Lin Hao-Xiang, Liu Zhao, Chang Chun
Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China.
Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China.
Nicotine Tob Res. 2020 Dec 12;22(12):2158-2163. doi: 10.1093/ntr/ntaa112.
Studies have shown that smoke-free (SF) workplace policies can create an SF environment, but most of them have focused only on reducing secondhand smoke (SHS) exposure or changing smoking behavior. Our study aims to explore the effects of SF workplace policies and the pathway between workplace SF policies and SHS exposure.
14 195 employees from 79 companies in China participated in this survey. Binary logistic regression is used to examine the direct effects of SF workplace policies. Structured Equation Modeling approach is used to test other indirect effects. The Sobel test is used to estimate the mediation effect.
Working in a company with SF policies was associated with lower SHS exposure (odds ratio = 0.56; 95% confidence interval = 0.51 to 0.60). Such policy were associated with lower smoking prevalence (Coef. = -0.05, p < .05) and positively associated with smoking harm awareness (Coef. = 0.07, p < .05) and SHS harm awareness (Coef. = 0.05, p < .05). Sobel test suggests that approximately 16.3% of the effects on SHS exposure reduction are mediated through the channel of lower smoking prevalence for males. For smokers, we did not identify a direct effect of such policies on quitting intentions, but a significant indirect effect via increased smoking harm awareness (Coef. = 0.07, p < .05) and lower smoking consumption (Coef. = -0.10, p < .05) were found.
This study finds that SF workplace policies are not only associated with lower SHS exposure but also related to some indirect effects. Further mediation analyses for males confirmed that the effect on SHS exposure reduction is mediated through the channel of lower smoking prevalence.
This study joins the debate in recent years on the effects of workplace SF policies and provides evidence with more comprehensive data from Asia Best Workplace Mainland China program. It shows that SF workplace policies not only can reduce SHS exposure but also are associated with lower smoking prevalence, fewer cigarettes smoked, and higher smoking harm-related awareness. These findings provide valuable evidence to promote such policies in all workplaces and underline the need for more stringent SF policies to be enacted in all countries.
研究表明，无烟（SF）工作场所政策可营造无烟环境，但大多数研究仅关注减少二手烟（SHS）暴露或改变吸烟行为。我们的研究旨在探讨SF工作场所政策的效果以及工作场所SF政策与SHS暴露之间的路径。
来自中国79家公司的14195名员工参与了此项调查。采用二元逻辑回归来检验SF工作场所政策的直接效果。运用结构方程模型方法来测试其他间接效果。使用Sobel检验来估计中介效应。
在实施SF政策的公司工作与较低的SHS暴露相关（优势比=0.56；95%置信区间=0.51至0.60）。此类政策与较低的吸烟率相关（系数=-0.05，p<.05），与吸烟危害意识呈正相关（系数=0.07，p<.05）以及与SHS危害意识呈正相关（系数=0.05，p<.05）。Sobel检验表明，对减少SHS暴露的影响中约16.3%是通过男性较低吸烟率这一途径介导的。对于吸烟者，我们未发现此类政策对戒烟意愿有直接影响，但发现通过提高吸烟危害意识（系数=0.07，p<.05）和降低吸烟量（系数=-0.10，p<.05）存在显著的间接影响。
本研究发现，SF工作场所政策不仅与较低的SHS暴露相关，还存在一些间接影响。对男性的进一步中介分析证实，对减少SHS暴露的影响是通过较低吸烟率这一途径介导的。
本研究参与了近年来关于工作场所SF政策效果的讨论，并提供了来自亚洲最佳职场中国大陆项目的更全面数据的证据。结果表明，SF工作场所政策不仅可减少SHS暴露，还与较低的吸烟率、较少的吸烟量以及更高的吸烟危害相关意识有关。这些发现为在所有工作场所推广此类政策提供了有价值的证据，并强调了在所有国家制定更严格的SF政策的必要性。
