Worksite tobacco control programs: the role of occupational health
Introduction
In 1984, the National Institute for Occupational Safety and Health (NIOSH) concluded that simultaneous application of both health protection and health promotion would “make possible a ‘synergism of prevention’ to improve the health of workers through comprehensive risk reduction” (NIOSH, 1984). Health protection efforts are aimed at minimizing workers’ exposures to job-related risks, such as exposure to hazardous chemicals. Protection may be maximized through the use of product substitution, engineering controls, job re-design, and, as a supplemental measure, use of personal protective equipment – measures that are generally within the domain of management decisions rather than of individual worker actions. Individual behaviors are the target of health promotion, which aims to reduce risk-related behaviors such as use of tobacco. Worksites provide an important setting for educational efforts to reach large numbers of workers not accessible through other channels. Despite these differing aims, health protection and health promotion clearly share the common goal of promoting worker health, with complementary functions in protecting and enhancing the health of workers, and thereby provide an important opportunity for coordinated efforts (Robins and Klitzman, 1988, Sorensen et al., 1995).
Coordination between health protection and health promotion in the workplace has not been the norm in the United States, however. The two fields approach their objectives with differing assumptions, set differing priorities, and utilize different methods. Relationships may be strained by competition for resources in the face of scarce dollars devoted to worker health. The result has all too often been a fragmented approach to worker health (Sorensen et al., 1995, Baker et al., 1996). Nonetheless, there have been increasing calls for a comprehensive approach to worker health, based on multidisciplinary, integrated methods aimed at creating health-promoting workplaces (Robins and Klitzman, 1988, Walsh et al., 1991, DeJoy and Southern, 1992, Blewett and Shaw, 1995, Sorensen et al., 1995, Baker et al., 1996). Indeed, there are growing precedents for worksite programs that integrate efforts to reduce behavioral risks, including tobacco use, with health protection initiatives (Maes et al., 1998, Sorensen et al., 1998b).
The purpose of this paper is to present a model for worksite smoking cessation that is embedded in a comprehensive approach to worker health. In this paper, a comprehensive approach to worker health is defined as one which addresses multiple factors influencing worker health, including efforts to reduce exposures to workplace hazards, modify job factors to support healthy outcomes, and promote health-enhancing behaviors, including non-smoking. By definition, a comprehensive approach must target multiple levels of influence, including the levels of the work environment, the workplace organization, interpersonal supports, and the individual worker.
Section snippets
Worksite tobacco control programs
State-of-the-art tobacco control programs at the worksite focus on two levels of influence. At the individual level, worksite smoking cessation initiatives aim to help smokers quit smoking. At the level of the worksite environment, tobacco control policies serve the dual purpose of protecting non-smokers from the hazardous effects of environmental tobacco smoke, and promoting an environment supportive on non-smoking. Tobacco policies are a key component of an overall workplace tobacco control
Why integrate worksite tobacco control and occupational health and safety programs?
Worksite tobacco control initiatives face a crucial challenge: the growing occupational disparity in smoking prevalence. Blue-collar workers are more likely to be smokers than workers in white-collar jobs (Covey et al., 1992, Nelson et al., 1994). The smoking prevalence among blue-collar workers (including craftspersons and kindred workers, operatives, transportation operatives, and laborers) is 37% for men and 33% for women, compared to 21 and 20% for men and women, respectively, in
Promising worksite interventions promoting tobacco control: a comprehensive approach to promoting worker health within healthy worksites
Worker health is influenced by a range of workplace factors, including potential exposures to workplace hazards and job design factors, such as those contributing to job strain. Employers exert primary control over these workplace factors, and have the responsibility to provide a safe and healthy work environment. Worker health is also influenced by workers’ decisions about their health behaviors, including tobacco use. A comprehensive approach to worker health addresses these multiple factors
Intervening at the organizational level
To be effective, interventions at the organizational level must involve key stakeholders, including management, workers, and unions. Policies supporting worker health include those influencing the work environment and the organization of work.
Intervening at the interpersonal level
Interventions at the interpersonal level include promoting social support and social norms supportive of worker health and linking interventions to workers’ social contexts.
Intervening at the individual level
Interventions at the individual level must begin by reducing structural barriers influencing workers participation in intervention. For maximum reach, interventions must target workers at varying stages of readiness to make changes. Information about tobacco control can also be incorporated into hazards communications programs or other programs on worker health. Recent advances in tailoring messages to individual workers provide promise for increasing the efficacy of these interventions.
Conclusions
A comprehensive approach that integrates tobacco control initiatives into an overall worksite program for worker health holds considerable promise. Such programs may be of particular importance to blue-collar workers, whose high rates of tobacco use and exposures to hazards on the job place them at excess risk relative to other workers. Given the complexity required for effective interventions, it becomes increasingly important that we build bridges across disciplines interested in worker
Acknowledgements
This work was partially supported by grants from the Liberty Mutual Insurance Group, the National Cancer Institute (Grant numbers 1 PO1 CA75308 and 5 RO1 CA68087), and the National Institute of Occupational Safety and Health (Grant number CDC/NIOSH RO1 OH04012). This manuscript is based on the paper, “Smoking Cessation at the Worksite: What Works and What is the Role of Occupational Health?” prepared for the National Institute for Occupational Safety and Health, Centers for Disease Control,
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