The Impact of Tobacco Legislation on Restaurant Workers Exposure to Tobacco Smoke in Finland

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http://urn.fi/URN:ISBN:978-951-51-1200-2
Title: The Impact of Tobacco Legislation on Restaurant Workers Exposure to Tobacco Smoke in Finland
Author: Reijula, Jere
Contributor: University of Helsinki, Faculty of Medicine, Hjelt Institute, kansanterveystieteen osasto
Thesis level: Doctoral dissertation (article-based)
Abstract: Exposure to tobacco smoke significantly increases the risk of several diseases including cancer, cardiovascular and pulmonary diseases. Prohibition of smoking in workplaces effectively protects workers against occupational exposure to secondhand smoke (SHS). However, Finnish restaurant employees have still been exposed to SHS at work until recent years. In 2000, a reform in tobacco legislation was launched in Finland according to which restaurants had to reserve non-smoking areas for their clients. Smoking restrictions proceeded gradually so that in 2007 a total ban on smoking was enacted in Finnish restaurants. In this study, nationwide survey data concerning occupational exposure to ETS in restaurants was used to assess the impact of tobacco legislation. Additionally, the risk of restaurant waiting personnel to develop cancer was evaluated in five Nordic countries. AIM OF THE STUDY: The overall purpose of the present study was to assess the impact of tobacco legislation on the occupational exposure to tobacco smoke in Finnish restaurants. The aim was to compare the effects of partial restrictions and a total prohibition of smoking in reducing the exposure to SHS among restaurant workers. Another objective of the study was to evaluate the risk of restaurant workers to develop cancer compared to that of the general population. MATERIAL AND METHODS: The present thesis collects the data concerning exposure to SHS in restaurant work using national questionnaire surveys conducted in 1999, 2001, 2003, 2007, 2009 and 2010 among Finnish restaurant workers (I, II and III). Each year the surveys were sent to an average of 3000 restaurant employees belonging to the Service Union United (PAM). Study I assessed the data collected with the first four questionnaires (1999-2007). In study II, the main focus was in the results of the questionnaires conducted before and after the launch of the smoke free tobacco legislation (i.e., 2007 and 2009). Study III included data from the questionnaires conducted in 2003, 2007, 2009 and 2010, respectively. Exposure to SHS in restaurant work was assessed also by measuring indoor nicotine concentrations in restaurants in three towns (Helsinki, Jyväskylä and Lappeenranta). The measurements were done in each year when the questionnaire surveys were carried out. Altogether 730 measurements were carried out between 2004 and 2010, approximately 60 measurements in each type of restaurant each year. The measurements were done with sampling devices that were placed for 4 hours in three different types of restaurants, i.e., dining restaurants, pubs and nightclubs, and bar desks. In order to assess the risk of cancer among restaurant workers, data were collected from the database of the Nordic Occupational Cancer (NOCCA) study. It consists of those 14.9 million persons aged 30-64 years who participated in any computerized census in the five Nordic countries, in 1990 or earlier. The longest follow up times were from 1961 to 2005. Among this study population, we focused on the group of waiters, comprising 16,134 males and 81,838 females. Altogether 3,100 cancer cases among male and 16,288 cancer cases among female waiters were found in study IV. Standardized incidence ratios (SIRs) for 35 common cancer sites were then calculated as ratios of the observed number and the expected number of cancer cases assuming that the cancer incidence among male and female waiters would be the same as found in the respective national populations. The numbers of excess cancer cases for each cancer site were calculated by subtracting the expected numbers of cancer cases from the observed ones. RESULTS: The prevalence of restaurant workers who were not exposed to SHS at work increased from 34% to 54% during 1999-2007. The prevalence of those who reported more than 4 hours of exposure to tobacco smoke during their work shift decreased from 46% to 24%. Between 2007 and 2009, the prevalence of restaurant workers who were not exposed to SHS at work increased from 54% to 82%. The highest increase was among workers in pubs and nightclubs (from 7% to 69%). The prevalence of restaurant workers who were exposed to SHS more than 4 hours a day at work decreased from 24% to 4%. Between 2007 and 2009, the prevalence of work-related respiratory symptoms decreased from 18% to 4% and that of eye symptoms from 23% to 6%. The median nicotine concentration in restaurants decreased from 11.7 μg/m³ to 0.1 μg/m³ between 2004 and 2010. The highest decrease in median nicotine concentration was found in pubs, where the median nicotine concentration decreased from 16.1 μg/m³ to 0.1 μg/m³. The reported exposure to SHS (at least 1 hour per work shift) decreased from 59% to 11% during 2004-2010. The cancer incidence among male and female waiters was higher than among the general population in the Nordic countries. During the study period (1961-2005), the overall risk of cancer among male waiters was 1.46 (95% confidence interval 1.41-1.51) and among female waiters 1.09 (1.07-1.11). The highest SIRs were found in cancer sites that are related to alcohol consumption. The highest numbers of excess cases among male waiters were in lung cancer (n=282) and cancer of the pharynx (n=92). Among female waiters the highest numbers of excess cancer cases were in lung cancer (n=718) and in cancer of the cervical uterus (n=314). CONCLUSION: The reform of Finnish tobacco legislation in 2000 that only partially prohibited smoking in restaurants until 2007 decreased occupational exposure to SHS but was not fully effective in protecting restaurant workers from exposure to SHS at work, whereas the total prohibition of smoking in 2007 significantly decreased restaurant workers exposure to SHS. The total ban on smoking in restaurants also decreased the prevalence of work-related respiratory and eye symptoms among restaurant workers, which most likely was associated with the decrease of exposure to SHS at work. In the follow-up, the positive effects of the strict tobacco legislation remained intact. The risk of cancer among male and female waiters was higher than among the general population in the five Nordic countries. This may be explained by high prevalence of smoking, heavy occupational exposure to tobacco smoke and high alcohol consumption among the subjects.Tupakansavulle altistuminen lisää merkittävästi riskiä sairastua esimerkiksi syöpään sekä sydän- verisuoni- ja keuhkosairauksiin. Tupakoinnin kieltäminen työpaikoilla on tehokkaasti suojannut työntekijöitä tupakansavulle altistumiselta. Ravintolatyöntekijät ovat yksi viimeisistä ammattiryhmistä, jotka ovat viime vuosiin saakka altistuneet tupakansavulle työssään Suomessa. Vuonna 2000 Suomessa tuli voimaan ravintoloita koskeva tupakkalaki, jonka mukaan ravintoloiden tuli varata osa asiakastiloista tupakoimattomille asiakkaille. Siitä alkaen tupakointikielto on edennyt asteittain vuoteen 2007 saakka, minkä jälkeen tupakointi kiellettiin kokonaan ravintoloiden yhteisissä asiakastiloissa. TAVOITE: Tutkimuksen keskeinen tavoite oli arvioida ravintoloita koskevan tupakkalain toteutumista ja sen vaikutuksia ravintolatyöntekijöiden altistumiseen tupakansavulle työssä. Tavoitteena oli lisäksi verrata osittaisen tupakointikiellon ja totaalikiellon eroja työntekijöiden tupakansavulle altistumisessa. Tutkimuksessa haluttiin myös arvioida ravintolatyöntekijöiden riskiä sairastua syöpään viidessä pohjoismaassa. AINEISTO JA MENETELMÄT: Väitöskirjatutkimusta varten toteutettiin vuosittaiset valtakunnalliset kyselytutkimukset 3000:lle ravintolatyöntekijöille sekä sisäilman pitoisuusmittaukset ravintoloihin ajanjaksolla 1999-2010. Ravintolatyöntekijöiden syöpäriskiä varten kerättiin tiedot viiden pohjoismaan yhteisestä Nordic Occupational Cancer eli NOCCA-aineistosta. Aineistosta poimittiin tarjoilijat (16 134 mies- ja 81 838 naistarjoilijaa), joiden syöpäilmaantuvuutta seurattiin pisimmillään 45 vuotta. TULOKSET: Tupakansavulle altistumattomien ravintolatyöntekijöiden määrä kasvoi 34 %:sta 54 %:iin vuosina 1999-2007. Tupakansavulle yli 4 tuntia työvuoron aikana altistuneiden määrä puolestaan laski 46 %:sta 24 %:iin samana ajanjaksona. Vuosina 2007-2009 tupakansavulle altistumattomien määrä kasvoi 54 %:sta 82 %:iin. Yli 4 tuntia tupakansavulle altistuneiden määrä laski 24 %:sta 4 %:iin samana ajanjaksona. Vuosina 2007-2009 ravintolatyöntekijöiden hengitystieoireiden esiintyvyys laski 18 %:sta 4 %:iin ja silmäoireiden 23 %:sta 6 %:iin. Keskimääräinen nikotiinipitoisuus ravintoloiden sisäilmassa laski vuosina 2004-2010 tasosta 11.7 μg/m³ tasolle 0.1 μg/m³. Syövän kokonaisilmaantuvuus oli ravintolatyöntekijöillä suurempi kuin väestössä keskimäärin: Vakioitu ilmaantuvuussuhde (SIR) oli miestarjoilijoilla 1,46 (95 %:n luottamusväli CI 1,41-1,51) ja naistarjoilijoilla 1,09 (1,07-1,11). Suurimmat SIR-luvut havaittiin syövissä, jotka liittyvät alkoholin kulutukseen. Suurin ylimääräisten syöpätapausten määrä miestarjoilijoilla oli keuhkosyövässä (n=282) ja nielusyövässä (n=92). Naistarjoilijoilla oli 718 ylimääräistä keuhkosyöpää ja 314 kohdunkaulan syöpää. PÄÄTELMÄT: Vuonna 2000 voimaan tullut ravintoloita koskeva tupakkalaki, joka aluksi kielsi tupakoinnin ravintoloissa vain osittain, vähensi altistumista tupakansavulle, mutta ei täysin suojannut ravintolatyöntekijöitä. Tupakoinnin kieltäminen kokonaan ravintoloissa vuodesta 2007 alkaen puolestaan vähensi altistumista tupakansavulle merkittävästi. Tupakoinnin totaalikielto vähensi merkittävästi myös työntekijöiden työperäistä hengitysteiden ja silmien oireilua, mikä todennäköisimmin liittyi vähentyneeseen tupakansavulle altistumiseen. Seuranta osoitti, että tiukka tupakkalaki pysyi tehokkaana vielä kolme vuotta kiellon tultua voimaan. Todettu tarjoilijoiden riski sairastua syöpään oli kohonnut muuhun väestöön verrattuna viidessä pohjoismaassa. Tämä voi johtua siitä, että tarjoilijat tupakoivat muuta väestöä yleisemmin, altistuvat työssään tupakansavulle ja käyttävät alkoholia muuta väestöä enemmän.  
URI: URN:ISBN:978-951-51-1200-2
http://hdl.handle.net/10138/154551
Date: 2015-05-28
Subject: lääketiede
Rights: This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.


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