Impact on outcomes

Possible gaps in evidence

Sources

Impact on short term and intermediate outcomes

There is review level evidence supporting:

• developing a smoking cessation policy in collaboration with staff and their representatives as one element of an overall smoke-free workplace policy, and developing a whole-school or organisation-wide smoke-free policy (in consultation with young people and staff, applying this to everyone using the premises, for any purpose at any time, with no areas in the grounds to be designated as smoking, and widely publicise the policy and ensure that it is easily accessible for all users of the premises to be aware of its content) [2]
• combined activities such as development of whole-school/organisation-wide smoke-free policy linked in with prevention – see above for details [6]
• the issue being treated as a worker protection than a consumer protection law – see below for detail and context
• increased demand for smoking cessation connected with the introduction of smoke free legislation (and particularly linked to media activity) – see below for detail and recommendations [1]
• workplace interventions in general (which reduce the number of employees who smoke, leading to increased productivity, and higher cessation rates leading to lower associated productivity losses) [2]
• the creation and enforcement of a smoking compliance strategy to increase compliance and specific tips for its enforcement (including providing training on how to do so, establishing links between the policy and HR policies, increasing awareness of the consequences of breaching the policy, providing reminders that it is a criminal offence not to comply with smoke free legislation, and notifying staff that action will be taken if someone is in breach of the policy) [2]
• the careful planning of workplace smoking bans and smoke-free legislation (including the input of smokers and provision of help and support for smokers, media campaigns to inform the public about the adverse health effects of passive smoking, and treating the issue as a worker protection rather than a consumer protection law, to strengthen public support), and taking into account diversity issues and cultural appropriateness of materials and messages, and having an adequate revenue base to support legislation implementation, being the key criteria for workplace smoking bans & legislation [1]
• the provision of cessation support in the context of workplace smoking bans to reduce the risk of non-compliance with the law and to encourage smokers to quit [e.g. reducing levels of smoking among employees will in turn help reduce some illnesses and conditions that are important causes of sickness absence, improve staff morale, improve productivity and reduce costs for employers, and provide an opportunity to improve health through a healthier, smoke-free environment (e.g. promoting healthy living and ‘no smoking’ within society)]  i.e. interaction of the legislation and support to stop (which includes changes in social norms and physical environment in the workplace, in public places and in the home) and [2]:
• encouraging employers to provide advice, guidance and support to help employees who want to stop smoking [2]
• making a variety of cessation strategies available to increase participation in workplace programmes and meet their needs (e.g. tailored interventions, proactive interventions, access to subsidised pharmacotherapies, monetary incentives, direct personalised feedback, media/social marketing campaigns)
• information on local smoking cessation services being publicised and made widely available at work (including details on type of support available, when and where, and how to access services) [2]
• more intensive interventions over less interventions in the context of a localised smoking ban in producing higher success rates (although there was a lack of evidence at the time of which workplace interventions are most effective in the context of comprehensive smoke free legislation)
• provision of support in response to individual needs and preferences (including on-site where feasible and where sufficient demand, allowing services to be attended during working hours, and developing a policy as one element of an overall workplace policy) [2]
• implementation and maintained compliance with the ban in workplaces on smoking in enclosed public places and/or development and monitoring of, and/or enforcement of, the ban on smoking in enclosed public places leading to:
• reduced exposure to SHS including consistent evidence that smoking bans reduced exposure to SHS in workplaces, restaurants, pubs and in public places and hospitality workers experiencing a greater reduction in exposure post-implementation than the general population [but mixed evidence around whether the smoke-free environment is extended into the home/cars with no change in self-reported exposure to SHS in private cars or in the home – prevalence or duration of the latter; although studies suggest that there is no displacement of smoking from the workplace into the home, and both those from smoking and non-smoking households have reduced exposure, this is only statistically significant among those from non-smoking households or households in which only the father figure smoked] [3,4,5]
• some evidence of an improvement in health outcomes (e.g. self-reported respiratory and sensory symptoms and lung function measurements) “as a result of its implementation, most impressively in relation to heart attacks in hospitals” [3] and citing consistent evidence of a reduction in admissions for cardiac events (acute coronary syndrome) as providing the strongest evidence [3]
• increased support for, and compliance with, smoking bans post-legislation [3]
• high public awareness and increased understanding of SHS effects [4]
• greater reduction in SHS exposure – particularly from complete bans in workplaces (and also increased quitting and reductions in smoking), reduced costs, reduced productivity losses from absenteeism due to reduced SHS exposure (as well as from active smoking) and the reduction in SHS exposure saving NHS treatment costs [5]

Gaps in the evidence include:

• the longer-term effectiveness of workplace interventions [1,2]
• the long-term business benefits of providing smoking cessation support [2]
• comparisons of the effectiveness of interventions for different sectors of the workforce; the effectiveness of workplace smoking cessation interventions in countries with national smoke free legislation which covers workplaces; the role of employers in the provision of smoking cessation support [2].
• the degree to which the lowered exposure to SHS is directly from enforcement of and maintained compliance with smoke-free legislation, or whether it is from education and social marketing activities with increased awareness and understanding and social environment (norms) changes or reduced smoking rates and frequency
• data on smoking prevalence and smoking behaviour post-smoke free legislation (data were often a co-variable rather than an end-point, with either no change or a downward trend reported but “no consistent evidence of a reduction in smoking prevalence attributable to the ban” although total tobacco consumption was reduced where prevalence declined) [3,4,5] 

Source:
1. NICE (2008). Public Health Programme Guidance 10 – Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard-to-reach communities.  NICE, London.          

2. NICE (2007).  Public Health Intervention Guidance 5 – Workplace health promotion: how to help employees to stop smoking. NICE, London.

3. Callinan JE, Clarke A, Doherty K, et al. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub2

4. Haw, S. Ch.3 Fresh Air? Second-hand smoke. In: Barlow, J. [Ed] (2009).  Substance Misuse: The Implications of Research, Policy and Practice. Jessica Kingsley Publishers, London.

5. Ludbrook A, Bird S, van Teijlingen E. (2005). International Review of the Health and Economic Impact of the Regulation of Smoking in Public Places.  NHS Health Scotland, Edinburgh.

6. NICE (2010). Public Health Guidance 23 – School-based interventions to prevent the uptake of smoking among children. NICE, London.