Objectives To compare exposure to secondhand smoke and respiratory health in bar staff in the Republic of Ireland and Northern Ireland before and after the introduction of legislation for smoke-free workplaces in the Republic. Design Comparisons before and after the legislation in intervention and control regions. Setting Public houses in three areas in the Republic (intervention) and one area in Northern Ireland (control). Participants 329 bar staff enrolled in baseline survey; 249 (76%) followed up one year later. Of these, 158 were non-smokers both at baseline and follow-up. Main outcome measures Salivary cotinine concentration, self reported exposure to secondhand smoke, and respiratory and sensory irritation symptoms. Results In bar staff in the Republic who did not themselves smoke, salivary cotinine concentrations dropped by 80% after the smoke-free law (from median 29.0 nmol/l (95% confidence interval 18.2 to 43.2 nmol/l)) to 5.1 nmol/l (2.8 to 13.1 nmol/l) in contrast with a 20% decline in Northern Ireland over the same period (from median 25.3 nmol/l (10.4 to 59.2 nmol/l) to 20.4 nmol/l (13.2 to 33.8 nmol/l)). Changes in self reported exposure to secondhand smoke were consistent with the changes in cotinine concentrations. Reporting any respiratory symptom declined significantly in the Republic (down 16.7%, −26.1% to −7.3%) but not in Northern Ireland (0% difference, −32.7% to 32.7%). After adjustment for confounding, respiratory symptoms declined significantly more in the Republic than in Northern Ireland and the decline in cotinine concentration was twice as great. Conclusion The smoke-free law in the Republic of Ireland protects non-smoking bar workers from exposure to secondhand smoke.

A growing body of literature is documenting the health effects of racial discrimination. The authors investigated the association between racial discrimination and alcohol-related behavior in a sample of urban transit operators. Using data from a 1993-1995 cross-sectional study of transit operators in San Francisco, California, the authors analyzed responses to two sets of questions about racial discrimination; the first set focused on reaction to unfair treatment and the second on arenas, or domains, of discrimination. Alcohol-related variables were: number of drinks per month, heavy drinking, alcohol dependence, and negative consequences of alcohol consumption. Operators who reported five or more domains of discrimination drank an average of 13.4 more drinks per month than those who reported no domains of discrimination (P = 0.01). Similarly, they were more likely to be heavy drinkers (adjusted odds ratio [OR] = 2.16; 95% confidence interval [CI] 1.14, 4.09) and dependent on alcohol (adjusted OR = 2.02; 95% CI 1.08, 3.79) than operators who reported no domains of discrimination. The number of domains in which operators reported having experienced discrimination was not related to sex, age, household income, job seniority, or marital status, but varied significantly by educational level and race/ethnicity. Data from a sample of urban transit operators showed an association between the number of domains of discrimination and some alcohol-related outcomes, but not others.

Objective: To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing. Methods: Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible. Results: We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type “Job and task modifications” and a moderate level of evidence for the types “Flexible work and scheduling” and “Changes in the physical work environment”. For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed. Conclusion: Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.

The demand/control/support and effort/reward imbalance models have relied on self-reported methods to describe how poor psychosocial working conditions lead to harmful health outcomes. The hindrance/utilization model uses an observational methodology to assess these relationships. Cross-sectional observational and self-reported data from 98 civil servants participating in the Whitehall II Study of British civil servants were used to test whether work conditions measured by each of the three theoretical models explained a significant amount of the variance in depression and anxiety symptoms. Observational measures were also used to assess potential common methods variance bias between the self-reported job conditions and the outcomes. Results showed that the demand/control/support model explained the most variance in depression and anxiety symptoms and the associations were not wholly due to common methods variance. Moreover, measures associated with job resources (e.g., skill discretion, social support and skill utilization) had a protective effect on depression and anxiety symptoms. Exertion-related conditions (e.g., demands, effort, over commitment) were not consistently associated with depression or anxiety symptoms.