Smoking in Casinos Survey

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1 Smoking in Casinos Survey Are London casino workers concerned about exposure to other people s tobacco smoke at work?

2 August 2005 Prepared by: Paul Pilkington, Lecturer in Public Health, University of the West of England,

3 Smoking in Casinos Survey 1 Summary of findings 557 casino workers responded to the survey, representing a response rate of 36%. 22% of respondents are current cigarette smokers, compared to a national rate of 23% (ONS smoking-related behaviour and attitudes, 2004). 65% of the casino workers who responded want smoking to be banned in all working areas of the casino. Workers would in general prefer to maintain separate smoking and non-smoking staff rest areas (63%). 83% of casino workers report being exposed to other people s tobacco smoke nearly all the time at work. 75% report being exposed to heavy levels of other people s tobacco smoke at work. 78% of casino workers report being bothered by other people s tobacco smoke at work, while 91% have at some time wanted to move away from where they work because of it. 57% of casino workers feel that their health has suffered because of exposure to other people s tobacco smoke in the workplace, while a further 29% are not sure. 30% of casino workers have taken time off work because of a health problem they believe was caused by exposure to other people s tobacco smoke whilst at work. Casino workers report higher levels of sensory irritation symptoms than California bar workers (before the California smoking legislation). 59% of casino workers who currently smoke at work believe that if no one was allowed to smoke in the casino they would try to quit smoking. 2 Introduction The debate about smoking in the workplace often focuses on workers in pubs and bars. However, casino workers are also frequently exposed to other people s tobacco smoke at work. Casino workers work long shifts, in environments that often have little or no natural or artificial ventilation. Smoking is a common activity amongst customers, so levels of smoke are high in casino environments. We wanted to give casino workers the chance to join the debate on smoking in the workplace. This is particularly important, as, given that casinos are

4 private members clubs, they may not become smoke-free under the proposed smoking legislation. The University of the West of England led the survey, with support from both the GMB and T&G trade unions. We conducted a postal survey between February and May 2005 that targeted all casino workers in London who are members of either the GMB or T&G trade unions. The survey was restricted to union members because the major casino companies declined to participate in the study, meaning access could only be gained to unionised workers. At the time of the survey, 1568 workers were union members (representing around 50% of the total London casino workforce). Two mailings were conducted, to maximise the response rate. 3 Characteristics of respondents Of the 1568 casino workers targeted, 557 responded to the survey after two mailings, representing a response rate of 36%. Just over half of respondents were male (298, 54%), which compares to a 60% male union membership. Mean length of employment in casinos was 17 years, with an average of 48 hours worked per week. The majority of respondents worked on the gaming floor (470, 84%), while other areas of work included the reception (22, 4%) and restaurant areas (16, 3%). 22% (n=125) of respondents were current cigarette smokers, while 39% (n=216) had never smoked. 12% (n=64) of respondents had degree level qualifications, while the highest level of qualification obtained by the majority was GCSE A-C equivalent (160, 29%). Ages of respondents followed a normal distribution, with the majority being between the ages of Do casino workers want more restrictive smoking policies? Smoking appears to be widespread in casinos, as 94% (n=520) of respondents indicate that customers can smoke in most or all areas of their casino (i.e. staff working areas). In comparison, most workers reveal that they can only smoke in designated smoking rooms or areas (531, 96%). 92% (n=513) report that there are separate smoking and non-smoking staff rest areas in their casino, although 5% (n=29) say that all staff rest areas are smoking at all times. The majority of workers want to see a ban on smoking in all customer / working areas (361, 65%), with 31% (n=171) of workers preferring to have a mixture of smoking and non-smoking customer areas (see chart overleaf).

5 Never-smokers are more likely to want to see a total ban in customer areas, with smokers tending to favour a mixture of smoking and non-smoking customer areas (see chart overleaf).

6 However, although smokers are less supportive of a total ban, 40% (n=49) of current smokers do want a total ban in customer areas. Significantly, only 1% (n=7) of all respondents want smoking to be allowed in all customer areas (the current policy in most casinos). The majority of respondents want to have separate smoking and non-smoking staff rest areas (349, 63%). This reflects the current policy in most casinos. However 34% (n=189) do want smoking banned in all staff rest areas (see chart overleaf).

7 Again, there are differences in attitudes by smoking status. Current cigarette smokers are more likely to favour separate smoking and non-smoking staff rest areas (97, 78%) compared to never smokers (128, 50%). Never smokers are more likely to favour banning smoking in all staff rest areas (86, 40%) compared to current smokers (22, 18%). 5 How much tobacco smoke are casino workers exposed to? Casino workers were asked to estimate the frequency and intensity of their exposure to other people s tobacco smoke whilst at work (see charts overleaf).

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9 In their own view, the majority of casino workers are exposed to other people s tobacco smoke nearly all the time (459, 83%), while most rate the intensity of their exposure as heavy (414, 75%). 6 Are casino workers bothered by exposure to tobacco smoke? 78% (n=435) of respondents say that they mind if people smoke near them at work, while an additional 10% (n=56) say that it depends (usually on whether customers deliberately blow smoke in their face). Never smokers and exsmokers are more likely to mind (see chart below), but more than half (65, 53%) of current smokers say that they mind people smoking near them at work. The most popular reasons given for why casino workers mind people smoking near them at work is because it is bad for their health (430, 88%), makes their clothes smell (417, 86%), has an unpleasant smell (410, 84%), gets in their eyes (400, 82%), makes them cough (319, 66%), and affects their breathing (260, 53%). The negative view held towards exposure to other people s tobacco smoke is again highlighted in that 91% (n=506) of workers have at some time wanted to

10 move away from where they are working because of exposure to other people s tobacco smoke. Indeed, a majority of smokers, never smokers and ex-smokers have ever wanted to move away (see chart below). A significant proportion of workers have taken action regarding tobacco smoke. 54% (n=273) of workers have raised the issue of exposure to other people s tobacco smoke with their manager, 42% (n=183) with their health and safety representative, and 40% (n=175) with their trade union representative. It is concerning that only 10% of respondents (n=57) can definitely say that their employer has conducted a health and safety risk assessment on them. And of those, only 25% (n=14) can remember that their risk assessment did ask about exposure to other people s tobacco smoke. 7 Do casino workers feel their health has been affected by exposure to other people s tobacco smoke at work? The survey did not aim to directly link ill-health with exposure to other people s tobacco smoke. However, general health and self-reported prevalence of health conditions known to be exacerbated by exposure to other people s tobacco smoke was investigated.

11 Respondents were asked directly whether they thought they have suffered health problems as a result of exposure to other people s tobacco smoke at work. 57% (n=315) of respondents believe that they had suffered health problems, while 29% (n=161) aren t sure (see chart below). Current smokers are less likely to believe that they have suffered health problems (45, 36%) compared with never smokers (141, 65%) and exsmokers (129, 60%). Casino workers appear to be in worse health than the general population, as 22% (n=125) say their health in the past year is not good, compared to the UK average of 9% (taken from the 2001 Census). Self-reported sensory irritation symptoms amongst the casino workers were compared to those found in a study of California bar workers (the study took place before smoking was banned in Californian bars). The same questions were used in each workforce. Number of workers reporting sensory irritation symptoms in the past 4 weeks Sensory irritation symptoms London casino workers California bar workers* Eyes red or irritated 370 (71%) 22 (42%) Runny nose, sneezing or nose irritation 431 (80.9%) 32 (60%) Sore or scratchy throat 368 (69.3%) 13 (25%) * Eisner M et al. Bartenders' Respiratory Health After Establishment of Smoke-Free Bars and Taverns. JAMA. 1998; 280:

12 Casino workers appear to suffer more from sensory irritation symptoms. This could be because they are exposed for longer periods of time and to high levels of pollutants in indoor environments that have little natural or artificial ventilation. However the California sample was small, so caution should be used when comparing the two populations. Within casino workers, never smokers were most likely to report sensory irritation symptoms. The casino workers were also asked about another group of symptoms linked to exposure to other people s tobacco smoke; respiratory symptoms. Again, self-reported prevalence amongst casino workers were compared to the California bar workers. Number of workers reporting respiratory symptoms in the past 4 weeks Respiratory symptoms London casino workers California bar workers* Wheezing or whistling in the chest 213 (40%) 17 (32%) Short of breath 260 (49.1%) 10 (19%) Usually cough first thing in the morning 194 (36.9%) 28 (53%) Cough at all during the rest of the day or night 338 (63.8%) 26 (49%) Bring up any phlegm 246 (46.2%) 28 (53%) * Eisner M et al. Bartenders' Respiratory Health After Establishment of Smoke-Free Bars and Taverns. JAMA. 1998; 280: Casino workers have higher reported prevalence of all respiratory symptoms except coughing first thing in the morning and bringing up phlegm. 30% (n= 165) of respondents say they had taken time off because of a health problem they associated with exposure to other people s tobacco smoke (see chart overleaf). Never-smokers are more likely to report being off sick because of other people s tobacco smoke (84, 39%), while current smokers are the least likely (19, 15%).

13 The most frequent health problem (thought to be caused by exposure to other people s tobacco smoke) resulting in absence from work is throat problems (108, 66%), followed by respiratory / breathing problems (105, 64%). 8 Do smokers believe that smoking restrictions would alter their behaviour? Smokers do feel that there is a relationship between their smoking habits and exposure to other people s tobacco smoke at work (see chart overleaf).

14 77% (n=95) of current cigarette smokers either agree or agree strongly that exposure to other people s tobacco smoke in the workplace makes it harder for smokers to quit smoking. 89% (n=111) of smokers who responded to the survey smoke in the workplace, with the majority smoking in rest areas during breaks (101, 91%). These smokers were asked how they thought their smoking behaviour would change if they could not smoke at work (see charts overleaf). 53% (n=58) say they would try to quit smoking, with 25% (n=27) saying they would cut down. If no one (customers or staff) were allowed to smoke at work those who think they would try and quit rises to 59% (n=65).

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16 9 Comments from casino workers The survey gave casino workers the opportunity to comment openly on the issue of exposure to other people s tobacco smoke in the workplace. A number of workers say that customers deliberately blow smoke in their face, especially when they are losing in a game. Some quotes are given below. I have been reported to a director of my company by a customer because I objected to her blowing smoke in my face. It would be considered a very bad career move to suggest to a punter to refrain from smoking. If a dealer shows any sign of the dislike of smoke the punter will then go out of his/her way to make this discomfort even more They use it as a weapon when they lose, they blow smoke into your face. Punters blow cigar smoke at you when losing. Some customers purposefully blow smoke into the dealer s face, which is downright rude and grossly unpleasant. It is rude in the extreme to smoke at another person's face - this is common in my workplace. Another concerning issue is that some casino companies now seem to ask employees to sign a declaration that they are happy to work in a smoky environment. This is probably a reaction to the growing threat of legal action for health problems caused by exposure to other people s tobacco smoke at work. Some quotes are below. Absolute disgrace that the management at Gala casinos are trying to force existing staff and making new staff sign new contracts that state I hereby agree to work in a smoky atmosphere. This is terrible and must be stopped! The casino has already taken steps they are making new staff sign a clause in their contract that in the event of a smoke related illness they are not to sue the company. Smoking kills there are no two ways about it.

17 Casino owners approach to this problem is to incorporate additions into staff terms and conditions such as you must be prepared to work in smoky atmospheres These are just two of the issues that came out of the open comments. Many other quotes referred to the health problems workers believe have been caused by exposure to other people s tobacco smoke in casinos. 10 Strengths and weaknesses of the study This study has a number of strengths. It has provided the first opportunity for casino workers in London to join the debate on smoking in the workplace. The questionnaire used in the survey was developed carefully over a period of twelve months, with special emphasis given to ensuring that questions were valid. Existing validated questions were used where available - including a number of questions from the ONS survey on smoking attitudes and behaviour. Questions created especially for the survey were piloted to ensure validity. Two mailings, along with a number of reminders, ensured a good response rate of 36%, equating to nearly 600 people. The survey does however have some limitations. Only union members could be targeted by the survey, and it may be that unionised casino workers somehow differ from workers who have not joined a union. Unfortunately data does not exist to assess whether important differences do exist. There may be some underrepresentation of smokers, as 22% of respondents were current smokers, which is slightly lower than the national figure of 23% (reported in the ONS survey of smoking-related behaviour and attitudes, 2004). However without knowing the true prevalence of smoking amongst London casino workers we cannot tell for sure. The questionnaires were anonymous, because of concerns amongst casino workers and unions about workers being identified by their employer. While we believe this helped to increase the response rate, it did mean that we did not know who had responded to the first mailing. Therefore all workers received a second copy of the questionnaire in the second mailing, and could potentially have responded twice. However, through a matching analysis using Work History / Demographic data (age, sex, number of years working in casinos etc) in the questionnaires returned we identified only one likely duplicate responder who was excluded from the analysis. We feel it unlikely that an individual would have returned two questionnaires and deliberately altered their demographic data (thereby evading detection as a duplicate responder), although this is possible. 11 Conclusions This is one of the first pieces of research to give a voice to those who are most exposed to other people s tobacco smoke at work and at risk of not benefiting from current legislative proposals.

18 The majority of the casino workers who responded are bothered by exposure to other people s tobacco smoke at work, and many are concerned about the potential health impacts. The majority of casino workers would support a comprehensive ban on smoking in all working areas. The findings suggest that there are substantial health risks associated with exposure to other people s tobacco smoke in casinos. There appears to be important economic impacts of exposure to other people s tobacco smoke in casinos, arising through time off work. Many smokers anticipate quitting or cutting down on smoking if a comprehensive smoking ban in casinos is introduced. The findings emphasise the scope for health and economic benefits of a comprehensive ban on smoking in casinos. 12 Recommendations We believe that, given the findings in this survey, all working (customer) areas in casinos should become smoke-free. Provisions for continued smoking in staff rest areas should be considered, but each casino must have a smoke-free staff rest area that is both totally separate from any smoking rest area and also equivalent in terms of size and facilities.

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