Smoking Among Spanish Workers After Smoking Regulation

Smoking Among Spanish Workers After Smoking Regulation

576932
research-article2015
WHSXXX10.1177/2165079915576932Workplace Health & SafetyWorkplace Health & Safety
Workplace Health & Safety
March 2015
ARTICLE
Smoking Among Spanish Workers After
Smoking Regulation
Marta Hernández-Martín, PhD candidate, MSc, OHN, RN1, Alfonso Meneses-Monroy, PhD, MSc, RN2,
Silvia Arranz Alonso, PhD candidate, BA, MSc, OHN, RN1, and Patricia Martín-Casas, PhD, MSc, PT1
Abstract: The aim of this study was to determine the
prevalence of smoking among Spanish workers after a new
smoking regulation became law. The researchers conducted
a retrospective study with a worker sample. Information was
collected via health examinations of 185 adults with a mean
age of 35.93 ± 9.13 for men and 36.16 ± 9.52 for women who
agreed to participate in the study in 2010, 2011, and 2012. The
percentages of occasional smokers, light smokers, moderate
smokers, and heavy smokers were compared by year for
men and women. In 2010, 18% of women smokers were
occasional, 45% light, 27% moderate, and 10% heavy smokers.
Twenty-two percent of male smokers were occasional, 16%
light, 28% moderate, and 34% heavy smokers. In 2011, 12% of
ex-smokers were women and 14% were men. In 2012, 30% of
ex-smokers were women and 22% were men. In conclusion,
the percentage of ex-smokers has increased in this sample
after the anti-smoking law was enacted.
Keywords: smoking, ex-smoker, prevalence, working
population, Law 42/2010
D
ue to the impact of smoking on active consumers and via
passive smoking, the World Health Organization and
many governments have attempted to decrease smoking
through public awareness campaigns and ban smoking through
regulation (Calvete, 2005; World Health Organization, 2011). If
measures are not taken, smoking will kill a billion individuals
(Shafey, Eriksen, Ross, & Mackay, 2009) worldwide in the 21st
century. In Spain, more than 50,000 individuals die of smoking
annually (Ministerio de Sanidad Política Social e Igualdad, 2011).
Debate about tobacco use has existed for decades, but the
decision to legislate its use is relatively recent in Spain. Spanish
Law 28/2005, enacted December 26, 2005, was the first
anti-smoking legislation in the country (García-Perrote, 2006;
Lushchenkova et al., 2008; Ministerio de Sanidad y Consumo,
2005). On January 2, 2011, a new smoking regulation went into
effect; Law 42/2010 regulated the sale, supply, consumption,
and advertising of smoking products (Ministerio de Sanidad y
Consumo, 2010). This law aimed to prevent smoking in the
workplace (Camarelles, 2006; Clemente et al., 2012; JiménezRuiz et al., 2008).
Employees, exposed to both occupational hazards and
tobacco, are at increased risk for a variety of illnesses (Aceituno
et al., 2010; Nebot et al., 2004; Twose, Schiaffino, Garcia, Borras,
& Fernández, 2007). Workers are already at risk for injury and
illness due to working conditions, but tobacco and other drugs
increase their health risks (Ministerio de Trabajo y Asuntos
Sociales, 2003). Currently, research is underway on smoking
prevalence and the health effects of tobacco but few studies
have reported on how specific smoking regulations have
affected employees (Fichtenberg & Glantz, 2002; Hyland,
Travers, Dresler, Higbee, & Cummings, 2008).
Therefore, studies are needed to identify the target
population in need of preventive measures, describe the
evolution of smoking over time, and measure the possible
decrease in morbidity after the recent regulation change in
Spain (Diaz & Martin, 2009; López et al., 2012; Olano, 2011).
The main goal of this research was to determine the prevalence
of ex-smokers in a Spanish working population before and after
implementation of Smoking Law 42/2010.
Method
A retrospective study was designed to determine the
prevalence of smoking in a sample of Spanish workers before
and after implementation of Law 42/2010. The study was
previously approved by the Ethics Committee of the Infirmary,
Physiotherapy and Podiatry School of the University
Complutense of Madrid. All data were gathered from
occupational health examinations of 185 employees conducted
by a Basic Health Unit of Group MGO Occupational Hazard, S.
A. This company provides occupational health surveillance to
companies from various sectors (e.g., commercial, transport,
health care, cleaning, and office) and also conducts periodic
DOI: 10.1177/2165079915576932. From 1University Complutense of Madrid and 2Red Cross Nursing School of Madrid (UAM). Address correspondence to: Marta Hernández-Martín, MSc, OHN, RN,
Infirmary, Physiotherapy and Podiatry School, University Complutense of Madrid, Calle Hermosilla Nº 98 1ºCD, Madrid 28009, Spain; email: [email protected].
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2015 The Author(s)
116
Workplace Health & Safety
vol. 63 ■ no. 3
Applying Research to Practice
This research assessed the impact of legislation limiting
smoking in public places. The law regulates the sale,
supply, consumption, and advertising of smoking
products. This investigation demonstrated that antismoking regulations may reduce smoking among
workers providing a healthier work environment. This
effect was higher among office workers and occasional
smokers.
occupational health examinations for workers. According to
Spanish law (i.e., application of European Union regulation),
occupational health examinations are voluntary. Employees
must consent to occupational health examinations and
researchers using their data for epidemiological research studies.
All data for this study were gathered from occupational
health examinations conducted between 2010 and 2012. To be
included in the study, workers had to report they were smokers
during their occupational health examination in 2010. In
addition, these workers had to complete occupational health
examinations in 2011 and 2012. Non-smoking workers who
participated in occupational health examinations in 2010 were
excluded from the study as were workers who reported
smoking in 2010 but did not participate in the occupational
health examination in later years and workers with incomplete
occupational health records during the data collection period.
Complying with specific Spanish law regarding the Protection
of Personal Data, no personal information that could compromise
the confidentiality and privacy of the participants was used in this
study (Ministerio del Interior, 1999). Studied variables included age,
gender, smoking status, occupation, work hours, alcohol
consumption, and physical exercise. Smoking was classified as
occasional, light, moderate, or heavy according to data mined from
revised occupational health records.
All data were transcribed manually into a spreadsheet and
then analyzed using SPSS 18.0. Categorical variables were
described by frequency distribution, and continuous variables
were assessed via mean and standard deviation. Contingency
tables and chi-square were used to study the association
between categorical variables. Significance was set at p < .05 at
a confidence interval of 95%.
Results
More than 68% of the sample was male (n = 125) and nearly
32% female (n = 60). The mean age of male participants was
35.93 years (SD = 9.13) and the mean age of female participants
was 36.16 (SD = 9.52). The range of ages for both genders was
between 18 years and 65 years. The sample distribution by age
is shown in Table 1.
In 2010, 18% of women study participants reported being
occasional (n = 11), 45% light (n = 27), 27% moderate (n = 16),
and 10% heavy smokers (n = 6) and 22% of men study
Table 1. Sample Characteristics by Age Group
Men and
women (n)
Men (n)
Women (n)
[21-31]
62
43
19
[32-41]
68
46
22
[42-51]
36
23
13
[52-65]
19
13
6
Age range
participants reported being occasional (n = 27), 16% light (n =
20), 28% moderate (n = 35), and 34% heavy smokers (n = 45).
In 2011, following the implementation of the 2010 smoking law,
the prevalence of smoking among men was 14% ex-smokers, 22%
occasional smokers, 15% light smokers, 20% moderate smokers,
and 29% heavy smokers. In 2012, 22% of the male sample were
ex-smokers, 13% occasional smokers, 14% light smokers, 20%
moderate smokers, and 31% heavy smokers. In contrast, the
prevalence of smoking among women in 2011 was as follows: 12%
ex-smokers, 23% occasional smokers, 33% light smokers, 27%
moderate, and 5% heavy smokers. In 2012, 30% of the female
sample were ex-smokers, 12% occasional smokers, 33% light
smokers, 20% moderate smokers, and 5% heavy smokers.
Compared with 2010 data, both men and women quit
smoking and the prevalence of occasional smokers decreased in
both 2011 and 2012. Most women are light smokers. However,
the highest percentage of male smokers reported heavy smoking.
Table 2 specifies characteristics by smoking status and
employment sector (frequency and percentage). In the sample
of women, the largest percentage of smokers for the study
period was found among office and health care workers.
Moreover, the percentage of smokers in offices decreased each
year, but increased among health care employees. For men,
smokers were most likely to work in office, driving, and
construction sectors. The percentage of smokers decreased each
year in offices but increased in driving and construction sectors.
The number of smokers differed by year depending on
employment sector for both men and women (p = .000).
Analysis of the relationship between smoking and work
hours showed a chi-square value of (p = .269). Chi-square
demonstrated a significant relationship between gender and
smoking (p = .001). In addition, a potential relationship between
smoking and alcohol use and physical exercise was explored.
The chi-square for smoking and alcohol use was not significant
(p = .639). However, smoking was significantly associated with
physical activity (p = .001).
Discussion
A significant relationship between smoking and employment
sector of the described sample was established. The most
common occupations currently in the Spanish labor market
117
Workplace Health & Safety
March 2015
Table 2. Smoking Status by Gender, Employment Sector, and Examination Year
Frequency and percentage
2010
2011
Men
Women
Men
Women
Men
Women
n (%)
n (%)
n (%)
n (%)
n (%)
n (%)
4 (5)
5 (8)
4 (4)
5 (11)
3 (3)
3 (11)
18 (13)
1 (2)
16 (16)
1 (2)
15 (16)
1 (2)
Hospitality workers
6 (7)
4 (7)
6 (6)
3 (7)
6 (6)
4 (7)
Cleaning workers
4 (7)
7 (12)
2 (7)
4 (9)
2 (4)
7 (13)
40 (27)
29 (48)
28 (26)
21 (45)
27 (26)
19 (41)
Health care workers
7 (13)
14 (23)
5 (11)
12 (26)
5 (11)
12 (26)
Construction workers
46 (28)
0 (0)
37 (30)
0 (0)
38 (34)
0 (0)
125
60
98
46
96
46
Commercial workers
Drivers
Office workers
Total sector
were considered in this study (e.g., office work, drivers, and
construction workers). Among workers in diverse sectors, the
tendency to quit smoking differed, with less behavioral change
in construction workers. These findings are consistent with
previous research studies, which found that smoking prevalence
differed by employment sector; smoking was more prevalent
among industrial workers (Aceituno et al., 2010; Diaz & Martin,
2009; Ministerio de Sanidad Política Social e Igualdad, 2011).
Concerning smoking and shiftwork, no relationship was
found between smoking and shift worked in this sample.
However, other studies have reported an association between
night shift and smoking, due to the increased stress of shiftwork
(Reyes & Martin, 2010).
The relationship between smoking and gender was also
statistically significant in this study. Prevalence of heavy smoking
differed by gender, higher among men than women (Becoña,
2002; Ministerio de Sanidad Política Social e Igualdad, 2011). For
example, according to the latest survey conducted by the Spanish
National Health System, the percentage of smokers is higher in
men than in women. However, according to recent studies with
younger populations, the percentage of smokers is higher among
women than men (Instituto Nacional de Estadística, 2008).
A statistically significant relationship between smoking and
physical exercise was also shown in this study (Fernández, Sanz
de Burgo, Garrido, & Lopez, 2011; Martínez et al., 2009; Sánchez
et al., 2006; Zullino et al., 2003). Smoking cessation studies
suggest that physical exercise can positively affect smoking
cessation, because exercise accelerates metabolism and thus
moderates weight gain in ex-smokers.
The most significant limitation of this research was the
voluntary nature of occupational health examinations in Spain.
118
2012
Therefore, not all employees agreed to annual occupational health
surveillance. Although the number of these examinations in the
Basic Unit of the Occupational Prevention Service was large, a
sample of only 185 smoking workers had completed occupational
health examinations in 2010, 2011, and 2012. Therefore, these
results cannot be extrapolated to the general population.
Implications for Occupational Health Nurses
Occupational health nurses should focus their efforts on
reducing smoking in those industrial sectors where smoking is
most prevalent. Anti-smoking campaigns should be directed
toward Spanish construction, health care, and driving sector
workers because this study showed that reducing the number of
smokers after the new smoking law was initiated did not
change smoking behavior among workers in these sectors.
Moreover, these campaigns should be accompanied by physical
exercise that has been shown to support smoking cessation.
Exercise could also prevent withdrawal symptoms, stress or
anxiety and sleep disturbances often experienced during the
cessation process (Moher, Hey, & Lancaster, 2005). These efforts
should improve workers’ health by limiting the development of
smoking-related diseases (Sargent, Shepard, & Glantz, 2004).
Conclusion
Smoking was mainly associated with gender and
employment sector in this study. Smoking prevalence was
higher among male workers than among female workers, and
higher among specific employment sectors: driving, health care,
and construction.
Smoking prevalence has lessened over time. In 2011, 12% of
the studied sample were ex-smoker women and 14% were
vol. 63 ■ no. 3
ex-smoker men. In 2012, 22% of the sample were ex-smoker
men and 30% were ex-smoker women.
In the analyzed sample data, the highest rate of smoking
cessation was observed among occasional smokers: In 2010,
18% of the sample were occasional female smokers; in 2011,
22% were occasional female smokers; and in 2012, 12% were
occasional female smokers. Similarly, in 2010, 22% of the sample
were occasional male smokers; in 2011, 23% were occasional
male smokers; and in 2012, occasional male smokers decreased
to 13%.
After Law 42/2010 was implemented, the number of smokers
diminished. The legal regulations regarding smoking in the
workplace might have contributed to a reduction in smoking.
To confirm this hypothesis, further studies are needed with a
larger sample that would allow researchers to extrapolate the
results to the general population.
Conflict of Interest
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
Aceituno, P., Iglesias, V., Erazo, M., Droppelmann, A., Orellana, C., &
Navas-Acién, A. (2010). El ambiente laboral como fuente de exposición
a humo de tabaco ambiental: Estudio en trabajadores de bares y
restaurantes de Santiago, Chile [The work environment as a source
of exposure to environmental smoke snuff: Studio workers bars and
restaurants in Santiago, Chile]. Revista Médica de Chile, 138, 1517-1523.
Retrieved from http://www.scielo.cl/pdf/rmc/v138n12/art07.pdf
Becoña, E. (2002). Factores relevantes en el abandono del tabaco en
mujeres [Relevant factors to quit smoking in women.]. Revista Medicina
Clínica, 119, 41-46.
Calvete, A. (2005). Actividad de la Unión Europea en materia de lucha
contra el tabaquismo [European union fight against smoking related
activity]. Revista Española de Salud Pública, 79, 521-529. Retrieved from
http://scielo.isciii.es/pdf/resp/v79n5/colaboracion.pdf
Camarelles, F. (2006). El papel de las redes profesionales para promover
el cumplimiento de la Ley de espacios libres de humo, obstáculos
y oportunidades. Espacios laborales libres de humo [The role of
professional networks to promote compliance with the Law, smokefree,
obstacles and opportunities. Smoke-free workplaces.]. Madrid, España:
CNPT y MSC.
Clemente, M. L., Bartolomé, C., Rubio, E., Martín, C., Puente, D.,
& Sobradiel, N. (2012). Actitudes de los españoles frente a los
espacios libres de humo de tabaco [Spanish opinions on tobacco
smoke-free areas]. Atención Primaria, 44(3), 138-144. doi:10.1016/j.
aprim.2011.01.015
Diaz, S., & Martin, I. (2009). Impacto presupuestario de un programa de
deshabituación tabáquico en empresas [Budgetary impact of a smoking
cessation programme within companies.]. Revista Medicina y Seguridad
del Trabajo, 55, 46-55. Retrieved from http://scielo.isciii.es/pdf/
mesetra/v55n216/original4.pdf
Workplace Health & Safety
Fernández, J., Sanz de Burgo, V., Garrido, P., & Lopez, E. (2011). Riesgo
cardiovascular: evaluación del tabaquismo y revisión en atención
primaria del tratamiento y orientación sanitaria. Estudio RETRATOS
[Cardiovascular risk in Spanish smokers compared to non-smokers.
RETRATOS study]. Atención Primaria, 43, 595-603. doi:10.1016/j.
aprim.2010.10.005
Fichtenberg, C. M., & Glantz, S. A. (2002). Effect of smoke-free workplaces
on smoking behaviour: Systematic review. British Medical Journal, 325,
Article 188. doi:10.1136/bmj.325.7357.188
García-Perrote, I. (2006). Comentarios de urgencia a la Ley de Medidas
frente al tabaquismo [Urgent comments to the anti-smoking Law].
Valladolid, Spain: Lex Nova.
Hyland, A., Travers, M. J., Dresler, C., Higbee, C., & Cummings, K. M.
(2008). A 32-country comparison of tobacco smoke derived particle
levels in indoor public places. Tobacco Control Journal, 17, 159-165.
doi:10.1136/tc.2007.020479
Instituto Nacional de Estadística. (2008). Encuestas Nacionales de Salud.
Año 2006 [National Health Surveys. Year 2006]. Retrieved from http://
www.ine.es/jaxi/menu.do?type=pcaxis&path=/t15/p419&file=inebase
Jiménez-Ruiz, C. A., Miranda, J. A., Hurt, R. D., Pinedo, A. R., Reina, S. S.,
& Valero, F. C. (2008). Study of the impact of laws regulating tobacco
consumption on the prevalence of passive smoking in Spain. European
Journal of Public Health, 18, 622-625. doi:10.1093/eurpub/ckn066
López, M. J., Nebot, M., Schiaffino, A., Pérez-Ríos, M., Fu, M., & Fernández, E.
(2012). Two-year impact of the Spanish smoking law on exposure to
secondhand smoke: Evidence of the “Spanish model.” Tobacco Control
Journal, 21, 407-411. doi:10.1136/tc.2010.042275
Lushchenkova, O., Fernández, E., López, M. J., Fu, M., Martínez-Sánchez,
J. M., Nebot, M., . . . Borras, & (2008). Exposición al humo ambiental
de tabaco en población adulta no fumadora en España tras la Ley
de medidas sanitarias frente al tabaquismo [Secondhand smoke
exposure in Spanish adult non-smokers following the introduction of
an anti-smoking law]. Revista Española de Cardiología, 61, 687-694.
doi:10.1157/13123989
Martínez, A. J. M., Balanza, S., Leal, M., Martínez, A., Conesa, C., & Abellán
Aleman, J. (2009). Relación entre el consumo de tabaco y alcohol y el
ejercicio físico con el paso por la universidad [Association between the
consumption of tobacco and alcohol and physical exercise while at
university]. Atención Primaria, 41, 558-563.
Ministerio del Interior. (1999). Ley Orgánica 15/1999, de 13 de diciembre,
de protección de datos de carácter personal [The organic law 15/ 1999,
on the protection of personal data]. Retrieved from http://www.boe.es/
boe/dias/1999/12/14/pdfs/A43088-43099.pdf
Ministerio de Sanidad Política Social e Igualdad. (2011). Observatorio
Español de la droga y las toxicomanías: Situación y tendencias de los
problemas de drogas en España [Spanish observatory of drugs and drug
addiction: Status and trends of drug problems in Spain]. Retrieved from
http://www.pnsd.msc.es/Categoria2/observa/pdf/oed2011.pdf
Ministerio de Sanidad y Consumo. (2005). Ley 28/2005, de 2006 de
diciembre, de medidas sanitarias frente al tabaquismo y reguladora de
la venta, el suministro, el consumo y la publicidad de los productos del
tabaco [Law 28/2005, of December 2006, on health measures against
smoking and regulating the sale, supply, consumption and advertising
of snuff products]. Retrieved from http://www.boe.es/aeboe/consultas/
bases_datos/doc.php?id=BOE-A-2005-21261
Ministerio de Sanidad y Consumo (2010). Ley 42/2010, de 30 de diciembre,
por la que se modifica la Ley 28/2005, de 26 de diciembre, de medidas
sanitarias frente al tabaquismo y reguladora de la venta, el suministro,
el consumo y la publicidad de los productos del tabaco [Law 42/2010,
of 30 December, amending Law 28/2005, of 26 December, on health
measures against smoking and regulating the sale, supply, consumption
119
Workplace Health & Safety
and advertising of snuff products]. Retrieved from http://www.boe.es/
boe/dias/2010/12/31/pdfs/BOE-A-2010-20138.pdf
Ministerio de Trabajo y Asuntos Sociales. (2003). Problemas relacionados
con el alcohol y las drogas en el trabajo: el cambio hacia la prevención
[Alcohol and Drug problems at work: The shift to prevention]. Madrid,
España: Ministerio de Trabajo y Asuntos Sociales.
Moher, M., Hey, K., & Lancaster, T. (2005). Workplace interventions
for smoking cessation. Cochrane Database of Systematic Reviews, 2.
doi:10.1002/14651858.CD003440.pub2
Nebot, M., López, M. J., Tomas, Z., Ariza, C., Borrell, C., & Villalbi, J. R.
(2004). Exposure to environmental tobacco smoke at work and at
home: A population based survey. Tobacco Control Journal, 13(1), 9596. doi:10.1136/tc.2003.006221
Olano, E. (2011). Efectividad de un programa de entrenamiento en
abordaje y tratamiento del consumo de tabaco a los profesionales
sanitarios de atención primaria: un ensayo clínico aleatorizado y
controlado [Effectiveness of a training program in management and
treatment of the consumption of snuff to health professionals in
primary care: A randomized Controlled Clinical Trial.]. Madrid, España:
Universidad Complutense de Madrid.
Reyes, R., & Martin, I. (2010). Influencia de la turnicidad de los trabajadores
en el sector de la energía removable [Influence of turnicidad of workers
in the sector of renewable energy]. Revista digital de Prevención,
2, 1-20. Retrieved from http://rabida.uhu.es/dspace/bitstream/
handle/10272/5472/Influencia_de_la_turnicidad_sobre_la_salud_de_los_
trabajadores.pdf?sequence=2
Sánchez, M. A., Román, J., Calvo, E., Gómez, T., Fernández, A., Sainz
Gutierrez, J. C., . . .González, A. (2006). Prevalencia de factores
de riesgo vascular en la población laboral española [Prevalence of
cardiovascular risk factors in the Spanish working population]. Revista
Española de Cardiología, 59, 421-430. doi:10.1157/13087894
Sargent, R. P., Shepard, R. M., & Glantz, S. A. (2004). Reduced incidence
of admission for myocardial infarction associated with public smoking
ban: Before and after study. British Medical Journal, 328, 977-980.
doi:10.1136/bmj.38055.715683.55
Shafey, O., Eriksen, M., Ross, H., & Mackay, J. (2009). The tobacco atlas.
Atlanta, GA: American Cancer Society.
120
March 2015
Twose, J., Schiaffino, A., García, M., Borras, J. M., & Fernández, E.
(2007). Correlates of exposure to second-hand smoke in an urban
Mediterranean population. BMC Public Health Journal, 7, Article 194.
doi:10.1186/1471-2458-7-194
World Health Organization. (2011). Report on the global tobacco
epidemic, 2011. Retrieved from http://whqlibdoc.who.int/
publications/2011/9789240687813_eng.pdf?ua=1
Zullino, D. F., Besson, J., Favrat, B., Krenz, S., Zimmermann, G., Schnyder,
C., & Borgeat, F. (2003). Acceptance of an intended smoking ban in an
alcohol dependence clinic. European Psychiatry Journal, 118, 255-257.
doi:10.1016/S0924-9338(03)00067-1
Author Biographies
Marta Hernández-Martín (PhD candidate, MSc, OHN) is an
occupational health nurse and also holds a master’s degree in health
care. She has participated in several research studies, conferences,
and publications about nursing and occupational health.
Alfonso Meneses-Monroy (PhD, MSc, BA, OHN), professor at Red
Cross Nursing School Madrid (Spain), has participated in several
research studies, conferences, and publications about nursing,
occupational health and pharmacology.
Silvia Arranz Alonso (PhD candidate, MSc, BA, OHN) is an
occupational health nurse and also holds a master’s degree in
health care and a degree in Anthropology. She has participated
in several research studies as PI and is author of more than 30
publications and conferences.
Patricia Martín-Casas (PhD, MSc, PT) is assistant professor in
Infirmary, Physiotherapy and Chiropody School of The
Complutense University of Madrid. She has participated in
several research studies, conferences, and publications mainly
on physiotherapy, ergonomy and worker health.