Martínez 2014.
| Methods | Country: Spain Setting: Hospital, Cancer centre Design: Uncontrolled before‐and‐after study Analysis: Logistic regression to compare differences in the odds of smoking after the laws took effect |
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| Participants | 6 cross‐sectional surveys from 2001 to 2012 Employees of oncology centre surveyed Total: n = 1263 Baseline: n = 580 After 1st law (2006 ‐ 2009): n = 462 After 2nd law (2012): n = 221 Female:male ratio remained stable at 75:25; however, the proportion of staff ≥ 35 years increased during study period. The professional status distribution also changed, with nurses accounting for 44.9% at baseline and 34.9% after extension of ban |
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| Interventions | Smoke‐free centre policy was progressively introduced. Tobacco control programme (2000 ‐ 2012) National Ban 2005 (indoor smoking) National Ban 2011 (outdoor smoking) | |
| Outcomes | Attitudes to active and passive smoking Attitude to tobacco policies and restrictions Tobacco consumption and smoking status, quit attempts Staff compliance with policy |
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| Notes | National Ban: Yes, 2005. Enacted 2006 2006 ‐ 2010, Spain had a partial ban on smoking in public places. Offices, schools, hospitals and public transportation were smoke‐free, but restaurants and bars could create a "smokers' section" or allow smoking if they were small (under 100 m²). Extension of ban January 2011 restricted smoking in every indoor public place, including restaurants, bars and cafes. Hotels may designate up to 30% of rooms for smoking; mental hospitals, jails and old people's residences may have public rooms where workers cannot enter. Outdoor smoking is also prohibited at childcare facilities, in children's parks and around schools and hospital grounds Biochemical Verification: No, self‐reported smoking status Follow‐up period: 1 year after full ban and 5 years after partial ban Face‐to‐face interviews by trained interviewers. Questionnaire developed European Network of smoke free hospitals Current tobacco consumption status as smokers either daily (at least 1 cigarette/day) or occasional smokers, former smokers, and never‐smokers as < 1 cig/day, former smokers (not smoking for ≥ 6 months)], and never‐smokers. Among daily smokers, tobacco dependence was evaluated in terms of the number of cigarettes per day (< 10, 10 – 20, and > 20) and the time to the first cigarette after waking up (≤ 30 and > 30 minutes) Studies all completed April to June periods Sample size calculation to account for smoking prevalence in health professionals in Catalonia |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Not applicable |
| Allocation concealment (selection bias) | High risk | Not applicable |
| Sampling bias (selection bias) | Unclear risk | Random sample of workers based on age and sex drawn from HR department updated files |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | None |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Self‐reported smoking status |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Expected outcomes reported |
| Selective reporting (reporting bias) | Unclear risk | Expected outcomes reported |
| Other bias | Unclear risk | Cancer centre and smoking reduction could be higher No biochemical measures of smoking status SHS exposure unknown No control |