Workplace compliance with a no-smoking law: a randomized community intervention trial

Signs, Fines and Compliance Officers: A Systematic Review of Strategies for Enforcing Smoke-Free Policy

Background. Smoke-free environment policies limit or eliminate the use of smoke-producing tobacco in designated areas thereby reducing second hand smoke. Enforcement is perceived as critical to the successful adoption of a smoke-free policy. However, there is limited guidance available regarding effective enforcement strategies. A systematic review was conducted to examine the effectiveness of enforcement strategies at increasing compliance with and enforcement of smoke-free policies; and to determine circumstances other than enforcement strategies that are associated with compliance with smoke-free policies. Design. Medline, Medline in Process, The Cochrane Library, Embase, PsycInfo and CINAHL databases were searched using MeSH and keywords for relevant studies published between January 1980 and August 2017. A narrative synthesis and methodological quality assessment of included studies was undertaken. Results. Policy promotion and awareness-raising activities, signage, enforcement officers, and penalties for violations were the enforcement strategies most frequently cited as being associated with successful policy enforcement. Additionally, awareness of the laws, non-smoking management and lower staff smoking rates, and membership of a network guiding the policy enforcement contributed to higher compliance with smoke-free policies. Conclusions. There is weak evidence of the effectiveness of strategies associated with compliance with smoke-free policies. Given the evidence base is weak, well-designed trials utilizing appropriate evaluation designs are needed. Overall enforcement strategies associated with total smoke-free bans resulted in higher levels of compliance than strategies for policies that had only partial smoke-free bans.

The carrot and the stick? Strategies to improve compliance with college campus tobacco policies

OBJECTIVE

Tobacco-free policies are being rapidly adopted nationwide, yet compliance with these policies remains a challenge. This study explored college campus key informants' experiences with tobacco policies, and their perceived benefits, drawbacks, and outcomes.

PARTICIPANTS

The sample for this study was 68 key informants representing 16 different California universities with varying tobacco policies (no smoking indoors and within 20 feet of entrances, designated smoking areas, 100% smoke-free, and 100% tobacco-free).

METHODS

Qualitative, descriptive study. Semistructured interviews were transcribed verbatim and analyzed using content analysis.

RESULTS

Strategies to improve compliance ranged from a social approach to a heavy focus on punitive enforcement. Key informants from campuses using a social approach alone reported barriers to improving compliance, including a perceived lack of efficacy of the approach. However, these campuses found it challenging to incorporate enforcement through campus police or security.

CONCLUSIONS

College campus decision makers should explore using a combined approach (social approach as well as formal enforcement), with enforcement primarily the responsibility of nonpolice university channels (eg, Student Affairs, employee supervisors).

Effect of clean indoor air laws on smokers: the clean air module of the SimSmoke computer simulation model

OBJECTIVES

To develop a simulation model to examine the effects of clean indoor air laws on prevalence rates and smoking attributable deaths.

METHODS

Based on empirical and theoretical research, the effects of clean air laws are modelled by type of law. The model considers clean air laws at the state levels between 1993 and 2000, and projects the number of smokers and smoking attributable deaths in the USA under different scenarios from 2000 onward.

RESULTS

The model predicts that comprehensive clean air laws have the potential to reduce substantially the number of smokers and smoking attributable deaths, and these effects are predicted to grow over time. The predicted impact of new worksite laws are reduced when previously implemented private and public worksite restrictions are taken into account.

CONCLUSIONS

Clean indoor air laws have the ability to reduce smoking rates substantially and save lives, but their impact is likely to depend on their comprehensiveness and prior private worksite restrictions in place.

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.

Smoking control in the workplace: is workplace size related to restrictions and programs?

Regarding smoking control in the workplace, small independent operations may differ from large workplaces or from small worksites that are branch units of large companies/organizations. We examined the relationships of worksite and company size to workplace smoking restrictions and programs, using data from a population-based telephone survey. Three worker groups, differentiated by worksite and company size, were compared. Small workplace workers were least knowledgeable about smoking restrictions, reported fewer restrictions in place, and were least willing to intervene in coworkers' smoking. As well, smoking-related programs, although generally uncommon, were reported least often by these workers. Branch workers were not uniformly similar to either small or large workplace workers. In policy and program interventions, organizational influences and/or attributes of individuals drawn to different-size work settings should be considered.

Employee and public responses to simulated violations of no-smoking regulations in Spain

OBJECTIVES

This study evaluated compliance with regulations prohibiting smoking in public places by using a new method of smoking simulation.

METHODS

Sites in Sabadell, Spain, were visited by observers who lit a cigarette, simulating the act of smoking, and noted the placement and content of signs indicating smoking restrictions.

RESULTS

A warning was given in only 17% of sites. A significant association was observed between the presence of signs banning smoking and the elicitation of a warning from people present.

CONCLUSIONS

Simulating the violation of smoking restrictions may be used as an efficient method of assessing enforcement of the prohibition of public smoking.

[Consumption and sales of tobacco in public places: evaluation of compliance with the current standards]

OBJECTIVE

To evaluate the compliance with current legislation on smoking and tobacco sale in public places in the city of Sabadell (Barcelona).

METHODOLOGY

A sample of 218 sites was randomly selected from a total of 1,224 affected by the legislation, after excluding those where direct, anonymous access was difficult. The existence of signs banning smoking, of areas reserved for smokers and the observation of an indication of smoking presence were analyzed, and also a simulation of the act of smoking was performed.

RESULTS

An indication of smoking presence was observed in 61.5% of sites visited, 85.8% and 74.8% did not have a sign banning smoking at the entrance or in the interior, respectively, excluding restaurants and cafeterias. Only 4.1% of sites complied with all requirements established by the Law. Only one restaurant (1.7%) had a nonsmoking section.

CONCLUSIONS

Our results show a low level of compliance with the legislation. The Administration should state a coherent and progressive strategy to achieve its complete application.

Are community health interventions evaluated appropriately? A review of six journals

OBJECTIVES

To determine if Randomized Controlled Trial (RCT) methodology was used appropriately in community health, we: (1) determined the proportion of non-randomized studies that should have been RCTs, and (2) assessed the quality of the RCTs.

METHODS

The 1992 issues of six community health journals were manually searched. Intervention studies were analyzed. Studies that did not use randomization were analyzed for feasibility and practicality of RCT methods; RCTs were analyzed for quality using a checklist. RCTs were compared with community health RCTs from The New England Journal of Medicine. The proportion of studies meeting each criterion was determined.

RESULTS

Fourteen percent of 603 studies were interventions and 4% were RCTs. Of those not using randomization, 42% should have. Mean RCT scores were significantly lower for the community health journals than for The New England Journal of Medicine. Many criteria important to quality scored poorly.

CONCLUSIONS

RCTs are underused and lack methodologic rigor in community health. Conclusions regarding the effectiveness of interventions are therefore suspect.

Environmental tobacco smoke: health effects and policies to reduce exposure

The health hazards due to exposure to environmental tobacco smoke (ETS) are increasingly established. ETS contains thousands of chemicals including 43 known carcinogens. Known health effects of ETS exposure are lung cancer in nonsmokers, childhood disorders such as bronchitis, and perhaps, heart disease. Workplace exposure to ETS is widespread and is influenced strongly by the type of smoking policy in the workplace. To decrease ETS exposure, efforts to restrict public smoking have proliferated over the past decade. These restrictions have emanated from government as well as voluntary measures by various private industries. Bans on public smoking are effective in reducing nonsmokers' exposure to ETS. Workplace smoking bans also influence the intensity of smoking among employees and may increase quit smoking rates. In addition to the health benefits from smoke-free workplaces, there are likely cost savings to employers who implement such policies.

Effectiveness of a consultation intervention to promote tobacco control policies in Northwest Indian tribes: integrating experimental evaluation and service delivery

A quasi-experimental replication of an intervention for promoting tobacco control policies in Northwest Indian tribes is described and the process of intervention including issues of collaboration among research institutions and Indian organizations is discussed. The policy intervention was evaluated using a pretest-posttest design wherein 20 tribes that had served as wait-list controls now received the intervention. The intervention comprised a tribal representative attending a kickoff orientation; follow-up visits to the tribes; distribution of tobacco policy workbooks; and phone call consultations. Policy status and stringency were assessed by means of telephone interviews with two key contacts per tribe, and by a count of enacted policies. There were significant pre-post changes in the primary outcome measure, a composite summary score of tobacco policy stringency, and changes were also reflected in enacted policies. The intervention effects observed were similar to those found in the prior randomized trial and suggest a robust, disseminable intervention. Much of the success achieved was attributed to the role of an Indian organization in planning the project and implementing the intervention and evaluation protocols.

Retail stores' compliance with a city no-smoking law

OBJECTIVES

Laws restricting smoking in public places and workplaces can protect the public only if they are obeyed. We sought to assess compliance with a Cambridge, Mass, no-smoking ordinance.

METHODS

We prospectively observed 174 retail stores 1 month before and 3, 11, and 24 months after the law took effect. At 24 months, we interviewed one employee per store.

RESULTS

Full compliance with the law was low; at 24 months, only 4% of stores displayed the mandated sign and were free of smokers and smoke. Fewer than half the stores posted any no-smoking sign. Sign prevalence increased over 2 years (22% to 41%, P < .001), but the frequency of smoke or smokers (13% and 10%, respectively, at baseline) did not change. According to employees interviewed at 24 months, 38% of stores illegally permitted customers or employees to smoke. These stores had more smoke and fewer signs than did stores prohibiting smoking. Compliance was poor in liquor and convenience stores. Employees who had been told how to handle customers' smoking were more likely to enforce the law.

CONCLUSIONS

Compliance with a no-smoking law is not guaranteed. For retail stores, compliance may improve if stores adopt no-smoking policies, post signs, and teach employees to enforce the law.

Compliance with worksite nonsmoking policies: baseline results from the COMMIT study of worksites

PURPOSE

Little is known about compliance with worksite nonsmoking policies. This study provides an examination of the relationship of policy compliance to characteristics of the organization and the manner in which the policy was implemented.

DESIGN

Data came from two separate surveys of 1) representatives of worksites that reported having a nonsmoking policy and 2) employed residents from the same communities whose worksites had nonsmoking policies.

SETTING

This study was conducted as part of the Community Intervention Trial for Smoking Cessation (COMMIT), being conducted in 11 diverse intervention communities.

SUBJECTS

Data are presented from surveys of 710 worksites (response rate = 90%) and 3,143 employed residents (response rate = 80%) of the same communities.

MEASURES

Compliance with nonsmoking policies was measured by self-report in both surveys and is compared with worksite and respondent characteristics, type of policy, and methods of policy implementation.

RESULTS

Compliance with nonsmoking policies was high; 55% of worksites with a policy restricting smoking reported that employees always adhered to the policy. Compliance was highest in worksites with more restrictive policies and where labor-management relations were reported to be good. Compliance also was high where the policy was effectively communicated to workers, as through worksite distribution channels, the absence of cigarette vending machines, and the availability of cessation assistance.

CONCLUSIONS

These findings indicate that compliance with worksite nonsmoking policies is generally high, especially in the presence of more stringent policies.