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.
Due 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; Jiménez-Ruiz 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 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.
Sample Characteristics by Age Group
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 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).
Smoking Status by Gender, Employment Sector, and Examination Year
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 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. 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 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.
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 anti-smoking regulations may reduce smoking among workers providing a healthier work environment. This effect was higher among office workers and occasional smokers.
Footnotes
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.
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.