Assessing Tobacco Use Policies in the Workplace

Carol A. Riker, RN, MSNAssociate Professor

riker@uky.edu

Kathy Begley, BAData Manager

kathy.begley@uky.edu

Ellen J. Hahn, DNS, RNProfessor

ejhahn00@email.uky.edu

www.mc.uky.edu/tobaccopolicy/

Kentucky Continues to be a National Leader in Adult

Cigarette Smoking

2007 estimates, Centers for Disease Control and Prevention, 2008

Most Kentuckians are Regularly Exposed to Secondhand Smoke at

Work and/or in Public PlacesMost (75%) do NOT smoke

cigarettes.

Exposed Not Exposed

70%

30%

Yet most (70%) ARE exposed to secondhand smoke.

25%

75%

Smokers Nonsmokers

Smoking on the Job

Smoking when combined with workplace chemicals and other toxic agents is particularly harmful.

Nonsmokers exposed to secondhand smoke on the job increase their heart disease and lung cancer risk by 20-30%.

Effects of Secondhand Smoke (SHS)

Those exposed to SHS, at work or at home, have an increased risk of developing asthma.

SHS contributes to the severity and exacerbation of existing asthma among adults.(Jaakkola, 2002)

SHS and Heart Disease Short term exposure (5 min.-2 hrs.)

can increase risk of heart attack and stroke.

Affects platelets, endothelium, and heart rate variability (narrowing of blood vessels and clot formation)

An estimated 46,000 U.S. cardiac deaths are attributed to secondhand smoke exposure each year (Surgeon General’s Report, 2006).

SHS and Lung Cancer There is a clear dose-response

relationship between duration of exposure to SHS and increased lung cancer risk in never smokers.

Those ever exposed to spousal SHS are 18% more likely to get lung cancer; those with long-term exposure are 23% more likely.

Reducing exposure to SHS results in decreased opportunities to smoke, thus reducing active smoking levels (Brennan, et al., 2004)

Stayner’s (2007) meta analysis showed a 24% increase in lung cancer risk among workers exposed to SHS (two-fold increase for those highly exposed).

Smoking in the Workplaceand Disparities

Significantly lower likelihood of smoke-free workplace policy protection among:

Young - <$50,000 annual income

Males - H.S. education or less

Non-whites - Everyday smokers Heavy laborers - Southern & Midwestern

workers

(Delnevo, Hrywna, & Lewis, 2004)

Smoking’s Adverse Impactsin the Workplace

Increased health care costs and disability Greater absenteeism Decrements in job performance Increased risk of injury Secondhand smoke exposure

(Osinubi & Slade, 2002)

Costs of Smoking in the Workplace

Smoking costs the U.S. $193 billion in direct health care costs and productivity losses each year (CDC, 2009). Productivity losses account for about $96.8 billion of the total costs (CDC, 2008).

Additional cost estimates in 2005 dollars Housekeeping and maintenance per 1000 sq. ft. of

assembly or warehouse space: $305-$441 Annual fire insurance losses per smoker: $11-15 Annual cost for “ventilation” per smoker: $84

(Javitz et al., 2006)

Benefits of a Smoke-free Workplace Totally smoke-free workplaces associated with

3.8% reduction in prevalence of smoking and 3.1 fewer cigarettes smoked per day per continuing smoker. (Fichtenberg & Glantz, 2002) Similar reductions would require the tax on a pack

to increase from $0.76 to $3.05 in the U.S. Smoke-free workplace policies about 9 times

more cost-effective per smoker than free NRT programs (Ong & Glantz, 2005)

Bauer et al. (2005) found that those working in environments with S-F policies were 2.3 times more likely to quit than those not working in such environments.

Worksite Smoke-free Policies Help Smokers Quit

Smoke-free environments help smokers quit or cut back(Osinubi & Slade, 2002)

The Ventilation Lie No feasible ventilation system can reduce SHS

exposure to safe levels Simply separating smokers and nonsmokers is

not effective The current indoor air standard set by ASHRAE

assumes no smoking

Average Fine Air Particle Pollution in One Louisville Venue with a Smoking and Non-Smoking Area, 2006

181 178

0

50

100

150

200

250

300

350

Smoking Area Non-Smoking Area

PM2.

5 ug

/m3

The National Ambient Air Quality Standard (NAAQS) for PM2.5 is 35 µg/m3 for 24 hours

Tobacco Policy in Kentucky Manufacturing Facilities, 2002-2008

Percent0 20 40 60 80 100

Reimburse for NRT/Meds

Offer Cessation Resources

Ban Indoor Smoking

Have Written Smoking policies

2002200420062008

Smoking Policies in ALL Worksites in Kentucky, 2008

Over half (70%) of ALL worksites were smoke-free in Kentucky, similar to worksites nationwide (ALA,2006)

Workplace Tobacco Policy Interview: Purpose

To collect workplace policy data for planning and monitoring change over time

To lay the groundwork for helping manufacturers with tobacco policy change

To recruit partners for your tobacco prevention and cessation coalition

Elements of the Workplace Tobacco Policy Interview, 2010

Presence of a WRITTEN policy How the policy is communicated Where and when employees are allowed to smoke How the policy is enforced How violators are handled Existence of cessation resources

Workplace Tobacco Policy Interviews: Methods in a Nutshell

Recruit Human Resource Managers Record all contact attempts on Disposition

Sheets Phone Interview with Human Resource

Manager &/or Other Administrative Personnel Use online form to submit data Email Kathy once you have completed data

collection and we will send you a mailer for returning all paperwork to UK

Follow-up with interested manufacturers

Conduct the Phone Interview Get complete information…ask

clarifying questions if needed. If person being interviewed is

uncertain about an answer, complete the interview and ask them to get the information and call them back.

You may need to talk with more than one person to get the correct information!

Wait until AFTER the interview to discuss issues or follow-up desired by the company.

Averting Refusals If hesitant to participate:

“You sound busy….when is a more convenient time to call?”

“There are no right or wrong answers. We are just interested in what you are doing, so that we can be more effective in planning our health programs.”

“The information will be kept confidential. The information will be summarized by health department service area, not by individual manufacturer.”

Proper Phone Etiquette Find the most convenient time Be sensitive to time constraints Be polite Use nonjudgmental approach

Human Subjects Protections

Voluntary participation Minimize barriers to participation Understanding the benefits of participation Right to withdraw or refuse to answer Confidentiality

No names or addresses of the interviewees on the actual interview form!

Submitting Forms Onlinewww.mc.uky.edu/tobaccopolicy

Go to Data Collection Forms and enter your log in information (case-sensitive). To get a log in ID and password, you must first complete the 2010 Workplace Policy Training. Be sure to mark yourself as complete. We will check the course roster regularly and email passwords to individuals who have completed the training. If you have not received your log in credentials, email Kathy at kathy.begley@uky.edu.

Click on 2010 Workplace Tobacco Policy Study.

Submitting Forms Onlinewww.mc.uky.edu/tobaccopolicy

Click on your county(ies) to print out the list(s) of Manufacturers.

Print and complete a disposition sheet (available online) for each manufacturer to keep track of each contact attempt. The disposition sheet is a fillable PDF. If more than one person will be conducting interviews, you should create and distribute a disposition sheet for each manufacturer first to prevent duplicating interviews.

Select 2010 Workplace Tobacco Policy Interview Guide: Online version.

Submitting Forms Onlinewww.mc.uky.edu/tobaccopolicy

Click on the circles to answer and type in specifications.

Type any additional comments in the space provided at the end.

Most of the front page info and “Time Interview Ended” are required to submit the survey.

Pay attention to SKIP patterns.

Check over the entire form before clicking “submit” to double-check that all questions are answered. If you have used the “other” field, make sure you check the “other” box.

If you collect the information on paper and then submit online, send the paper forms to UK in the mailer provided.

If you submit online as you conduct the interview, your disposition sheets are the only thing you’ll send.

Submitting Forms Onlinewww.mc.uky.edu/tobaccopolicy

When ALL Interviews are Complete

When all interviews are completed, mail all disposition sheets and any interview forms you have written on to UK in the mailer.

Keep a copy of the MANUFACTURER LIST for future contacts…make notes about which manufacturers are interested in more information.

Do not keep copies of the interview forms. Shred any extra copies of the interview

form.

If you are training a helper to conduct interviews…

Train them using this PowerPoint located on the Workplace Policy page on our website (www.mc.uky/tobaccpolicy). The Workplace training video conference will be archived on KY TRAIN, so helpers can access this training.

Emphasize the Human Subject Protections. Access our website and show them how to submit

data online (or print forms for faxing). SUPERVISE their initial interview. Continuously monitor their progress

to ensure that they are following protocol.

Follow-Up Contacts with the Manufacturing Facilities

Send thank you letters. Gather materials on workplace tobacco policy

or other info requested. Send information packets with cover letter. Follow up with phone contact. Involve coalition partners.

Linking Data to Policy Change Share data with coalition and manufacturers. Present data at interested worksites. Use data as a media opportunity, if appropriate.

Meet with media leaders. Identify local newsletter/neighborhood bulletins for

a summary of the results. Specify and evaluate targets using baseline data.

Manufacturers Expressing Interest in Changing Policy

Although most manufacturers were satisfied with their current policy in 2008, 19.2% expressed interest in changing policy and 52.6% were interested in effective cessation programs.

The opportunity exists to motivate and help with voluntary policy change that can then promote community readiness for a smoke-free ordinance campaign.

Find your friends!

How to Frame the Issue with Manufacturing Facilities

Health effects of SHS justify smoke-free policy Other good reasons include:

Cuts cleaning and maintenance costs Improves employee morale Provides an incentive to stop smoking Providing cessation resources demonstrates

the manufacturer’s commitment to employees Reinforcement of non-smoking norm helps the

community by increasing public awareness of the dangers of smoking (Evans, 1999).

Model Workplace Tobacco Policy

Rationale for Policy (Effects of SHS) Types of Tobacco Product Covered When and Where Tobacco Allowed How Policy is Communicated How Violators are Handled What Department Provides Cessation Resources To Whom it Applies

Employer Action Steps (CDC, 2003)

1. Plan your approach Designate key staff person to study, plan

and propose the policy Communicate SHS info to influential

personnel from key areas (smokers and non-smokers)

Consult with union, if applicable Take a sympathetic approach to smokers

and offer cessation help Focus on Secondhand Smoke (SHS), not

smokers

Employer Action Steps

2. Gather facts and information on: SHS Ventilation science Costs and consequences (business,

health, liability) Benefits of going smoke free Support for smokers, including cessation

resources and insurance coverage for cessation

Model Policy

Employer Action Steps

3. Assess readiness Conduct survey to help tailor efforts and

plan education, policy and enforcement mechanisms.

4. Educate Take into account organizational

readiness and level of knowledge.

Employer Action Steps5. Implement the plan

Complete implementation is key; incomplete implementation leads to confusion.

Give four weeks notice. Emphasize protection of employee’s health. Distribute the complete policy, with a letter

from the CEO. Post signs at all entrances and stairwells. Conduct awareness programs and distribute

materials clearly describing all procedures.

Employer Action Steps

6. Enforce the policy Be fair and equitable. Give all new employees written information

on the policy to read and sign.

Manufacturers with Unions

Unions are interested in meeting the needs of all employees (smokers, non-smokers, and those who want to quit).

Target both the manufacturers and their unions for assessment of policy and discussion of policy options.

Unions as Potential Partners

Unions are potential partners, as evidenced by the strong advocacy of flight attendants in making airline travel smoke-free. (Pan et al., 2005)

Sorensen et al (2000) national phone survey of local union leaders found 48% of local unions supported smoke-free worksite policies or smoking restrictions.

Visit American Nonsmokers’ Rights Foundation for helpful information on how to partner with unions: http://www.no-smoke.org/pdf/Smokefree_Air_is_a_Union_Issue.pdf.

Workplace Cessation

Tiede et al. (2007) interviewed 22 small business employers, conducted focus groups with 59 smokers and found:

Despite barriers, both employers and employees thought it desirable to promote cessation resources to those wanting to quit

Both groups were unaware of cessation resources available through health plans or in the community.

Workplace Cessation

Moher, Hey, & Lancaster (2003) systematic review of workplace interventions showed: Strong evidence that programs directed

toward individuals (group therapy, individual counseling, & NRT) increased likelihood of quitting. Self-help less effective.

Limited evidence that participation can be increased by competitions and incentives

Consistent evidence that workplace policies & bans decrease smoking during the day and decrease exposure to ETS

Workplace Cessation

Simple, generalizable intervention (N=217) resulted in 20.2% continuous abstinence (CO confirmed) at 12 mos. compared to 8.7% in control group using intent to treat analysis Nicotine patches for 3 months Adapted to smokers’ tobacco dependence

(minimal structured counseling at 1st visit – 5 to 8 minutes)

3 sessions to reinforce abstinence (2-3 minutes)

(Rodriguez-Artalejo et al., 2003)

Workplace Cessation Couple cessation messages with safety

messages Sorensen et al (2003) found smoking quit

rates among blue-collar workers comparable to those of white-collar workers at worksites integrating health promotion with occupational health and safety (avoiding occupational exposures).

Benefits of cessation Decreased rates of smoking-related

diseases Total savings (lower health care and

workplace costs) exceeded costs of the benefit in 4 years

Total savings per smoker: $350-$582 @ 10 yrs and $1152-$1743 at 20 years

(Halpern ,Dirani, & Schmier, 2007)

Other Factors in Work Environment High job demands associated with higher

frequency of smoking and increased likelihood of cessation

Resources at work and social support positively associated with cessation negatively associated with relapse and

amount smoked Combine workplace environment change with

health promotion interventions.

(Albertsen, Borg, & Oldenburg, 2006)

Helpful Websites http://www.cdc.gov/tobacco/secondhand_smoke/wor

kplace_guide.htm http://www.no-smoke.org/pdf/modelworkplacepolicy.p

df (2 pages)

http://www.cancer.org/docroot/PED/content/PED_10_2X_Smoking_In_The_Workplace.asp?sitearea=PED (3 pages)

http://endsmoking.org/resources/employersguide/pdf/employersguide-2nd-edition.pdf

http://www.no-smoke.org/pdf/Smokefree_Air_is_a_Union_Issue.pdf

References Albertsen K, Borg V, Oldenburg B. A systematic

review of the impact of work environment on smoking cessation, relapse and amount smoked. PrevMed. 2006 Oct;43(4):291-305.

Bauer JE, Hyland A, Li Q, Steger C, Cummings KM. A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use. AJPH 2005 Jun;95(6): 1024-9.

CDC, State Specific prevalence trends in adult cigarette smoking, US 1998- 2007. MMWR 2009;58 (09) 221-226.

References

Delnevo CD, Hrywna M, Lewis MJ. Predictors of smoke-free workplaces by employee characteristics: who is left unprotected? AmJIndMed.2004 Aug; 46(2): 196-202.

Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ; 2002 Jul 27; 325(7357):188

Halpern MT, Dirani R, Schmier JK. Impacts of a smoking cessation benefit among employed populations. JOccupEnvironMed; 2007 Jan;49(1):11-21.

Javitz HS, Zbikowski SM, Swan GE, Jack LM (2006). Financial burden of tobacco use: an employer’s perspective. Clinics in Occupational and Environmental Medicine. 2006;5(1):9-29.

References

Moher M, Hey K, Lancaster T. Workplace interventions for smoking cessation. CochraneDatabaseSystRev. 2003;(2):CD003440.

Ong MK, Glantz, SA. Building capacity and evaluating strategies. Free nicotine replacement therapy programs vs implementing smoke-free workplaces: a cost –effectiveness comparison. AJPH 2005 Jun;95(6):969-75.

Osinubi OYO, Slade J. Tobacco in the workplace. OccupMedStateArtRev 2002 Jan-Mar;17(1):137-58.

References

Pan J, Balbach ED, Barbeau EM, Levenstein C. Government, politics, and law. Smoke-free airlines and the role of organized labor: a case study. AJPH 2005 Mar;95(3):398-404.

Rodriguez-Artalejo JI, Foj-Aleman M, Banegas JR. One year effectiveness of an individualised smoking cessation intervention at the workplace: a randomised controlled trial. OccupEnvironMed. 2003 May; 60(5);358-63.

References

Sorensen G, Stoddard AM, LaMontagne AD, Emmons K, Hunt MK, Youngstrom R, McLellan D, Christiani DC. A comprehensive worksite cancer prevention intervention: behavior change results from a randomized controlled trial. JPublicHealthPolicy. 2003;24(1):5-25

Sorensen G, Stoddard AM, Youngstrom R, Emmons K, Barbeau E, Khorasanizadeh F, Levenstein C. Local labor unions’ positions on worksite tobacco control. AJPH 2000 Apr;90(4):618-20.

Stayner L, Bena J, Sasco AJ, Smith R, Steenland K, Kreuzer M, Straif K. Lung cancer risk and workplace exposure to environmental tobacco smoke. AJPH 2007 Mar;97(3):545-51

References

Tiede LP, Hennrikus DJ, Cohen BB, Hilgers DL, Madsen R, Lando HA. Feasibility of promoting smoking cessation in small worksites: an exploratory study. NicTobRes 2007 Jan; 9 Suppl 1:S83-90.

US Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General – Executive Summary. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.