53656 Smoke-free workplaces at a glance Why should workplaces be smoke-free? These costs add up to significant amounts. A 1995 Canadian study estimated that smokers cost their Smoking harms the health of smokers and those employers $2,565 each year (1995 US dollars). around them. Smokers are at far higher risk of strokes, Significant legal costs may result from claims filed by heart attacks and heart disease, cancers of the employees seeking compensation for damages lungs, mouth, larynx, bladder, pancreas, kidneys and caused by exposure to tobacco smoke in the stomach, emphysema, bronchitis, and tuberculosis. workplace, or by customers seeking protection from These diseases cause serious illness, disability and tobacco smoke. premature death. Separate smoking areas are a poor compromise – “Second-hand smoke” (SHS) is harmful. (SHS is smoke they neither protect health nor save money. from a burning cigarette or other tobacco product Smoking anywhere in a building significantly usually combined with smoke exhaled by the increases SHS, even in parts of the building where smoker). Tobacco smoke contains at least 250 people do not smoke. Designated smoking rooms chemicals known to be harmful; 69 of them cause (DSR), whether with separate ventilation and air cancer. Pollution levels in indoor places that allow filtration or not, reduce SHS exposure only by about smoking are higher than on busy roadways, in closed half. And exposure in DSRs can be very high, and motor garages and during firestorms. The evidence is they incur costs to set up and maitain. The American irrefutable -- SHS exposure contributes to serious and Society of Heating, Refrigerating, and Air often fatal diseases. Risk and harm increase with Conditioning Engineers (ASHRAE) no longer provides higher levels of exposure. SHS exposure caused over recommended standards for ventilation when 600,000 deaths in 2004 -- 1% of all global deaths, and tobacco smoking is present. Its 2005 position 0.7% of the global disease burden. document concluded that “the only means of SHS exposure is common in workplaces: Two studies effectively eliminating health risk associated with in 39 developed and developing countries in indoor exposure is to ban smoking”. 2002/03 and 2006 found SHS in most locations Smoke-free workplaces have the added benefit of surveyed – e.g. in 94% of hospitals, schools, reducing smoking. A review of studies in Australia, government buildings and other locations surveyed Canada, Germany and the United States in seven Latin American countries. Employees in bars concluded that smoke-free workplaces result in 29% and restaurants are at particular risk because their fewer cigarettes smoked. SHS exposure is substantially higher than in most other work places. SHS exposure can interact with Smoke-free workplaces do not hurt business. Fears in chemicals and radiation in workplaces to produce the hospitality industry that smoking bans would hurt an additive or multiplicative effect and significantly business are unfounded. Studies of hotels, bars and increase the risk of many occupational diseases. restaurants in several U.S. states and other countries consistently conclude that smokefree policies do not Smoking and SHS exposure imposes economic costs reduce business or profits. In fact, empirical studies of on employers, employees, and countries. Specific actual changes after smoking bans are enforced estimates vary, but all are significant. SHS exposure in find small positive effects on sales, employment, and the United States alone costs an estimated US$ 5 business viability. billion annually in medical costs and another US$ 5 billion in indirect costs of lost wages and productivity What can employers do about workplace due to disability and premature death. In Hong Kong smoking? Special Administrative Region, the annual value of medical costs, long-term care and productivity lost Two approaches have been used to protect people due to SHS exposure is estimated at US$ 156 million. from tobacco smoke: comprehensive smoke free legislation (for all indoor public places, workplaces, Smokefree workplaces save employers money and transportation and other places); and voluntary improve employee’s health. Businesses bear direct policies or agreements. Growing awareness of SHS and indirect costs as a result of employees’ smoking, exposure’s health effects and fear of worker including: litigation has led many workplaces to become  Lost productivity from disease and premature smoke-free. But voluntary action fails to provide death caused by smoking and SHS exposure comprehensive and universal protection, leaving  Higher annual costs of healthcare, health some workers unprotected. Even strong voluntary insurance and life insurance premiums policies have major limitations that make legislation  More employee absenteeism far preferable. Employers can protect their  Increased early retirement due to ill health employees’ health and reduce smoking-related  Higher maintenance and cleaning costs costs by supporting the adoption, implementation  Higher fire insurance premiums and enforcement of country-wide comprehensive smoke-free laws that include all indoor workplaces. April 2011 Smoke-free policies are easy to implement. . Worksite cessation programs are a good Compliance is high, since both management and complement to smoke-free policies. Individual and employees usually support smoke-free policies. In group counseling and pharmacological treatment 2006, Uruguay was the first country in the Americas to overcome nicotine addiction provided at work (or to become 100% smoke-free by enacting a ban on elsewhere) are effective in helping smokers who smoking in all public spaces and workplaces, want to quit. The latest (2008) Cochrane review including bars, restaurants and casinos. Eight of meta-analysis of 19 studies of worksite smoking every 10 Uruguayans supported the law, including cessation programs found an average quit rate after nearly two thirds of the country’s smokers. After New 12 months of 20.8%, much higher than the 12.2% Zealand passed smoke-free laws in 2004, 69% of its average quit rate in the control groups. Cessation citizens said they supported the right of people to programs are relatively low-cost and yields financial work in a smoke-free environment. returns over the long run that far outweigh their costs. Goals: Protect workers from harmful effects of second-hand tobacco smoke & encourage smokers to quit, to gain health benefits for employees and economic benefits for employers. Main Activities Beneficiaries/ Indicators Target groups Make workplace smoke-free to protect employees from second-hand smoke exposure  Learn about law on smoke-free workplaces (if exists) Written policy exists that  Establish a written smoke-free policy with active clearly states rationale, time participation of employees and managers All employees frame, and where – if at all –  Communicate the policy and its rationale clearly, and (including smoking is permitted in work sanctions for non-compliance managers), place  Implement the smoke-free policy according to agreed customers, visitors timetable. The policy should apply also to customers, and clients  % of employees exposed to visitors and clients. SHS  Enforce, monitor and adjust the policy if necessary Help employees to quit smoking to reduce risks of disease and premature death  For smokers who want to quit, ensure easy access to % of smokers who attempt to trained counsellors for individual or group counselling. quit each year  Consider subsidizing pharmaceutical treatments for Employees % of quitters still not smoking nicotine addiction (including 12 months after quitting  Provide information to all workers on benefits of managers) who quitting and how to support colleagues trying to quit smoke % smokers in company (and decreases in this) the information. Offer support to smokers who How to make a workplace smoke- want to quit. The approach to providing cessation free support will vary depending on the types of service Convene a planning committee. The committee to be provided, and how it will be made available can have broad representation – managers and (e.g., at a company clinic, through the health employees, with representatives from various plan, or by referral to an existing quitline). The departments including Personnel/HR, Communications about the policy should include Communications, Facilities and operations, Health this information. The cessation support must be in and safety, Labour unions, Health and safety, place and employees made aware of it before Policy/Legal, Security. the smoke-free policy takes effect. Please note that quitting is difficult because nicotine is highly Develop a plan and the policy. The committee addictive; most smokers make 4-11 quit attempts needs to select a chairperson, clearly define goals before finally succeeding. The planning process and tasks, develop an estimated budget, and should consider supporting at least two quit create a tentative (appropriate, for example 12 to attempts per year. Keep records on the number of 18 months) timeline for implementing the smoke employees who use the services, the number of free policy. Subcommittees or workgroups to take employees who actually try to quit, and numbers responsibility for different components could be who succeed (measured six months after quitting). considered (e.g., policy development, policy implementation, cessation services, evaluation). Announce the smokefree policy. If the planning committee decides to implement the cessation Establish and offer cessation services. Provide services before the policy is implemented, information on the risks of smoking and the benefits consider announcing that the policy is on its way of quitting. Use the organization’s newsletter, together with the information on the new internal website, posters, flyers and email to deliver cessation services. The announcement should 2 come from top management. The date when the support for the policy is crucial and needs to be policy will take effect should be decided, allowing actively and visibly maintained. If free cessation sufficient lead time (several months) to carry out services are provided, a report on their use could the communication plan. If possible, have the be a strategy for continuing to promote them. policy take effect at a time of warm and gentle Evaluate Success. Evaluation needs to be planned weather. The timing for implementing the policy early to clarify the data needs for evaluating the can take advantage of publicity opportunities implementation and impact of the policy. such as the World No Tobacco Day (31st May). Remember to keep it fairly simple to assure that Ideally, the new policy should be well promoted the evaluation will be conducted. A pre- and post- before it takes effect (e.g. periodic reminders sent implementation employee survey can be done to out to employees in the period leading up to the assess awareness and knowledge of the policy date the policy takes effect, and one final and of available cessation services. Evaluating quit announcement, from top management, rates after six months among those who have immediately before the policy takes effect. On the received cessation services through the employee day that the smoke free policy takes effect, it will health service can also be considered. For be useful to hold one or more high-profile events example, it is fairly easy to keep track of how many featuring top management. These events should employees call or come in for help in quitting, visit emphasize the policy’s benefits for employees’ the web-link for the policy announcement. health and publicize the cessation services that Evaluation results need to be reported to the are available. planning team and management. Create a supportive environment. This includes Formal evaluation of a workplace smoke-free removing smoking shelters and cigarette butt policy is an ongoing activity. Do periodic follow-up receptacles and installing clear signs by the time assessments (every year or two) to check whether the policy goes into effect. (If signs cannot be the smoke-free policy continues to be installed in time, banners can be used until signs implemented as planned and to identify become available.) Signs should be placed at all necessary modifications. vehicle and pedestrian entrances to notify employees and visitors that they are entering a tobacco-free area. Place decals on building doors stating that buildings are smoke-free. Resources Enforce the policy. In the weeks before the policy INSTITUTIONS: takes effect, management should clearly communicate to supervisors and security officials ■ Tobacco Control Team in the Health, Nutrition their role in enforcing the policy, including specific and Population sector of the World Bank guidance on how to correct noncompliance. http://www.worldbank.org/tobacco Supervisors and security officials should be trained ■ Tobacco Free Initiative of the World Health in enforcement procedures, and conflict Organization http://www.who.int/tobacco management. Enforcement should be monitored to make sure that the policy is applied equitably ■ ILO http://www.ilo.org without singling out or exempting any groups of ■ Office on Smoking and Health of the US Centers employees or individuals. During the first few days for Disease Control and Prevention after the policy takes effect, top managers can http://www.cdc.gov/tobacco/osh/index.htm show visible support for the policy by walking ■ Tobacco Control Research, National Cancer through indoor places where employees have Institute smoked in the past. http://www.tobaccocontrol.cancer.gov Monitor the policy. Once implemented, carefully DOCUMENTS AND DATA monitor all components of the policy to identify any noncompliance, areas of confusion, or other General Information for Employers: problems. If necessary the policy provisions can be ■ The Economics of Health, Safety and Well- clarified and implementation and enforcement being; BAREFOOT ECONOMICS: Assessing the procedures adjusted. It is also useful to document economic value of developing an healthy work the lessons learned and monitor employee environment, Finnish Ministry of Social Affairs comments to help identify issues that need to be and Health and ILO SafeWork programme. addressed. Respond to employee comments, http://www.ilo.org/wcmsp5/groups/public/--- suggestions, and concerns in a timely, thoughtful ed_protect/---protrav/---safework/documents/ way that shows that comments are taken seriously. publication/wcms_110381.pdf A simple guide A frequently asked questions document (and area on how to estimate costs and benefits of on the company website) should provide answers measures to improve workplace safety. A to recurring questions. Attention and practical tool for use by small businesses, and communication efforts need to be focused on the other decision makers. places where employees have been accustomed to smoking. The planning committee should be ■ Griffiths J, Grieves K. “Why Smoking in the debriefed and the implementation process should Workplace Matters: An Employer’s Guide”, be evaluated. Unconditional top management WHO Regional Office for Europe, Copenhagen, 2002. Explains the rationale for developing an http://www.surgeongeneral.gov/library/second organizational tobacco control policy from an handsmoke/. employer’s perspective. Concise, readable ■ Proposed identification of environmental and clear. Copies on request from tobacco smoke as a toxic air contaminant (As tobaccofree@euro.who.int. approved by the Scientific Review Panel on Practical Guides: June 24, 2005). California, Cal EPA, 2006. http://www.arb.ca.gov/regact/ets2006/ets2006 ■ “Making Your Workplace Smokefree: A .htm. Decision Maker’s Guide”, US Department of Health and Human Services, 2000. Details on ■ Update of evidence of health effects of costs and benefits of smoke-free workplace secondhand smoke. London, Scientific policy. Step-by-step directions on how to Committee on Tobacco and Health (SCOTH.) develop and implement a smoke-free policy. http://www.dh.gov.uk/prod_consum_dh/idcpl "http://www.uams.edu/coph/reports/SmokeFre g?IdcService=GET_FILE&dID=13632&Rendition= e_Toolkit/Media/Other%20Helpful%20Resources Web /CDC%20Making%20your%20Workplace%20Sm ■ M Öberg, MS Jaakkola, A Woodward, A Peruga okefree%20Guide.pdf A Prüss-Ustün, “Worldwide burden of disease ■ Smokefree in a Box - a guide for smokefree from exposure to second-hand smoke: a workplaces. Toolkit to help companies design retrospective analysis of data from 192 and implement a smoke-free workplace. Easy- countries,” Lancet, 2011;377 (9760): 139-146. to-use advice. http://www.globalsmokefreepartnership.org/fic heiro/SFIB.pdf. ■ “Tobacco in the Workplace: Meeting the Challenge. A Handbook for Employers” WHO, Regional Office for Europe, 2002. A step-by-step guide on how to adopt a strong and cost- effective response to smoking. Economic Analysis: ■ Adams E et al. The costs of environmental tobacco smoke (ETS): An international review. (Background paper WHO/NCD/TFI/99.11) Geneva, World Health Organization, 1999. http://www.who.int/tobacco/media/en/adam s.pdf. ■ Behan DF et al. “Economic effects of environmental tobacco smoke”. Schaumburg, IL, Society of Actuaries, 2005. http://www.soa.org/research/life/researcheco nomic-effect.aspx. ■ Scollo M. et al. Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry. Tobacco Control 2003; 12:13−20. http://tobaccocontrol.bmj.com/content/12/1/ 13.full Evidence: ■ Cahill K, Moher M, Lancaster T. “Workplace interventions for smoking cessation” Cochrane Database of Systematic Reviews 2008. ■ Tobacco smoke and involuntary smoking: summary of data reported and evaluation. Geneva, WHO and IARC, 2002 (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83). http://monographs.iarc.fr/ENG/Monographs/v ol83/volume83.pdf. ■ The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA, US Department of Health and Human Services, 2006.