health education concerning the risks of second hand smoke must also be given to non-smokers and efforts should be made to denormalize smoking.

Matched MeSH terms: Smoke-Free Policy*
Predictors of sustained six months quitting success: efforts of smoking cessation in low intensity smoke-free workplaces

Yasin SM, Retneswari M, Moy FM, Taib KM, Ismail N

Ann Acad Med Singap, 2013 Aug;42(8):401-7.
PMID: 24045376

INTRODUCTION: This study aims to identify the predictors of a 6-month quitting success among employees involved in workplace smoking cessation with low-intensity smoke-free policy.
MATERIALS AND METHODS: A multicentre prospective cohort study was conducted among employees from 2 different public universities in Malaysia. Interventions include at least 2 sessions of behavioural therapy combined with free nicotine replacement therapy (NRT) for 8 weeks. Participants were followed up for 6 months. Independent variables assessed were on sociodemographic and environmental tobacco smoke. Their quit status were determined at 1 week, 3 months and 6 months.
RESULTS: One hundred and eighty- five smokers volunteered to participate. Among the participants, 15% and 13% sustained quit at 3 months and 6 months respectively. Multivariate analysis revealed that at 6 months, attending all 3 behavioural sessions predicted success. None of the environmental tobacco exposure variables were predictive of sustained cessation.
CONCLUSION: Individual predictors of success in intra-workplace smoking cessation programmes do not differ from the conventional clinic-based smoking cessation. Furthermore, environmental tobacco exposure in low intensity smoke-free workplaces has limited influence on smokers who succeeded in maintaining 6 months quitting.

Matched MeSH terms: Smoke-Free Policy*
Fulltext Prevalence of Smoke-Free Zone Compliance among Schools in Indonesia: A Nationwide Representative Survey

Asyary A, Veruswati M, Arianie CP, Ratih TSD, Hamzah A

Asian Pac J Cancer Prev, 2021 Feb 01;22(2):359-363.
PMID: 33639648 DOI: 10.31557/APJCP.2021.22.2.359

BACKGROUND: With the increasing prevalence of teenage or school-age smokers, schools have become the main focus of the Indonesian government in tobacco control, including through the smoke-free zone (SFZ) policy. This study aims to obtain information related to the implementation of SFZ policies in schools.
METHODS: A nationally representative survey was employed in 900 elementary, junior high, and senior high schools that were located in 60 regions or 24 provinces of Indonesia. Each school's compliance with SFZ parameters was measured using a closed-ended questionnaire. The dataset was analyzed using frequency distribution, while the chi-square was performed to analyze the measurement effect of each parameter for SFZ compliance.
RESULTS: Java Island is the region with the largest proportion of school units (10%) studied in this study, and the largest group of the schools are high schools (36.1%). In terms of SFZ compliance, 413 (45.9%) of schools had perfect compliance scores of 8, followed by 183 schools (20.3%) with a score of 7 and 107 (11.9%) with a score of 6. It was found that parameter 5, namely cigarette butts found in the school environment, had the largest proportion when a school did not apply SFZ. Cigarette butts were found in 261 (29.0%) schools. Cigarette butts found in schools contributed 7.8 times to not applying SFZ compared to schools where no cigarette cutters were found.
CONCLUSION: Although the SFZ compliance rate in Indonesian schools is 66.2% at least on 7 of 8 existed parameters, this means most of schools still aren't fully complying with the regulations for SFZs. This recent evidence will help decisionmakers to enforce tobacco control, particularly among youth, which form the pillar of national development.
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Matched MeSH terms: Smoke-Free Policy/legislation & jurisprudence*
Fulltext Support for smoke-free policy among Malaysian adults: findings from a population-based study

Kuang Hock L, Hui Li L, Chien Huey T, Yuvaneswary V, Sayan P, Muhd Yusoff MF, et al.

BMJ Open, 2019 Feb 12;9(2):e020304.
PMID: 30760510 DOI: 10.1136/bmjopen-2017-020304

OBJECTIVE: Public opinion and support can be powerful mandates for smoke-free policy. However, the scarcity of evidence on public opinion among Malaysians necessitates further investigation. Therefore, this study aimed to determine the level of support for smoke-free policy at various public domains and its associated factors among Malaysian adults.
DESIGN: Data were derived from the Global Adult Tobacco Survey, Malaysia (GATS-M). GATS-M is a nationwide study that employed a multistage, proportionate-to-size sampling strategy to select a representative sample of 5112 Malaysian adults aged 15 years and above. Multiple logistic regression was used to identify factors associated with support for smoke-free policy in selected public domains that is, workplaces, restaurants, bars, hotels, casinos, karaoke centres, public transport terminals and shopping centres.
RESULTS: The level of support for enactment of a smoke-free policy at selected public domains varied from 37.8% to 94.4%, with the highest support was for gazetted smoke-free domains, namely, shopping centres (94.4%, 95% CI: 93.2% to 95.3%) and public transport terminals (85.2%, 95% CI: 83.3% to 86.9%). Multiple logistic regression revealed that non-smokers were more likely to support smoke-free policy at all domains. In addition, respondents who worked in workplaces with total or partial smoking restrictions were more likely to support a smoke-free policy ((total restriction adjusted OR (AOR): 14.94 (6.44 to 34.64); partial restriction AOR: 2.96 (1.138 to 6.35); non-restriction was applied as a reference).
CONCLUSION: A majority of the Malaysian adult population supported the smoke-free policy, especially at gazetted smoke-free domains. Therefore, expansion of a total smoking ban to workplaces, restaurants, bars, hotels, casinos and karaoke centres is strongly recommended to reduce exposure to secondhand smoke and to denormalise smoking behaviour.

Matched MeSH terms: Smoke-Free Policy*
Fulltext Malaysia Abridged SimSmoke model - towards achieving 2025 and 2045 smoking prevalence targets

Mohamed Nor N, Ross H, Thinng WBK, Abdul Ghani J, Hassan N, Baharom N

Malaysian Journal of Medicine and Health Sciences, 2018;14(3):8-15.
MyJurnal

Introduction: In respond to the World Health Assembly global NCD target of 30% reduction in the prevalence of adult tobacco use by 2025, Malaysian government called for lowering its smoking prevalence to 15% by 2025. In addition, moving towards the endgame target of less than 5% smoking prevalence in 2045. Methods: Malaysia Abridged SimSmoke model, a simulation model uses specific policy parameters, the most recent smoking prevalence, and population size for Malaysia is developed to estimates and access the impact of MPOWER policies in achieving the targets. Results: The 15% prevalence rate in 2025 can be achieved if the Malaysian government increase tobacco excise tax to 72% of the retail price, implement and enforce comprehensive smoke-free air policies, ban all forms of advertising/promotions and run intensive mass media campaigns. Such approach would reduce the number of smokers by about 2.6 million, averting almost 1.3 million premature deaths in the long term. The tobacco endgame target of less than 5% smoking prevalence by 2045 is achievable if the excise tax is further increased to 86.5% of the retail price while all other tobacco control policies are kept at the enhanced level. Conclusions: Both the targeted smoking prevalence are a realistic proposition if the proposed measures are fully implemented. It requires a whole government approach with the MOH as a leading agency driving the process. It is important to monitor both the compliance with the new measures and smoking prevalence to make sure that Malaysia is on track in achieving its targets.

Matched MeSH terms: Smoke-Free Policy
Fulltext Exposure to tobacco secondhand smoke and its associated factors among non-smoking adults in smoking-restricted and non-restricted areas: findings from a nationwide study in Malaysia

Lim KH, Teh CH, Nik Mohamed MH, Pan S, Ling MY, Mohd Yusoff MF, et al.

BMJ Open, 2018 01 08;8(1):e017203.
PMID: 29317411 DOI: 10.1136/bmjopen-2017-017203

OBJECTIVES: Secondhand smoke (SHS) has been associated with increased morbidity and mortality. Therefore, the aims of the paper are to assess SHS exposure among non-smoking adults in Malaysia attending various smoking-restricted and non-restricted public areas according to the Control of Tobacco Product Regulations (CTPR) as well as its relationship with various sociodemographic variables.
DESIGN: Data were extracted from a cross-sectional study, the Global Adults Tobacco Survey (GATS) 2011 which involved 3269 non-smokers in Malaysia. Data was obtained through face-to-face interviews using a validated pre-tested questionnaire. Factors associated with exposure to SHS were identified via multivariable analysis.
RESULTS: The study revealed that almost two-thirds of respondents were exposed to SHS in at least one public area in the past 1 month, with a significantly higher exposure among males (70.6%), those with higher educational attainment (81.4%) and higher income (quintile 1%-73.9%). Besides, the exposure to SHS was almost four times higher in non-restricted areas compared with restricted areas under the CTPR (81.9% vs 22.9). Multivariable analysis revealed that males and younger adults at non-restricted areas were more likely to be exposed to SHS while no significant associated factors of SHS exposure was observed in restricted areas.
CONCLUSIONS: The study revealed the prevalence of SHS exposure was higher among Malaysian adults. Although smoke-free laws offer protection to non-smokers from exposure to SHS, enforcement activities in restricted areas should be enhanced to ensure strict public abidance. In addition, legislation of restricted areas should also be extended to greatly reduce the SHS exposure among non-smokers in Malaysia.
Study name: Global Adults Tobacco Survey (GATS-2011)

Matched MeSH terms: Smoke-Free Policy*
Fulltext Environmental influence and intention to quit smoking among college students

Muhammad Adil Zainal Abidin, Hayati Kadir Shahar, Rosliza Abdul Manaf

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):77-77.
MyJurnal

Introduction: Secondhand tobacco smoke is a known carcinogen and has shown positive association with smok-ing status, susceptibility and cessation. Smoke free environment policy seem to reduce this exposure and influence intention to quit and frequency of quit attempts. Despite having a smoke free policy, smokers are still exposed to second hand smoke and this might influence their smoking behaviour and cessation. The objective of this study was to examine the association between environmental tobacco smoke exposures with intention to quit smoking among young adults in college with smoke free policy. Methods: Data were drawn from a cluster based randomised controlled trial in 10 government colleges in Selangor. Baseline characteristics of 160 college smokers were mea-sured using adapted questionnaire. Intention to quit was measured using Transtheoretical Model and environmental influence of tobacco smoke exposure. Results: Majority of the smokers were male (99.4%), single (100%), of Malay ethnicity (94.4%) and Muslim (95.6%). Most of them are in pre-contemplation stage where they do not have any intention to quit (65.6%). On environmental influence, at work or college environmental exposure, majority were exposed between 1 to 2 hours (36.9%) and 3 to 8 hours (40.6%). On exposure at home or hostel, majority were exposed between 1 to 4 hours (44.4%) and 5 to 14 hours (21.9%). In terms of friend’s exposures, majority have most of their friends smoking (68.1%). We found no statistically significant association between environmental influence and intention to quit smoking. Conclusion: Although we found no relationship, future research should examine the pathway between environmental influence and smoking behaviour.

Matched MeSH terms: Smoke-Free Policy
Fulltext Cancer control programs in East Asia: evidence from the international literature

Moore MA

J Prev Med Public Health, 2014 Jul;47(4):183-200.
PMID: 25139165 DOI: 10.3961/jpmph.2014.47.4.183

Cancer is a major cause of mortality and morbidity throughout the world, including the countries of North-East and South-East Asia. Assessment of burden through cancer registration, determination of risk and protective factors, early detection and screening, clinical practice, interventions for example in vaccination, tobacco cessation efforts and palliative care all should be included in comprehensive cancer control programs. The degree to which this is possible naturally depends on the resources available at local, national and international levels. The present review concerns elements of cancer control programs established in China, Taiwan, Korea, and Japan in North-East Asia, Viet Nam, Thailand, Malaysia, and Indonesia as representative larger countries of South-East Asia for comparison, using the published literature as a guide. While major advances have been made, there are still areas which need more attention, especially in South-East Asia, and international cooperation is essential if standard guidelines are to be generated to allow effective cancer control efforts throughout the Far East. Cancer is a major cause of mortality and morbidity throughout the world, including the countries of North-East and South-East Asia. Assessment of burden through cancer registration, determination of risk and protective factors, early detection and screening, clinical practice, interventions for example in vaccination, tobacco cessation efforts and palliative care all should be included in comprehensive cancer control programs. The degree to which this is possible naturally depends on the resources available at local, national and international levels. The present review concerns elements of cancer control programs established in China, Taiwan, Korea, and Japan in North-East Asia, Viet Nam, Thailand, Malaysia, and Indonesia as representative larger countries of South-East Asia for comparison, using the published literature as a guide. While major advances have been made, there are still areas which need more attention, especially in South-East Asia, and international cooperation is essential if standard guidelines are to be generated to allow effective cancer control efforts throughout the Far East.

Matched MeSH terms: Smoke-Free Policy
Fulltext Socioeconomic inequalities in secondhand smoke exposure at home and at work in 15 low- and middle-income countries

Nazar GP, Lee JT, Arora M, Millett C

Nicotine Tob Res, 2016 May;18(5):1230-9.
PMID: 26610936 DOI: 10.1093/ntr/ntv261

INTRODUCTION: In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs).
METHODS: Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008-2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality.
RESULTS: SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04-1.22] in Turkey to 3.31 [95% CI 2.91-3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02-0.11] in Turkey to 0.43 [95% CI 0.38-0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education.
CONCLUSION: SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure.
IMPLICATIONS: SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke-free policies are pro-equity for certain health outcomes that are strongly influenced by SHS exposure. Using nationally representative Global Adult Tobacco Survey (2008-2011) data from 15 LMICs, we studied socioeconomic inequalities in SHS exposure at homes and at workplaces. The study showed that in most LMICs, SHS exposure at homes is higher among the poor and the less educated. At workplaces, SHS exposure is higher among the less educated groups. Accelerating implementation of pro-equity tobacco control interventions and strengthening of efforts targeted at the socioeconomically disadvantaged groups are needed to reduce inequalities in SHS exposure in LMICs.
Study name: Global Adults Tobacco Survey (GATS-2011)

Matched MeSH terms: Smoke-Free Policy/economics

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