Decreasing Tobacco Use Among Workers: Smoke-Free Policies to Reduce Tobacco Use

Research Gap

What are Research Gaps?

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field or can be a more extensive narrative that weaves mention of gaps into a discussion generated by findings from the review.

Identified Research Gaps

The effectiveness of smoke-free policies in protecting nonsmokers from exposure to secondhand smoke is already established. This report also finds evidence of effectiveness of these policies in reducing tobacco use among workers. Some important areas for future research remain.

Future research might be able to quantify both the independent and synergistic effects of smoke-free policies. The impact of smoke-free policies might differ when voluntarily adopted in isolation (in a single workplace) or when adopted in response to community-wide smoke-free ordinances (affecting all workplaces in the community). Smoke-free policies in the workplace might be more effective when implemented in combination with other worksite-based cessation support interventions or when implemented community-wide with other population-based tobacco prevention efforts.

Future research should also determine the impact of smoke-free policies on different populations of workers who smoke. Research to date has primarily focused on identifying disparities in the adoption of smoke-free policies by location, setting, and occupation. It is unclear if disparities exist in the impact of smoke-free policies on reductions in tobacco use. Future research should investigate ways to reduce disparities in both implementation and response, so that workers receive both the protections and the benefits of these policies.

Some economic questions about smoke-free policies remain, as well. Our systematic review of economic data found evidence that smoke-free workplace interventions could result in significant cost savings based on averted healthcare costs, reductions in productivity losses, and outcomes not related to health, such as fire damages. The only cost-effectiveness study that reports cost per QALY also demonstrates very good value of the intervention in terms of conventional benchmarks. The problem with these studies is that primary information on program costs relies on model- or literature-based estimates of benefits to compute an economic summary measure. A follow-up of intervention participants over a longer time period could directly measure health benefits and averted cost of illness from the intervention itself.

The cost-effectiveness ratio of a smoke-free intervention in a particular workplace depends on a variety of factors including prevailing smoking status of employees, current smoking regulations in place, size of the workplace, and other relationships between employees, work, and tobacco use. Further research is needed to incorporate and conclusively document all of the economic returns from investment in smoke-free worksite policies.

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