***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT The association between environmental tobacco smoke ( ETS ) exposure and respiratory symptoms has not been well established in adults . OBJECTIVE To study the respiratory health of bartenders before and after legislative prohibition of smoking in all bars and taverns by the state of California . DESIGN Cohort of bartenders interviewed before and after smoking prohibition . SETTING AND PARTICIPANTS Bartenders at a r and om sample of bars and taverns in San Francisco . MAIN OUTCOME MEASURES Interviews assessed respiratory symptoms , sensory irritation symptoms , ETS exposure , personal smoking , and recent upper respiratory tract infections . Spirometric assessment included forced expiratory volume in 1 second ( FEV1 ) and forced vital capacity ( FVC ) measurements . RESULTS Fifty-three of 67 eligible bartenders were interviewed . At baseline , all 53 bartenders reported workplace ETS exposure . After the smoking ban , self-reported ETS exposure at work declined from a median of 28 to 2 hours per week ( P<.001 ) . Thirty-nine bartenders ( 74 % ) initially reported respiratory symptoms . Of those symptomatic at baseline , 23 ( 59 % ) no longer had symptoms at follow-up ( P<.001 ) . Forty-one bartenders ( 77 % ) initially reported sensory irritation symptoms . At follow-up , 32 ( 78 % ) of these subjects had resolution of symptoms ( P<.001 ) . After prohibition of workplace smoking , we observed improvement in mean FVC ( 0.189 L ; 95 % confidence interval [ CI ] , 0.082 - 0.296 L ; 4.2 % change ) and , to a lesser extent , mean FEV1 ( 0.039 L ; 95 % CI , -0.030 to 0.107 L ; 1.2 % change ) . Complete cessation of workplace ETS exposure ( compared with continued exposure ) was associated with improved mean FVC ( 0.287 L ; 95 % CI , 0.088 - 0.486 ; 6.8 % change ) and mean FEV1 ( 0.142 L ; 95 % CI , 0.020 - 0.264 L ; 4.5 % change ) , after controlling for personal smoking and recent upper respiratory tract infections . CONCLUSION Establishment of smoke-free bars and taverns was associated with a rapid improvement of respiratory health Smoking and health are increasingly understood to be incompatible . To evaluate , prospect ively and retrospectively , the attitudes of employees , staff physicians , and patients of a medical institution , a question naire was administered before and after implementation of a no-smoking policy . Of many questions , select ones review ed here focused on the following concerns : ( 1 ) how tobacco smoke affects  employees and patients , ( 2 ) employee acceptance of a no-smoking policy before and after its implementation , and ( 3 ) the consequences of the policy on employee smokers .  Open-ended questions about smoking were constructed by a committee comprised of clinicians , investigators , and administrators . The question naire was given to 2,000 r and omly selected patients and the institution 's entire staff of 4,200 employees and 225 staff physicians . Data were obtained on three occasions : six months before , six months after , and one year after the implementation of the no-smoking policy . The majority of patients , employees , and physicians indicated that the smoke of others bothered them and ranked the following as most offensive : smell , eye irritation , provocation of sinus problems , coughing , and headache . Approximately 80 percent of employees and patients favored the policy before its inception ; and employees increasingly favored it through the year after its implementation with a favorable attitude increasing by nearly 10 percentage points . One year after implementation , 80 percent of patients were in favor of the policy . In the final survey , 74 percent of respondents indicated the policy had helped them . One year after policy implementation , employee smoking was reduced significantly from 22 to 14 percent ; and of those employees who continued to smoke , 81 percent smoked less than eight cigarettes per day . ( ABSTRACT TRUNCATED AT 250 WORDS In view of the fact that the impact of statewide smoking laws on private worksite policies and the smoking behavior of employees has not been evaluated , two cross-sectional surveys were performed in Vermont to measure compliance with such a law : a r and om-digit telephone survey  of employees and a subsequent  mail  survey of their employers . Employers were not aware that one of their employees had been surveyed . Roughly half ( 56 percent ) of the employees and 66.5 percent of their employers described policies that are in compliance . Among all employers who described policies in compliance with the law , 68.1 percent of their employees also described compliant policies . Among all employees who described non-compliant policies , 48.8 percent had employers who described compliant policies . Overall , employees and employers agreed on how their policies stood with respect to compliance in 67.6 percent of cases . The prevalence and amount of smoking at work declined after the institution of the law but so did the prevalence and amount of smoking at home . Changes toward more restrictive policies were associated with reductions in cigarette consumption at work , but not with quitting . The study suggests that a large fraction of worksite smoking policies may not comply with a statewide worksite smoking law . The proportion of companies complying with such a law may be overestimated if information on compliance is obtained only from employers BACKGROUND AND OBJECTIVES To examine the long term impact of workplace smoking bans on  employee smoking cessation and relapse .  Over three years we studied a total of 1033 current or former smokers ( intervention group ) employed in smoke-free hospitals and 816 current or former smokers ( comparison group ) employed in non-smoke-free workplaces . The design of this natural experiment is a prospect i ve cohort study . We r and omly selected both hospitals and employees from 12 strata based on hospital size and state tobacco regulations , and sample d employees in the same communities . Main outcome measures were post-ban quit ratio and relapse rate . RESEARCH DESIGN Between groups comparisons were conducted using the Cochran-Mantel-Haenszel statistic for general association , stratified Cox proportional hazards models , and the CMH analysis of variance statistic based on ranks . McNemar 's test and the sign test were used to test for changes over time within each group . RESULTS Differences in the post-ban quit ratio were observed between intervention and comparison groups ( p ⩽ 0.02 ) . For employees whose bans were implemented at least seven years before survey , the post-ban quit ratio was estimated at 0.256 , compared with 0.142 for employees in non-smoke-free workplaces ( p = 0.02 ) . After controlling for a variety of factors , time to quit smoking was shorter for the hospital employees ( p < 0.001 ) , with an overall relative risk of quitting of 2.3 . Contrary to expectations , relapse rates were similar between the groups . CONCLUSION Employees in workplaces with smoking bans have higher rates of smoking cessation than employees where smoking is permitted , but relapse is similar between these two groups of employees . The results of this investigation have international applicability for policy makers , clinicians , employers , and employees . Countries should review smoking policies in workplaces in light of their own smoking patterns and efforts to deal with environmental tobacco smoke STUDY OBJECTIVE : The aim of this study was to evaluate the impact of a smoke free programme implemented at the University of Geneva , Switzerl and , in 1996 . This programme included a prohibition to smoke in university buildings everywhere except in limited areas , and a smoking cessation counselling service . METHODS : Surveys were conducted before and four months after the programme was implemented , in representative sample s of programme participants ( n = 833 ) and university members not exposed to the programme ( n = 1023 ) . RESULTS : In retrospective assessment s , participants reported being less bothered by environmental tobacco smoke after programme implementation , but no between group difference was detected in prospect i ve assessment s. Relationships between smokers and non-smokers improved moderately in the intervention group and remained unchanged in the comparison group ( between group p = 0.001 ) . Proportions of smokers who attempted to quit smoking in the past four months increased from 2.0 % to 3.8 % in the intervention group and remained unchanged at 3.5 % in the comparison group ( between group difference : p = 0.048 ) . No impact on smoking prevalence ( 25 % ) was detected . The programme was appreciated by university members , although some of its modalities were criticised . CONCLUSION : A regulation prohibiting smoking everywhere but in limited areas of university buildings was acceptable and reduced the perception of bother by environmental tobacco smoke . It did not , however , influence smoking habits or attitudes toward smoking Purpose . To determine the prevalence of tobacco use among Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry ( ATSDR ) employees and the effect of the smoke-free policy on smoking behavior and air quality at work . Design . A stratified telephone survey of 1181 CDC/ATSDR employees r and omly selected from employee rosters . Setting . CDC/ATSDR work sites in Atlanta , Georgia , and other major CDC locations throughout the United States and Puerto Rico . Subjects . R and omly selected employees of CDC/ATSDR1 , or about 22 % of the total CDC/ATSDR population ; 98 % of eligible persons selected agreed to participate . Measures . Demographic and smoking history variables , attitudes toward and impact of the  smoke-free policy  on smoking behavior , and self-report changes in air quality were the measures used . Results . Overall cigarette smoking prevalence was only 11.1 % . One percent reported using chewing tobacco , 1.1 % reported smoking a pipe , and 1.4 % reported smoking cigars . Average self-reported , daily cigarette comsumption significantly decreased after the smoking ban took effect . Overall , 90 % of the employees supported the smoke-free policy , and 80 % of the employees believed that smokers were complying with the smoke-free policy . Most employees believed that the air quality of work areas and nonwork areas ( 65 % and 69 % , respectively ) had improved since the smoke-free policy was implemented . Conclusions . These findings are consistent with previous evaluations of smoke-free policies and suggest that most employees are generally supportive of workplace smoking restrictions . Such policies can also have a positive impact on smoking behavior and perceived air quality BACKGROUND This study reports the barriers and challenges for hospital tobacco control efforts after the institution of  smoke-free policies . METHODS Surveys of employees and in patients of five hospitals in Augusta , Georgia , were conducted and evaluated 4 months after joint  hospital implementation of smoke-free policies . A r and om sample of 1997 employees and a convenience sample of 517 in patients returned usable surveys . RESULTS Although attitudes to the hospital bans on smoking reflected strong support for smoke-free policies , four out of five hospitals reported significant implementation problems . Despite the bans , 49 % of patients who were smokers continued to smoke while hospitalized , and almost one half of all hospitalized smokers had received no advice to quit smoking from a physician or a nurse since admission . Employees and patients both agreed that the smoke-free policies had benefited employees more than patients . CONCLUSIONS Despite achieving a smoke-free status , there are many challenges that remain for comprehensive hospital tobacco-control efforts . Hospitals and health care professionals must remain particularly alert and attentive to the needs of patients and employees still addicted to tobacco OBJECTIVES This study evaluated the biological and subjective consequences observed in individual smokers after implementation of a workplace smoking-restriction policy .  METHODS Employees were evaluated for 4 weeks before and 4 weeks after their workplace became smoke-free ( n = 34 ) . A comparison group of smokers whose work-site smoking was unrestricted served as controls ( n = 33 ) . Daily exposure to tobacco constituents and withdrawal effects were measured . RESULTS Smokers at the restricted site had verified smoking reduction ( mean = four cigarettes per day ) and significantly reduced nicotine and carbon monoxide during the work shift . There were increases in ratings of some common withdrawal symptoms ( cravings/urges , concentration difficulties , increased eating , depression ) . No evidence of compensatory smoking during nonwork hours was found . Overall tobacco exposure , as measured in saliva cotinine , showed a nonsignificant 15 % decline . CONCLUSIONS Workplace smoking restriction markedly altered smoking patterns ( i.e. , reduced daytime smoking ) and reduced cotinine levels to an amount consistent with cigarette reduction . Thus , work-site smoking restriction may promote meaningful , albeit limited , reductions in tobacco exposure and consequent health risks OBJECTIVE To determine the effectiveness of laws restricting youth access to cigarettes on  prevalence of smoking among teens .  METHODS We conducted a systematic review of studies that reported changes in smoking associated with the presence of restrictions on the ability of teens to purchase cigarettes . We calculated the correlation between merchant compliance levels with youth access laws and prevalence ( 30-day and regular ) prevalence of youth smoking , and between changes in compliance and prevalence associated with youth access interventions . We also conducted a r and om effects meta- analysis to determine the change in youth prevalence associated with youth access interventions from studies that included control communities .  RESULTS Based on data from 9 studies , there was no detectable relationship between the level of merchant compliance and 30-day ( r = .116 ; n = 38 communities ) or regular ( r = .017 ) smoking prevalence . There was no evidence of a threshold effect . There was no evidence that an increase 
    Output:
    
Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking , they also encourage smokers to quit or to reduce consumption