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Research & Evidence: Tobacco-Free Workplace
The qualifying studies provided sufficient evidence that smokefree policies reduce tobacco use among workers when implemented in worksites or by communities. Finally, a systematic economic review identified four studies that, overall, demonstrated economic benefits from a smokefree workplace policy.
Smokefree Policies to Reduce Tobacco Use: A Systematic Review
American Journal of Preventive Medicine
Wang, Teresa W., PhD; Michael A. Tynan; Cynthia Hallett, MPH; Laura Walpert, JD; Maggie Hopkins; Darryl Konter; Brian A. King, PhD. "Smoke-Free and Tobacco-Free Policies in Colleges and Universities ― United States and Territories, 2017." Morbidity and Mortality Weekly Report (MMWR), June 22, 2018.
Each year in the United States, cigarette smoking causes an estimated 480,000 deaths, including approximately 41,000 deaths from secondhand smoke exposure among nonsmoking adults. Smoke-free policies protect nonsmokers from secondhand smoke exposure, reduce the social acceptability of smoking, help in preventing youth and young adult smoking initiation, and increase smokers’ efforts to quit smoking. Given that 99% of adult cigarette smokers first start smoking before age 26 years and many smokers transition to regular, daily use during young adulthood, colleges and universities represent an important venue for protecting students, faculty, staff members, and guests from secondhand smoke exposure through tobacco control policies
Ahmed Jamal, MBBS; Elyse Phillips, MPH; Andrea S. Gentzke, PhD; David M. Homa, PhD; Stephen D. Babb, MPH; Brian A. King, PhD; Linda J. Neff, PhD. "Current Cigarette Smoking Among Adults — United States, 2016." CDC Morbidity and Mortality Weekly Report, January 19, 2018.
The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reduce cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the highest prevalences.
Elyse Phillips, MPH; Teresa W. Wang, PhD; Corinne G. Husten, MD; Catherine G. Corey, MSPH; Benjamin J. Apelberg, PhD; Ahmed Jamal, MBBS; David M. Homa, PhD; Brian A. King, PhD . "Tobacco Product Use Among Adults — United States, 2015." Centers for Disease Control and Prevention, November 10, 2017.
In 2015, approximately one in five U.S. adults (48.7 million) currently used any tobacco product, with most using combustible tobacco products. Any tobacco product use was significantly higher among males; adults aged <65 years; non-Hispanic AI/AN, whites, blacks, and persons of multiple races; persons living in the Midwest; persons with a GED; persons with annual household income <$35,000; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons who were uninsured or insured through Medicaid; persons with a disability; and persons who identified as LGB. Adults with serious psychological distress had the highest prevalence of any tobacco product use of any subpopulation.
Girija Syamlal, MBBS; Brian A. King, PhD; Jacek M. Mazurek, MD. "Tobacco Use Among Working Adults — United States, 2014–2016." Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, October 27, 2017.
Cigarette smoking has declined considerably among U.S. adults over several decades; however, increases have occurred in the use of noncigarette tobacco products in recent years, and the use of multiple tobacco products has become common among current users of noncigarette tobacco products.
Babb, Stephen MPH, Benmei Liu PhD, Brandon Kenemer MPH, Carissa Baker Holmes MPH, Anne M. Hartman MS, MA, James T. Gibson BS, Brian A. King PhD, MPH. "Changes in Self-Reported Smokefree Workplace Policy Coverage Among Employed Adults— United States, 2003 and 2010–2011." Oxford University Press on behalf of Society for Research on Nicotine & Tobacco Research, October 12, 2017.
The workplace is a major source of exposure to secondhand smoke from combustible tobacco products. Smokefree workplace policies protect nonsmoking workers from secondhand smoke and help workers who smoke quit. This study examined changes in self-reported smokefree workplace policy coverage among U.S. workers from 2003 to 2010–2011.
Dutra, Lauren M.; Stanton A. Glantz, Nadra E. Lisha, Anna V. Song. "Beyond experimentation: Five trajectories of cigarette smoking in a longitudinal sample of youth." February 9, 2017.
The first goal of this study was to identify the most appropriate measure of cigarette smoking for identifying unique smoking trajectories among adolescents; the second goal was to describe the resulting trajectories and their characteristics.
Tobacco-induced disease remains the leading preventable cause of death in the United States, with minorities bearing a disproportionate burden of the disease burden. Because 80% of adult smokers begin smoking before age 18, tobacco control efforts often focus on preventing adolescents from smoking their first cigarette. However, only one-third of youth who experiment with cigarettes ever become regular smokers. As a result, these programs miss a key opportunity to prevent the transition from experimentation to established smoking, which may occur in the mid-to-late 20s. In combination with growing recognition that young adulthood (ages 18 to 25) is a critical period of vulnerability, particularly due to significant life changes such as starting college, separating smokers into different trajectories (patterns of smoking) and identifying when escalation and de-escalation occurs can inform efforts to prevent transition to regular smoking.
Maki Inoue-Choi, PhD, MS; Linda M. Liao, PhD, MPH; Carolyn Reyes-Guzman, PhD, MPH; Patricia Hartge, ScD; Neil Caporaso, MD; Neal D. Freedman, PhD, MPH. "Association of Long-term, Low-Intensity Smoking With All-Cause and Cause-Specific Mortality in the National Institutes of Health–AARP Diet and Health Study." JAMA Internal Medicine, December 5, 2016.
A growing proportion of US smokers now smoke fewer than 10 cigarettes per day (CPD), and that proportion will likely rise in the future. The health effects of smoking only a few CPD over one’s lifetime are less understood than are the effects of heavier smoking, although many smokers believe that their level is modest.
Michael C. Fiore, MD, MPH, MBA. "Tobacco Control in the Obama Era — Substantial Progress, Remaining Challenges." New England Journal of Medicine, August 24, 2016.
The steady decline in smoking rates among U.S. adults that began in the early 1960s has acceleratedsubstantially during the 7 years of the Barack Obama presidency.
Polinski, Jennifer M., ScD, MPH; Benjamin Howell, PhD, MPP; Troyen A. Brennan, MD, JD, MPH; William H. Shrank, MD, MSHS . "Impact of the CVS tobacco sales removal on smoking cessation: when CVS Health quit tobacco, many smokers quit, too." CVS Health, 2015.
The study, conducted by the CVS Health Research Institute, evaluated cigarette pack purchases at drug, food, big box, dollar, convenience and gas station retailers in the eight months after CVS Pharmacy stopped selling tobacco products.
U.S. Department of Health and Human Services. "The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. ." U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
This comprehensive report chronicles the devastating consequences of 50 years of tobacco use in the United States. It updates data on the numerous health effects resulting from smoking and exposure to secondhand smoke, and details public health trends, both favorable and unfavorable, in tobacco use. This report marks the steady progress achieved in reducing the prevalence of smoking and validates tobacco control strategies that have consistently proven to be effective. It also examines strategies with the potential to eradicate the death and disease caused by the tobacco epidemic at long last, and identifies specific measures that should be taken immediately to move smoking off its decades-old number one spot as the largest single cause of preventable death and disease for the citizens of the United States. Finally, the report documents that effective interventions are available and calls for their full implementation.
"Preventing Tobacco Use among Youth and Young Adults: A Report of the Surgeon General." US Department of Health and Human Services, 2012.
Tobacco is the leading cause of preventable and premature death, killing an estimated 443,000 Americans each year. Cigarette smoking costs the nation $96 billion in direct medical costs and $97 billion in lost productivity annually. In addition to the billions in medical costs and lost productivity, tobacco is enacting a heavy toll on young people.
Each day in the United States, over 3,800 young people under 18 years of age smoke their first cigarette, and over 1,000 youth under age 18 become daily cigarette smokers. The vast majority of Americans who begin daily smoking during adolescence are addicted to nicotine by young adulthood. Despite the well-known health risks, youth and adult smoking rates that had been dropping for many years have stalled. When this Administration took office, we decided that if these numbers were not changing, we had to do something. We accelerated our efforts to fight tobacco by helping Americans stop smoking and protecting young people from starting to smoke.
"Position Statement on Tobacco on College and University Campuses." American College Health Association, November 2011.
The American College Health Association (ACHA) acknowledges and supports the findings of the Surgeon General that tobacco use in any form, active and/or passive, is a significant health hazard...ACHA joins with other professional health associations in promoting tobacco-free environments.
Steven A. Schroeder, M.D. and Kenneth E. Warder, PhD. "Don’t Forget Tobacco." New England Journal of Medicine, July 15, 2010.
At a time when all eyes are focused on health care reform, escalating medical costs, and childhood obesity, cigarette smoking remains by far the most common cause of preventable death and disability in the United States.
David P. Hopkins, MD, MPH, Sima Razi, MPH, Kimberly D. Leeks, PhD, MPH, Geetika Priya Kalra, MPA, Sajal K. Chattopadhyay, PhD, Robin E. Soler, PhD. "Smokefree Policies to Reduce Tobacco Use: A Systematic Review." American Journal of Preventive Medicine, February 2010.
In 2001, a systematic review for the Guide to Community Preventive Services identified strong evidence of effectiveness of smoking bans and restrictions in reducing exposure to environmental (secondhand) tobacco smoke. As follow-up to that earlier review, the focus here was on the evidence on effectiveness of smokefree policies in reducing tobacco use. Smokefree policies implemented by worksites or communities prohibit smoking in workplaces and designated public areas. The conceptual approach was modified for this review; an updated search for evidence was conducted; and the available evidence was evaluated. Published articles that met quality criteria and evaluated changes in tobacco-use prevalence or cessation were included in the review.
Fichtenberg, Caroline M.; Stanton A Glantz. "Effect of smokefree workplaces on smoking behaviour: systematic review." British Medical Journal, March 21, 2002.
Passive smoking is linked with cancer, heart disease, respiratory illness and is the leading source of indoor airpollution. 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.
We investigated the effects of smoke-free workplaces on cigarette consumption and compared these effects with those obtained by raising taxes.