title: Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys.
abstract: BACKGROUND
  Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws.
  
  
  METHODS
  Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law).
  
  
  RESULTS
  Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project.
  
  
  CONCLUSIONS
  A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.
authors.affiliation: Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av, Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain. cmartinez@iconcologia.net.
authors.forename: Cristina
authors.initials: C
authors.lastname: Martínez
authors.forename: Marcela
authors.initials: M
authors.lastname: Fu
authors.forename: Jose María
authors.initials: JM
authors.lastname: Martínez-Sánchez
authors.forename: Laura
authors.initials: L
authors.lastname: Antón
authors.forename: Paz
authors.initials: P
authors.lastname: Fernández
authors.forename: Montse
authors.initials: M
authors.lastname: Ballbè
authors.forename: Ana
authors.initials: A
authors.lastname: Andrés
authors.forename: Anna
authors.initials: A
authors.lastname: Riccobene
authors.forename: Xisca
authors.initials: X
authors.lastname: Sureda
authors.forename: Albert
authors.initials: A
authors.lastname: Gallart
authors.forename: Esteve
authors.initials: E
authors.lastname: Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010564:Personnel, Hospital; D015995:Prevalence; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000453:epidemiology / Q000331:legislation & jurisprudence*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D014029:Tobacco Use Disorder / Q000453:epidemiology; D055815:Young Adult; D014026:Nicotiana
chemical_list: D014028:Tobacco Smoke Pollution