Article discussion: Workplace smoking bans and work-related stress

I thought this research article, The association between workplace smoking bans and self-perceived, work-related stress among smoking workers, by Azagba and Sharaf, merited discussion on a number of points.

First, this article examines unintended consequences of public health interventions. While this is a required part of biomedical clinical trials, this is not a routine part of the literature for public health. The emotional and social investment that are tied to policies and other social interventions can actively interfere with objective evaluation.  So it is great to see researchers and journals support this line of inquiry.

Secondly, this also concerns the work environment as an outcome. This is a dominant aspect (at least in terms of time) of most of our lives, but it is not addressed in proportion to its importance.

The study's strengths include its use of longitudinal data, a sample that is representative of the Canadian population ethnically and geographically, and also enrolls a wide variety of occupations. The data also contain information on a wide variety of covariates, including health status and drinking status, that allowed for better modeling and analysis.

Work-place smoking bans were positively associated with perceived work-related stress for smokers. When examining effects separately for age and gender, the associations were only significant for males and for younger workers (18-40). These associations remained even after adjusting for the effects of variables such as marital status, drinking status, health status, province of residence and type of occupation.

There was no association between workplace smoking bans and work-related stress for nonsmokers. While this may sound like "duh", it is important that the "common sense" assumption was actually verified by data. It might also not be "common sense". Some nonsmokers have indicated that they would actually go more frequently and enjoy public places such as restaurants and bars if there were smoking bans. So examining the data and trying to understand the complexity of the relationships between nonsmokers and smokers is beneficial.

The authors don't call for rescinding smoking bans based on their research, and neither would I. This type of research can point out the additional facets of a smoking policy intervention that would be beneficial for optimizing employee outcomes, such as stress management training and assistance with smoking cessation and access to pharmacological aids.

I hope in the future that objective and subjective data on people's work environments are integrated into health surveillance systems in the United States.