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Is Workplace Smoking Policy Equally Prevalent and Equally Effective for Immigrants?
  1. Theresa L Osypuk1,
  2. S V Subramanian2,
  3. Ichiro Kawachi2,
  4. Dolores Acevedo-Garcia2
  1. 1 Northeastern University Bouve College of Health Sciences, United States;
  2. 2 Harvard School of Public Health, United States
  1. E-mail: tosypuk{at}


Background: We examined whether immigrants were less likely to be covered by a smokefree workplace policy, as well as whether workplace smoking policies garnered comparable associations with smoking for immigrants and the US-born, in the US.

Methods: We used the 2001/02 Current Population Survey Tobacco Use Supplement among US indoor workers (n=85,784) using multiple logistic regression analyses. First, we examined whether nativity (immigrants vs. US-born) was independently associated with smokefree policy coverage. Second, we examined whether the smokefree policy association with current smoking was differential by nativity (effect modification).

Results: Immigrants were less likely to work in smokefree workplaces than the US-born; however occupation and industry accounted for these disparities. Employment in a workplace that was not smokefree was associated with higher odds of smoking (vs. smokefree workplaces), both before (OR=1.83, 95% CI:1.79-1.87) and after (OR=1.36, (1.32-1.40)) covariate adjustment among the US-born, but associations were weaker among immigrants (OR=1.39(1.29-1.50) unadjusted, OR=1.14(1.05-1.24) adjusted). Worker industry partly explained (16% of) the weaker policy-smoking association among immigrants, while other socioeconomic variables reduced the policy-smoking association without explaining the disparity.

Conclusions: The patchwork of US workplace smoking restriction policy at different governmental levels, combined with a voluntary regime among some employers, generates coverage inequalities. Workplace smokefree policies may be less effective for immigrants, and this is related to differential coverage by such policies due to occupational segregation. Understanding the complex patterns of the social context of smoking is important for understanding how policy interventions might have heterogeneous effects for different demographic groups.

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