Workplace Smoke-Free Policies and Cessation Programs

Nearly half a million Americans still die prematurely from tobacco use each year despite the fact that it is the single most preventable cause of disease, disability, and death in the U.S.^{1, 2}. So what can be done to prevent the toll of smoking in the U.S.? The workplace is an important setting for implementing tobacco control interventions. ^{3, 4} However, data on smoke-free workplace policies and cessation programs are limited. A new study from NIOSH researchers published in the American Journal of Preventive Medicine assessed smoke-free workplace policies and employer-offered cessation programs among U.S. workers, by industry and occupation. This information can help target public health efforts to reduce tobacco use.

Smoke-free policies in indoor public places significantly improve indoor air quality and reduce secondhand smoke exposure. These policies can also help change social norms regarding the acceptability of smoking. Smoke-free policies can prevent young people from starting to smoke and help smokers quit. They are also associated with reduced heart attack and asthma hospitalizations among nonsmokers.^2,3 The NIOSH research found that 80% of indoor workers reported having smoke-free policies at their workplace. By industry, 91% of those working in education services were covered by a 100% smoke-free policy. Those working in agriculture, forestry, fishing, and hunting reported the least coverage with only 64% of workers in those industries covered by a 100% smoke-free policy. Some workplaces offered partial smoke-free policies allowing some smoking in public or work areas. Just over 23% of workers in the mining industry reported coverage by partial smoke-free policies in the workplace.  Workers in the agriculture, forestry, fishing, and hunting industries and those in the farming, fishing, and forestry occupations were most likely to report no smoke-free policy in their workplace. By sociodemographic characteristics, those least likely to be covered by a 100% smoke-free policy were workers aged 18–24 years, male and Hispanic. Additionally, those with a high school education or less, an annual household income less than $35,000, and living in the South had less access to a 100% smoke-free workplace.

In addition to smoke-free policies, employer-sponsored smoking cessation programs such as individual and group counseling, self-help materials, and advice from a health professional are also beneficial. They can improve worker health, lower employees’ health insurance premiums, and help reduce employee tobacco use rates.^{3, 5,6,7} Participation in workplace smoking cessation interventions can increase quitting rates and decrease rates of smoking-related diseases.^5,7,8,9,10 NIOSH researchers found that 27% of indoor workers had smoking cessation programs offered by employers and the cessations programs were more common among indoor workers than outdoor workers. Additionally, the proportions of workers reporting cessation programs varied by sociodemographic characteristics and by industry and occupation. Workers reporting 100% smoke-free workplace policies were more likely to have access to employer-offered smoking cessation programs than those with partial or no policies.

These data combined with data on the tobacco use among workers can help tailor specific tobacco control efforts. During 2014–2015, 16% of working adults were current tobacco smokers. Outdoor workers were more likely to smoke than indoor workers. Among indoor workers, smoking prevalence was highest among males and those aged 18–24 years. Those from the Midwest, with a high school education or less, or an annual household income of less than $35,000 were also more likely to smoke. Additionally, workers in construction and extraction occupations and in food preparation and serving related occupations were more likely to smoke.

This information on smoking prevalence, smoke-free workplace policies, and smoking cessation programs offered by employers in specific industries and occupations can help public health professionals to target tobacco control efforts, especially among workers with the highest tobacco use prevalence. Please share with us any programs or strategies in your workplace to help prevent tobacco-related disease.

Girija Syamlal, MBBS, MPH, is an epidemiologist in the NIOSH Respiratory Health Division.

References

1. CDC Best practices for comprehensive tobacco control programs — 2014 HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA (2014)
2. HHSThe health consequences of smoking – 50 years of progress: a report of the Surgeon General HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA (2014)
3. RM Castellan, LC Chosewood, D Trout, et al.Current Intelligence Bulletin 67: Promoting health and preventing disease and injury through workplace tobacco policies HHS, CDC, NIOSH, Publication No. 2015–113, Morgantown, WV (2015) www.cdc.gov/niosh/docs/2015-113, Accessed 7th Mar 2018
4. CDC. Work place health promotion. Workplace health model. www.cdc.gov/workplacehealthpromotion/model/. Accessed March 7, 2018.
5. MT Halpern, R Dirani, JK Schmier Impacts of a smoking cessation benefit among employed populations. J Occup Med, 49 (1) (2007), pp. 11-21 https://doi.org/10.1097/JOM.0b013e31802db579
6. K Cahill, T Lancaster. Workplace interventions for smoking cessation. Cochrane Database Syst Rev (4) (2014), Article CD003440. https://doi.org/10.1002/14651858.CD003440.pub4
7. EM Barbeau, Y Li, P Calderon, et al. Results of a union-based smoking cessation intervention for apprentice iron workers (United States). Cancer Causes Control, 17 (1) (2006), pp. 53-61 https://doi.org/10.1007/s10552-005-0271-0
8. S Babb, A Malarcher, G Schauer, K Asman, A Jamal. Quitting smoking among adults — United States, 2000–2015. MMWR Morb Mortal Wkly Rep, 65 (52) (2017), pp. 1457-1464 https://doi.org/10.15585/mmwr.mm6552a1
9. MW Kreuter, RJ Wray Tailored and targeted health communication: strategies for enhancing information relevance. Am J Health Behav, 27 (suppl 3) (2003), pp. S227-S232 https://doi.org/10.5993/AJHB.27.1.s3.6
10. JR Strickland, N Smock, C Casey, T Poor, MW Kreuter, BA Evanoff. Development of targeted messages to promote smoking cessation among construction trade workers. Health Educ Res, 30 (1) (2015), pp. 107-120 https://doi.org/10.1093/her/cyu050