Alcohol drinking as a mediator of the influence of smoking prevalence on second-hand smoke exposure in workplaces: a mediation analysis

Abstract

Objective: Both alcohol drinking and secondhand smoke (SHS) exposure have shown a strong association with smoking behaviour. This study uses mediation analysis to clarify the process underlying the relationship between smoking prevalence and SHS exposure and the extent to which this relationship is mediated by alcohol use in the workplace. Method: A total of 14,195 employees from 81 companies in China participated in this survey. Mediation analysis was used to establish the mediation effect of alcohol drinking. Structural equation modelling (SEM) was used to evaluate the role of alcohol drinking when a smoke-free (SF) workplace policy was imposed. Results: For males, approximately 6.3% of the effects on SHS exposure were mediated through the channel of alcohol use. For females, this channel mediated 14.1% of the total effects. SF policy was negatively associated with smoking prevalence and SHS exposure. The indirect effect of the SF policy on reducing SHS exposure by controlling smoking behaviour was significant. For smokers, worksite smoking bans were negatively associated with the smoking amount and drinking behaviour, and the indirect effect of this policy on promoting smokers' intention to quit by reducing the smoking amount and controlling drinking behaviour was significant. Conclusion: This study confirmed that alcohol drinking is among the channels that mediate the association between smoking prevalence and SHS exposure in workplaces. Our results also find a spillover effect of SF workplace policy and call for effective interventions for alcohol use, which may influence the outcomes of SF policy implementation.

Protection motivation theory and smoking quitting intention: findings based on structural equation modelling and mediation analysis

“…Until recently, the association between different factors related to smoking behaviours has been investigated by a few studies [ 8 – 11 ]. For example, a study found that reducing second-hand smoke exposure (SHS) is not simply the result of the implementation of smoke-free workplace policies.…”

“…Another study confirmed that a smoke-free workplace policy can not only reduce SHS exposure but also have spill-over effects on smoking by controlling drinking behaviour. However, the topics related to quitting intention are almost untouched by researchers [ 11 ].…”

“…Therefore, it is suggested that the objective of reducing SHS exposure can be achieved through smoke-free policies. However, in terms of triggering stronger quitting intentions, companies should integrate multilevel health promotion, such as alcohol drinking intervention programmes [ 11 ].…”

The association of workplace smoke-free policies on individual smoking and quitting-related behaviours

“…Seventh, the survey questionnaire consists of researchers and organized companies, and some of the questions may not be consistent with standard questions in the Global Adult Tobacco Survey, such as SHS exposure. However, given the number of scholars applying this questionnaire to conduct tobacco-related research [ 15 , 16 , 25 ], the overall picture is believed to be meaningful.…”

“…In China, one study in 2010 reported that workplace SF policy had significant associations with lower smoking prevalence and daily cigarette consumption but not with employee quitting intentions; however, this study only collected 1070 questionnaires from one company in Shanghai [ 14 ]. Until recently, two Chinese studies reported the association of workplace SF policies and possible effects and showed that SF workplace policies are associated with lower SHS exposure and broader spillover effects, such as reduced drinking behaviour [ 15 , 16 ]; however, both studies used only one-year cross-sectional data. To the best of our knowledge, no other recent studies have been conducted on this topic.…”