Assessing Tobacco Use Policies in the Workplace

Carol A. Riker, RN, MSNAssociate Professorriker@uky.edu

Ellen J. Hahn, DNS, RNAssociate Professor

ejhahn00@email.uky.edu

UK College of Nursingwww.mc.uky.edu/tobaccopolicy/

Adult Smoking in Kentucky and the U.S., 2002

32.6

22.8

34.8

25.2

30.5

20.7

0

5

10

15

20

25

30

35

Total Men Women

Kentucky

U.S.

Behavioral Risk Factor Surveillance System, CDC, 2002

Smoking in the Workplace

Worksites with blue collar workers are more likely to have higher prevalence of cigarette smoking than those with white collar workers (Bang & Kim, 2001).

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)

Heart disease accounts for about 37,000 of the 53,000 U.S. deaths attributed to involuntary smoking each year. (Glantz & Parmley, 2001)

(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)

Costs of Smoking in the Workplace

A smoking employee costs the employer at least $1,000 MORE in direct and indirect health care costs compared with a similar nonsmoking employee.

SHS can cause burning of the eyes and nose, headaches, and nausea in nonsmokers, affecting their morale and productivity.

Smoking costs the U.S. $75.5 billion in direct health care costs and $81.9 billion in lost productivity costs annually (ALA, 2003).

Benefits of a Smoke-free Workplace

Smoking bans decrease disability and early retirement payments by 75%.

Smoking bans reduce health and fire insurance premiums by over 25%.

Dramatic decreases in maintenance costs.

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

Worksite Smoking Bans Help Smokers

Quit

Smoke-free workplaces are associated with a 29% drop in cigarette consumption. Smokers are more likely to make serious quit attempts and achieve cessation (Glasgow, 1997).

Tobacco Policy in Kentucky Manufacturing Facilities, 1999-2002

67

43

40

69

43

74

46

47

33

3226

24

0 20 40 60 80

Have Smoking Policies

Ban Indoor Smoking

Offer Cessation Resources

Reimburse for Cessation 2002 (N = 625)2000 (N = 437)1999 (N = 160)

Percent

Company Characteristics and Smoking Policies (2000)

Companies with a written smoking policy more likely to provide cessation resources than those without a policy

Large companies 2 ½ times more likely to have written smoking policies but more likely to sell cigarettes than small manufacturers

Companies with unions more likely to permit indoor smoking and sell cigarettes, but 5 ½ times more likely to provide cessation resources than those without a union.

Smoking Policies in ALL Worksites in Kentucky, 1999

Over half (56%) of ALL worksites were smoke-free in Kentucky, compared to 43% of manufacturers

Smoke-Free Kentucky Food Service Establishments, 1999-2002

3235

39 40

0

10

20

30

40

50

1999 2000 2001 2002

Per

cen

t

Public Support for Smoke-free Workplaces

Nearly all Americans (95%), both smokers and nonsmokers, support banning or restricting smoking in workplaces.

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, 2004

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 Presence of nutrition policies

Workplace Tobacco Policy Interviews: Methods in a Nutshell

Recruit Human Resource Managers Phone Interview with Human Resource

Manager &/or Other Administrative Personnel Document data on interview form or online FAX data forms to University of Kentucky Send data forms to UK in mailer provided Follow-up with interested manufacturers

Preparing for the Interview

Use one PINK Disposition Sheet for every company

Use the MASTER COPY of the Interview Guide to make copies

Make only SINGLE-SIDED copies When making copies, be sure not to cut the

BRACKETS off!

Recruiting Manufacturing Facilities

Check list of manufacturers for accuracy Call the company and ask for the Human

Resource Manager Introduce yourself Explain purpose of interview Explain who is being asked to participate Say interview will last 10-15 minutes Explain how information will be used

Conducting the Phone Interview

Choose a convenient time without potential interruption

Verify contact information and list name of person interviewed on PINK Disposition Sheet (not on form)– Name– Phone/FAX/e-mail– Verify name of company

and address

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 further comments about the questions

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!

Documentation Issues

Complete ALL questions Use a PEN…DO NOT ERASE Put an “X” through incorrect information and fill

in the correct response Completely fill in all circles and boxes Print legibly Fill in only ONE circle per question unless it

says, “Fill in all that apply”

Documentation Issues

PRINT name of the workplace on every page. Pay attention to SKIP patterns. Fill in the CIRCLE for “Other” in addition to PRINTING

the information for “please specify.” PRINT comments on the top or bottom of the page or

between questions, staying away from the boxes, circles, page identifiers, or page definers.

I you don’t PRINT, all your pages will have to be verified.

When adding comments, stay away from the page definers, page identifiers,

boxes, and circles.

Places to print comments:

•Top

•Bottom

•Between questions

•Away from boxes, circles, and page identifiers & definers

Submitting Forms Onlinewww.mc.uky.edu/tobaccopolicy

Online version is similar to the print form. Click on the correct circles to answer and type in

specifications. Type extra comments in the space provided at the end. Most of the front page info and “Time Interview Ended”

are required to submit the survey. Check over the entire form before clicking “submit” to

see that all questions are answered. If you collect the information on a paper version of the

form and then submit online, send the paper forms to UK in the mailer provided.

If you submit online as you conduct the interview, do not send paper copies to UK.

AFTER Each Interview

Check interview form for completeness FAX forms to UK as you complete them

(859-323-1033), unless you submit online. Do not FAX forms in bulk! Do one at a time. Best to use a high-speed FAX machine with

memory, if available. Contact Rob Rasnake (859-323-8539) or

robrasnake@hotmail.com if you are having difficulty FAXing the forms or have questions

When ALL Interviews are Complete

When all interviews are completed, mail a copy of the PINK Disposition sheets and any completed interview forms to UK in the mailer provided. If you interview while submitting online, just send pink disposition sheets to UK. Everyone sends Disposition sheets!

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

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

Follow-Up Contacts with the Manufacturing Facilities

Send thank you letters. Gather materials on workplace tobacco

policy and tips for employers. Send information packets with cover letter. Follow up with phone contact. Involve coalition partners.

Model Workplace Tobacco Policy

Rationale for Policy (Effects of SHS) Types of Tobacco Product Covered

–Cigarettes, Cigars, Pipes, and Spit When and Where Tobacco Allowed

–Breaks? Lunch?–Exact locations of Designated Areas–Vehicles

How Policy is Communicated How Violators are Handled What Department Provides Cessation Resources To Whom it Applies

–Employees, Visitors, Clients, Contractors

Linking Data to Policy Change

Share data with coalition and manufacturers. Present data at interested worksites. Use data as a media opportunity, if

appropriate. Specify targets using baseline data. Base all policy change suggestions on Best

Practices. Recommend only research-based prevention

and cessation activities.

Manufacturers Expressing Interest in Changing Policy

Although most manufacturers were satisfied with their current policy, many expressed interest in changing policy and asked for assistance.

The opportunity exists to motivate and help with policy change that can then begin to change community norms!

Motivating Workplaces Considering Policy Change

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).

Employer Action Steps (CDC, 2003)http://www.cdc.gov/tobacco/ETS_Toolkit/worksites /employer.htm

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 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 Steps

5. Implement the plan Complete implementation is key; incomplete

implementation leads to confusion. Give 4 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 policyBe fair and equitableGive 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.