Workplace Smoking Policies and Programs

WORKPLACE SMOKING POLICIES AND PROGRAMS

Worksite smoking policies aim mainly to protect nonsmokers from environmental tobacco smoke (ETS), while the objective of worksite cessation programs is to help employees who do smoke (and sometimes their family members, too) give up the habit. Together, these two elements form a worksite tobacco-control program.

Worksite smoking policies began with an early concern for protection of equipment, such as computers, and for employee safety, such as those working around natural gas. Following the 1986 Surgeon General's Report on the Health Consequences of Involuntary Smoking, the rate of adoption of restrictive smoking policies increased. With the classification of ETS as a "Group A" carcinogen by the Environmental Protection Agency in 1993, it became a major risk and liability issue for worksites.

In 1999, 79 percent of worksites with fifty or more employees were smoke-free, or limited smoking to separately ventilated areas, a large increase from 27 percent in 1985. All occupational groups are not equally protected, however. In a 1992–1993 national survey, blue-collar and service workers, who have higher smoking rates than that of the total population, reported a percentage of smoke-free worksites well below the national average.

Policies that ban smoking are more effective than restrictive policies, as they reduce exposure to ETS for all employees. In addition, such policies may influence smokers to cut down or quit, are easier to implement and enforce, and decrease maintenance costs.

A secondary effect of restrictive smoking policies is their impact on employee smoking behavior. There is consistent evidence that restrictive policies lead to a reduction of cigarettes smoked at work (a median reduction of 3.4 per day in one review article). The evidence that these policies influence smoking employees to quit, however, is inconclusive. Researchers have estimated that smoke-free workplaces are currently responsible for a 2 percent decrease in cigarette consumption in the United States (a decrease of 9.7 billion cigarettes), and that if all worksites were smoke-free, a 4.1 percent decrease (20.9 billion cigarettes) would occur.

In 1992, 40 percent of worksites with fifty or more employees offered smoking cessation programs. The rationale for corporate sponsorship of smoke cessation programs has been to decrease health care demand and to reduce health care costs, as smokers have been shown to have higher than average health care costs, and to increase productivity, as smoking has been associated with absenteeism and reduced productivity. A recent economic analysis, using current data for the background quit rate, participation and cessation rates of programs, absenteeism, on-the-job productivity, employee turnover rates, and the health effects of smoking, showed an average positive cost-benefit ratio of 1.75 five years after a program began, and increasing to 8.89 after twenty-five years.

A review of studies evaluating the effectiveness of smoking cessation programs between 1968 and 1994 found median quit rates for cessation groups to be 23 percent, while those for minimal treatment programs were 10.1 percent. Competitions and incentives were found to boost cessation rates, although how much was unclear due to methodological flaws. Comprehensive programming that included smoking was successful in reducing smoking in twelve of nineteen studies reviewed. A meta-analysis of long-term (over twelve months) cessation rates from twenty controlled cessation trials at worksites found a weighted average quit rate of 13 percent, with higher rates from longer interventions, those that used employee time as well as work time, and those in smaller worksites.

The worksite provides a unique opportunity to create interventions for the total population of smoking employees. However, most cessation programs attract only those smokers who are motivated both to quit and to use the particular format of the program. Thus, participation rates are low. Better marketing and tailoring of programs would increase participation. Of particular importance is the tailoring of programs to different stages of change. Many smokers have no intention to quit or are merely thinking about it; these employees require a different intervention, one that emphasizes the benefits of quitting and decreases the perceived positive outcomes of smoking and negative outcomes of quitting. Media communication, through employee newsletters, for example, is a good format for this and can be part of a comprehensive cessation intervention that reaches smokers at all stages of change.

To augment worksite programming, corporate health-insurance benefits should include nicotine replacement therapy and other recommended pharmacotherapy, and programs should be coordinated with managed-care providers' offerings of tobacco assessment and counseling. Internally, physical activity, nutrition, and stress management programs will assist smokers to quit and to stay abstinent.

NELL H. GOTTLIEB

(SEE ALSO: Absenteeism; Addiction and Habituation; Environmental Tobacco Smoke; Occupational Safety and Health; Smoking Behavior; Smoking Cessation; Smoking: Indoor Restrictions; Tobacco Control)

BIBLIOGRAPHY

Association for Worksite Health Promotion, U.S. Department of Health and Human Services, and William M. Mercer, Inc. (2000). 1999 National Worksite Health Promotion Survey. Northbrook, IL: Association for Worksite Health Promotion.

Brownson, R. C.; Eriksen, M. P.; Davis, R. M.; and Warner, K. E. (1997). "Environmental Tobacco Smoke: Health Effects and Policies to Reduce Exposure." Annual Review Public Health 18:163–165.

Centers for Disease Control and Prevention, Office on Smoking and Health; Wellness Council of America; and American Cancer Society (1997). Making Your Workplace Smokefree. A Decision Maker's Guide. Atlanta, GA: Author. Available at http://www.cdc.gov/tobacco/research_data/environmental/etsguide.htm.

Centers for Disease Control and Prevention (1997). Chronology: Significant Developments Related to Smoking and Health 1964–1996. Available at http://www.cdc.gov/tobacco/chron96.htm.

Chapman, S.; Borland, R.; Scollo, M.; Brownson, R. C.; Dominello, A.; and Woodward, S. (1999). "The Impact of Smoke-Free Workplaces on Declining Cigarette Consumption in Australia and the United States." American Journal of Public Health 89:1018–1023.

Eriksen, M. P., and Gottlieb, N. H. (1998). "A Review of the Health Impact of Smoking Control at the Workplace." American Journal of Health Promotion 13(2):83–104.

Fiore, M. D.; Bailey, W. C.; Cohen, S. J. et al. (2000). Treating Tobacco Use and Dependence: A Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.

Fisher, E. J.; Glasgow, R. E.; and Terborg, J. R. (1990). "Worksite Smoking Cessation: A Meta-analysis of Long-Term Quit Rates from Controlled Studies." Journal of Occupational Medicine 32(5):429–439.

Gerlach, K. K.; Shopland, D. R.; Hartman, A. M.; Gibson, J. T.; and Pechacek, T. F. (1997). "Workplace Smoking Policies in the United States: Results from a National Survey of More Than 100,000 Workers." Tobacco Control 6:199–206.

Gottlieb, N. H. (2001). "Tobacco Control and Cessation." In Health Promotion in the Worksite, 3rd edition, ed. M. P. O'Donnell. Albany, NY: Delmar Publishers.

Heaney, C. A., and Goetzel, R. Z. (1997). "A Review of Health-Related Outcomes of Multi-component Worksite Health Promotion Programs." American Journal Health Promotion 11(4):290–308.

Nelson, D. E.; Emont, S. L.; Brackbill, R. M.; Cameron, L. L.; Peddicord, J.; and Fiore, M. C. (1994). "Cigarette Smoking Prevalence by Occupation in the United States. A Comparison between 1978–1980 and 1987–1990." Journal of Occupational Medicine 36(5): 516–525.

Prochaska, J. O.; Redding, C. A.; and Evers, K. E. (1997). "The Transtheoretical Model and Stages of Change." In Health Behavior and Health Education: Theory, Research, and Practice, 2nd edition, eds. K. Glanz, F. M. Lewis, and B. K. Rimer. San Francisco: Jossey-Bass.

U.S. Department of Health and Human Services (1986). The Health Consequences of Involuntary Smoking. A Report of the Surgeon General. Washington, DC: U.S. Government Printing Office.

—— (1993). 1992 National Survey of Worksite Health Promotion Activities: Summary Report. Washington, DC: USDHHS, U.S. Public Health Service, Office of Disease Prevention and Health Promotion.

Warner, K. E.; Smith, R. J.; Smith, D. G.; and Fries, B. E. (1996). "Health and Economic Implications of a Work-Site Smoking Cessation Program: A Simulation Analysis." Journal of Occupational and Environmental Medicine 38(10):981–992.