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

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