BMJ 2002;325:188-191 ( 27 July )

Papers

Effect of smoke-free workplaces on smoking behaviour: systematic review

Caroline M Fichtenberg, research fellow, Stanton A Glantz, professor of medicine. 

Center for Tobacco Control Research and Education, Institute for Health Policy Studies, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA

Correspondence to: S A Glantz glantz{at}medicine.ucsf.edu


    Abstract
Top
Abstract
Introduction
Methods
Results
Discussion
References

Objective: To quantify the effects of smoke-free workplaces on smoking in employees and compare these effects to those achieved through tax increases.
Design: Systematic review with a random effects meta-analysis.
Study selection: 26 studies on the effects of smoke-free workplaces.
Setting: Workplaces in the United States, Australia, Canada, and Germany.
Participants: Employees in unrestricted and totally smoke-free workplaces.
Main outcome measures: Daily cigarette consumption (per smoker and per employee) and smoking prevalence.
Results: Totally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8% (95% confidence interval 2.8% to 4.7%) and 3.1 (2.4 to 3.8) fewer cigarettes smoked per day per continuing smoker. Combination of the effects of reduced prevalence and lower consumption per continuing smoker yields a mean reduction of 1.3 cigarettes per day per employee, which corresponds to a relative reduction of 29%. To achieve similar reductions the tax on a pack of cigarettes would have to increase from $0.76 to $3.05 (0.78 to 3.14) in the United States and from £3.44 to £6.59 (5.32 to 10.20) in the United Kingdom. If all workplaces became smoke-free, consumption per capita in the entire population would drop by 4.5% in the United States and 7.6% in the United Kingdom, costing the tobacco industry $1.7 billion and £310 million annually in lost sales. To achieve similar reductions tax per pack would have to increase to $1.11 and £4.26.
Conclusions: Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking, they also encourage smokers to quit or to reduce consumption.

What is already known on this topic
Smoke-free workplaces are associated with lower cigarette consumption per continuing smoker

What this study adds
Smoke-free workplaces reduce prevalence of smoking as well as consumption

The combined effects of people stopping smoking and reducing consumption reduces total cigarette consumption by 29%

To achieve similar results through taxation would require cigarette taxes per pack to increase from $0.76 to $3.05 in the United States and from £3.44 to £6.59 in the United Kingdom




    Introduction
Top
Abstract
Introduction
Methods
Results
Discussion
References

In the United States, passive smoking has been linked to the deaths of at least 53 000 non-smokers each year, about one non-smoker for each eight smokers that tobacco kills. 1 2 Legislation enforced to protect the health of non-smokers also creates an environment that encourages smokers to cut back or quit. Since as early as the 1980s the tobacco industry has recognised that smoke-free workplaces have a major effect on cigarette consumption.3 In 1992 Phillip Morris Tobacco Company privately estimated that if all workplaces were smoke-free, total consumption would drop about 10%, through a combination of quitting and cutting down.4

We investigated the effects of smoke-free workplaces on cigarette consumption and compared these effects with those obtained by raising taxes.


    Methods
Top
Abstract
Introduction
Methods
Results
Discussion
References

Study selection
We located studies on the effects of totally smoke-free workplaces on prevalence of smoking and daily cigarette consumption through Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, and PsychInfo; from reviews; and from references in the papers we located.

We included 26 studies reported in 24 papers. Worksite studies measured changes in smoking that accompanied regulations in individual workplaces assessed prospectively,5-12 in sequential cross sections, 6 13-18 or retrospectively. 17 19-23 Population studies compared behaviour of smokers employed in workplaces with differing smoking policies and were cross sectional.24-28 See the long version of this paper on bmj.com for the details of the studies.

We excluded 16 studies because they evaluated policies that were not totally smoke-free and 11 because they did not report the desired outcomes. We excluded one study because the surveys carried out before and after the non-smoking policy were separated by eight years, so results could be contaminated by confounding factors.

Data analysis
We computed differences in consumption (per smoker and per employee) and prevalence before and after workplaces became smoke-free (in workplace studies) or between comparable samples with and without regulations (in population studies). We pooled all studies in a random effects meta-analysis. There was no evidence of publication bias as assessed with funnel plots (see bmj.com).




    Results
Top
Abstract
Introduction
Methods
Results
Discussion
References

Effects of smoke-free workplaces
Implementation of totally smoke-free workplace policies was associated with a reduction in absolute prevalence of 3.8% (95% confidence interval 2.8% to 4.7%) and a decrease in consumption of 3.1 (2.4 to 3.8) cigarettes per day per continuing smoker (see bmj.com). Combination of the effects of stopping smoking and the lower consumption per continuing smoker means that 1.3 (range 0.2-1.8) fewer cigarettes were smoked per day per employee (smokers and non-smokers), which corresponds to a 29% (11%-53%) relative reduction.

The time between implementation of the totally smoke-free workplace policies and the follow up survey ranged from 1 to 24 months (mean 10 months, median 9 months) in the 21 workplace studies. The correlation between length of follow up and effect was not significant. The effects of smoke-free workplaces after they were implemented remained stable over time.

Comparison with tax increases
Increasing the price of cigarettes by 10% leads to a 4% reduction in consumption per capita (which reflects changes in both consumption per smoker and prevalence).29 To obtain the 29% drop in employee consumption resulting from smoke-free workplaces would require an increase in the price of cigarettes of 73% (29%/0.4). Such an increase would require the average tax per pack to be increased from $0.76 to $3.05 in the United States and from £3.44 to £6.59 in the United Kingdom (table 1).


                              
View this table:
[in this window]
[in a new window]
 

Table 1.  Price and tax changes necessary to obtain same effect as smoke-free workplaces

The effect of workplace policies on consumption in the general population will be equivalent to a smaller tax increase because making workplaces smoke-free affects only those employed indoors and outside the home (about half of the US adult population 30 31 ) and whose workplaces are not already smoke-free (31% in the United States32 and 52% in the United Kingdom33), while tax increases will affect all tobacco buyers. The marginal effect on the entire population of making all workplaces smoke-free would be a reduction in per capita cigarette consumption of 4.5% in the United States and 7.6% in the United Kingdom. To achieve these reductions would require an increase in tax from $0.76 to $1.11 per pack in the United States and from £3.44 to £4.26 in the United Kingdom.

Totally smoke-free workplaces versus smoke-free areas
Totally smoke-free workplaces had about twice the effect on consumption and prevalence as policies that allowed smoking in some areas (table 2). Internal research at Phillip Morris reached similar conclusions in 1992: "Milder workplace restrictions, such as smoking only in designated areas, have much less impact on quitting rates [than totally smoke-free workplaces] and very little impact on consumption."4


                              
View this table:
[in this window]
[in a new window]
 

Table 2.  Comparison of the effects of totally smoke-free versus partially smoke-free workplaces*




    Discussion
Top
Abstract
Introduction
Methods
Results
Discussion
References

In this review we found that smoke-free workplaces are associated with a decrease in prevalence of tobacco consumption of nearly 4%, a decrease not due to underlying secular trends in prevalence.

Effect on tobacco company revenues
In the United States about 103 million people are employed indoors outside the home, 30 31 69% of whom are already in smoke-free workplaces.32 The marginal effect of the remaining workplaces becoming smoke-free would be 40 million fewer cigarettes smoked per day (103 million×31%×-1.3 cigarettes per day per employee). In the United States in 2000 the average pretax price for 20 cigarettes was $2.3634 so this reduced consumption would cost the tobacco industry $1.7bn per year in lost sales. Likewise in the United Kingdom 29.9 million people are employed indoors,35 with 48% already working in smoke-free workplaces. In 2001 the pretax price of 20 Marlboro cigarettes was £0.86 (Clive Bates, personal communication) so the marginal effect of all work sites becoming smoke-free would be 20 million fewer cigarettes smoked per day, worth £310m a year to the tobacco industry.

Effects of legislation
To protect the health of non-smokers US local and state governments have enforced legislation restricting smoking in public and in workplaces. Studies that characterised laws according to extensiveness of their coverage found decreases in consumption per capita or prevalence associated with more extensive laws compared with no laws ranging from 0.16 to 0.73 fewer cigarettes per day per capita and 3.7% to 4.5% reduction in absolute prevalence. 36 37-39 40

Local clean air laws are stronger and more comprehensive than state legislation.41 Strong local ordinances in California in 1990-1 were associated with an absolute quit rate (over the previous six months) 7.6% higher than in areas with no workplace laws.37 A Canadian study in 1990-1 found a 21% reduction in the odds of being a smoker in areas with high versus low coverage of smoking bylaws.42 A 1995 Finnish law that prohibited smoking in public areas in workplaces (with the option of creating separately ventilated smoking rooms) was associated with a 4.5% drop in prevalence of smoking and three fewer cigarettes smoked per day among continuing smokers.43

Effects of smoke-free workplaces and clean air legislation on teenagers
Teenagers respond to smoke-free environments by decreasing smoking. Teenagers who worked in totally smoke-free work sites were 68% (95% confidence interval 51% to 90%) as likely to ever smoke than those who worked in less restricted work sites.44 Studies that compared the effects of extensive versus no laws on smoking in young people found absolute reductions in prevalence of 2.3% to 46.0%, 45 46 a relative reduction in prevalence of 17.2%,47 and a relative reduction in per capita cigarette consumption of 50.4%.40

Voluntary action to make homes smoke-free leads to lower rates of smoking among US high school students (odds ratio 0.79, 95% confidence interval 0.67 to 0.91, for 30 day prevalence).47 Teenagers living in a smoke-free home were 74% (62% to 88%) as likely to ever smoke compared with those who lived in households with no smoking restrictions, after adjustment for demographics and smoking status of other household members.44 Among young people aged 14 to 22 years old in the United States the only significant predictor of planning to stop smoking was the belief that passive smoking harms non-smokers; this belief more than doubled the chances of planning to stop or of having stopped already.48 These effects, as well as the workplace effects, probably act by reinforcing the social unacceptability of smoking.

As interventions designed to restrict the purchase of cigarettes have no effect on the prevalence of smoking among teenagers,49 clean indoor air is an effective strategy for reducing tobacco consumption among teenagers.

Weaknesses of study
We included studies with different methods carried out in different settings at different points in time. There were, however, no systematic differences in the results obtained in the workplace and population based studies, and the random effects model in the meta-analysis allows for any heterogeneity in study design.

We used changes in consumption per continuing smoker to measure the effect of the policies on consumption. Eight of the studies, however, reported consumption per current smoker (that is, including in the baseline measurement people who quit after the policy was implemented and in the follow up those who started after the policy). We used these data as consumption per continuing smoker. There is evidence that changes in consumption among current smokers are smaller on average than those among continuing smokers. 50 51 We may therefore be underestimating the effect on continuing smokers.

Interpretation of results
While producing benefits for non-smokers by eliminating passive smoking, smoke-free workplaces make it easier for smokers to reduce or stop smoking and substantially reduce tobacco industry sales. This loss in revenues explains why the industry fights so hard against legislation to ensure that workplaces become smoke-free. 3 4 52



    Acknowledgments

Contributors: See bmj.com

    Footnotes

Editorial by West

Funding: National Cancer Institute Grant CA-61021.

Competing interests: None declared.

The full version of this article appears on bmj.com


    References
Top
Abstract
Introduction
Methods
Results
Discussion
References

1. National Cancer Institute. Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protectional Agency. Bethesda, MD: National Cancer Institute, 1999 (Smoking and Health Monograph 10).
2. Glantz SA, Parmley WW. Passive smoking and heart disease. Epidemiology, physiology, and biochemistry. Circulation 1991; 83: 1-12[Abstract/Free Full Text].
3. Chilcote S. Public smoking: the problem (SDC Introduction). Tobacco Institute,1985. Bates Range TIMN0014552/4597 www.tobaccoinstitute.com/getimg.asp?pgno=0&start=0&if=avtidx&bool=00145**&docid=TIMN0014554/4565&docnum=2&summary=0&sel1= (accessed 27 Oct 2001).
4. Heironimus J. Impact of workplace restrictions on consumption an incidence (memo to Louis Suwarna). Phillip Morris, 21 January, 1992: Bates Range 2045447779/7806 www.pmdocs.com/PDF/2045447779_7806.PDF (accessed 27 Oct 2001).
5. Borland R, Chapman S, Owen N, Hill D. Effects of workplace bans on cigarette consumption. Am J Public Health 1990; 80: 178-180[Abstract/Free Full Text].
6. Borland R, Owen N, Hocking B. Changes in smoking behaviour after a total workplace smoking ban. Aust J Public Health 1991; 15: 130-134[Web of Science][Medline].
7. Brigham J, Gross J, Stitzer M, Felch L. Effects of a restricted work-site smoking policy on employees who smoke. Am J Public Health 1994; 84: 773[Abstract/Free Full Text] -8.
8. Broder I, Pilger C, Corey P. Environment and well-being before and following smoking ban in office buildings. Can J Public Health 1993; 84: 254-258[Web of Science][Medline].
9. Gomel M, Oldenburg B, Lemon J, Owen N, Westbrook F. Pilot-study of the effects of a workplace smoking ban on indexes of smoking, cigarette craving, stress and other health behaviors. Psychol Health 1993; 8: 223-229.
10. Hudzinski LG, Frohlich ED. One-year longitudinal study of a no-smoking policy in a medical institution [see comments]. Chest 1990; 97: 1198-1202[Abstract/Free Full Text].
11. Hudzinski LG, Sirois PA. Changes in smoking behavior and body weight after implementation of a no-smoking policy in the workplace. South Med J 1994; 87: 322-327[Web of Science][Medline].
12. Stillman FA, Becker DM, Swank RT, Hantula D, Moses H, Glantz S, et al. Ending smoking at the Johns Hopkins Medical Institutions. An evaluation of smoking prevalence and indoor air pollution. JAMA 1990; 254: 1565-1569.
13. Becker D, Conner H, Waranch H, Stillman F, Pennington L, Lees P, et al. The impact of a total ban on smoking in the Johns Hopkins Children's Center. JAMA 1989; 262: 799-802[Abstract/Free Full Text].
14. Centers for Disease Control and Prevention. Evaluation of an employee smoking policy---Pueblo, Colorado. MMWR Morb Mortal Wkly Rep 1990; 39: 673-676[Medline].
15. Gottlieb NH, Eriksen MP, Lovatto CY, Weinstein RP, Green LW. Impact of a restrictive worksite smoking policy on smoking behavior, attitudes, and norms. J Occup Med 1990; 32: 16-23[CrossRef][Web of Science][Medline].
16. Mullooly JP, Schuman KL, Stevens VJ, Glasgow RE, Vogt TM. Smoking behavior and attitudes of employees of a large HMO before and after a work site ban on cigarette smoking. Public Health Rep 1990; 105: 623-628[Web of Science][Medline].
17. Offord KP, Hurt RD, Berge KG, Frusti DK, Schmidt L. Effects of the implementation of a smoking free policy in a medical center. Chest 1992; 102: 1531-1536[Abstract/Free Full Text].
18. Tsushima WT, Shimizu AA. Effects of a no-smoking policy upon medical center employees. Int J Addict 1991; 26: 23-28[Web of Science][Medline].
19. Baile WF, Gilbertini M, Ulschak F, Snow-Antle S, Hann D. Impact of a hospital smoking ban: changes in tobacco use and employee attitudes. Addict Behav 1991; 16: 419-426[CrossRef][Web of Science][Medline].
20. Daughton DM, Andrews CE, Orona CP, Patil KD, Rennard SI. Total indoor smoking ban and smoker behavior. Prev Med 1992; 21: 670-676[CrossRef][Web of Science][Medline].
21. Olive KE, Ballard JA. Changes in employee smoking behavior after implementation of restrictive smoking policies. South Med J 1996; 89: 699-706[Web of Science][Medline].
22. Stave GM, Jackson GW. Effect of a total work-site smoking ban on employee smoking and attitudes. J Occup Med 1991; 33: 884-890[CrossRef][Web of Science][Medline].
23. Rosenstock IM, Stregachis A, Heany C. Evaluation of a smoking prohibition policy in a health maintenance organization. Am J Public Health 1986; 76: 1014-1015[Abstract/Free Full Text].
24. Brenner H, Mielck A. Smoking prohibition in the workplace and smoking cessation in the Federal Republic of Germany. Prev Med 1992; 21: 252-261[CrossRef][Web of Science][Medline].
25. Farelly MC, Evans WN, Sfekas AE. The impact of workplace smoking bans: results from a national survey. Tob Control 1999; 8: 272-277[Abstract/Free Full Text].
26. Glasgow RE, Cummings KM, Hyland A. Relationship of worksite smoking policies to changes in employee tobacco use: findings from COMMIT. Tob Control 1997; 6(suppl 2): S44-S48[Free Full Text].
27. Kinne S, Kristal A, White E, Hunt J. Work-site smoking policies: their population impact in Washington State. Am J Public Health 1993; 83: 1031-1033[Abstract/Free Full Text].
28. Woodruff TJ, Rosbrook B, Peirce J, Glantz SA. Lower levels of cigarette consumption found in smoke-free workplaces in California. Arch Intern Med 1993; 153: 1485-1493[Abstract/Free Full Text].
29. US Department of Health and Human Services. Reducing tobacco use: a report of the surgeon general. Atlanta, GA: US Deparment of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 2000.
30. US Bureau of the Census. Resident population of the United States by age and sex. www.census.gov/population/estimates/nation/intfile2-1.txt (accessed 17 Aug 2001).
31. US Bureau of Labor Statistics. National employment and wage estimates, www.bls.gov/oes/1999/oes_nat.htm (accessed 17 Aug 2001).
32. Shopland DR, Gerlach KK, Burns DM, Hartman AM, Gibson JT. State-specific trends in smoke-free workplace policy coverage. The current population survey tobacco use supplement 1993 to 1999. J Occup Environ Med 2001; 43: 680-686[Web of Science][Medline].
33. Lader D, Meltzer H. Smoking related behaviour and attitudes, 1999. London: Office for National Statistics, 2000.
34. Orzechowski W, Walker R. The tax burden on tobacco. In: Arlington, VA: Orzechowski and Walker, 2000.
35. Office for National Statistics. Mid-2000 UK population estimates. www.statistics.gov.uk/pdfdir/pop0801.pdf (accessed 21 August 2001).
36. Chaloupka F. Clean indoor air laws, addiction and cigarette smoking. Appl Econ 1992; 24: 193-205[CrossRef].
37. Moskowitz JM, Lin Z, Hudes ES. The impact of workplace smoking ordinances in California on smoking cessation. Am J Public Health 2000; 90: 757-761[Abstract/Free Full Text].
38. Emont S, Choi W, Novotny T, Giovina G. Clean indoor air legislation, taxation and smoking behavior in the United States: an ecological analysis. Tob Control 1992; 2: 13-17.
39. Yurekli AA, Zhang P. The impact of clean indoor air laws and cigarette smuggling on demand for cigarettes: an empirical model. Health Econ 2000; 9: 159-170[CrossRef][Web of Science][Medline].
40. Wasserman J, Manning WG, Newhouse JP, Winkler JD. The effects of excise taxes and regulations on cigarette smoking. J Health Econ 1991; 10: 43-64[CrossRef][Web of Science][Medline].
41. National Cancer Institute. Major local tobacco control ordinances in the United States. Bethesda, MD: USDHHS, 1993 (Smoking and Tobacco Control Monograph 3).
42. Stephens T, Pederson LL, Koval JJ, Kim C. The relationship of cigarette prices and no-smoking bylaws to the prevalence of smoking in Canada. Am J Public Health 1997; 87: 1519-1521[Abstract/Free Full Text].
43. Heloma A, Jaakola M, Kahkonen E, Reijula K. The short-term impact of national smoke-free workplace legislation on passive smoking and tobacco use. Am J Pub Health 2001; 91: 1416-1418[Abstract/Free Full Text].
44. Farkas AJ, Gilpin EA, White MM, Pierce JP. Association between household and workplace smoking restrictions and adolescent smoking. JAMA 2000; 284: 717-722[Abstract/Free Full Text].
45. Lewit E, Hyland A, Kerrebrock N, Cummings K. Price, public policy and smoking in young people. Tob Control 1997; 6(suppl 2): S17-S24[Free Full Text].
46. Chaloupka FJ, Pacula RL. Sex and race differences in young people's responsiveness to price and tobacco control policies. Tob Control 1999; 8: 373-377[Abstract/Free Full Text].
47. Wakefield MA, Chaloupka FJ, Kaufman NT, Orleans CT, Barker DC, Ruel EE. Effect of restrictions at home, at school, and in public places on teenage smoking: cross sectional study. BMJ 2000; 321: 333-337[Abstract/Free Full Text].
48. Glantz SA, Jamieson P. Attitudes toward secondhand smoke, smoking, and quitting among young people. Pediatrics 2000; 106: E82.
49. Fichtenberg CM, Glantz SA. Youth access interventions do not affect youth smoking. Pediatrics 2002; 109: 1088-1092[Abstract/Free Full Text].
50. US Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. A report of the surgeon general. Rockville, MD: US Deparment of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, 1989.
51. Hymowitz N, Cummings KM, Hyland A, Lynn WR, Pechacek TF, Hartwell TD. Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob Control 1997; 6(suppl 2): S57-S62[Free Full Text].
52. Glantz S, Balbach E. Tobacco war: inside the California battles. Berkeley, CA: University of California Press, 2000.

(Accepted 21 March 2002)

© BMJ 2002
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Relevant Articles

The tobacco industry in developing countries
Ernesto Sebrié and Stanton A Glantz
BMJ 2006 332: 313-314. [Extract] [Full Text] [PDF]

Blowing smoke: British American Tobacco's air filtration scheme
Nadine Rae Leavell, Monique E Muggli, Richard D Hurt, and James Repace
BMJ 2006 332: 227-229. [Full Text] [PDF]

Smoke-free workplaces cut smoking
BMJ 2002 325: 0. [Full Text]

Banning smoking in the workplace
Robert West
BMJ 2002 325: 174-175. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

  • Tramacere, I, Gallus, S, Fernandez, E, Zuccaro, P, Colombo, P, La Vecchia, C (2009). Medium-term effects of Italian smoke-free legislation: findings from four annual population-based surveys. J. Epidemiol. Community Health 63: 559-562 [Abstract] [Full text]  
  • Chen, P.-L., Weigang Huang, , Chuang, Y.-L., Warren, C. W., Jones, N. R., Lee, J., Asma, S. (2009). Exposure to and Attitudes Regarding Secondhand Smoke Among Secondary Students in Taiwan. Asia Pac J Public Health 21: 259-267 [Abstract]  
  • Fiore, M. C., Baker, T. B. (2009). Stealing a March in the 21st Century: Accelerating Progress in the 100-Year War Against Tobacco Addiction in the United States. Am. J. Public Health 99: 1170-1175 [Abstract] [Full text]  
  • Brown, A., Moodie, C., Hastings, G. (2009). A longitudinal study of policy effect (smoke-free legislation) on smoking norms: ITC Scotland/United Kingdom. Nicotine Tob Res 0: ntp087v1-ntp087 [Abstract] [Full text]  
  • Hahn, E. J., Rayens, M. K., Langley, R. E., Darville, A., Dignan, M. (2009). Time since smoke-free law and smoking cessation behaviors. Nicotine Tob Res 0: ntp086v1-ntp086 [Abstract] [Full text]  
  • Hyland, A., Higbee, C., Travers, M. J., Van Deusen, A., Bansal-Travers, M., King, B., Cummings, K. M. (2009). Smoke-free homes and smoking cessation and relapse in a longitudinal population of adults. Nicotine Tob Res 11: 614-618 [Abstract] [Full text]  
  • McKee, S. A., Higbee, C., O'Malley, S., Hassan, L., Borland, R., Cummings, K. M., Hastings, G., Fong, G. T., Hyland, A. (2009). Longitudinal evaluation of smoke-free Scotland on pub and home drinking behavior: Findings from the International Tobacco Control Policy Evaluation Project. Nicotine Tob Res 11: 619-626 [Abstract] [Full text]  
  • Thrasher, J. F., Boado, M., Sebrie, E. M., Bianco, E. (2009). Smoke-free policies and the social acceptability of smoking in Uruguay and Mexico: Findings from the International Tobacco Control Policy Evaluation Project. Nicotine Tob Res 11: 591-599 [Abstract] [Full text]  
  • Karekla, M., Symeou, A., Tsangari, H., Kapsou, M., Constantinou, M. (2009). Smoking prevalence and tobacco exposure among adolescents in Cyprus. Eur J Public Health 0: ckp064v1-ckp064 [Abstract] [Full text]  
  • Hyland, A., Hassan, L. M., Higbee, C., Boudreau, C., Fong, G. T., Borland, R., Cummings, K. M., Yan, M., Thompson, M. E., Hastings, G. (2009). The impact of smokefree legislation in Scotland: results from the Scottish ITC Scotland/UK longitudinal surveys. Eur J Public Health 19: 198-205 [Abstract] [Full text]  
  • Mullally, B. J., Greiner, B. A., Allwright, S., Paul, G., Perry, I. J. (2009). The effect of the Irish smoke-free workplace legislation on smoking among bar workers. Eur J Public Health 19: 206-211 [Abstract] [Full text]  
  • Xin, Y, Qian, J, Xu, L, Tang, S, Gao, J, Critchley, J A (2009). The impact of smoking and quitting on household expenditure patterns and medical care costs in China. Tobacco Control 18: 150-155 [Abstract] [Full text]  
  • Hudmon, K. S., Corelli, R. L. (2009). ASHP Therapeutic Position Statement on the Cessation of Tobacco Use. Am J Health Syst Pharm 66: 291-307 [Full text]  
  • Houle, B, Siegel, M (2009). Smoker-free workplace policies: developing a model of public health consequences of workplace policies barring employment to smokers. Tobacco Control 18: 64-69 [Abstract] [Full text]  
  • Helakorpi, S. A., Martelin, T. P., Torppa, J. O., Patja, K. M., Kiiskinen, U. A., Vartiainen, E. A., Uutela, A. K. (2008). Did the Tobacco Control Act Amendment in 1995 affect daily smoking in Finland? Effects of a restrictive workplace smoking policy. J Public Health (Oxf) 30: 407-414 [Abstract] [Full text]  
  • Elton, P. J., Campbell, P. (2008). Smoking prevalence in a north-west town following the introduction of Smoke-free England. J Public Health (Oxf) 30: 415-420 [Abstract] [Full text]  
  • Frieden, T. R., Myers, J. E., Krauskopf, M. S., Farley, T. A. (2008). A Public Health Approach to Winning the War Against Cancer. The Oncologist 13: 1306-1313 [Abstract] [Full text]  
  • Spring, B. (2008). Health Decision Making: Lynchpin of Evidence-Based Practice. Med Decis Making 28: 866-874 [Abstract]  
  • Frohlich, K. PhD (2008). Is tobacco use a disease?. CMAJ 179: 880-882 [Full text]  
  • Schane, R. E., Glantz, S. A. (2008). Education on the Dangers of Passive Smoking: A Cessation Strategy Past Due. Circulation 118: 1521-1523 [Full text]  
  • Schaap, M M, Kunst, A E, Leinsalu, M, Regidor, E, Ekholm, O, Dzurova, D, Helmert, U, Klumbiene, J, Santana, P, Mackenbach, J P (2008). Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries. Tobacco Control 17: 248-255 [Abstract] [Full text]  
  • Pell, J. P., Haw, S., Cobbe, S., Newby, D. E., Pell, A. C.H., Fischbacher, C., McConnachie, A., Pringle, S., Murdoch, D., Dunn, F., Oldroyd, K., MacIntyre, P., O'Rourke, B., Borland, W. (2008). Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome. NEJM 359: 482-491 [Abstract] [Full text]  
  • Barzi, F, Huxley, R, Jamrozik, K, Lam, T-H, Ueshima, H, Gu, D, Kim, H C, Woodward, M (2008). Association of smoking and smoking cessation with major causes of mortality in the Asia Pacific Region: the Asia Pacific Cohort Studies Collaboration. Tobacco Control 17: 166-172 [Abstract] [Full text]  
  • Campion, J., Checinski, K., Nurse, J., McNeill, A. (2008). Smoking by people with mental illness and benefits of smoke-free mental health services. Adv. Psychiatr. Treat. 14: 217-228 [Abstract] [Full text]  
  • Pritsos, C A, Pritsos, K L, Spears, K E (2008). Smoking rates among gamblers at Nevada casinos mirror US smoking rate. Tobacco Control 17: 82-85 [Abstract] [Full text]  
  • Braverman, M. T., Aaro, L. E., Hetland, J. (2008). Changes in smoking among restaurant and bar employees following Norway's comprehensive smoking ban. HEALTH PROMOT INT 23: 5-15 [Abstract] [Full text]  
  • Kai, T., Maki, T., Takahashi, S., Warner, D. O. (2008). Perioperative tobacco use interventions in Japan: a survey of thoracic surgeons and anaesthesiologists. Br J Anaesth 100: 404-410 [Abstract] [Full text]  
  • Barnoya, J., Mendoza-Montano, C., Navas-Acien, A. (2007). Secondhand Smoke Exposure in Public Places in Guatemala: Comparison with other Latin American Countries. Cancer Epidemiol. Biomarkers Prev. 16: 2730-2735 [Abstract] [Full text]  
  • Rayens, M. K., Hahn, E. J., Langley, R. E., Hedgecock, S., Butler, K. M., Greathouse-Maggio, L. (2007). Public Opinion and Smoke-Free Laws. Policy Politics Nursing Practice 8: 262-270 [Abstract]  
  • Ramchand, R., Ialongo, N. S., Chilcoat, H. D. (2007). The Effect of Working for Pay on Adolescent Tobacco Use. Am. J. Public Health 97: 2056-2062 [Abstract] [Full text]  
  • Tong, E. K., Glantz, S. A. (2007). Tobacco Industry Efforts Undermining Evidence Linking Secondhand Smoke With Cardiovascular Disease. Circulation 116: 1845-1854 [Abstract] [Full text]  
  • Goto, R., Nishimura, S., Ida, T. (2007). Discrete choice experiment of smoking cessation behaviour in Japan. Tobacco Control 16: 336-343 [Abstract] [Full text]  
  • York, N. L., Hahn, E. J. (2007). The Community Readiness Model: Evaluating Local Smoke-Free Policy Development. Policy Politics Nursing Practice 8: 184-200 [Abstract]  
  • Macy, J. T., Seo, D.-C., Chassin, L., Presson, C. C., Sherman, S. J. (2007). Prospective Predictors of Long-Term Abstinence Versus Relapse Among Smokers Who Quit as Young Adults. Am. J. Public Health 97: 1470-1475 [Abstract] [Full text]  
  • Kouvonen, A., Vahtera, J., Elovainio, M., Cox, S. J, Cox, T., Linna, A., Virtanen, M., Kivimaki, M. (2007). Organisational justice and smoking: the Finnish public sector study. J. Epidemiol. Community Health 61: 427-433 [Abstract] [Full text]  
  • Koh, H. K., Joossens, L. X., Connolly, G. N. (2007). Making Smoking History Worldwide. NEJM 356: 1496-1498 [Full text]  
  • Messer, K., Pierce, J. P, Zhu, S.-H., Hartman, A. M, Al-Delaimy, W. K, Trinidad, D. R, Gilpin, E. A (2007). The California Tobacco Control Program's effect on adult smokers: (1) Smoking cessation. Tobacco Control 16: 85-90 [Abstract] [Full text]  
  • Albers, A. B, Siegel, M., Cheng, D. M, Biener, L., Rigotti, N. A (2007). Effect of smoking regulations in local restaurants on smokers' anti-smoking attitudes and quitting behaviours. Tobacco Control 16: 101-106 [Abstract] [Full text]  
  • Ritchie, D. (2007). An international review of tobacco smoking research in the nursing profession, 1976-2006. Journal of Research in Nursing 12: 183-184  
  • Meeker, J.D., Missmer, S.A., Cramer, D.W., Hauser, R. (2007). Maternal exposure to second-hand tobacco smoke and pregnancy outcome among couples undergoing assisted reproduction. Hum Reprod 22: 337-345 [Abstract] [Full text]  
  • Stranges, S., Bonner, M. R., Fucci, F., Cummings, K. M., Freudenheim, J. L., Dorn, J. M., Muti, P., Giovino, G. A., Hyland, A., Trevisan, M. (2006). Lifetime cumulative exposure to secondhand smoke and risk of myocardial infarction in never smokers: results from the Western new york health study, 1995-2001.. Arch Intern Med 166: 1961-1967 [Abstract] [Full text]  
  • Samet, J. M. (2006). Smoking Bans Prevent Heart Attacks. Circulation 114: 1450-1451 [Full text]  
  • Bartecchi, C., Alsever, R. N., Nevin-Woods, C., Thomas, W. M., Estacio, R. O., Bartelson, B. B., Krantz, M. J. (2006). Reduction in the Incidence of Acute Myocardial Infarction Associated With a Citywide Smoking Ordinance. Circulation 114: 1490-1496 [Abstract] [Full text]  
  • Radke, P. W., Schunkert, H. (2006). Public smoking ban: Europe on the move.. Eur Heart J 27: 2385-2386 [Full text]  
  • Shopland, D. R, Anderson, C. M, Burns, D. M (2006). Association between home smoking restrictions and changes in smoking behaviour among employed women. J. Epidemiol. Community Health 60: ii44-ii50 [Abstract] [Full text]  
  • Jaakkola, M. S., Jaakkola, J. J. K. (2006). Impact of smoke-free workplace legislation on exposures and health: possibilities for prevention.. Eur Respir J 28: 397-408 [Abstract] [Full text]  
  • Alamar, B., Glantz, S. A. (2006). Effect of Increased Social Unacceptability of Cigarette Smoking on Reduction in Cigarette Consumption. Am. J. Public Health 96: 1359-1363 [Abstract] [Full text]  
  • Smith, G S, Sorock, G S, Wellman, H M, Courtney, T K, Pransky, G S (2006). Blurring the distinctions between on and off the job injuries: similarities and differences in circumstances.. Inj. Prev. 12: 236-241 [Abstract] [Full text]  
  • Joossens, L, Raw, M (2006). The Tobacco Control Scale: a new scale to measure country activity. Tobacco Control 15: 247-253 [Abstract] [Full text]  
  • The GTSS Collaborative Group, (2006). A cross country comparison of exposure to secondhand smoke among youth.. Tobacco Control 15: ii4-ii19 [Abstract] [Full text]  
  • Fong, G T, Hyland, A, Borland, R, Hammond, D, Hastings, G, McNeill, A, Anderson, S, Cummings, K M, Allwright, S, Mulcahy, M, Howell, F, Clancy, L, Thompson, M E, Connolly, G, Driezen, P (2006). Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tobacco Control 15: iii51-iii58 [Abstract] [Full text]  
  • Britton, J., Godfrey, F. (2006). Lifting the smokescreen.. Eur Respir J 27: 871-873 [Full text]  
  • Cokkinides, V., Bandi, P., Ward, E., Jemal, A., Thun, M. (2006). Progress and opportunities in tobacco control.. CA Cancer J Clin 56: 135-142 [Abstract] [Full text]  
  • Amos, A., Wiltshire, S., Haw, S., McNeill, A. (2006). Ambivalence and uncertainty: experiences of and attitudes towards addiction and smoking cessation in the mid-to-late teens. Health Educ Res 21: 181-191 [Abstract] [Full text]  
  • Bornhauser, A, McCarthy, J, Glantz, S A (2006). German tobacco industry's successful efforts to maintain scientific and political respectability to prevent regulation of secondhand smoke.. Tobacco Control 15: e1-e1 [Abstract] [Full text]  
  • Janson, C., Kunzli, N., de Marco, R., Chinn, S., Jarvis, D., Svanes, C., Heinrich, J., Jogi, R., Gislason, T., Sunyer, J., Ackermann-Liebrich, U., Anto, J. M., Cerveri, I., Kerhof, M., Leynaert, B., Luczynska, C., Neukirch, F., Vermeire, P., Wjst, M., Burney, P. (2006). Changes in active and passive smoking in the European Community Respiratory Health Survey.. Eur Respir J 27: 517-524 [Abstract] [Full text]  
  • Gray, S., Pilkington, P., Pencheon, D., Jewell, T. (2006). Public health in the UK: success or failure?. JRSM 99: 107-111 [Full text]  
  • John, U, Riedel, J, Rumpf, H-J, Hapke, U, Meyer, C (2006). Associations of perceived work strain with nicotine dependence in a community sample.. Occup. Environ. Med. 63: 207-211 [Abstract] [Full text]  
  • Muellerleile, P., Mullen, B. (2006). Sufficiency and Stability of Evidence for Public Health Interventions Using Cumulative Meta-Analysis. Am. J. Public Health 96: 515-522 [Abstract] [Full text]  
  • Sebrie, E., Glantz, S. A (2006). The tobacco industry in developing countries. BMJ 332: 313-314 [Full text]  
  • Glantz, F. K., Glantz, S. A. (2006). Protecting Europeans from secondhand smoke: time to act. Eur Heart J 27: 382-383 [Full text]  
  • Barnoya, J., Glantz, S. A. (2006). The tobacco industry's worldwide ETS consultants project: European and Asian components. Eur J Public Health 16: 69-77 [Abstract] [Full text]  
  • Kadowaki, T, Kanda, H, Watanabe, M, Okayama, A, Miyamatsu, N, Okamura, T, Hayakawa, T, Hishida, K, Kita, Y, Ueshima, H (2006). Are comprehensive environmental changes as effective as health education for smoking cessation?. Tobacco Control 15: 26-29 [Abstract] [Full text]  
  • Leavell, N. R., Muggli, M. E, Hurt, R. D, Repace, J. (2006). Blowing smoke: British American Tobacco's air filtration scheme. BMJ 332: 227-229 [Full text]  
  • Chapman, S (2005). The most important and influential papers in tobacco control: results of an online poll. Tobacco Control 14: e1-e1 [Full text]  
  • Ling, P M, Glantz, S A (2005). Tobacco industry consumer research on socially acceptable cigarettes. Tobacco Control 14: e3-e3 [Abstract] [Full text]  
  • Chapman, S (2005). Research from tobacco industry affiliated authors: need for particular vigilance. Tobacco Control 14: 217-219 [Full text]  
  • Lewis, S, Arnott, D, Godfrey, C, Britton, J (2005). Public health measures to reduce smoking prevalence in the UK: how many lives could be saved?. Tobacco Control 14: 251-254 [Abstract] [Full text]  
  • Barnoya, J., Bialous, S. A., Glantz, S. A. (2005). Effective Interventions to Reduce Smoking-Induced Heart Disease Around the World: Time to Act. Circulation 112: 456-458 [Full text]  
  • Frieden, T. R., Mostashari, F., Kerker, B. D., Miller, N., Hajat, A., Frankel, M. (2005). Adult Tobacco Use Levels After Intensive Tobacco Control Measures: New York City, 2002-2003. Am. J. Public Health 95: 1016-1023 [Abstract] [Full text]  
  • Hu, S. C., Huang, S. Y., Li, D., Wen, C. P., Tsai, S. P. (2005). Workplace smoking policies in Taiwan and their association with employees' smoking behaviours. Eur J Public Health 15: 270-275 [Abstract] [Full text]  
  • Barnoya, J., Glantz, S. A. (2005). Cardiovascular Effects of Secondhand Smoke: Nearly as Large as Smoking. Circulation 111: 2684-2698 [Abstract] [Full text]  
  • Gray, N J. (2005). The case for smoker-free workplaces. Tobacco Control 14: 143-144 [Full text]  
  • Kawachi, I. (2005). More evidence on the risks of passive smoking. BMJ 330: 265-266 [Full text]  
  • Mandel, L L, Alamar, B C, Glantz, S A (2005). Smoke-free law did not affect revenue from gaming in Delaware. Tobacco Control 14: 10-12 [Abstract] [Full text]  
  • Kouvonen, A., Kivimaki, M., Virtanen, M., Pentti, J., Vahtera, J. (2005). Work stress, smoking status, and smoking intensity: an observational study of 46 190 employees. J. Epidemiol. Community Health 59: 63-69 [Abstract] [Full text]  
  • Pilkington, P, Gilmore, A B (2004). The Living Tomorrow Project: how Philip Morris has used a Belgian tourist attraction to promote ventilation approaches to the control of second hand smoke. Tobacco Control 13: 375-378 [Abstract] [Full text]  
  • Ibrahim, J K, Tsoukalas, T H, Glantz, S A (2004). Public health foundations and the tobacco industry: lessons from Minnesota. Tobacco Control 13: 228-236 [Abstract] [Full text]  
  • Mandel, L L, Glantz, S A (2004). Hedging their bets: tobacco and gambling industries work against smoke-free policies. Tobacco Control 13: 268-276 [Abstract] [Full text]  
  • Abdullah, A S M, Husten, C G (2004). Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax 59: 623-630 [Abstract] [Full text]  
  • Chapman, S (2004). "Half-pregnant" occupational health policy on environmental tobacco smoke. Occup. Environ. Med. 61: 383-384 [Full text]  
  • Pechacek, T. F, Babb, S. (2004). How acute and reversible are the cardiovascular risks of secondhand smoke?. BMJ 328: 980-983 [Full text]  
  • Sargent, R. P, Shepard, R. M, Glantz, S. A (2004). Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study. BMJ 328: 977-980 [Abstract] [Full text]  
  • Jamrozik, K. (2004). Population strategies to prevent smoking. BMJ 328: 759-762 [Full text]  
  • Nixon, M L, Mahmoud, L, Glantz, S A (2004). Tobacco industry litigation to deter local public health ordinances: the industry usually loses in court. Tobacco Control 13: 65-73 [Abstract] [Full text]  
  • Drope, J, Bialous, S A, Glantz, S A (2004). Tobacco industry efforts to present ventilation as an alternative to smoke-free environments in North America. Tobacco Control 13: i41-47 [Abstract] [Full text]  
  • Givel, M., Glantz, S. A. (2004). The "Global Settlement" With the Tobacco Industry: 6 Years Later. Am. J. Public Health 94: 218-224 [Abstract] [Full text]  
  • Glantz, S A, Wilson-Loots, R (2003). No association of smoke-free ordinances with profits from bingo and charitable games in Massachusetts. Tobacco Control 12: 411-413 [Abstract] [Full text]  
  • Drope, J, Glantz, S (2003). British Columbia capital regional district 100% smokefree bylaw: a successful public health campaign despite industry opposition. Tobacco Control 12: 264-268 [Abstract] [Full text]  
  • Tsoukalas, T., Glantz, S. A. (2003). The Duluth Clean Indoor Air Ordinance: Problems and Success in Fighting the Tobacco Industry at the Local Level in the 21st Century. Am. J. Public Health 93: 1214-1221 [Abstract] [Full text]  
  • Warner, K E, Jacobson, P D, Kaufman, N J (2003). Innovative approaches to youth tobacco control: introduction and overview. Tobacco Control 12: i1-5 [Full text]  

Rapid Responses:

Read all Rapid Responses

A Smoke-Free Womb Would be a Good Start
Tony Floyd
bmj.com, 27 Jul 2002 [Full text]
Can smoking bans be enforced?
Frank J Leavitt
bmj.com, 29 Jul 2002 [Full text]
Smoke-Inhalation? How about Smoker-Inhalation Machines?
Tony Floyd
bmj.com, 31 Aug 2002 [Full text]
Re: Smoke-Inhalation? How about Smoker-Inhalation Machines?
Frank J Leavitt
bmj.com, 5 Sep 2002 [Full text]
Doc2Doc Vacancy
Access jobs at BMJ Careers
Whats new online at Student BMJ