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

doi:10.1136/bmj.325.7357.188

BMJ 2002;325:188 ( 27 July )

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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

Objective: To quantify the effects of smoke-free workplaceson smoking in employees and compare these effects to those achievedthrough taxincreases.
Design: Systematic review with a random effects meta-analysis.
Study selection: 26 studies on the effects of smoke-freeworkplaces.
Setting: Workplaces in the United States, Australia,Canada, andGermany.
Participants: Employees in unrestricted and totallysmoke-freeworkplaces.
Main outcome measures: Daily cigarette consumption (per smoker andper employee) and smokingprevalence.
Results: Totally smoke-free workplaces are associatedwith reductions in prevalence of smoking of 3.8% (95% confidenceinterval 2.8% to 4.7%) and 3.1 (2.4 to 3.8) fewer cigarettes smokedper day per continuing smoker. Combination of the effects of reducedprevalence and lower consumption per continuing smoker yieldsa mean reduction of 1.3 cigarettes per day per employee, whichcorresponds to a relative reduction of 29%. To achieve similarreductions the tax on a pack of cigarettes would have to increasefrom $0.76 to $3.05 (0.78 to 3.14) in the United States andfrom £3.44 to £6.59 (5.32 to 10.20) in the United Kingdom. Ifall workplaces became smoke-free, consumption per capita in theentire population would drop by 4.5% in the United States and7.6% in the United Kingdom, costing the tobacco industry $1.7billion and £310 million annually in lost sales. To achieve similarreductions tax per pack would have to increase to $1.11 and £4.26.
Conclusions: Smoke-free workplaces not only protectnon-smokers from the dangers of passive smoking, they also encouragesmokers to quit or to reduceconsumption.

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

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