Worksite tobacco control programs: the role of occupational health

[Health risk behaviors by occupation in working population in Spain]

OBJECTIVE

This study aims to analyze the variations in the prevalence of different health risk behaviors according to occupation in working population in Spain.

METHOD

Cross-sectional study with data from the Spanish National Health Survey of 2017. The analysis includes adults between 18 and 65 years with employment at the time of the survey. Health risk behaviors are obesity, physical inactivity in free time, tobacco consumption and excessive alcohol consumption. The primary explanatory variable is the occupation, using the National Classification of Occupations of 2011. Sociodemographic characteristics are gender, age, country of birth and educational level. The prevalences (P) of risk behaviors have been calculated, as well as the odd and adjusted odds ratios (aOR).

RESULTS

The highest figures of obesity are observed in operators of installations and machinery and assemblers (P: 20.0%; ORa: 1.26; A95%CI: 1.04-1.52). The higher level of physical inactivity during free time appears in elementary occupations (P: 83.4%; ORa: 1.70; A95%CI: 1.45-1.99). Tobacco consumption is higher in operators of installations and machinery and assemblies (P: 37.4%; ORa: 1.22; A95%CI: 1.05-1.43). Excessive alcohol consumption appears to a greater extent on skilled workers in the agricultural sector, livestock, forestry and fisheries (P: 3.9%; ORa: 1.51; A95%CI: 0.83-2.75).

CONCLUSIONS

The results indicate a greater relationship between risk behaviors for health and manual or lower-skilled occupations.

The Effects of Smoke-Free Workplace Policies on Individual Smoking Behaviors in China

OBJECTIVE

Studies have shown that smoke-free (SF) workplace policies can create an SF environment, but most of them have focused only on reducing secondhand smoke (SHS) exposure or changing smoking behavior. Our study aims to explore the effects of SF workplace policies and the pathway between workplace SF policies and SHS exposure.

METHOD

14 195 employees from 79 companies in China participated in this survey. Binary logistic regression is used to examine the direct effects of SF workplace policies. Structured Equation Modeling approach is used to test other indirect effects. The Sobel test is used to estimate the mediation effect.

RESULTS

Working in a company with SF policies was associated with lower SHS exposure (odds ratio = 0.56; 95% confidence interval = 0.51 to 0.60). Such policy were associated with lower smoking prevalence (Coef. = -0.05, p < .05) and positively associated with smoking harm awareness (Coef. = 0.07, p < .05) and SHS harm awareness (Coef. = 0.05, p < .05). Sobel test suggests that approximately 16.3% of the effects on SHS exposure reduction are mediated through the channel of lower smoking prevalence for males. For smokers, we did not identify a direct effect of such policies on quitting intentions, but a significant indirect effect via increased smoking harm awareness (Coef. = 0.07, p < .05) and lower smoking consumption (Coef. = -0.10, p < .05) were found.

CONCLUSION

This study finds that SF workplace policies are not only associated with lower SHS exposure but also related to some indirect effects. Further mediation analyses for males confirmed that the effect on SHS exposure reduction is mediated through the channel of lower smoking prevalence.

IMPLICATIONS

This study joins the debate in recent years on the effects of workplace SF policies and provides evidence with more comprehensive data from Asia Best Workplace Mainland China program. It shows that SF workplace policies not only can reduce SHS exposure but also are associated with lower smoking prevalence, fewer cigarettes smoked, and higher smoking harm-related awareness. These findings provide valuable evidence to promote such policies in all workplaces and underline the need for more stringent SF policies to be enacted in all countries.

Integrating Worksite Smoking Cessation Services Into the Construction Sector: Opportunities and Challenges

Background. Smoking prevalence among Hispanic/Latino construction workers in the United States is very high (31%). Aims. To investigate tobacco use profiles in these minority workers and explore their management's views about implementing sustainable worksite smoking cessation services. Methods. Analysis of baseline data from a smoking cessation trial among Hispanic/Latino construction workers (n = 134; adult men ≥18 years), and semistructured, 45-minute interviews with 24 key personnel at six construction companies in south Florida were conducted. Interviews were recorded, transcribed, and analyzed thematically. Results. Overall, 43.3% of workers were Cuban, and 81.3% had low acculturation level. Nicotine dependence levels were "high" in 61.8% of workers. Half of the workers had a successful quit attempt but only 9.9% received advice from a physician to quit smoking, 16.7% used medication to quit, and 79.2% did not receive assistance. Participants in the interviews stated that nothing was provided to help smokers quit smoking and considered distributing self-help materials with free medications as the most appropriate service. Challenges to integrating the service were time restriction and cost. Recommendations for implementing the service were local/state government mandate. Discussion. Tailoring tobacco treatment to Hispanic/Latino construction workers' job circumstances and culture is essential to support their cessation efforts. Integrating worksite tobacco treatment services into other available health promotion programs (e.g., safety) and enforcing smoke-free legislation in the construction sector can facilitate its adoption. Conclusion. Involving key stakeholders and mandating the service by the State and local government are necessary to integrate sustainable worksite smoking cessation services in the construction sector.

Clustering of chronic disease risk factors with tobacco smoking habits among adults in the work place in Sousse, Tunisia

Introduction

The aim of our study was to explore the major non-communicable risk factors (unhealthy diet, sedentarily, alcohol consumption) of smokers and nonsmokers in workplaces.

Methods

A cross-sectional study was derived from an initial assessment in workplaces which was part of a community-based intervention to prevent chronic disease risk factors conducted in 2009 in the region of Sousse, Tunisia. The surveyed subjects were employees in six factories spread across three delegations in the region. Overall, 1770 of 2250 employees participated in the assessment. In this study, the clustering of non-communicable diseases risk factors with smoking habits was made only for male employees including in this study 1099 among 2250. Data were collected at worksites by a questionnaire, via interview or self-report. The main items assessed socio-demographics characteristics, smoking status, eating habits, level of physical activity and alcohol use of the participants.

Results

The percentage of male smokers was 54.0%(n=594). Their average age of daily smoking initiation was 19.22 (±4.24 years). The percentage of male smokers consuming 5 fruits and vegetables per day was significantly lower than nonsmokers (57.2% vs 63.5%, p=0.04). The proportion of male smokers consuming alcohol was about three times that of nonsmokers (16.5% vs 5.8%, p=0.001). The proportion of male employees who agree with anti-smoking laws in work places was higher for nonsmokers than for smokers.

Conclusion

A strong association existed between smoking and risky lifestyles factors in the work place. Such findings are potentially useful in directing intervention efforts regarding smoking cessation in occupational settings.

Process Evaluation of an Integrated Health Promotion/Occupational Health Model in WellWorks-2

Disparities in chronic disease risk by occupation call for newapproaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.

Early Success Is Vital in Minimal Worksite Wellness Interventions at Small Worksites

INTERVENTION

In an effort to increase physical activity, 15 workplaces participated in a minimal-contact 10,000-steps-a-day program sponsored by the Sedgwick County Health Department in 2007 and 2008. Pedometers were provided to measure participants' weekly steps for the 10-week intervention.

METHOD

Participants were defined as those who completed the preregistration survey and logged at least 1 week of results. Registrants were defined as those who completed a registration survey but did not log any weekly results. The primary dependent variable was whether or not participants achieved weekly success, as measured by achieving at least 70,000 steps in a week. A secondary dependent variable was participants' number of steps each week during the weeks they logged results. Repeated measures logistic regression analysis was conducted to identify factors associated with weekly success.

RESULTS

Of the 2,515 registrants, 1,292 (51%) were participants. The average number of weeks of participation for this 10-week intervention was 5.6 weeks (SD = 3.4). Those from small employers (n < 750) were more likely (OR = 2.0) than those from large organizations (n > 750) to become participants. Participants who achieved at least 70,000 steps in the first week of the intervention were 7.3 times more likely than participants who walked less than 70,000 steps in the first week to achieve 70,000 steps each week for all 10 weeks.

CONCLUSIONS

Results from implementing a minimal-contact 10,000-step intervention can be maximized by targeting small worksites and supporting employees to achieve 70,000 steps in their first week.

Occupational variations in obesity, smoking, heavy drinking, and non-adherence to physical activity recommendations: findings from the 2010 National Health Interview Survey

BACKGROUND

Understanding occupational variations in health risks is necessary to identify high risk groups. We examined the recent prevalence of obesity, heavy alcohol consumption, smoking, and leisure time physical activity (PA) across occupations.

METHODS

Data from the 2010 National Health Interview Survey were used. Analysis was limited to adults, 18 and older who had a job or business the week before the interview (n = 14,754). Adjusted prevalences of outcomes across occupations were calculated using logistic regression.

RESULTS

The highest prevalence of obesity was within community and social services and morbid obesity was in computer and mathematical occupations. That of smoking was highest in healthcare support, heavy drinking in food preparation and serving related, and non-adherence to PA recommendations in the farming, fishing, and forestry occupations.

CONCLUSION

Important health risk factors vary across occupations. Worksite and public health interventions need to be designed and modified to address such occupational health disparities.

Occupational Factors and Smoking Cessation among Unionized Building Trades Workers

The purpose of this study was to estimate the contribution of occupational factors to smoking cessation among building trades workers. Longitudinal data came from the MassBUILT smoking cessation intervention study for unionized building trades workers. Multivariable logistic regression analyses were applied to identify the significant predictors of smoking cessation, which was defined as abstinence from smoking during the previous 7 days at the 1-month monitoring and prolonged abstinence for at least 6 months at the 6-month monitoring. Greater concern about exposure to occupational hazards was significantly associated with increased likelihood of smoking cessation at 1 month (odds ratio = 1.06; 95% confidence interval = 1.01–1.11). Additionally, smokers who had a more positive view of their unions had at least marginally increased likelihood of smoking cessation at 1 month. Furthermore, older age, higher levels of educational attainment and household income, and fewer cigarettes smoked per day were important covariates that predicted smoking cessation. Concerns about exposures to work hazards should be incorporated into comprehensive intervention approaches for building trades workers. Additionally, the findings emphasize that blue-collar workers with lower income and education levels and heavy smokers should be considered target groups for implementing cessation interventions.

Occupational status, work-site cessation programs and policies and menthol smoking on quitting behaviors of US smokers

AIM

This exploratory study sought to examine the relationships among occupational status, menthol smoking preference and employer-sponsored smoking cessation programs and policies on quitting behaviors.

DESIGN

Data for this cross-sectional study were obtained from the 2006 Tobacco Use Supplement to the Current Population Survey (TUS CPS), a large national survey representative of the civilian population, containing approximately 240,000 respondents. The total sample for the current study was 30,176.

MEASUREMENTS

The TUS CPS regularly collects data on cigarette prevalence, quitting behaviors, smoking history and consumption patterns. We performed a logistic regression with 'life-time quitting smoking for 1 day or longer because they were trying to quit' as outcome variable. Independent variables included type of occupation, employer-sponsored cessation programs and policies and menthol status.

FINDINGS

When controlling for occupational status and work-place policies, there were no differences for menthol versus non-menthol smokers on quitting behaviors [odds ratio (OR) = 0.98; 95% confidence interval (CI) = 0.83, 1.15]. Service workers were less likely to quit compared with white-collar workers (OR = 0.80; 95% CI = 0.69, 0.94), and those with no employer-sponsored cessation program were less likely to quit (OR = 0.70; 95% CI = 0.60, 0.83). White-collar workers, compared with blue-collar and service workers, were more likely to have a smoking policy in the work area (93% versus 86% versus 88%, respectively).

CONCLUSIONS

When occupational status and work-place smoking policies are controlled for, smokers of menthol cigarettes in the United States appear to have similar self-reported life-time rates of attempts to stop smoking to non-menthol smokers.

Non-smoking worksites in the residential construction sector: using an online forum to study perspectives and practices

Objectives

Blue-collar workers are a recognised priority for tobacco control. Construction workers have very high smoking rates and are difficult to study and reach with interventions promoting smoke-free workplaces and cessation. The objectives of this study were to explore the smoking-related social climate in the North American residential construction sector and to identify potential barriers and facilitators to creating smokefree worksites.

Methods

The data source used was a popular internet forum on home building. Participants included a broad and unselected population of employers, employees and freelance tradespersons working in residential construction. The forum archive contained 10 years of discourse on the subjects of smoking, workplace secondhand smoke and smoking restrictions on construction sites. Qualitative data analysis methods were used to describe major and minor discussion themes relevant to workplace smoking culture and policies in this sector.

Results

Participants described considerable tension between smoking and non-smoking tradespersons, but there was also much interpersonal support for cessation and support for non-smokers' rights. Employers and employees described efforts to make construction sites smoke free, and a movement towards preferential hiring of non-smoking tradespersons was discussed. Board participants wanted detailed scientific evidence on secondhand smoke exposure levels and risk thresholds, particularly in open-air workplaces.

Conclusions

Experience with success of smoking bans in other challenging workplaces can be applied to the construction sector. Potential movement of smokers out of the workforce represents a challenge for public health systems to ensure equitable access to cessation supports and services.

Partner smoking characteristics: Associations with smoking and quitting among blue-collar apprentices

BACKGROUND

Studies suggest that the social context of blue-collar workers contribute to their low smoking cessation rates. However, little is known on the effect of partner smoking and requests to quit on workers' cessation attempts.

METHODS

Using data from a longitudinal smoking cessation intervention, multivariable logistic regression models were constructed to investigate the association of partner smoking characteristics with cessation among blue-collar apprentices.

RESULTS

Smokers were more likely to have partners who smoke (OR 13.06; 95% CI 8.52-20.01). Partner's request to quit was associated with higher odds of smoking cessation at 1 month (OR 3.74; 95% CI 2.49-5.63) and 6 months (OR 1.90; 95% CI 1.06-3.41) post-intervention. Having a partner who smoked was associated with lower odds of smoking cessation at 1 month (OR 0.41; 95% CI 0.27-0.62), but not 6 months post-intervention.

CONCLUSIONS

Results suggest that smoking cessation interventions that include partner support might improve cessation among blue-collar smokers.

MassBuilt: effectiveness of an apprenticeship site-based smoking cessation intervention for unionized building trades workers

Objective

Blue-collar workers are difficult to reach and less likely to successfully quit smoking. The objective of this study was to test a training site-based smoking cessation intervention.

Methods

This study is a randomized-controlled trial of a smoking cessation intervention that integrated occupational health concerns and was delivered in collaboration with unions to apprentices at 10 sites (n = 1,213). We evaluated smoking cessation at 1 and 6 months post-intervention.

Results

The baseline prevalence of smoking was 41%. We observed significantly higher quit rates in the intervention versus control group (26% vs. 16.8%; p = 0.014) 1 month after the intervention. However, the effects diminished over time so that the difference in quit rate was not significant at 6 month post-intervention (9% vs. 7.2%; p = 0.48). Intervention group members nevertheless reported a significant decrease in smoking intensity (OR = 3.13; 95% CI: 1.55–6.31) at 6 months post-intervention, compared to controls.

Conclusion

The study demonstrates the feasibility of delivering an intervention through union apprentice programs. Furthermore, the notably better 1-month quit rate results among intervention members and the greater decrease in smoking intensity among intervention members who continued to smoke underscore the need to develop strategies to help reduce relapse among blue-collar workers who quit smoking.

Tobacco-related practices and policies in residential perinatal drug treatment programs

Despite serious health consequences from high rates of smoking among perinatal women, smoking cessation and/or nicotine treatment practices have yet to be broadly adopted into perinatal substance abuse treatment settings. This correlational cross-sectional survey examined tobacco-related policies, practices, knowledge, and attitudes of 31 directors of perinatal residential substance abuse treatment programs in California. We found that the directors' programs had limited on-site adoption of evidence-based practices for smoking cessation, and that directors had gaps in their knowledge of perinatal tobacco effects. Implications for tobacco policy initiatives in perinatal substance abuse treatment are discussed.

The effectiveness of an education program on stages of smoking behavior for workers at a factory in Turkey

The aim of the study was to determine the smoking behavior based on "stages of change" model of the workers and to assess the effectiveness of a education program at a workplace. The first step was descriptive and the second step was an experimental study. The intervention group received an smoking cessation education. Before intervention 36% of the intervention group were at precontemplation stage. Six months after the intervention decline the percentage of those at precontemplation stage was significantly lower. In the control group there was not a significant reduction in the percentages of smokers at precontemplation stage before and after the intervention. After the 6 months the "maintenance" stage rates were 6% and 2% in the intervention and control groups, respectively. The study showed that the education in factory for workers could not be successful in quiting, however it impacted the intention and preparation of to quit in the future.

Results of a union-based smoking cessation intervention for apprentice iron workers (United States)

OBJECTIVE

Blue-collar workers are more likely to smoke, smoke more heavily, and have less success in quitting compared to white-collar workers, and this occupational gap is growing over time. Effective smoking cessation interventions among blue-collar workers are needed to address growing class-based disparities.

METHODS

We used a pre-post study design to test feasibility and effect size of a smoking cessation trial in a union apprenticeship training program for iron workers (n = 337). The 4-month intervention drew upon a health promotion-health protection model for smoking cessation among blue-collar workers. We conducted pairwise analyses to assess pre-post intervention differences in 7-day point prevalence smoking abstinence measured 1 month after intervention was completed. Additional secondary outcomes, including smoking frequency, intensity, intention and self-efficacy to quit, were also assessed.

RESULTS

Baseline smoking prevalence was 41%. We observed a 19.4% post-intervention quit rate among baseline smokers. There were statistically significant positive changes pre- and post-intervention in intention to quit smoking, self-efficacy to quit, and a reduction in the number of days smoked. Participation in pro-active intervention components was associated with a three-fold (OR = 3.0, 1.15, 7.83) increase in the likelihood of quitting. Overall, participation in intervention components was low.

CONCLUSIONS

Labor union apprenticeship programs represent a promising venue for smoking cessation interventions, particularly those that draw upon a health promotion-health protection model.

Parental occupation, education, and smoking as predictors of offspring tobacco use in adulthood: a longitudinal study

This study examined the interrelation of parental occupational status (blue- versus white-collar), parental education, parental smoking, parent-child relations, late adolescent tobacco use, and adult offspring smoking. A longitudinal data set was employed, composed of 603 participants who were first studied in childhood and then followed to mean age 27 years. Structural Equation Modeling (SEM) showed that the distal factors of parental blue-collar status, low parental educational achievement, and parental smoking were related to adult offspring smoking. Specifically, parental blue-collar status and parental smoking were mediated by the latent construct of the parent-child relationship, which in turn was mediated by smoking in late adolescence with respect to adult offspring smoking. Parental educational level was partially mediated by the parent-adolescent relationship but also had a direct path to adult offspring smoking. The most powerful predictor of offspring smoking in adulthood was smoking in late adolescence. Findings imply areas that may be targeted by intervention programs to decrease offspring tobacco use.

Reducing occupation-based disparities related to tobacco: roles for occupational health and organized labor

BACKGROUND

Persistent and growing occupation-based disparities related to tobacco pose a serious public health challenge. Tobacco exacts a disproportionate toll on individuals employed in working class occupations, due to higher prevalence of smoking and exposure to secondhand smoke among these workers compared to others.

METHODS

We provide an overview of recent advances that may help to reduce these disparities, including research findings on a successful social contextual intervention model that integrates smoking cessation and occupational health and safety, and a new national effort to link labor unions and tobacco control organizations around their shared interest in reducing tobacco's threat to workers' health.

CONCLUSIONS

Implications of these efforts for future research and action are discussed.

Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers

In the United States in 1997, the smoking prevalence among blue-collar workers was nearly double that among white-collar workers, underscoring the need for new approaches to reduce social disparities in tobacco use. These inequalities reflect larger structural forces that shape the social context of workers' lives. Drawing from a range of social and behavioral theories and lessons from social epidemiology, we articulate a social-contextual model for understanding ways in which socioeconomic position, particularly occupation, influences smoking patterns. We present applications of this model to worksite-based smoking cessation interventions among blue-collar workers and provide empirical support for this model. We also propose avenues for future research guided by this model.

A pilot study of telephone-based smoking cessation intervention in asbestos workers

Smoking markedly increases the risk of asbestos-related lung cancer. We conducted a randomized pilot trial of a telephone-based smoking cessation intervention in asbestos workers. Fifty-nine smokers were assigned to either a control or telephone-based smoking cessation treatment group and were followed-up at 6 months. Intent-to-treat analysis revealed a 16.7% quit rate at 6 months for the intervention group compared to 6.9% for the control group (P = 0.25). Treatment-received quit-rates were 33% for the intervention group and 6.9% for the control group (P = 0.05). The intervention group was twice as likely to use smoking cessation medicines and progressed further along the stage of change continuum compared with the control group. Incorporating telephone-based smoking cessation treatment into medical screening activities for asbestos workers is feasible and the intervention is effective in increasing quit rates at 6 months.