Effects of a multi-behavioral health promotion program at worksite on smoking patterns and quit behavior

Sociodemographic factors, health behavior, parental or workplace smoking, and adult asthma risk in the United States

BACKGROUND

Although several studies have found a link between parental or workplace smoking and asthma risk, particularly in children and adolescents, only a few studies have found this link in adults.

OBJECTIVE

This study aimed to investigate the associations of sociodemographic factors, health behavior, and parental or workplace smoking with adult asthma risk in the United States (US).

METHODS

A secondary data analysis on 874 participants aged 25-45 was performed using data from the 2011-2014 National Survey of Midlife Development in the United States Refresher. Participants were divided into smokers and nonsmokers. Participants were further divided into groups A (a father or mother with a smoking history) and B (others in the house or colleagues in the workplace who had a smoking history).

RESULTS

Findings from the FREQ procedure revealed that sociodemographic (female, black, school or college education, unmarried/divorced, and employed) and lifestyle (no alcohol intake, physically inactive, and obese) and clinical (diabetes and joint disease) factors were significantly associated with one- or more-fold odds of asthma among adult smokers than nonsmokers. Adult smokers in group A, particularly females, those with a high school or college education, physically inactive, and overweight or obese, had a higher risk of asthma than those in group B.

CONCLUSION

Adult smokers' risk of developing asthma is increased in the US by having smoked with their parents, being a woman, being black, having a school or college education, being single or divorced, working, not drinking alcohol, being physically inactive, being obese, having diabetes, and having a joint disease.

Association between School Achievement and Tobacco Susceptibility among US Adolescents: Ethnic Differences

BACKGROUND

Although risky behaviors such as educational problems and tobacco use tend to co-occur, these associations may vary across diverse ethnic groups, in part because ethnic minorities tend to reside in worse neighborhoods and tend to attend worse schools than Non-Latino White adolescents.

AIM

To compare the association between baseline school achievement (student grades) and subsequent tobacco use susceptibility (openness to smoke in future) by ethnicity, we compared African American, Latino, and Non-Latino White adolescents in the US over a four-year period.

METHODS

This longitudinal study followed 3636 adolescents who were never smokers at baseline for a period of four years. Baseline and four-year data of the Population Assessment of Tobacco and Health (PATH) study were used for this analysis. All participants were 12 to 17 years old at baseline and were either Non-Latino White (Majority), African American (Minority), or Latino (Minority). The outcome was a tobacco use susceptibility score at wave 4 which was defined as openness to use tobacco in the future, measured at year four. The predictor was school achievement at wave 1, measured as grades from F to A+. The moderator was ethnicity (African American, Latino, Non-Latino White), and covariates were age, gender, parental education, and family structure.

RESULTS

Our linear regressions in the pooled sample showed an inverse association between baseline school achievement and subsequent tobacco use susceptibility four years later. However, this inverse association was weaker for ethnic minorities than for Non-Latino White adolescents, as documented by interaction effects between ethnic minority status and baseline school grades.

CONCLUSION

Higher educational success better correlates with lower tobacco use susceptibility of non-Latino White than African American and Latino adolescents, which may reflect some tobacco use susceptibility of Latino and African American adolescents with highly educated parents. Future research should investigate how social context such as high-risk school environment, neighborhood risk, peer risk, and other mechanisms increase behavioral risk of educationally successful African American and Latino adolescents.

Comparison of Motivational Short Interventions to Improve Smokers' Health Behavior (The COSMOS Study): A Pragmatic Cluster-Randomized Two-Arm Trial in General Practice

INTRODUCTION

Helping smokers to quit is an important task of general practitioners (GPs). However, achieving tobacco abstinence is difficult, and smokers who fail may still want to improve their health in other ways. Therefore, Swiss GPs developed a multithematic coaching concept that encourages health behavior changes beyond smoking cessation alone.

AIMS AND METHODS

To compare the effectiveness of such coaching with state-of-the-art smoking cessation counseling, we conducted a pragmatic cluster-randomized two-arm trial with 56 GPs in German-speaking Switzerland and 149 of their cigarette smoking patients. GPs were instructed in either multithematic health coaching or smoking cessation counseling. After 12 months, we compared their patients' improvements in cigarette consumption, body weight, physical inactivity, alcohol consumption, stress, unhealthy diet, and a health behavior of their own choice, using hierarchical logistic regression models and Fisher's exact and t tests.

RESULTS

Over 95% of all participants achieved clinically relevant improvements in at least one health behavior, with no difference between study arms (health coaching vs. smoking cessation counseling: aOR = 1.21, 95% CI = [0.03-50.76]; and aOR = 1.78, 95% CI = [0.51-6.25] after non-responder imputation). Rates of clinically relevant improvements in the individual health behaviors did not differ between study arms either (they were most frequent in physical activity, achieved by 3 out of 4 patients), nor did the extent of the improvements.

CONCLUSIONS

Multithematic health coaching and state-of-the art smoking cessation counseling were found to be comparable interventions, both in terms of smoking cessation success and, quite unexpectedly, their effects on other health behaviors.

IMPLICATIONS

The findings of our study suggest that in general practice, multithematic health coaching is an effective smoking cessation intervention, and conversely, monothematic smoking cessation counseling also achieves the beneficial effects of a multithematic health behavior intervention. This opens up the possibility for GPs to support their smoking patients in improving their health behavior in additional and more flexible ways.

Exploring Multilevel Workplace Tobacco Control Interventions: A Scoping Review

BACKGROUND

The workplace provides a unique opportunity to intervene on tobacco use, by implementing multilevel interventions engaging diverse employees. Using the social ecological model (SEM), this scoping review aimed to synthesize descriptions of multilevel workplace tobacco control programs to create a health equity informed framework for intervention planning.

METHODS

Multiple databases were searched for articles published from January 2010 to December 2020 meeting inclusion criteria (i.e., discussed multilevel tobacco cessation interventions that intervene, target, or incorporate two or more levels of influence, and one of the levels must be the workplace). Articles were screened by two independent researchers and included if they discussed multilevel tobacco cessation interventions that intervened, targeted, or incorporated two or more levels of influence. To integrate the extracted information into the SEM, we utilized the McLeroy et al. model and definitions to describe potential multilevel interventions and their determinants.

RESULTS

Nine articles were included in this review. No studies intervened across all five levels (individual, interpersonal, institutional, community, and policy), and the most common levels of intervention were individual (e.g., individual counseling), interpersonal (e.g., group therapy), and institutional (e.g., interventions during work hours). Participation rates varied by key social determinants of health (SDOHs) such as age, gender, education and income. Barriers including cost and sustainability influenced successful implementation, while leadership endorsement and accessibility facilitated successful implementation.

DISCUSSION/APPLICATION TO PRACTICE

Multilevel interventions targeting at least two SEM levels may reduce persistent health inequities if they address how SDOHs influence individual health behaviors. Employee characteristics impacted the success of tobacco cessation interventions, but more research is needed to understand the barriers and facilitators related to workplace characteristics.

Unique Barriers to Workplace Health Promotion Programs (WHP) by Wage Category: A Qualitative Assessment of Secondary Data

PURPOSE

To understand barriers around accessing or using workplace health promotion (WHP) programs among workers in different wage categories.

APPROACH

We conducted qualitative analysis of responses to three open-ended questions about WHP program participation, collected as part of an existing WHP program evaluation.

SETTING

A large mid-western university.

PARTICIPANTS

Of the 20,000 employees emailed an online survey, 3,212 responded (16.1%). The sample was mostly female (75%), white (79%), and comprised of staff members (84%). The average age was 44 years and 67% had annual incomes <$75,001.

METHOD

We used NVivo-12 Plus and two coders to apply Grounded Theory on the open-ended questions and identify emergent themes.

RESULTS

Although most respondents were happy with the program, differences across wage categories emerged around time, financial incentives, commute, workload, and organizational policies/support. Employees at all wage levels were enthusiastic about creating a culture of health but needed different supports to do so. For instance, higher-wage workers needed to overcome self-made time constraints, while lower-wage workers needed supervisor support to overcome coverage constraints that prevented participation.

CONCLUSION

The unique participation challenges experienced by employees in different wage categories provide justification for WHP programs that can better accommodate the participation barriers of all employees. While some programs may simply require more flexible offerings, others may need to train supervisors to support and foster healthy environments.

Participation in a workplace smoking cessation program incentivized by lowering the cost of health care coverage: Findings from the LLUH BREATHE cohort

INTRODUCTION

Systematic analyses of workplace smoking cessation programs indicate that efficacy can be enhanced by using incentives. There is variation in the type of incentives used and their effect on participation and efficacy. The aim of our study was to examine whether lowering employee health plan costs (employee contributions, co-pays) encourage employee smokers to participate in workplace smoking cessation.

METHODS

We conducted a 2014-2015 prospective cohort study of 415 employee smokers of Loma Linda University Health (LLUH). The employees were offered participation in a workplace smoking cessation program (LLUH BREATHE Initiative) with the incentive of enrollment in an employer-provided health plan that had a 50% lower employee monthly contribution and co-payment relative to the employer-provided health plan for non-participants. Participation rates and variables associated with participation were analyzed.

RESULTS

In the LLUH BREATHE cohort, we found a very high rate of participation (72.7%; 95% CI: 69-77%) in workplace smoking cessation that was encouraged by a lower out-of-pocket health plan cost for the participating employee and/or spouse. Participation did, however, vary by gender and spouse, whereby female employee households with a qualifying smoker were more than two times more likely (employee: OR=2.89, 95% CI: 1.59-5.24; or spouse: OR=2.71, 95% CI: 1.47-5.00) to participate in smoking cessation than male employee households. The point prevalence, at four months, of abstinence from smoking among the participants was 48% (95% CI: 42-54%).

CONCLUSIONS

Our findings indicate that a workplace smoking cessation program that uses a novel reward-based incentive of lower out-of-pocket health plan costs results in a participation rate that is much higher than US norms.

Innovative call emerging from a qualitative study for workplace designated stop-smoking area

INTRODUCTION

Designated smoking areas (DSAs) have become a common feature of public places in various developed and developing countries that have ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). However, this situation is not in line with the WHO FCTC. In this context, this study was designed to explore the perception of stakeholders on the DSA prevailing in workplaces in Mauritius and to explore the feasibility of smoking cessation interventions in the workplace.

METHODS

A qualitative study using semi-structured, face-to-face interviews was conducted among the various stakeholders in tobacco control in Mauritius. Data collected were transcribed verbatim for analysis.

RESULTS

Three main themes emerged from this study: 1) a need for comprehensive smoke-free law, 2) a need for smoking cessation services, and 3) a need for stakeholders' involvement (local government, employers, and health professionals) in the promotion of tobacco cessation programs.

CONCLUSIONS

We make a call for a workplace Designated Stop Smoking Area (DSSA) in order to phase out existing DSAs. DSSAs will be a therapeutic means to divert smokers away from DSAs, in order to change their behaviour with respect to tobacco use. Group therapy, individual counselling, and tobacco treatment will be made accessible in these DSSAs, which with a touch of innovation can become a VIP lounge for stop-smoking services. This innovative call for DSSAs is meant to sensitize policy makers of developing countries on how to proceed for the elimination of DSAs.