In Scotland on March 26, 2006 a comprehensive prohibition on smoking in all enclosed public places was introduced. This study examines bar workers' attitudes towards a smoke-free working environment.
An intervention study comparing bar workers' opinions before and after the implementation of the smoke-free legislation. Bars were randomly selected in three Scottish cities (Glasgow, Edinburgh & Aberdeen) and towns (Aberdeenshire & Borders). Bar workers were recruited from 72 bars that agreed to participate from159 approached. Pre- and post-implementation attitudes towards legislation, second-hand smoke and smoke-free working environments were compared.
Initially the majority of bar workers agreed with the proposed legislation on smoking (69%) and the need for it to protect the health of workers (80%), although almost half (49%) thought the legislation would damage business. In 266 bar workers seen at both surveys, a significant positive attitudinal change towards the legislation was seen. Post-implementation, support for the legislation rose to 79%, bar workers continued to believe it was needed to protect health (81%) and concerns about the impact on business were expressed by fewer than 20%. Only the statement that the legislation would encourage smokers to quit showed reduced support, from 70% pre-implementation to fewer than 60% post-implementation. Initial acceptance was greater among younger bar workers; older workers, initially more sceptical, became less so with experience of the legislation's effects.
This study shows that bar workers had generally positive attitudes towards the legislation prior to implementation, which became stronger after implementation. The affirmative attitudes of these key stakeholders are likely to contribute towards the creation of 'smoke-free' as the new social norm.
The Shanghai Public Places Smoking Control Legislation was implemented in March 2010 as the first provincial-level legislation promoting smoke-free public places in China.
To evaluate the compliance with this policy as well as its impact on exposure to secondhand smoke (SHS), respiratory symptoms, and related attitudes among employees in five kinds of workplaces (schools, kindergartens, hospitals, hotels, and shopping malls).
A cross-sectional survey was conducted six months before and then six months after the policy was implemented. Five types of occupational employees from 52 work settings were surveyed anonymously using multistage stratified cluster sampling.
Six months after implementation, 82% of the participants agreed that “legislation is enforced most of the time”. The percentage of self-reported exposure to secondhand smoke declined from round up to 49% to 36%. High compliance rates were achieved in schools and kindergartens (above 90%), with less compliance in hotels and shopping malls (about 70%). Accordingly, prevalence of exposure to SHS was low in schools and kindergartens (less than 10%) and high in hotels and shopping malls (40% and above). The prevalence of respiratory and sensory symptoms (e.g., red or irritated eyes) among employees decreased from 83% to 67%.
Initial positive effects were achieved after the implementation of Shanghai Smoking Control legislation including decreased exposure to SHS. However, compliance with the policies was a considerable problem in some settings. Further evaluation of such policy implementation should be conducted to inform strategies for increasing compliance in the future.
"Smoke-Free" legislation prohibiting smoking in all enclosed public places was introduced in March 2006. This qualitative study presents insights from bar workers about their observations of the changing social bar environment, changing patrons' behaviours and challenges bar workers have faced in managing smoke-free legislation.
Twelve in-depth interviews were conducted between November 2006 and January 2007 with a purposively-selected sample of bar workers, identified from a larger quantitative study evaluating the impact of the legislation in Scotland [the Bar Workers' Health and Environmental Tobacco Smoke Exposure project (BHETSE)].
Bar workers all spoke of the improvements the legislation had brought to their working lives and the greater comfort it appeared to offer patrons. Bar workers reported that patrons were generally quick to accept and comply with the new law, and that families had become a greater feature of pub life since the legislation. However, they expressed concerns that older men seemed to have had most difficulty adjusting to the legislation and lack of knowledge about the best practices they should adopt in order to reduce the risks of unattended drinks being spiked and of anti-social behaviour associated with patrons moving outside to smoke.
Smoke-free legislation is changing the social context of smoking in Scotland. Further research to assess the impact the legislation is having on older male smokers and on the incidence of drink spiking would be useful. More specifically, bar workers would benefit from guidance on how to manage issues arising from patrons moving outside to smoke.
Objectives To compare exposure to secondhand smoke and respiratory health in bar staff in the Republic of Ireland and Northern Ireland before and after the introduction of legislation for smoke-free workplaces in the Republic.
Design Comparisons before and after the legislation in intervention and control regions.
Setting Public houses in three areas in the Republic (intervention) and one area in Northern Ireland (control).
Participants 329 bar staff enrolled in baseline survey; 249 (76%) followed up one year later. Of these, 158 were non-smokers both at baseline and follow-up.
Main outcome measures Salivary cotinine concentration, self reported exposure to secondhand smoke, and respiratory and sensory irritation symptoms.
Results In bar staff in the Republic who did not themselves smoke, salivary cotinine concentrations dropped by 80% after the smoke-free law (from median 29.0 nmol/l (95% confidence interval 18.2 to 43.2 nmol/l)) to 5.1 nmol/l (2.8 to 13.1 nmol/l) in contrast with a 20% decline in Northern Ireland over the same period (from median 25.3 nmol/l (10.4 to 59.2 nmol/l) to 20.4 nmol/l (13.2 to 33.8 nmol/l)). Changes in self reported exposure to secondhand smoke were consistent with the changes in cotinine concentrations. Reporting any respiratory symptom declined significantly in the Republic (down 16.7%, -26.1% to -7.3%) but not in Northern Ireland (0% difference, -32.7% to 32.7%). After adjustment for confounding, respiratory symptoms declined significantly more in the Republic than in Northern Ireland and the decline in cotinine concentration was twice as great.
Conclusion The smoke-free law in the Republic of Ireland protects non-smoking bar workers from exposure to secondhand smoke.
Background: On 29 March 2004, the Republic of Ireland (ROI) became the first EU country to introduce a nationwide ban on workplace smoking. While the focus of this measure was to protect worker health by reducing exposure to second-hand smoke, other effects such as a greater reduction in smoking prevalence and consumption were likely among bar workers. Methods: A random sample of bar workers from Cork city were surveyed before (n = 129) and after (n = 107; 82.9% follow-up rate) implementation of the smoke-free legislation. Self report and combined self report and cotinine concentration were used to determine smoking status. For comparison a cross-sectional random telephone survey of the general population (ROI) was conducted before and 1 year after the smoke-free legislation. There were 1240 pre- and 1221 participants post-ban in the equivalent age and occupational subset of the general population. Results: There was a non-significant decline in smoking prevalence among bar workers 1 year post-ban (self report: −2.8% from 51.4% to 48.6%, P = 0.51; combined self report and cotinine: −4.7% from 56.1% to 51.4%, P = 0.13), but a significant decline in consumption of four cigarettes (95% CI 2.21–6.36) per day. Within the occupationally equivalent general population sub-sample there was a significant drop (3.5%, P = 0.06) in smoking prevalence but no significant change in consumption. Conclusions: Ireland's smoke-free workplace legislation was accompanied by a drop in smoking prevalence in both bar workers and the general population sub-sample.
All Ireland Bar Study; bar workers; cigarette consumption; smoke-free legislation; smoking prevalence; tobacco control
Casino workers are exposed to high levels of secondhand smoke (SHS) at work, yet remain at risk of being excluded from smoke-free legislation around the world. If the prime motivation for smoke-free legislation is the protection of workers, then a workforce experiencing ill-health associated with SHS exposure should not be excluded from legislation. This study aimed to determine the prevalence of respiratory and sensory irritation symptoms among a sample of casino workers, to identify any association between the reporting of symptoms and exposure to SHS at work, and to compare the prevalence of symptoms with that in other workers exposed to SHS.
A postal questionnaire survey of 1568 casino workers in London. Using multivariate analysis we identified predictors of respiratory and sensory irritation symptoms.
559 workers responded to the questionnaire (response of 36%). 91% of casino workers reported the presence of one or more sensory irritation symptoms in the previous four weeks, while the figure was 84% for respiratory symptoms. The presence of one or more sensory irritation symptoms was most strongly associated with reporting the highest exposure to SHS at work (OR 3.26; 1.72, 6.16). This was also true for reporting the presence of one or more respiratory irritation symptoms (OR 2.24; 1.34, 3.74). Prevalence of irritation symptoms in the casino workers was in general appreciably higher than that reported in studies of bar workers.
Our research supports the need for comprehensive smoke-free legislation around the world, covering all indoor workplaces including casinos.
To evaluate the effect of a total ban on smoking indoors in restaurants and other hospitality business premises in Norway, on respiratory symptoms among workers in the industry.
Phone interviews with 1525 employees in the hospitality business were conducted immediately before the enacting of the law. In a follow‐up study five months later, 906 of the workers from the baseline sample participated. Questions were asked on demographic variables, passive smoking exposure, personal smoking, attitudes towards the law, and five respiratory symptoms. Change in symptom prevalence was analysed with McNemar's test and with analysis of variance (ANOVA) for repeated measures.
The prevalence of all five symptoms declined after the ban; for morning cough from 20.6% to 16.2% (p < 0.01); for daytime cough from 23.2% to 20.9%; for phlegm cough from 15.3% to 11.8% (p < 0.05); for dyspnoea from 19.2% to 13.0% (p < 0.01); and for wheezing from 9.0% to 7.8%. ANOVA showed that the largest decline in symptom prevalence was seen among workers who themselves gave up smoking, and subjects with a positive attitude towards the law before it took effect.
A significant decrease in respiratory symptoms among service industry workers was found five months after the enacting of a public smoking ban.
hospitality industry; public smoking ban; respiratory symptoms.
Objective To measure change in adult non-smokers' exposure to secondhand smoke in public and private places after smoke-free legislation was implemented in Scotland.
Design Repeat cross sectional survey.
Participants Scottish adults, aged 18 to 74 years, recruited and interviewed in their homes.
Intervention Comprehensive smoke-free legislation that prohibits smoking in virtually all enclosed public places and workplaces, including bars, restaurants, and cafes.
Outcome measures Salivary cotinine, self reported exposure to smoke in public and private places, and self reported smoking restriction in homes and in cars.
Results Overall, geometric mean cotinine concentrations in adult non-smokers fell by 39% (95% confidence interval 29% to 47%), from 0.43 ng/ml at baseline to 0.26 ng/ml after legislation (P<0.001). In non-smokers from non-smoking households, geometric mean cotinine concentrations fell by 49% (40% to 56%), from 0.35 ng/ml to 0.18 ng/ml (P<0.001). The 16% fall in cotinine concentrations in non-smokers from smoking households was not statistically significant. Reduction in exposure to secondhand smoke was associated with a reduction after legislation in reported exposure to secondhand smoke in public places (pubs, other workplaces, and public transport) but not in homes and cars. We found no evidence of displacement of smoking from public places into the home.
Conclusions Implementation of Scotland's smoke-free legislation has been accompanied within one year by a large reduction in exposure to secondhand smoke, which has been greatest in non-smokers living in non-smoking households. Non-smokers living in smoking households continue to have high levels of exposure to secondhand smoke.
The objective of this study was to evaluate the impact of 100% smoke-free environment legislation on respiratory and sensory irritation symptoms and respiratory function among bar and restaurant workers from the city of Neuquén, Argentina.
Pre-ban and post-ban studies without a comparison group in an Argentinean city were conducted. A baseline survey and spirometric measurements were performed with a total of 80 bar and restaurant workers 1 month before (October 2007) and 3 months after (March 2008) the implementation of the new 100% smoke-free legislation.
A significant reduction in secondhand smoke exposure was observed after the enactment and enforcement of the new legislation, and an important reduction in respiratory symptoms (from a pre-ban level of 57.5% to a post-ban level of only 28.8%). The reduction of sensory irritation symptoms was even higher. From 86.3% of workers who reported at least one sensory irritation symptom in October 2007, only 37.5% reported the same symptoms in March 2008. Also, data obtained by spirometry showed a significant forced vital capacity increase.
Consistent with other studies, 100% smoke-free legislation improved short-term health outcomes in the sample and should be implemented nationwide. Furthermore, undertaking this study has been highly important in promoting 100% smoke-free environment legislation at the workplace as a legitimate right of hospitality workers, and in reducing social acceptance of designated smoking areas in bars and restaurants.
Secondhand smoke; smoke-free legislation; hospitality workers; respiratory health; impact evaluation; environmental tobacco smoke; public policy
OBJECTIVE: With regard to the workplace, to examine restrictions on smoking, smoking at work, attitudes toward and reactions to restrictions, and workplace programmes in the context of the legislative environment. DESIGN: Population-based telephone interview survey of adult residents of the jurisdictions of Metropolitan Toronto, Ontario, Canada. SUBJECTS: Workers within the City of Toronto (n = 374) were compared with other workers (n = 536), because their legislative environments with regard to workplace smoking were markedly different, with workplaces in the City of Toronto being covered by a much more stringent bylaw. RESULTS: In comparison with other workers, City of Toronto workers reported workplace restrictions to be more common and widespread. These workers were also less likely to smoke at work, and more likely to smoke less at work and to have cut down on smoking at work. Quit-smoking rates, however, were similar. There was evidence of some compensatory smoking outside work, but additional compensation in association with more stringent restrictions was not found. City workers and other workers were similar in their support for smoke-free workplaces, in their attitudes to the role of governments in regulating workplace smoking, and in their perceptions of conflict between smokers and non-smokers. Reports of quit-smoking programmes and educational interventions in the workplace were similarly uncommon, although both groups of workers indicated strong support for the role of business and industry in helping people quit. CONCLUSIONS: Restrictions on smoking and smoking patterns reflected the legislative environment; a more stringent environment was associated with more restrictions and less smoking at work.
Aims: To assess knowledge, attitude, practice, and toxicity symptoms associated with pesticide use and exposure among 189 farm workers in the Gaza Strip.
Methods: A cross section of agricultural farm workers in the Gaza Strip were asked to fill in a questionnaire on knowledge, attitudes, practice towards pesticide use, and associated toxicity symptoms.
Results: Farm workers reported high levels of knowledge on the health impact of pesticides (97.9%). Moderate to high levels of knowledge were recorded on toxicity symptoms related to pesticides. Most farm workers were aware of the protective measures to be used during applying pesticides. However, no one took precautions unless they knew about the measures. Burning sensation in eyes/face was the commonest symptom (64.3%). The prevalence of self reported toxicity symptoms was dependent on mixing and use of high concentrations of pesticides. The highest percentage of self reported toxicity symptoms was found among the farm workers who returned to sprayed fields within one hour of applying pesticides.
Conclusions: Farm workers in the Gaza Strip used pesticides extensively. Despite their knowledge about the adverse health impact of the pesticides, the use of protective measures was poor. Most had self reported toxicity symptoms, particularly the younger workers. It would be useful to minimise the use of pesticides and encourage alternative measures. Prevention and intervention programmes regarding the use of protective measures and monitoring the health status of farm workers should be implemented.
Objectives: To compare support for, and perceptions of, the impacts of smoke-free workplace legislation among bar workers in the Republic of Ireland (ROI) pre- and post-implementation, and to identify predictors of support for the legislation.
Setting: Public houses (pubs) in three areas of the ROI.
Design: Comparisons pre- and post-implementation of smoke-free workplace legislation.
Participants: From a largely non-random selection, 288 bar workers volunteered for the baseline survey; 220 were followed up one year later (76.4%).
Outcome measures: Level of support for the legislation, attitude statements concerning potential impacts of the law and modelled predictors of support for the legislation.
Pre-implementation 59.5% of participants supported the legislation, increasing to 76.8% post-implementation. Support increased among smokers by 27.3 percentage points from 39.4% to 66.7% (p < 0.001) and among non-smokers by 12.4% percentage points from 68.8% to 81.2% (p = 0.003).
Pre-legislation three-quarters of participants agreed that the legislation would make bars more comfortable and was needed to protect workers' health. Post-legislation these proportions increased to over 90% (p < 0.001). However, negative perceptions also increased, particularly for perceptions that the legislation has a negative impact on business (from 50.9% to 62.7%, p = 0.008) and that fewer people would visit pubs (41.8% to 62.7%, p < 0.001). After adjusting for relevant covariates, including responses to the attitude statements, support for the ban increased two to three-fold post-implementation. Regardless of their views on the economic impact, most participants agreed, both pre- and post-implementation, that the legislation was needed to protect bar workers' health.
Smoke-free legislation had the support of three-quarters of a large sample of bar workers in the ROI. However, this group holds complex sets of both positive and negative perspectives on the legislation. Of particular importance is that negative economic perceptions did not diminish the widely held perception that the ban is needed to protect workers' health.
The topographical relationship between stress fiber-like structures (SFLS) and nascent myofibrils was examined in cultured chick cardiac myocytes by immunofluorescence microscopy. Antibodies against muscle- specific light meromyosin (anti-LMM) and desmin were used to distinguish cardiac myocytes from fibroblastic cells. By various combinations of staining with rhodamine-labeled phalloidin, anti-LMM, and antibodies against chick brain myosin and smooth muscle alpha- actinin, we observed the following relationships between transitory SFLS and nascent and mature myofibrils: (a) more SFLS were present in immature than mature myocytes; (b) in immature myocytes a single fluorescent fiber would stain as a SFLS distally and as a striated myofibril proximally, towards the center of the cell; (c) in regions of a myocyte not yet penetrated by the elongating myofibrils, SFLS were abundant; and (d) in regions of a myocyte with numerous mature myofibrils, SFLS had totally disappeared. Spontaneously contracting striated myofibrils with definitive Z-band regions were present long before anti-desmin localized in the I-Z-band region and long before morphologically recognizable structures periodically link Z-bands to the sarcolemma. These results suggest a transient one-on-one relationship between individual SFLS and newly emerging individual nascent myofibrils. Based on these and other relevant data, a complex, multistage molecular model is presented for myofibrillar assembly and maturation. Lastly, it is of considerable theoretical interest to note that mature cardiac myocytes, like mature skeletal myotubes, lack readily detectable stress fibers.
Objective To detect any change in exposure to secondhand smoke among primary schoolchildren after implementation of smoke-free legislation in Scotland in March 2006.
Design Comparison of nationally representative, cross sectional, class based surveys carried out in the same schools before and after legislation.
Participants 2559 primary schoolchildren (primary 7; mean age 11.4 years) surveyed in January 2006 (before smoke-free legislation) and 2424 in January 2007 (after legislation).
Outcome measures Salivary cotinine concentrations, reports of parental smoking, and exposure to tobacco smoke in public and private places before and after legislation.
Results The geometric mean salivary cotinine concentration in non-smoking children fell from 0.36 (95% confidence interval 0.32 to 0.40) ng/ml to 0.22 (0.19 to 0.25) ng/ml after the introduction of smoke-free legislation in Scotland—a 39% reduction. The extent of the fall in cotinine concentration varied according to the number of parent figures in the home who smoked but was statistically significant only among pupils living in households in which neither parent figure smoked (51% fall, from 0.14 (0.13 to 0.16) ng/ml to 0.07 (0.06 to 0.08) ng/ml) and among pupils living in households in which only the father figure smoked (44% fall, from 0.57 (0.47 to 0.70) ng/ml to 0.32 (0.25 to 0.42) ng/ml). Little change occurred in reported exposure to secondhand smoke in pupils' own homes or in cars, but a small decrease in exposure in other people's homes was reported. Pupils reported lower exposure in cafes and restaurants and in public transport after legislation.
Conclusions The Scottish smoke-free legislation has reduced exposure to secondhand smoke among young people in Scotland, particularly among groups with lower exposure in the home. We found no evidence of increased secondhand smoke exposure in young people associated with displacement of parental smoking into the home. The Scottish smoke-free legislation has thus had a positive short term impact on young people's health, but further efforts are needed to promote both smoke-free homes and smoking cessation.
Most continuing medical education programs on intimate partner violence (IPV) use an expert-driven approach and focus on changing knowledge and screening behaviors. The Voices of Survivors program aims to also improve attitudes and empathy.
To test the Attitudes Toward Survivors of IPV (ATSI) survey psychometrically. To assess the effectiveness of the Voices of Survivors program in changing health care workers' responsibility to assess for and counsel about IPV, respect for patient autonomy, empathy toward patients in abusive relationships, barriers, confidence, knowledge, and self-reported assessment behaviors.
Thirty-one unaffiliated primary care practices in Washington County, Ore.
Comparison of ATSI survey results before and after a two-hour workshop including a 30-minute video and an advocate-led discussion.
Convenience sample of primary care providers, medical support staff, and other clinic employees.
Two hundred and eighty-four health care workers participated in the training. Two hundred and sixty-seven (94%) completed workshop evaluations and 187 (66%) completed both pre- and postintervention surveys. Cronbach's α for all scales ranged from 0.68 to 0.92. Postintervention, participants' summary scores improved for responsibility to assess for IPV (3.96 vs 3.64; P<.0001), respect for patient autonomy (2.78 vs 2.41; P<.0001), empathy (3.24 vs. 2.99; P=.002), confidence (2.33 vs 2.07; P<.0001), knowledge (2.08 vs 1.64; P<.0001), and self-reported behaviors (3.08 vs 2.53; P=.0001). Barriers related to availability of resources and referrals also improved.
The ATSI scales demonstrated good internal reliability and responsiveness to change in all domains except responsibility to counsel. The Voices of Survivors documentary, along with a workshop based on its companion guide, improved clinic employees' knowledge, attitudes, empathy, and self-reported assessment behaviors about IPV.
intimate partner violence; continuing medical education; survey instrument; provider attitudes; measurement
A smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban.
Methods and Finding
We formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p<0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p<0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned.
Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health.
California’s Smoke-Free Workplace Act— CA Labor Code Sec. 6404.5(a)—was extended to bars in 1998. This paper analyzes changes in normative beliefs and behaviors related to bar smoking in the decade following the adoption of the Act. In a series of studies evaluating the smoke-free workplace law in bars, researchers conducted extensive observations and interviews with bar staff and patrons, health officials, and law enforcement personnel in three California counties. Smoking outside became a normal pause in the social environment and created a new type of bar socializing for outside smokers. Although some bar owners and staff reported initially resenting the responsibility to uphold the law, once norms regarding cigarettes and smoking began changing, bar workers experienced less conflict in upholding the law. Non-smoking behavior within bars also became the normative behavior for bar patrons. California’s Smoke-Free Workplace Act has both reflected and encouraged normative beliefs and behaviors related to smoking in bars. The findings indicate that such shifts are possible even in contexts where smoking behaviors and attitudes supporting smoking were deeply entrenched. Recommendations include attending to the synergistic effect of education and policy in effective tobacco control programs.
Tobacco control policy; norm change; California; bars; qualitative
This paper describes the varying levels of smoking policies in nationally representative samples of smokers in four countries and examines how these policies are associated with changes in attitudes and beliefs about secondhand smoke over time.
We report data on 5,788 respondents to Wave 1 of the International Tobacco Control Four Country Survey who were employed at the time of the survey. A cohort of these respondents was followed up with two additional survey waves approximately 12 months apart. Respondents’ attitudes and beliefs about secondhand smoke as well as self-reported policies in their workplace and in bars and restaurants in their community were assessed at all waves.
The level of comprehensive smoke-free policies in workplaces, restaurants, and bars increased over the study period for all countries combined and was highest in Canada (30%) and lowest in the United Kingdom (0%) in 2004. In both cross-sectional and longitudinal analyses, stronger secondhand smoke policies were associated with more favorable attitudes and support for comprehensive regulations. The associations were the strongest for smokers who reported comprehensive policies in restaurants, bars, and their workplace for all three survey waves.
Comprehensive smoke-free policies are increasing over time, and stronger policies and the public education opportunities surrounding their passage are associated with more favorable attitudes toward secondhand smoke regulations. The implication for policy makers is that, although the initial debate over smoke-free policies may be tumultuous, once people understand the rationale for implementing smoke-free policies and experience their benefits, public support increases even among smokers, and compliance with smoke-free regulations increases over time.
This study aims to test the pathways of change from individual exposure to smoke-free legislation on smoking cessation, as hypothesized in the International Tobacco Control (ITC) Conceptual Model.
A nationally representative sample of Dutch smokers aged 15 years and older was surveyed during 4 consecutive annual surveys. Of the 1,820 baseline smokers, 1,012 participated in the fourth survey. Structural Equation Modeling was employed to test a model of the effects of individual exposure to smoke-free legislation through policy-specific variables (support for smoke-free legislation and awareness of the harm of [secondhand] smoking) and psychosocial mediators (attitudes, subjective norm, self-efficacy, and intention to quit) on quit attempts and quit success.
The effect of individual exposure to smoke-free legislation on smoking cessation was mediated by 1 pathway via support for smoke-free legislation, attitudes about quitting, and intention to quit smoking. Exposure to smoke-free legislation also influenced awareness of the harm of (secondhand) smoking, which in turn influenced the subjective norm about quitting. However, only attitudes about quitting were significantly associated with intention to quit smoking, whereas subjective norm and self-efficacy for quitting were not. Intention to quit predicted quit attempts and quit success, and self-efficacy for quitting predicted quit success.
Our findings support the ITC Conceptual Model, which hypothesized that policies influence smoking cessation through policy-specific variables and psychosocial mediators. Smoke-free legislation may increase smoking cessation, provided that it succeeds in influencing support for the legislation.
Smokefree environments legislation is increasingly being implemented around the world. Evaluations largely find that the legislation is popular, compliance is high and report improved air quality and reduced exposure to secondhand smoke (SHS). The impact of the legislation on disadvantaged groups, including indigenous peoples has not been explored. We present findings from a multifaceted evaluation of the impact of the smokefree workplace provisions of the New Zealand Smokefree Environments Amendment Act on Māori people in New Zealand. Māori are the indigenous people of New Zealand. The Smokefree Environments Amendment Act extended existing smokefree legislation to almost all indoor workplaces in December 2004 (including restaurants and pubs/bars).
Review of existing data and commissioned studies to identify evidence for the evaluation of the new legislation: including attitudes and support for the legislation; stakeholders views about the Act and the implementation process; impact on SHS exposure in workplaces and other settings; and impact on smoking-related behaviours.
Support for the legislation was strong among Māori and reached 90% for smokefree restaurants and 84% for smokefree bars by 2006. Māori stakeholders interviewed were mostly supportive of the way the legislation had been introduced. Reported exposure to SHS in workplaces decreased similarly in Māori and non-Māori with 27% of employed adult Māori reporting SHS exposure indoors at work during the previous week in 2003 and 9% in 2006. Exposure to SHS in the home declined, and may have decreased more in Māori households containing one or more smokers. For example, the proportion of 14–15 year old Māori children reporting that smoking occurred in their home fell from 47% in 2001 to 37% in 2007. Similar reductions in socially-cued smoking occurred among Māori and non-Māori. Evidence for the effect on smoking prevalence was mixed. Māori responded to the new law with increased calls to the national Quitline service.
The New Zealand Smokefree Environments Amendment Act had a range of positive effects, including reducing SHS exposure among Māori communities. If the experience is replicated in other countries with indigenous populations, it suggests that comprehensive smokefree environments legislation will have beneficial effects on the health of indigenous groups and could contribute to reducing inequalities in health within societies.
This study tested whether high spider fearful individuals’ implicit and explicit attitudes toward spiders are sensitive to exposure treatment, and whether post-treatment implicit and/or explicit attitudes are related to the generalization of treatment effects. Self-reported explicit and implicit attitudes (indexed with a pictorial Extrinsic Affective Simon Task) were assessed in high spider fearful, treatment-seeking individuals (n = 60) before and after a one-session exposure in vivo treatment and at 2-month follow-up. A group of non-fearful participants (n = 30) completed the same assessments once. Results show that implicit attitudes did not change following treatment over and above test–retest effects. In contrast, explicit attitudes did change favorably following treatment, but negative explicit attitudes at post-treatment were associated with less pronounced overt approach behavior at follow-up. These findings support the idea that residual negative explicit attitudes interfere with the generalization of treatment effects.
Implicit attitudes; Spider-fear; Phobia; Treatment; Exposure in vivo
Sfl1p and Sfl2p are two homologous heat shock factor-type transcriptional regulators that antagonistically control morphogenesis in Candida albicans, while being required for full pathogenesis and virulence. To understand how Sfl1p and Sfl2p exert their function, we combined genome-wide location and expression analyses to reveal their transcriptional targets in vivo together with the associated changes of the C. albicans transcriptome. We show that Sfl1p and Sfl2p bind to the promoter of at least 113 common targets through divergent binding motifs and modulate directly the expression of key transcriptional regulators of C. albicans morphogenesis and/or virulence. Surprisingly, we found that Sfl2p additionally binds to the promoter of 75 specific targets, including a high proportion of hyphal-specific genes (HSGs; HWP1, HYR1, ECE1, others), revealing a direct link between Sfl2p and hyphal development. Data mining pointed to a regulatory network in which Sfl1p and Sfl2p act as both transcriptional activators and repressors. Sfl1p directly represses the expression of positive regulators of hyphal growth (BRG1, UME6, TEC1, SFL2), while upregulating both yeast form-associated genes (RME1, RHD1, YWP1) and repressors of morphogenesis (SSN6, NRG1). On the other hand, Sfl2p directly upregulates HSGs and activators of hyphal growth (UME6, TEC1), while downregulating yeast form-associated genes and repressors of morphogenesis (NRG1, RFG1, SFL1). Using genetic interaction analyses, we provide further evidences that Sfl1p and Sfl2p antagonistically control C. albicans morphogenesis through direct modulation of the expression of important regulators of hyphal growth. Bioinformatic analyses suggest that binding of Sfl1p and Sfl2p to their targets occurs with the co-binding of Efg1p and/or Ndt80p. We show, indeed, that Sfl1p and Sfl2p targets are bound by Efg1p and that both Sfl1p and Sfl2p associate in vivo with Efg1p. Taken together, our data suggest that Sfl1p and Sfl2p act as central “switch on/off” proteins to coordinate the regulation of C. albicans morphogenesis.
Candida albicans can switch from a harmless colonizer of body organs to a life-threatening invasive pathogen. This switch is linked to the ability of C. albicans to undergo a yeast-to-filament shift induced by various cues, including temperature. Sfl1p and Sfl2p are two transcription factors required for C. albicans virulence, but antagonistically regulate morphogenesis: Sfl1p represses it, whereas Sfl2p activates it in response to temperature. We show here that Sfl1p and Sfl2p bind in vivo, via divergent motifs, to the regulatory region of a common set of targets encoding key determinants of morphogenesis and virulence and exert both activating and repressing effects on gene expression. Additionally, Sfl2p binds to specific targets, including genes essential for hyphal development. Bioinformatic analyses suggest that Sfl1p and Sfl2p control C. albicans morphogenesis by cooperating with two important regulators of filamentous growth, Efg1p and Ndt80p, a premise that was confirmed by the observation of concomitant binding of Sfl1p, Sfl2p and Efg1p to the promoter of target genes and the demonstration of direct or indirect physical association of Sfl1p and Sfl2p with Efg1p, in vivo. Our data suggest that Sfl1p and Sfl2p act as central “switch on/off” proteins to coordinate the regulation of C. albicans morphogenesis.
Compelling reasons exist for labor and public health to collaborate. For example, compared to white-collar workers, blue-collar and service workers are much more likely to be targeted by the tobacco industry and become smokers. The purpose of this descriptive study was to assess if there were ways public health and labor could collaborate to document the health attitudes and needs of hospitality industry workers.
Eligible union members were identified through an electronic enrollment file consisting of 3,659 names maintained by the union. The mail survey instrument covered exposure to secondhand smoke, exposure to hazardous chemicals and materials, time pressure and job demands, and work-related pain/disability. Additional questions related to age, gender, race/ethnicity, level of education, employment history, English proficiency, and self-reported health status.
Study results demonstrated that important health information could be successfully collected on unionized workers. Survey data showed that union members were a very diverse group who were exposed to secondhand smoke and supported working in clean-air settings. Workers, especially housekeeping staff, characterized their work as being chaotic and demanding, while almost half of workers reported work-related pain.
Key to the successful collaboration was establishing trust between the parties and emphasizing data collection that served the information needs of both organizations. Opportunities exist to improve the health and working conditions of this population. Health interventions need to be designed to take into consideration the very diverse, mostly female, and limited English proficiency of this group of workers.
Negative parental attitudes towards smoking decrease adolescent smoking initiation but limited research explores the relationship between parental attitudes and degree of adolescent smoking among established smokers. The aim of this study was to examine the relationship between parental allowance of smoking in the home and adolescent smoking behavior and level of dependence. Interviews from 408 youths seeking assistance to quit smoking showed that adolescents who were allowed to smoke at home smoked more cigarettes per day and had higher scores on the Fagerström Test of Nicotine Dependence than those not allowed to smoke at home. Studies that additionally evaluate parental smoking status and the temporal relationship of parental allowance of smoking with changes in adolescent smoking behavior are warranted to clarify public health implications of parental smoking interdictions.
Adolescents; Smoking; Parental Allowance; Tobacco
New Zealand introduced a smokefree bars and restaurants policy in December 2004. We reviewed the data available at December 2005 on the main public health, societal and political impacts and responses within New Zealand to the new law.
Data were collected from publicly available survey reports, and from government departments and interviews. This included data on smoking in bars, attitudes to smokefree bars, bar patronage, socially cued smoking, and perceived rights to smokefree workplaces.
The proportion of surveyed bars with smoking occurring decreased from 95% to 3% during July 2004 – April 2005. Between 2004 and 2005, public support for smokefree bars rose from 56% to 69%. In the same period, support for the rights of bar workers to have smokefree workplaces rose from 81% to 91%. During the first ten months of the smokefree bars policy, there were only 196 complaints to officials about smoking in the over 9900 licensed premises. The proportion of smokers who reported that they smoked more than normal at bars, nightclubs, casinos and cafés halved between 2004 and 2005 (from 58% to 29%).
Seasonally adjusted sales in bars and clubs changed little (0.6% increase) between the first three quarters of 2004 and of 2005, while café and restaurant sales increased by 9.3% in the same period. Both changes continued existing trends. Compared to the same period in 2004, average employment during the first three quarters of 2005 was up 24% for 'pubs, taverns and bars', up 9% for cafés/restaurants, and down 8% for clubs (though employment in 'pubs, taverns and bars' may have been affected by unusually high patronage around a major sports-series).
The proportion of bar managers who approved of smokefree bars increased from 44% to 60% between November 2004 and May 2005. Bar managers also reported increased agreement with the rights of bar workers and patrons to smokefree environments. The main reported concerns of the national and regional Hospitality Associations, in 2005, were the perceived negative effects on rural and traditional pubs.
As in other jurisdictions, the introduction of smokefree bars in New Zealand has had positive overall health protection, economic and social effects; in contrast to the predictions of opponents.