Lung (1990) Suppl:437-444
Smoking Policy in the Workplace and Other Public Places Luk Joossens Center for Research and Information of the Consumer Organizations, Brussels, Belgium
Abstract. In May 1989, the Council of Health Ministers of the European Community adopted a joint resolution which urges the 12 member states to adopt legislation restricting smoking in public places. European citizens support this action. A survey in March-April 1987 using a sample of 12,000 Europeans in the 12 member states concluded that 77% of European citizens want measures to ban smoking in public places. The conditions that are necessary to make a smoking policy successful in the workplace and other public places will be discussed. We want to stress that an information and-awareness campaign before the enforcement of the smoking ban is the most important condition. Key words: European Community--Smoking policy--Information campaign. In~oducfion 1. Involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers. 2. The children of parents who smoke, compared with the children of nonsmoking parents, have an increased frequency of respiratory infections, increased respiratory symptoms, and slightly smaller rates of increase in lung function as the lung matures. 3. Simple separation of smokers and nonsmokers within the same air space may reduce, but does not eliminate, exposure of nonsmokers to environmental tobacco smoke.
Offprint requests to: L. Joossens, Center for Research and Information of the Consumer Organizations, Rue Souveraine 28, 1050 Brussels, Belgium.
438
L. Joossens
A Report of the Surgeon General 1986 [1] The best estimate that the available studies provide for the increased risk o f lung cancer in nonsmoking w o m e n involuntarily exposed to smoke, as compared with unexposed nonsmokers, is in the range 20%-55%. Both the widespread distribution o f the exposure and its involuntary nature argue in favor of regulatory and legislative action, in line with a c c e p t e d public health principles for the management o f involuntary risks.
International Agency for Research on Cancer 1988 [2] A resolution of the Council and of the Ministers for Health of the E u r o p e a n Community of July 18, 1989 invites the m e m b e r states. "To take the followingmeasures by introducing legislation or by other methods in accordance with national practices and conditions: 1. Ban smoking in enclosed premises open to the public which form part of the public or private establishments; 2. Extend the ban on smoking to all forms of public transport; 3. Provide, where necessary, for clearly defined areas to be reserved for smokers in the above establishments and, if possible, in public transport, particularly for long journeys; 4. Ensure that in the event of a conflict, in areas other than those reserved for smokers, the fight to health of nonsmokers prevails over the right of smokers to smoke; To inform the Commission every two years of action taken in response to this resolution." In 1986, two reports by the Surgeon General [1] and the National A c a d e m y o f Sciences [3] reached similar conclusions about the adverse health effects of involuntary smoking on healthy adults and children. The results o f these studies were confirmed by the Fourth R e p o r t o f the Independent Scientific Committee on Smoking and Health (1987) in the United Kingdom [4] and by reports of the International Agency for Research on Cancer (1988) [2]. These conclusions, and the finding that separating smokers from n o n s m o k ers within the same physical space does not eliminate involuntary smoking, have engendered an extensive debate on the medical, social, and legal aspects o f the problem and on alternative strategies o f controlling it [5]. Since the mid1980s, movements to ban smoking in offices and public places have accelerated, and 42 states in the United States have legislated smoking restrictions, most o f them applicable to public transportation (35 states), hospitals (33), elevators (31), indoor cultural or recreational facilities (29), schools (27), and libraries (19) [5].
Smoking Policy in Public Places A public place has usually been defined as any enclosed area to w h i c h the public is invited or in which the public is permitted. This broad definition
Smoking Policyin the Workplace
439
encompasses a diverse range of facilities that share the characteristic of being indoor enclosed spaces that permit the general public relatively free access [1]. Although they fit the definition, restaurants are usually treated separately in these laws. Private businesses are also separately addressed and private homes specifically excluded. As noted in the 1986 Surgeon General's Report, the degree to which smoking is restricted in public places also depends on history or tradition, the level of involuntary smoke exposure that is likely (determined by size, ventilation, and amount of smoking), the ease with which smokers and nonsmokers can be separated, and the degree of inconvenience that smoking restrictions pose to smokers. Public places may be owned by government or private interests. As a consequence of these factors and others, there is considerable variability in the methods by which new regulations have been proposed and the ease with which they have been adopted. Smoking restrictions have been most easily adopted in public facilities, especially facilities where smoking has traditionally been prohibited for safety reasons, where smoking is not associated with the activity taking place, and where the public spends limited time. Such considerations explain the relatively slower acceptance of smoking restrictions in restaurants, bars, and private businesses [1, 6]. In our view it is impossible to achieve a complete ban of smoking in public places, if the majority of the population is still smoking, if there is no experience of partial bans in certain places (even enforced for security reasons) and if there is no large support for such a policy. The implementation, the compliance, and the enforcement of a smoking ban in public depends on how this policy has been prepared. An information and awarenes s campaign before the enforcement of the smoking ban is in our view a crucial condition for success. Belgium was the first country of the European Community to ban smoking in public places. A brief description of the history of this legislation and the experience of the Belgian smoking policy in public places now follows. An act of Parliament of January 24, 1977 made it possible to restrict smoking in public places by Royal Decree. Since the government did not formulate any concrete proposals to promulgate the smoking ban, the Flemish Tobacco Prevention Coordinating Committee decided in 1985 to launch a large campaign with the slogan "two out of three": two persons out of three want a smoking ban in public places. In this campaign we used posters, spots on local radio stations, a specially designed "smoking ban" game, and a booklet on passive smoking.
Main Arguments of the Campaign 1. There is a no-smoking majority in Belgium [7]. 2. Three of four nonsmokers and even one of two smokers want a smoking ban in public places [8, 9]. 3. Most political parties agreed with the smoking ban.
440
L. Joossens
4. According to the World Health Organization, passive smoking is an undeniable health risk. In 1987 we reached our goal: the Royal Decree of March 31 restricted smoking in all indoor areas to which the public is admitted, such as post offices, hospitals, schools, universities, old people's homes, music and sports arenas, theatres, railway stations, municipal, federal, and national government buildings, law courts, and publicly owned banks. Smokers face fines of between 40 and 500 U.S. dollars. The smoking ban came into effect on the first of September 1987. The response from the public and the media was considerable: for almost 4 days the smoking ban was the major topic in the media and for a week people talked of little else.
Evaluation o f the Belgian Ban on Smoking in Public Places 1. Support for the smoking ban from the public was very high and this support is perhaps the most important incitement to convince political leaders to promulgate a smoking ban. EEC countries can refer to the 1987 survey which indicated that 77% of the 11,651 people interviewed were in favor of restricting smoking in public places [10]. 2. The public has to be well informed about the law. As well as major coverage by the media, the smoking restrictions were also announced on the day itself via the internal broadcasting system of the major railway stations. The high level of public awareness resulted in an easier enforcement of the law [11]. However, we regret that, apart from the voluntary press campaign, there was not a government-sponsored promotion campaign on television or on billboards that announced the smoking ban. Other countries that introduce a smoking ban should consider such a campaign. 3. No-smoking laws passed by state and local governments are generally implemented by public health, rather than police departments [6]. While the announcement of sanctions is necessary to be credible and to convince smokers to respect the ban, the implementation of such policies is "self-enforcing." Such a strategy requires substantial awareness about the provisions of smoking bans or regulations. The Belgian law was not always very clear. You may smoke in a private bank, but not in a state-owned one. This has caused confusion and resentment. A self-enforcing policy also requires appropriate placement of signs. In order to respect the law, smokers should at least know in which places they may not smoke by observing the official no-smoking signs. We calculated that some 1,000,000 no-smoking signs were needed to enable smokers to respect the smoking ban. However, on the first of September 1987, many public places were without no-smoking signs. At the Brussels Intemational Airport, for instance, no-smoking signs were very scarce and the smoking ban was hardly respected.
SmokingPolicyin the Workplace
441
4. Different interpretations of a law are always possible. (Is the public, for instance, permitted to smoke in this conference room?) The Spanish regulation and the European resolution stipulate "that in the event of a conflict, the right to health of nonsmokers prevails over the right of smokers to smoke." 5. The fact that there was a clear date for the enforcement of the smoking ban gave journalists a good reference point for their editorials and improved public awareness that the ban would be enforced starting from the first of September 1987. A fixed date is an important element in the information campaign surrounding a smoking ban policy. Finally, an important long-term effect of a ban on smoking in public places is that it promotes nonsmoking as the most acceptable social norm and creates a "nonsmoking culture." This is the best possible reinforcement for those youngsters who decide to be nonsmokers all their lives.
Smoking Policy in the Workplace In Support of a Workplace Smoking Policy The health dangers of involuntary smoking in the workplace are much more important than in public places. An employee spends 8 hours a day, 5 days a week, and 40 years of his or her life at work and can be exposed to the smoke of his or her colleagues. The time you spend at the post office or theatre is limited in time and in frequency. There are also other reasons that justify a smoking policy in the private sector, such as security reasons, lower costs, and the right to fresh air.
Security. The risk of fire and explosion stimulated some companies to adopt a firm position against smoking. After the fire in the chain store Innovation in Brussels with more than 300 deaths, this company enforced a complete ban on smoking in the workplace. According to data from the Brussels agglomeration one out of eight fires was caused by smokers in 1984 [12]. Lower Costs. In the United States, studies have estimated that the annual cost of a smoking employee varied between $336 and $624 in 1980 [13]. There is, for instance, the following: 1. Reduced absenteeism. Smokers take about 50% more sick leave than nonsmokers. There may also be reduced absenteeism among nonsmokers. 2. Lower maintenance costs. Smoking increases litter and necessitates more frequent renewal of decoration and furnishings. 3. Lower ventilation and air-conditioning costs.
442
L. Joossens
4. Increased productivity. Smoking takes up the working time of smokers and may disturb nonsmokers. 5. Lower risk of losing key employees through premature retirement or death. On average smokers are twice as likely to die before 65 years as nonsmokers. This has an effect on labor turnover, recruitment, and training costs [14]. The Right to Fresh Air. Besides the so-called individual right to smoke, there is the more fundamental right that nonsmokers have the right to breathe air free from tobacco smoke. According to a CRIOC survey in 1980, three out of four nonsmokers found it unpleasant to sit next to a smoker [9]. The most common effects of tobacco smoke exposure are tissue irritation. The eyes appear to be especially sensitive to irritation by environmental tobacco smoke, but the nose, throat, and airways may also be affected by smoke exposure. It is well known that participants in surveys report irritation and annoyance due to smoke in the environment under real-life conditions [1]. A smoking policy in the workplace is considered more difficult to achieve than a smoking policy in public places. A survey among 88 company medical doctors in Belgium stipulated that 63% were convinced that the smoking employees would oppose a smoking policy in the workplace [15]. We are wondering if we are not overestimating this obstacle, since another survey among employees in three companies showed that 75%-90% are in favor of restricting smoking to specific places [16]. Fear of workers' discontent or union opposition is another reason cited by employers who considered and rejected a workplace smoking policy. Other reasons cited by companies were questions about the legality of limiting employees' smoking and the opposition from those members of the management who are smokers [1]. Policies regulating smoking in the workplace for the protection of employees' health are a trend of the 1980s, first in the United States, but also more and more in Europe. Support for an employer's right to restrict smoking to a designated area at work grew from 52% to 61% during the 1970s in the United States and continued to increase in the 1980s (Gallup Poll, 1983, 1985). In 1985, 79% of U.S. adults, including 76% of smokers, favored restricting smoking at work to designated areas. Only 8% favored a total workplace smoking ban (Gallup Poll, 1985) [1]. The myriad of current smoking policies have been categorized in several ways. The range, in ascending order of protection for the nonsmoker, includes the following:
1. No explicit policy ("the individual solution" approach). 2. Environmental alterations (separating smokers with physical barriers, using air filters, or altering ventilation). . Restricting employee smoking, a range with these extremes: a. Smoking permitted except in designated no-smoking areas. b. Smoking prohibited except in designated areas.
Smoking Policy in the Workplace
443
4. Banning employee smoking at the worksite. 5. Preferential hiring of nonsmokers. Options (1) through (3a) effectively state that smoking at work is acceptable behavior; options (3b) through (5) indicate to employees that nonsmoking is the company norm [1]. To aid employers, the Flemish Tobacco Prevention Organization KKAT has developed a guide (including posters) with specific recommendations on how to adopt and implement worksite smoking policy [17]. Sixty-eight percent of the 88 company medical doctors interviewed said that they needed some practical assistance on how to develop a smoking policy in the workplace [15]. Our colleagues at Action on,Smoking and Health (ASH) in the United Kingdom worked out a five-step policy to achieve a smoking policy at work [18].
Five Steps to a Policy 1. Set up a working party. Try to make it representative of the workforce. Include smokers, nonsmokers, and ex-smokers. Review current practice in your organizationwis smoking already restricted; have there been any complaints? Set out the basic objectives of a policy. 2. Raise the issue. The issue is not about whether people smoke, but where they smoke. Circulate information about the health hazards from passive smoking and the options available to solve the problem. Use in-house journals, staff notice boards, or other means to encourage feedback. 3. Consult the workforce. For example, circulate a survey form to all staff with a letter that explains the purpose of the survey or, alternatively, hold staff meetings. Make it clear that this is only one part of the process and that other information will be taken into account as well when deciding the final policy. Discuss the results in the working party. Use them to find out where support already exists among staff for a policy and where more work needs to be done. 4. The policy. Make clear the principle that nonsmokers have the right to breath air free from tobacco smoke. Set out the options available for your workplace. Be clear about where and when smoking is and is not allowed. Circulate the policy to all employees and explain what it entails and the rationale behind it. Encourage feedback. 5. Implement thepolicy [18]. My final conclusion is that a smoking policy in the workplace has to go through several stages. Without planning, without consultation and dialogue, without sensitivity training, this smoking policy would end as a failure. But it is also my conviction that in the year 2000 most of the companies in Belgium will have adopted a smoking policy in the workplace.
444
L. Joossens
References 1. U.S. Department of Health and Human Services (1986) The health consequences of involuntary smoking. A report of the Surgeon General. Washington, DC 2. International Agency for Research on Cancer (1989) Tobacco or Health. Smoke-free Europe: 4. WHO Regional Office for Europe (ed) Copenhagen 3. National Research Council (1986) Environmental Tobacco Smoke Measuring Exposures and Assessing Health Effects. Washington, DC 4. (1988) Fourth Report of the Independent Scientific Committee on Smoking and Health, Her majesty's Stationery Office, London 5. Fielding JE, Phenow KJ (1988) Health effects of involuntary smoking. N Engl J Med 319:1452-1460 6. U.S. Department of Health and Human Services (1989) Reducing the Health consequences of smoking, 25 years of progress. A report of the Surgeon General. Washington, DC 7. Joossens L (1987) De evolutie van het rookgedrag in Belgi~ tot 1 september 1987. OIVO, Brussels 8. Dooghe G, Vanden Boer L, Van Loon F (1984) Verantwoordelijkheid voor eigen gezondheid. CBGS Report 63. Brussels 9. Joossens L (1981) De gedragingen en de houdingen van de Vlaamse bevolking i.v.m, het Tabaksverbruik. OIVO-UNIOP, Brussels 10. Commission des Communaut6s Europ6ennes, l'Europe contre le cancer (1987) Les Europ6ens et al pr6vention du cancer, Une 6tude d'opinion publique. Brussels 11. Joossens L, Aoki M, Hisamichi S, Tominaga S (eds) (1987) Success and failure of the legislative action against smoking in Belgium, In: Proceedings of the 6th World Conference, Smoking and Health. Tokyo, pp 467--470 12. (1984) Agglom6ration de Bruxeltes, Services Incendie, Rapport annuel, Brussels 13. Schwartz JL (1987) Review and evaluation of smoking cessation methods: The United States and Canada, 1978-1985. National Cancer Institute, Washington, DC 14. Jenkins M, McEwen J (1987) Smoking Policies at work. Department of Community Medicine, King's College, London 15. Koordinatiekomitee Algemene Tabakspreventie (1987) Resultaten Enqu~te Arbeidsgeneesheren. Brussels 16. Koordinatiekomitee Algemene Tabakspreventie (1987) Enqu6te: m'n coUega rookt niet. Brussels 17. Koordinatiekomitee Algemene Tabakspreventie (1987) M'n collega rookt niet. Handleiding voor Tabakspreventie in het bedrijf. Brussels 18. Action on Smoking and Health (1988) How to achieve a smoking policy at work. London
Smoking Policy in the Workplace and Other Public Places Luk Joossens Center for Research and Information of the Consumer Organizations, Brussels, Belgium
Abstract. In May 1989, the Council of Health Ministers of the European Community adopted a joint resolution which urges the 12 member states to adopt legislation restricting smoking in public places. European citizens support this action. A survey in March-April 1987 using a sample of 12,000 Europeans in the 12 member states concluded that 77% of European citizens want measures to ban smoking in public places. The conditions that are necessary to make a smoking policy successful in the workplace and other public places will be discussed. We want to stress that an information and-awareness campaign before the enforcement of the smoking ban is the most important condition. Key words: European Community--Smoking policy--Information campaign. In~oducfion 1. Involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers. 2. The children of parents who smoke, compared with the children of nonsmoking parents, have an increased frequency of respiratory infections, increased respiratory symptoms, and slightly smaller rates of increase in lung function as the lung matures. 3. Simple separation of smokers and nonsmokers within the same air space may reduce, but does not eliminate, exposure of nonsmokers to environmental tobacco smoke.
Offprint requests to: L. Joossens, Center for Research and Information of the Consumer Organizations, Rue Souveraine 28, 1050 Brussels, Belgium.
438
L. Joossens
A Report of the Surgeon General 1986 [1] The best estimate that the available studies provide for the increased risk o f lung cancer in nonsmoking w o m e n involuntarily exposed to smoke, as compared with unexposed nonsmokers, is in the range 20%-55%. Both the widespread distribution o f the exposure and its involuntary nature argue in favor of regulatory and legislative action, in line with a c c e p t e d public health principles for the management o f involuntary risks.
International Agency for Research on Cancer 1988 [2] A resolution of the Council and of the Ministers for Health of the E u r o p e a n Community of July 18, 1989 invites the m e m b e r states. "To take the followingmeasures by introducing legislation or by other methods in accordance with national practices and conditions: 1. Ban smoking in enclosed premises open to the public which form part of the public or private establishments; 2. Extend the ban on smoking to all forms of public transport; 3. Provide, where necessary, for clearly defined areas to be reserved for smokers in the above establishments and, if possible, in public transport, particularly for long journeys; 4. Ensure that in the event of a conflict, in areas other than those reserved for smokers, the fight to health of nonsmokers prevails over the right of smokers to smoke; To inform the Commission every two years of action taken in response to this resolution." In 1986, two reports by the Surgeon General [1] and the National A c a d e m y o f Sciences [3] reached similar conclusions about the adverse health effects of involuntary smoking on healthy adults and children. The results o f these studies were confirmed by the Fourth R e p o r t o f the Independent Scientific Committee on Smoking and Health (1987) in the United Kingdom [4] and by reports of the International Agency for Research on Cancer (1988) [2]. These conclusions, and the finding that separating smokers from n o n s m o k ers within the same physical space does not eliminate involuntary smoking, have engendered an extensive debate on the medical, social, and legal aspects o f the problem and on alternative strategies o f controlling it [5]. Since the mid1980s, movements to ban smoking in offices and public places have accelerated, and 42 states in the United States have legislated smoking restrictions, most o f them applicable to public transportation (35 states), hospitals (33), elevators (31), indoor cultural or recreational facilities (29), schools (27), and libraries (19) [5].
Smoking Policy in Public Places A public place has usually been defined as any enclosed area to w h i c h the public is invited or in which the public is permitted. This broad definition
Smoking Policyin the Workplace
439
encompasses a diverse range of facilities that share the characteristic of being indoor enclosed spaces that permit the general public relatively free access [1]. Although they fit the definition, restaurants are usually treated separately in these laws. Private businesses are also separately addressed and private homes specifically excluded. As noted in the 1986 Surgeon General's Report, the degree to which smoking is restricted in public places also depends on history or tradition, the level of involuntary smoke exposure that is likely (determined by size, ventilation, and amount of smoking), the ease with which smokers and nonsmokers can be separated, and the degree of inconvenience that smoking restrictions pose to smokers. Public places may be owned by government or private interests. As a consequence of these factors and others, there is considerable variability in the methods by which new regulations have been proposed and the ease with which they have been adopted. Smoking restrictions have been most easily adopted in public facilities, especially facilities where smoking has traditionally been prohibited for safety reasons, where smoking is not associated with the activity taking place, and where the public spends limited time. Such considerations explain the relatively slower acceptance of smoking restrictions in restaurants, bars, and private businesses [1, 6]. In our view it is impossible to achieve a complete ban of smoking in public places, if the majority of the population is still smoking, if there is no experience of partial bans in certain places (even enforced for security reasons) and if there is no large support for such a policy. The implementation, the compliance, and the enforcement of a smoking ban in public depends on how this policy has been prepared. An information and awarenes s campaign before the enforcement of the smoking ban is in our view a crucial condition for success. Belgium was the first country of the European Community to ban smoking in public places. A brief description of the history of this legislation and the experience of the Belgian smoking policy in public places now follows. An act of Parliament of January 24, 1977 made it possible to restrict smoking in public places by Royal Decree. Since the government did not formulate any concrete proposals to promulgate the smoking ban, the Flemish Tobacco Prevention Coordinating Committee decided in 1985 to launch a large campaign with the slogan "two out of three": two persons out of three want a smoking ban in public places. In this campaign we used posters, spots on local radio stations, a specially designed "smoking ban" game, and a booklet on passive smoking.
Main Arguments of the Campaign 1. There is a no-smoking majority in Belgium [7]. 2. Three of four nonsmokers and even one of two smokers want a smoking ban in public places [8, 9]. 3. Most political parties agreed with the smoking ban.
440
L. Joossens
4. According to the World Health Organization, passive smoking is an undeniable health risk. In 1987 we reached our goal: the Royal Decree of March 31 restricted smoking in all indoor areas to which the public is admitted, such as post offices, hospitals, schools, universities, old people's homes, music and sports arenas, theatres, railway stations, municipal, federal, and national government buildings, law courts, and publicly owned banks. Smokers face fines of between 40 and 500 U.S. dollars. The smoking ban came into effect on the first of September 1987. The response from the public and the media was considerable: for almost 4 days the smoking ban was the major topic in the media and for a week people talked of little else.
Evaluation o f the Belgian Ban on Smoking in Public Places 1. Support for the smoking ban from the public was very high and this support is perhaps the most important incitement to convince political leaders to promulgate a smoking ban. EEC countries can refer to the 1987 survey which indicated that 77% of the 11,651 people interviewed were in favor of restricting smoking in public places [10]. 2. The public has to be well informed about the law. As well as major coverage by the media, the smoking restrictions were also announced on the day itself via the internal broadcasting system of the major railway stations. The high level of public awareness resulted in an easier enforcement of the law [11]. However, we regret that, apart from the voluntary press campaign, there was not a government-sponsored promotion campaign on television or on billboards that announced the smoking ban. Other countries that introduce a smoking ban should consider such a campaign. 3. No-smoking laws passed by state and local governments are generally implemented by public health, rather than police departments [6]. While the announcement of sanctions is necessary to be credible and to convince smokers to respect the ban, the implementation of such policies is "self-enforcing." Such a strategy requires substantial awareness about the provisions of smoking bans or regulations. The Belgian law was not always very clear. You may smoke in a private bank, but not in a state-owned one. This has caused confusion and resentment. A self-enforcing policy also requires appropriate placement of signs. In order to respect the law, smokers should at least know in which places they may not smoke by observing the official no-smoking signs. We calculated that some 1,000,000 no-smoking signs were needed to enable smokers to respect the smoking ban. However, on the first of September 1987, many public places were without no-smoking signs. At the Brussels Intemational Airport, for instance, no-smoking signs were very scarce and the smoking ban was hardly respected.
SmokingPolicyin the Workplace
441
4. Different interpretations of a law are always possible. (Is the public, for instance, permitted to smoke in this conference room?) The Spanish regulation and the European resolution stipulate "that in the event of a conflict, the right to health of nonsmokers prevails over the right of smokers to smoke." 5. The fact that there was a clear date for the enforcement of the smoking ban gave journalists a good reference point for their editorials and improved public awareness that the ban would be enforced starting from the first of September 1987. A fixed date is an important element in the information campaign surrounding a smoking ban policy. Finally, an important long-term effect of a ban on smoking in public places is that it promotes nonsmoking as the most acceptable social norm and creates a "nonsmoking culture." This is the best possible reinforcement for those youngsters who decide to be nonsmokers all their lives.
Smoking Policy in the Workplace In Support of a Workplace Smoking Policy The health dangers of involuntary smoking in the workplace are much more important than in public places. An employee spends 8 hours a day, 5 days a week, and 40 years of his or her life at work and can be exposed to the smoke of his or her colleagues. The time you spend at the post office or theatre is limited in time and in frequency. There are also other reasons that justify a smoking policy in the private sector, such as security reasons, lower costs, and the right to fresh air.
Security. The risk of fire and explosion stimulated some companies to adopt a firm position against smoking. After the fire in the chain store Innovation in Brussels with more than 300 deaths, this company enforced a complete ban on smoking in the workplace. According to data from the Brussels agglomeration one out of eight fires was caused by smokers in 1984 [12]. Lower Costs. In the United States, studies have estimated that the annual cost of a smoking employee varied between $336 and $624 in 1980 [13]. There is, for instance, the following: 1. Reduced absenteeism. Smokers take about 50% more sick leave than nonsmokers. There may also be reduced absenteeism among nonsmokers. 2. Lower maintenance costs. Smoking increases litter and necessitates more frequent renewal of decoration and furnishings. 3. Lower ventilation and air-conditioning costs.
442
L. Joossens
4. Increased productivity. Smoking takes up the working time of smokers and may disturb nonsmokers. 5. Lower risk of losing key employees through premature retirement or death. On average smokers are twice as likely to die before 65 years as nonsmokers. This has an effect on labor turnover, recruitment, and training costs [14]. The Right to Fresh Air. Besides the so-called individual right to smoke, there is the more fundamental right that nonsmokers have the right to breathe air free from tobacco smoke. According to a CRIOC survey in 1980, three out of four nonsmokers found it unpleasant to sit next to a smoker [9]. The most common effects of tobacco smoke exposure are tissue irritation. The eyes appear to be especially sensitive to irritation by environmental tobacco smoke, but the nose, throat, and airways may also be affected by smoke exposure. It is well known that participants in surveys report irritation and annoyance due to smoke in the environment under real-life conditions [1]. A smoking policy in the workplace is considered more difficult to achieve than a smoking policy in public places. A survey among 88 company medical doctors in Belgium stipulated that 63% were convinced that the smoking employees would oppose a smoking policy in the workplace [15]. We are wondering if we are not overestimating this obstacle, since another survey among employees in three companies showed that 75%-90% are in favor of restricting smoking to specific places [16]. Fear of workers' discontent or union opposition is another reason cited by employers who considered and rejected a workplace smoking policy. Other reasons cited by companies were questions about the legality of limiting employees' smoking and the opposition from those members of the management who are smokers [1]. Policies regulating smoking in the workplace for the protection of employees' health are a trend of the 1980s, first in the United States, but also more and more in Europe. Support for an employer's right to restrict smoking to a designated area at work grew from 52% to 61% during the 1970s in the United States and continued to increase in the 1980s (Gallup Poll, 1983, 1985). In 1985, 79% of U.S. adults, including 76% of smokers, favored restricting smoking at work to designated areas. Only 8% favored a total workplace smoking ban (Gallup Poll, 1985) [1]. The myriad of current smoking policies have been categorized in several ways. The range, in ascending order of protection for the nonsmoker, includes the following:
1. No explicit policy ("the individual solution" approach). 2. Environmental alterations (separating smokers with physical barriers, using air filters, or altering ventilation). . Restricting employee smoking, a range with these extremes: a. Smoking permitted except in designated no-smoking areas. b. Smoking prohibited except in designated areas.
Smoking Policy in the Workplace
443
4. Banning employee smoking at the worksite. 5. Preferential hiring of nonsmokers. Options (1) through (3a) effectively state that smoking at work is acceptable behavior; options (3b) through (5) indicate to employees that nonsmoking is the company norm [1]. To aid employers, the Flemish Tobacco Prevention Organization KKAT has developed a guide (including posters) with specific recommendations on how to adopt and implement worksite smoking policy [17]. Sixty-eight percent of the 88 company medical doctors interviewed said that they needed some practical assistance on how to develop a smoking policy in the workplace [15]. Our colleagues at Action on,Smoking and Health (ASH) in the United Kingdom worked out a five-step policy to achieve a smoking policy at work [18].
Five Steps to a Policy 1. Set up a working party. Try to make it representative of the workforce. Include smokers, nonsmokers, and ex-smokers. Review current practice in your organizationwis smoking already restricted; have there been any complaints? Set out the basic objectives of a policy. 2. Raise the issue. The issue is not about whether people smoke, but where they smoke. Circulate information about the health hazards from passive smoking and the options available to solve the problem. Use in-house journals, staff notice boards, or other means to encourage feedback. 3. Consult the workforce. For example, circulate a survey form to all staff with a letter that explains the purpose of the survey or, alternatively, hold staff meetings. Make it clear that this is only one part of the process and that other information will be taken into account as well when deciding the final policy. Discuss the results in the working party. Use them to find out where support already exists among staff for a policy and where more work needs to be done. 4. The policy. Make clear the principle that nonsmokers have the right to breath air free from tobacco smoke. Set out the options available for your workplace. Be clear about where and when smoking is and is not allowed. Circulate the policy to all employees and explain what it entails and the rationale behind it. Encourage feedback. 5. Implement thepolicy [18]. My final conclusion is that a smoking policy in the workplace has to go through several stages. Without planning, without consultation and dialogue, without sensitivity training, this smoking policy would end as a failure. But it is also my conviction that in the year 2000 most of the companies in Belgium will have adopted a smoking policy in the workplace.
444
L. Joossens
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