Abstract:
Tobacco smoking among workers remains a major public health issue. One effective approach to encourage smokers to quit or reduce smoking is to make workplaces smoke-free.1 The Health Promotion Law of Japan, which came into force in 2002, put the managers of public facilities – including restaurants, cafes, public transportation, schools and offices – under the obligation to control secondhand smoke. In accordance with this legislation, the Nara City Government implemented a total smoke-free school policy in all municipal schools in April 2007. Taking this opportunity, questionnaire surveys were conducted for all teachers working in the municipal schools in Nara City before and after implementation of the policy. The authors have previously reported baseline smoking behaviour and attitudes towards the smoke-free school policy,2 and changes in the health-related quality of life among teachers following enforcement of the policy.3 The aim of the present study was to investigate the changes in smoking behaviour of teachers who smoke following enforcement of the smoke-free policy.
Two self-reported questionnaire surveys were conducted in January 2007 and September 2007, 3 months before and 5 months after enforcement of the total smoke-free public school policy in Nara City, respectively. The questionnaires were sent to all teachers affiliated with the public elementary, junior high and senior high schools in Nara City for each survey (70 schools; n = 1748). As eight schools had already adopted the smoke-free school policy of their own accord before the first survey, the 214 teachers assigned to these schools were excluded. The remaining 1534 teachers were enrolled in the study. In the baseline survey, in addition to smoking status, sex, age, school type, managerial position, attitude towards the smoke-free school, age at smoking initiation, number of cigarettes consumed per day, and score on the Fagerstrom Test of Nicotine Dependence (FTND), 4 experience of quit attempts, intention to quit and existence of smoking peers were examined. In the follow-up survey, smoking status, attempts to quit during the follow-up period, time of quitting, time of relapse and reasons for quitting were examined as the outcome measures.
Of the 1534 teachers enrolled in the study, those who smoked at baseline, answered both the baseline and follow-up questionnaires, and had no missing values in the required questionnaire items were eligible for the following analyses. Changes in smoking status and changes in number of cigarettes smoked per day between the baseline and follow-up surveys were evaluated using McNemar's Chi-squared test and Wilcoxon's signed-rank test, respectively. In addition, the relationship between each baseline variable and subsequent smoking cessation was evaluated using Fisher's exact test. The level of significance was set at 5%. In addition, factors for attempting to quit and success in quitting were examined separately using logistic regression analyses with forward selection methods. All analyses were conducted using Statistical Package for the Social Sciences Version 15.0 (SPSS Inc., Chicago, IL, USA).
In total, 1153 of the 1534 teachers completed the baseline questionnaire with no missing data. Following exclusion of teachers who did not answer the follow-up questionnaire and had missing data in the follow-up survey, 844 teachers (377 males and 467 females) were eligible for the analyses. No significant difference was observed in the baseline characteristics between the eligible and the ineligible teachers. Among the eligible participants, 111 (13%) were smokers at baseline. The majority (94%) of the smokers were males, and their mean age was 47 (standard deviation 9) years. Eighty-nine smokers (80%) expressed an interest in smoking cessation. During the 9-month follow-up period, 35 of 111 (32%) teachers made a quit attempt. Nineteen (54%) of these teachers relapsed into smoking thereafter, but 16 (46%) teachers had not smoked for at least 1 month at the time of the follow-up survey. Since no new smokers were found, the overall smoking rate of the participants decreased from 13% to 11% (P < 0.01). Eight of 16 quitters (50%) ascribed their cessation to the total smoke-free policy. Other reasons for smoking cessation included ‘health concerns’ (n = 4), ‘own illnesses’ (n = 2), ‘marriage’ (n = 1) and ‘pregnancy’ (n = 1). Among the persistent smokers (n = 95), the number of cigarettes smoked per day decreased significantly following enforcement of the smoke-free policy (P < 0.01). The number of heavy smokers (smoking ≥ 20 cigarettes per day) decreased from 21 (22%) to 15 (16%), while the number of light smokers (smoking ≤ 10 cigarettes per day) increased from 17 (18%) to 25 (26%). Table 1 shows the relationship of the baseline characteristics with quit attempts and successful quitting. High intention to quit [odds ratio (OR) 3.8; 95% confidence interval (CI) 1.1–14.1] and lack of smoking peers [OR 3.6; 95% CI 1.5–8.6)] were found to be significantly associated with quit attempts. A low score on the FTND (OR 4.8; 95% CI 1.0–25.1) and previous attempts to quit smoking were significantly associated with successful quitting (OR 6.3; 95% CI 1.3–30.7).
My opinion:
It's stated that in general, no significant smoking cessation happened to teachers after the application of smoke free policy at schools, but according to this research, most teachers agrees that stopping smoking for several hours while at school is understandable and will promote healthier environment for the students. Stopping smoking for several hours while at school is not changing or affecting daily activities or daily number of cigarette smoking.
Using this model, it's proven that the application of smoke free regulation school is mandatory for healthier school and prevent student's exposure to indirect smoking advertisement and secondhand smoking. Applying this regulation at my program is a suitable step to take.
Reference of journal:
one thing is always said that.. smoking is injurious to health
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