Worksite smoking control activities: prevalence and related worksite characteristics from the COMMIT Study, 1990

Worksite tobacco prevention in the Canton of Zurich: stages of change, predictors, and outcomes

OBJECTIVES

This study provides information about the prevalence of tobacco prevention (TP) and the stages of change with respect to the introduction of TP among companies in the Canton of Zurich (n = 1,648). It explores the factors that predict restrictiveness of smoking policies, number of individual support measures, interest in services to promote TP, and the relationship between TP and health outcomes.

METHODS

Data were gathered by means of a written questionnaire and analysed using ordinal regression models.

RESULTS

Whereas many companies maintain smoke-free policies, only few provide cessation-courses. Health and welfare organisations have strictest, and building and hospitality companies have least strict policies. Company size predicts number of individual support measures but not policy restrictiveness. Both measures are predicted by personal concern of the representative. Interest in services is predicted by tobacco-related problems and medium stages of change. Finally, stricter policies are associated with lower proportion of smokers and less tobacco-related problems.

CONCLUSIONS

Health professionals should support less advanced companies in their endeavour to implement TP. The findings provide a baseline to evaluate the implementation of the forthcoming smoke-free legislation.

Availability of smoking prevention and cessation services for childhood cancer survivors

OBJECTIVE

To characterize the smoking-related services available to childhood cancer survivors and describe organizational characteristics that were related to institutions' capacity to provide smoking services.

METHODS

Institutions affiliated with the Children's Oncology Group were surveyed from 2003 to 2004.

RESULTS

Of the 132 responding institutions, 85% assessed the smoking status of their cancer survivors intermittingly, but only 3% assessed smoking status at every visit, as recommended by the PHS guidelines. A minority of sites offered either smoking prevention (39%) or cessation (25%) services; 58% of sites had a mechanism in place to refer survivors for cessation services. In multivariate analyses, the most parsimonious model predicting capacity for smoking service delivery included barriers, respondents' attitudes, complexity, and institutional stability.

CONCLUSIONS

These data highlight an important need to improve the availability of smoking services for childhood cancer survivors. Additionally, these findings will inform the development of future interventions that are sensitive to barriers and facilitators to providing prevention services.

Workplace smoking policies in Taiwan and their association with employees' smoking behaviours

BACKGROUND

The implementation of worksite smoking policies has shown significant effects on reducing employees' smoking consumption and protecting non-smoking workers. However, there are no data about workplace smoking policies in Taiwan. The purpose of this study was to document the status of worksite smoking policies in Taiwan and its potential impact on employees' smoking behaviours.

METHODS

A two-stage investigation was conducted. The first stage was to examine the current status of workplace smoking policies and the second was to evaluate the relationship between workplace smoking policies and employees' smoking behaviours. After two follow-ups in each stage, 264 companies and 1141 employees returned their questionnaires.

RESULTS

Workplace smoking policies were associated with types of businesses and size of workplaces. Only approximately half of manufacturing and service companies have implemented a prohibitive smoking policy. Large facilities (>750 employees) were more likely to implement a prohibitive policy (57%). Employees in workplaces with a prohibitive policy had lower prevalence of smoking and cigarette consumption, and less exposure to passive smoking. Although most smokers agreed with banning smoking in their work environment, no difference in interest in participating in cessation programs was found.

CONCLUSIONS

Significant associations were found between workplace smoking policies and employees' smoking behaviours. Results of the study provide basic information for designing more refined smoking policies in the workplace in Taiwan.

Measuring worksite resources for employee heart health

PURPOSE

Intervention at the organizational rather than the individual level is gaining greater attention in worksite health promotion efforts. However, little research has been done on instruments to measure this domain. Therefore, the purpose of this study was to further test the utility of an existing organizational heart health support instrument by examining relationships among worksite structural characteristics and comparing these results to other survey findings.

DESIGN

One-time cross-sectional.

SETTING

New York State.

SUBJECTS

One hundred fifteen volunteer worksites in the New York State Healthy Heart Program, representing manufacturing, government, education, health care, and other industries.

MEASURES

A survey was conducted using HeartCheck, an organizational assessment of employee support for heart health. HeartCheck contains 175 items measuring organizational support for tobacco control, nutrition, physical activity, stress, screening, and administrative support structure.

RESULTS

On average, only 22% of all worksite resources assessed were present in the sample. Having a workforce greater than 250 provided a 12% increase in predicted overall worksite resources. A predominantly female workforce (> 75%) provided 10% higher levels of worksite stress resources. Worksites with unions had higher levels of resources for physical activity (10%), screening (13%), and general supportive structures (10%). The presence of manual labor diminished support for tobacco control resources (-13%). Finally, manufacturing worksites demonstrated a clear advantage for all types of worksite resources, except for stress.

CONCLUSION

A number of trends found in this study are consistent with earlier work. Industry type and size both predict worksite supports similar to previous studies. Other findings that appear to contradict previous work, including the relatively low level of support observed in this sample, can be explained by the comprehensive nature of the instrument. Overall, these findings demonstrate the utility of HeartCheck.

Association of the health-promoting workplace with trade unionism and other industrial factors

PURPOSE

The study examines associations of five healthy workplace attributes with trade unionism and nine other industrial and sociodemographic factors. The aims were to illustrate the measurement of workplace health promotion indicators in Western Australia and to identify associations leading to a better understanding of determinants of the healthy workplace.

DESIGN

Personal and telephone cross-sectional surveys were performed using population-based sampling frames. The overall response rate was 72%.

SETTING

Workplaces in Western Australia.

SUBJECTS

Random samples of household respondents aged 16 to 69 years in 1992 (n = 1310) and 1994 (n = 1113).

MEASURES

Measures of association between healthy workplace attributes and trade unionism were adjusted for workplace location, size, sector, and industrial classification.

RESULTS

Trade unionism was strongly associated with healthy catering practices (adjusted OR 2.05; 95% CI 1.30 to 3.23), sun protection practices (2.66; 1.69 to 4.17), disability access (1.47; 1.10 to 1.95), and worksite health promotion programs (2.56; 2.07 to 3.17). A weak and nonsignificant association was observed with restrictive smoking policies (1.21; .95 to 1.55). Generally, healthy workplace attributes were reported less often by respondents working in rural locations, in the private sector, and at small worksites. There was no consistent relationship with sociodemographic factors, including an index of social disadvantage, but members of blue-collar occupations experienced a low prevalence of restrictive smoking policies.

CONCLUSIONS

The study raises the hypothesis, but cannot confirm, that trade unions could provide a means for employees to pursue the creation of a health-promoting workplace. Small business represents an excellent target for health promotion activities.

Worksite health and safety climate: scale development and effects of a health promotion intervention

BACKGROUND

Environmental influences on health and health behavior have an important place in research on worksite health promotion. We tested the validity and internal consistency of a new measure of organizational health and safety climate that was used in a large randomized trial of a worksite cancer prevention program (the Working Well Trial). The resulting scales then were applied to assess intervention effects.

METHODS

This study uses data from a subset of 40 worksites in the Working Well Trial. Employees at 20 natural gas pipeline worksite and 20 rural electrical cooperatives completed a cross-sectional questionnaire at baseline and 3-year follow-up.

RESULTS

A factor analysis of this self-report instrument produced a two-factor solution. The resulting health and safety climate scales had good internal consistency (Cronbach's alpha = 0.74 and 0.82, respectively) and concurrent validity. The health climate scale was correlated more highly with organizational measures that were indicative of a supportive health climate than those indicating supportive safety climate, while the reverse was true of the safety climate scale. Changes in health climate were associated with the number of smoking and smokeless tobacco programs offered at the worksites at the time of the 3-year follow-up (r = 0.46 and 0.42, respectively). The scales were not correlated with most employee health behaviors. The health climate scores increased at intervention worksites, compared with scores at control worksites (F[1,36] = 7.57, P = 0.009).

CONCLUSIONS

The health and safety climate scales developed for this study provide useful instruments for measuring organizational change related to worksite health promotion activities. The Working Well Intervention resulted in a significant improvement in worksite health climate.

Worksite characteristics and changes in worksite tobacco-control initiatives. Results from the COMMIT study

Few studies have prospectively examined the characteristics associated with worksite adoption of tobacco-control initiatives. Data were collected as part of the Community Intervention Trial (COMMIT) for Smoking Cessation, which conducted interventions in 11 communities. This smoking cessation intervention was based on community organization principles and delivered through multiple community channels, including worksites, health care providers, the media, and cessation resources. This article reports results from telephone interviews of intervention community worksites having 50 or more employees, conducted at baseline and the end of the intervention period. Among worksites that responded to both baseline and final surveys, 83% had not adopted a smoke-free policy at baseline, and 61% did not offer any cessation aid or quitting resources at baseline. By the final survey, 34% of those with no smoking ban at baseline had become smoke-free, and 36% of those offering no cessation assistance at baseline were offering cessation resources at the follow-up. The prevalence of policy adoption was higher among worksites employing more female employees and offering other health-promotion activities; manufacturing businesses were significantly less likely than businesses other than service and wholesale/retail businesses to adopt policies. Adoption of cessation programs was significantly more likely among worksites employing 100 to 249 workers, compared with those employing 50 to 99 workers; those predominantly employing men; those offering other types of health-promotion activities; and those with a higher rate of turnover. These results provide important information about the characteristics of worksites likely to engage in tobacco-control efforts. Health educators and others may choose to target those worksites most ready for adoption of tobacco control policies and programs, as indicated by these findings.

Relationship of organizational characteristics of Canadian workplaces to anti-smoking initiatives

BACKGROUND

In Canada, with universal single-payer health care insurance and a lower proportion of the gross domestic product going to health care costs, employers may be less motivated than their U.S. counterparts to develop health promotion programs for their employees. This study determined the extent to which nongovernmental workplaces in Canada have made smoking-related information, policies, and programs available to their employees. Several characteristics of those workplaces most likely to have engaged in such activities were identified.

METHODS

A secondary analysis of data collected in the 1992 National Workplace Survey was conducted. All Canadian provinces, except Saskatchewan, were included. Dunn and Bradstreet's register of companies was used to select companies randomly from those with 20 or more employees. Questionnaires were distributed to 10000 workplaces. The response rate was 35.5% (N = 3,549). There were no significant differences found between responders and nonresponders in a phone survey.

RESULTS

One-half of workplaces reported some kind of smoking-related initiative. Most of the initiatives were smoking policies; only 11.7% of workplaces provided smoking cessation programs. The number of employees and the number of other lifestyle and occupational health and safety programs available are most predictive of smoking-related programs.

CONCLUSIONS

If Canadians are going to achieve a smoke-free society, greater efforts to assist smokers to quit will be necessary. The workplace provides an excellent opportunity for such efforts. Health promotion advocates must communicate the cost savings and other benefits to employers garnered from workplace smoking reduction efforts.

Effectiveness of a consultation intervention to promote tobacco control policies in Northwest Indian tribes: integrating experimental evaluation and service delivery

A quasi-experimental replication of an intervention for promoting tobacco control policies in Northwest Indian tribes is described and the process of intervention including issues of collaboration among research institutions and Indian organizations is discussed. The policy intervention was evaluated using a pretest-posttest design wherein 20 tribes that had served as wait-list controls now received the intervention. The intervention comprised a tribal representative attending a kickoff orientation; follow-up visits to the tribes; distribution of tobacco policy workbooks; and phone call consultations. Policy status and stringency were assessed by means of telephone interviews with two key contacts per tribe, and by a count of enacted policies. There were significant pre-post changes in the primary outcome measure, a composite summary score of tobacco policy stringency, and changes were also reflected in enacted policies. The intervention effects observed were similar to those found in the prior randomized trial and suggest a robust, disseminable intervention. Much of the success achieved was attributed to the role of an Indian organization in planning the project and implementing the intervention and evaluation protocols.

The shape up challenge: a community-based worksite exercise competition

PURPOSE

To assess organizational and employee participation during three community-wide worksite exercise competitions in two communities.

DESIGN

A one-group, posttest-only design was used. Lack of controls, exercise baseline, and the short-term nature of the interventions were limitations.

SETTING

The Minnesota Heart Health Program conducted annual exercise campaigns between 1982 and 1989 within three intervention communities to reduce behavioral risk for cardiovascular disease. The Shape Up Challenge was a worksite exercise competition designed, in conjunction with other campaign activities, to increase levels of physical activity.

SUBJECTS

A total of 119 participating companies in two Minnesota communities, and 17,626 employees within these worksites, composed the subjects in this study.

INTERVENTION

Eligible worksites were invited to participate in a month-long competition during which employees recorded minutes spent daily in aerobic activities. Incentives were established to promote intragroup cooperation and intergroup competition. Companies competed for awards that were based on average minutes of exercise per employee versus per participant.

MEASURES

Numbers of companies recruited and participating, campaign activities, minutes of exercise, and costs were recorded on implementation logs. Companies completed surveys describing business type, number and sex of employees, existing health promotion programs, and perceived benefits of participation.

RESULTS

Of the 365 companies invited to participate, 33% participated (range 15% to 50%). Participating companies were more likely than nonparticipating companies to offer other health promotion programs and perceived greater benefits from participation. Women and smaller companies had significantly greater participation rates than men and larger companies. Average employee participation rates ranged from as high as 84% in smaller organizations to as low as 16% as organization size increased.

CONCLUSIONS

Community-based worksite exercise competitions appear to be a viable strategy for promoting employee exercise, particularly in smaller companies. Group-based contingencies applied in natural work units may facilitate employee participation. Further research is needed to assess the relative efficacy of this approach, compare alternative incentives, and identify strategies to enhance exercise maintenance after the intervention has ceased.

Cigarette smoking control strategies of firms with small work forces in two Northeastern States

PURPOSE

Cigarette smoking control strategies of firms with small work forces were assessed and compared with those of larger firms.

DESIGN

A cross-sectional telephone survey was conducted in 1990 among private employers systematically selected from a proprietary database.

SETTING

These firms were located in four counties of two northeastern states.

SUBJECTS

Interviews were conducted with managers of 470 small (< or = 25 employees; n = 262), medium (26-50; n = 87), and larger (> 50; n = 121) firms.

MEASURES

Interviews assessed characteristics of the firms and their cigarette smoking policies and cessation programs.

RESULTS

Small firms differed from larger firms in several areas. They were less likely to have written policies, used fewer methods to communicate their policies, and their policies were consistently less restrictive. Small firms also offered less assistance to employees who wished to quit.

CONCLUSIONS

The less restrictive smoking policies reported here may be relatively ineffective in protecting nonsmokers in small firms. Small firms may encounter difficulties introducing more restrictive smoking policies because of the relative closeness of employee relations, smaller work spaces, and inability to deliver smoking cessation services to employees. Methods should be developed to assist managers of smaller firms to implement stronger smoking policies and to devise ways of making cessation assistance more easily available to their employees.

Participation in worksite health promotion: a critique of the literature and recommendations for future practice

One of the major rationales for conducting health promotion/disease prevention activities at the worksite is the potential to reach a high percentage of employees, including many who would otherwise be unlikely to engage in preventive health behaviors. Most studies of worksite health promotion do not report participation data, but among those that do, definitions of participation and participation rates vary dramatically. In general, men and blue-collar employees appear less likely to participate, but little is known about other employee variables related to participation. There have been few studies of worksite characteristics associated with participation and even fewer experimental evaluations of interventions to increase participation. In this paper we review what is known about participation in worksite health promotion programs and recommend procedures for defining participation for different types of programs, for reporting determinants of participation, and for increasing participation. We conclude that participation is both an important process measure and an outcome that should be reported routinely. Participation data have important implications for generalizability of results, feasibility of interventions, and health outcomes.

Results of a year-long incentives-based worksite smoking-cessation program

This study evaluated the impact of a year-long incentives-based worksite smoking-cessation program. Nineteen moderate-sized worksites, employing a total of approximately 1100 smokers, were randomized to Incentive or No Incentive conditions. All identified smokers in the worksite were considered as subjects, whether or not they participated in the intervention. Analyses were conducted at both the worksite and individual level, and using both self-reported and biochemically validated cessation as endpoints. The incentive program did not significantly improve cessation rates at either the 1-year or 2-year follow-up assessments. We conclude that more broadly focused interventions that also address worksite smoking policies, skills training, and cessation resources, or programs that target additional risk factors are needed to substantially enhance quit rates.