|ORIGINAL RESEARCH REPORT
|Year : 2017 | Volume
| Issue : 1 | Page : 29-35
Second-hand smoke exposure among workers of restaurants, bars, and nightclubs in Lagos State
Oluwakemi Ololade Odukoya, Abiola Olokodana, Olanrewaju Onigbogi, Uchenna Ohanusi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi Araba, Lagos State, Nigeria
|Date of Web Publication||30-Jan-2017|
Oluwakemi Ololade Odukoya
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi Araba, Lagos State
Source of Support: None, Conflict of Interest: None
Background: The Lagos State Regulation of Smoking Law was passed in February 2014 and stipulates the total restriction of tobacco smoking in listed public places. Workers in hospitality venues are at a high risk of exposure to second-hand smoke (SHS). Therefore, their awareness of the health risks, attitudes toward SHS and their reported levels of exposure may play a crucial role in developing an effective monitoring, implementation, and enforcement mechanism. Methods: We conducted a cross-sectional, descriptive study among workers in restaurants, bars, and nightclubs registered with the Lagos State Ministry of Tourism in the second quarter of the year 2014. We used a multistage sampling technique to select one respondent each from the 300 centers randomly selected to participate in the survey. Data were collected using a modified version of the World Health Organization Global tobacco surveillance system tools. Univariate and bivariate analysis were carried out. Exposure to SHS in the workplace and in other public places was treated as the outcome variable in the bivariate analysis. Results: Majority (75.3%) of the respondents were aged between 21 and 40 years with a mean age of 27.7 + 8.6 years. Many (66%) were waiters/waitresses and spent more than 8 h a day. Most (60.6%) of the venues were indoor only establishments, and 26.8% had no form of smoking restrictions. Majority of the respondents were exposed to SHS at work, and this was higher in bars and nightclubs. A bivariate analysis of results showed that workers were exposed to SHS at work irrespective of workplace smoking restrictions or respondents smoking status. Conclusion: Our study demonstrates that second-hand smoke exposure is very high (65% in smokers; 65.6% in nonsmokers) among workers in restaurants, bars, and nightclubs in Lagos State. We are therefore of the opinion that strict enforcement of law would ensure the protection of these workers.
Keywords: Bars, nightclubs, restaurants, second-hand smoke, workers
|How to cite this article:|
Odukoya OO, Olokodana A, Onigbogi O, Ohanusi U. Second-hand smoke exposure among workers of restaurants, bars, and nightclubs in Lagos State. J Clin Sci 2017;14:29-35
|How to cite this URL:|
Odukoya OO, Olokodana A, Onigbogi O, Ohanusi U. Second-hand smoke exposure among workers of restaurants, bars, and nightclubs in Lagos State. J Clin Sci [serial online] 2017 [cited 2020 Jun 2];14:29-35. Available from: http://www.jcsjournal.org/text.asp?2017/14/1/29/199164
| Introduction|| |
Second-hand tobacco smoke (SHS) exposure remains a major public health problem worldwide., The scientific evidence on the health risks associated with SHS is clear and overwhelming. SHS is a known cause of lung cancer, heart disease, low birth weight, chronic lung ailments, and other health problems. According to the World Health Organization, 600,000 nonsmokers die annually from SHS exposure. SHS contains more than 7000 chemicals and compounds, many of which are known to cause cancer. There is no safe level of exposure to second-hand tobacco smoke (SHS), and implementing 100% smoke-free environments including workplaces is the only effective way to protect the population from the harmful effects of exposure to SHS.,,
In the absence of smoke-free legislations, studies in other parts of the world have identified restaurants, bars, and nightclubs as the work environments with the highest concentrations of tobacco smoke ,, resulting in high second-hand tobacco smoke exposure among the employees, particularly those who work for long hours in these venues. In Nigeria, SHS exposure is also high in hospitality venues. The 2012 Global Adult Tobacco Survey (GATS) which assessed SHS exposure in public places reported that exposure was comparatively higher in hospitality venues compared with other public places. Among adults who had visited different public places in the past 30 days, 29.3% were exposed to second-hand smoke in restaurants; compared with 16.7%, 9.4%, and 5.3% in government buildings, public transportation, and health-care facilities, respectively.
The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) was developed in response to the global tobacco epidemic, and it is a global evidence-based treaty that reaffirms the right of all people to the highest standard of health. Nigeria signed the WHO FCTC in 2004 and ratified it in 2005. The protection of people from SHS exposure in workplaces is a key principle of Article 8 of the WHO FCTC, which requires the adoption of effective measures to protect people from exposure to tobacco smoke in all public places. Policymakers, therefore, need to prioritize the complete protection of the population by ensuring that all indoor public places, including workplaces, are free from exposure to second-hand tobacco smoke.
In the light of this, lawmakers in Lagos State passed the Lagos State Regulation of Smoking Law in February 2014. The law stipulates the prohibition of tobacco smoking in listed public places including restaurants; it, however, permits the creation of designated smoking areas in nightclubs and bars. Enforcing this law is, therefore, crucial if workers are to be protected from the health risks associated with second-hand smoke exposure at work.
Workers in the hospitality venues are at a high risk of exposure to SHS.,,, Their awareness of the health risks, attitudes toward SHS, and levels of exposure play a crucial role in the effective development, monitoring, implementation, and enforcement of laws designed to protect all people from second-hand smoke. Few of such studies have been conducted in Nigeria and to our knowledge; none have been conducted in Lagos State where this law has been passed. We set out to determine the awareness and attitudes toward the health risks associated with SHS and assess the level of exposure of workers in restaurants, bars, and nightclubs in Lagos State. It is hoped that these findings will provide useful information for the development of WHO FCTC-compliant policies and provide a baseline for future evaluation of the impact of the Lagos State Regulation of Smoking Law.
| Methods|| |
Study background, study design, study population, sample size calculation
This cross-sectional, descriptive study was conducted in Lagos State, the commercial nerve center of Nigeria. In the state, all restaurants, bars, and nightclubs are registered under the State Ministry of Tourism and Inter-Governmental Relations. This ministry is saddled with the responsibility of the registration and maintenance of standards among the establishments. The study population included workers in establishments registered with the State Ministry of Tourism. Eligible study participants had to be aged 18 years or older and must have worked in the establishment for at least 6 months. In addition, only workers whose jobs involved direct contact with clients were included in the study. The minimum sample size was determined using the standard formula for determination of sample size for descriptive studies. We obtained a minimum sample size of 80 using a prevalence (95.5%) of SHS exposure among bar workers from a previous study in Osun State, a 5% margin of error, 95% confidence levels, and 10% nonresponse rate. This number was however increased to 300.
A multistage sampling technique was used in this study. First, we obtained a list of all registered bars, restaurants, and nightclubs from the State Ministry From this list using a table of random numbers, we randomly selected 300 hospitality venues. The selected hospitality venues were identified and an informed consent sought from the owner/manager of the establishment. Thereafter, a list of all eligible respondents was created and one eligible and consenting respondent was interviewed.
Data were collected using a modified version of the WHO Global Youth and Adult Tobacco Survey tools. The questionnaire elicited information on respondents' sociodemographic characteristics, workplace characteristics, smoking status, knowledge of health related risks of exposure to SHS, attitudes toward SHS and workplace SHS protection policies, and their self-reported exposure to SHS within the past week. The tool was pretested and appropriate corrections made thereafter. Reliability testing showed a Cronbach alpha of 0.83. Questionnaires were administrated by trained research assistants. All completed questionnaires were collected and appropriately coded immediately after.
Standard measures of exposure to SHS were used to assess exposure using the WHO Global Tobacco Survey tools. Respondents were asked, “In the past week, on how many days has anyone smoked in your presence in your workplace.” Similar questions were asked for exposure to SHS in other public places. Participants who were exposed on at least 1 day in the past week were classified as being “exposed” to SHS, while all the other were classified as being “not exposed.” A similar classification was carried out for exposure in public places. Data were analyzed using Statistical Package for Social sciences (SPSS) 17.0. Univariate and bivariate analysis were carried out. Exposure to SHS in the workplace and in other public places was treated as the outcome variable in the bivariate analysis where sociodemographic characteristics, workplace characteristics, and other factors were the independent variables. P = 0.05 was considered to be statistically significant.
Approval for this study was obtained from the Research and Ethics Committee of the Lagos University Teaching Hospital. A written informed consent was also obtained from each respondent. All information was obtained at the venue level. Individual responses were anonymous and treated with confidentiality. Participation was voluntary and respondents were free to withdraw from the survey at any point in time if they so desired.
| Results|| |
Sociodemographic and workplace characteristics
Majority (75.3%) of the respondents were aged between 21 and 40 years with a mean age of 27.7 ± 8.6 years. They were mostly male and only 52.4% had a tertiary level of education. Majority (66%) were waiters/waitresses and spent more than 8 h a day (66.3%) at work. Only 7% were current smokers [Table 1]. Up to 58.7% had facilities for bars, 46.1% for restaurants (46.1%), and only 10% had nightclubs. Majority (60.6%) of the venues were indoor only establishments. Tobacco was sold in only about a third of the venues, and 26.8% had no form of smoking restrictions [Table 2].
Knowledge and attitudes toward second-hand smoke
More than 60% were aware of the associations between SHS and lung cancer and a worsening of asthma. Much fewer were aware of the associations with other cancers (30%), stroke (26.7%), osteoporosis, and reproductive health problems (25%) [Table 3]. However, up to 70.3% agreed that SHS causes serious illness and 67.7% felt that it shortens a person's lifespan. Many (77.3%) had home smoking restrictions and would prefer to work in a smoke-free environment (79.7%) [Table 4].
|Table 3: Knowledge of health risks associated with exposure to second-hand smoke (n=300)|
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Self-reported exposure to second-hand smoke and factors associated with exposure
Majority of the respondents were exposed to SHS in the workplace and in other public places, and they were mostly exposed for at least 3 days in the past week [Table 5]. The bivariate analysis showed that not many sociodemographic or workplace factors were observed to be associated with SHS exposure either in the workplace or in other public places. Workers were exposed to SHS regardless of workplace smoking restrictions or respondents smoking status. Persons who worked in larger establishments appeared to be more exposed (P = 0.039) [Table 6].
|Table 6: A bivariate analysis showing the factors associated with exposure to second-hand smoke among the workers at work and in public places|
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| Discussion|| |
Our study demonstrates that second-hand smoke exposure is very high (65% in smokers; 65.6% in nonsmokers) among workers in these restaurants, bars, and nightclubs. These findings are in agreement with those in other parts of the world and even in Nigeria, where workers in such hospitality venues have been shown to have high levels of exposure to SHS.,,,, Our figures are however slightly lower than those reported in a similar study in Osun State, Nigeria, where a similar law was passed in 2009, and 95.5% of the workers were exposed to SHS. This may be because of the convenient nature of that sample compared with the probability sampling nature of ours. More than half of the workers in our study worked for more than 8 h a day, and majority of those exposed were exposed for more than 3 days in the past week. Their high levels of exposure and long working hours put these workers at an unduly high risk of SHS-related diseases. To reduce the morbidity and mortality associated with SHS, it is pertinent to ensure that policies designed to protect these workers are enacted and enforced.
At the time of data collection, there was no law in the state prohibiting indoor smoking. These workers, therefore, were exposed to high levels of SHS due to long hours at work. Moreover, we found that exposure was high not only in restaurants but also in the bars and nightclubs. We are of the opinion that stricter enforcement of state smoking policies would ensure the protection of these workers. Surprisingly, SHS exposure was high regardless of the smoking policies of the establishments or whether they were indoors or outdoors. One might have expected that venues with smoking restrictions or indoor venues would have lower levels of SHS exposure however this was not observed. This calls to question the level of implementation of existing smoking policies in these venues, and further highlights the need for adequate law enforcement. In addition, it also suggests that partial smoking restrictions may not be effective in protecting workers from SHS exposure.
Despite the high levels of SHS exposure, workers awareness of the specific health risks associated with SHS was relatively low when compared with findings among similar workers in other countries. Only 60%, 59%, and 66.3% were aware that SHS was associated with lung cancer, heart disease, and a worsening of asthma, respectively. A similar study conducted in North Carolina  among restaurant owners showed a higher knowledge level of these harmful SHS effects with 79% and 73% for cancer and asthma, respectively. Similar findings were reported in China, Egypt, and Ghana where the knowledge of the specific health risks of SHS was also high.,, The 2012 GATS showed that 74.5% of Nigerian adults believed that breathing other people's smoke causes serious illness similar to the 70.3% observed in our study. Findings among workers in Osun State showed that 70.2% of the workers had good knowledge of the health risks associated with SHS. These workers are the key stakeholders in the implementation of smoke-free workplace policies, and our findings highlight the need for focused efforts to educate them on the dangers associated with SHS exposure. It is recommended that future policies consider the mandatory education of all workers in such establishments of the dangers of workplace exposure to SHS.
In other countries,,,, majority of the workers in hospitality venues with high levels of SHS exposure prefer to work in smoke-free environments, and similar findings were observed in our study, where 79.7% preferred to work in a smoke-free environment. In New Zealand, about three quarters of the respondents preferred to have a smoking restriction in bars, while in another study conducted among London casino workers, most of them desired to work in 100% smoke-free environments, and 91% had considered quitting their workplace because of high levels of exposure to SHS., When designing smoke-free policies, it is important to consider the opinions of the workers and their exposure. Policy makers in Lagos State may need to consider these issues when the law is being revised.
As much as we know, this is one of the first few studies to examine SHS exposure among workers in restaurants, bars, and nightclubs in Lagos State just before the commencement of implementation of the Lagos State Regulation of Smoking Laws. Nevertheless, it does have some limitations. First, exposure was assessed by self-report, and no biochemical validations were carried out. Second, the cross-sectional nature of the study does not allow for any causal inference. It, however, sheds some light on the high levels of exposure of these workers and the need to prioritize the enforcement of the law. It may also serve to provide useful baseline figures for future evaluation of the effects of the law.
| Conclusion|| |
Our study presents a baseline which could help in evaluating the implementation of the Lagos State Regulation of Smoking Law. We found that workers awareness of the specific health risks associated with SHS was relatively low when compared with findings among similar workers in other countries. We also found out that workers reported exposure to SHS in their workplace and other public places. There is, therefore, a need for greater inclusiveness and probably mandatory education of all workers in such establishments of the dangers of workplace exposure to SHS. Stricter enforcement of the current law with total smoking restrictions and inclusion of bars and nightclubs as smoke-free areas would also be beneficial to the workers.
OOO conceived the research idea. OOO and AO designed the study. AO and UO assisted in the data collection. OOO and OO wrote the article and critically reviewed the manuscript. All authors read the final manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]