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


What the CPSTF Found

Summary of Results

Thirty-five studies qualified for the review.

  • Prevalence of tobacco use: median decrease of 3.4 percentage points (interquartile interval: –6.3 to –1.4 percentage points; 22 study arms)
  • Tobacco use cessation: median increase in tobacco quit rates of 6.4 percentage points (interquartile interval: 2.0 to 9.7 percentage points; 18 study arms)
  • Attempts to quit: median increase of 4.1 percentage points (interquartile interval: –0.7 to +6.8 percentage points; 6 studies)
  • Number of cigarettes smoked per day: median reduction of 2.2 cigarettes smoked per day (interquartile interval: –1.7 to –3.3 cigarettes/day; 18 studies)
  • Studies included in this review:
    • Evaluated responses from workers in a wide range of both public- and private-sector indoor worksites
    • Evaluated specific workplaces such as healthcare settings, telecommunications companies, and government worksites
    • Were conducted in the United States, Canada, Germany, Australia, and Finland

Summary of Economic Evidence

A review of economic effectiveness of this intervention was conducted. Studies included in this review demonstrated a range of outcomes.

  • An assessment of a smoke-free workplace policy found a cost of $526 per quality of life adjusted year (QALY) compared to a cost of $4613 per QALY for a free nicotine replacement therapy program (one study).
  • There is a collective net benefit from smoke-free policies ranging from $48 billion to $89 billion per year in the United States (one study from 1994).
  • A smoke-free workplace policy could prevent about 1500 heart attacks and 350 strokes in one year with approximately $55 million in direct medical cost savings (one study).
  • An employer could potentially save $10,246 per year for every smoker who quits due to a smoke-free workplace policy (one study).

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to worksite health promotion and prevention of tobacco use.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence 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.