BMJ 2002;325:188 ( 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

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

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© BMJ 2002

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