Effectiveness of a Smoke-Free Policy in Lowering Secondhand Smoke Concentrations in Offices in China

“The Tobacco Monopoly Act of the People’s Republic of China” passed in 1991 requires that smoking should be banned or restricted in public places and on public transportation. “The Act for Protection of Minors” (1991) stipulates that no smoking is allowed in classrooms or dorms of middle schools, elementary schools, and kindergartens. In 1997, the central government drafted its first legislation that banned smoking in public transportation and its waiting areas.1 Many provinces and cities also passed their own regulations. In 1993, Suzhou of Jiangsu Province became the first city in the country to ban smoking in all public places. By October 2006, 46% of all cities in China had passed regulations banning smoking in public places. The coverage of these local regulations went beyond public transportation and associated waiting areas, which are stipulated by the national law, to encompass most of the public places, including cinemas, museums, shopping malls, pubs, hospitals, kindergartens, and schools.1 Compared with smoking in public places, workplace smoking has scarcely been mentioned in the law in China. There are cases of voluntary adoption of smoke-free policies at work, typically in certain professions, such as among health care institutions, but to date, there has been no regulation at any government level restricting workplace smoking in China. A typical worker spends 8 hours a day at work, and studies have shown that the work-place is one of the most important sources of secondhand smoke (SHS) exposure for nonsmokers.2,3 In 2005, China Center for Disease Control and Prevention (China CDC) proposed that all CDC offices, hospitals, and university hospitals around the country ban smoking in their premises. Some institutes already had a smoke-free policy in place before the proposal, and some others signed the proposal to adopt the policy. Nevertheless, China CDC has no administrative control over most of the institutes mentioned above. In the end, only a minority of the institutes signed the proposal, and most were left without a smoking policy. To investigate the degree to which such a smoke-free policy has achieved its desired goal of protecting the health of non-smokers at work, we compared the SHS level across fourteen health-related government buildings with different types of smoking policy. In one building where a smoke-free policy was recently enacted, we were also able to evaluate the policy by sampling the SHS concentration both before and after the policy implementation.