Health Promotion Strategies to Reduce Tobacco Use among Blue

							Health Promotion Strategies to
 Reduce Tobacco Use among
    Blue-Collar Workers

  Deborah McLellan, Elizabeth Harden,
           Glorian Sorensen
 2002 National Conference on Tobacco or Health
           San Francisco, California
              November 19, 2002
          Learner Outcomes
• Describe at least two components of a
  tobacco use reduction model for blue-collar
  workers.

• Describe a process for designing a tobacco
  use reduction intervention using qualitative
  research findings.

• Apply these strategies for blue-collar
  workers in your community.
        Topics to be Covered
• Occupational class disparities in smoking
  prevalence, cessation, and exposure.

• WellWorks: a worksite-based tobacco use
  reduction program with blue-collar workers.

• Recommendations to reduce tobacco use
  with blue-collar workers.
    Smoking Prevalence Rates by
    Occupational Class: U.S. Data
     40
     35
     30
     25
     20                                           Men
                                                  Women
     15
     10
      5
      0
           Blue collar   Service   White collar

Giovino, 2000
   What else do we know about
     blue-collar workers?
• As compared to white collar workers, blue-collar
  workers have
   – lower rates of quitting smoking
   – higher exposure rates to secondhand smoke
   – Less access to programs and lower participation

Current programs and policies have not been as
 successful with blue-collar workers
   WellWorks: Integrating Health
 Promotion and Occupational Health
• The background: listening to blue-collar workers talk
  about smoking and other health priorities
• Synergistic effects of dual exposures
• Address blue-collar workers’ social context by integrating
  health promotion with occupational health
• Social ecological theory points to importance of
  conducting multilevel interventions

• Participatory strategies
             WellWorks
          Research Question

• Does an intervention integrating health
  promotion with occupational health and
  safety result in increases in smoking
  cessation compared to a standard health
  promotion intervention?
WellWorks Study Design

                 16 Worksites

            Baseline Assessments

                Randomization

          HP                   HP/OHS
   Smoking & Nutrition   Smoking, Nutrition & OH



               Final Assessments
                 WellWorks
                  Results
• Blue-collar workers were twice as likely to quit
  smoking in the HP/OHS condition (12% vs. 6%)

• There was no gender effect, so appears equally
  successful among women and men.
      Examples of the WellWorks
    multilevel intervention integrating
               HP and OHS
•   Participatory strategies
•   Organizational
•   Interpersonal
•   Individual
            WellWorks
      Participatory Strategies
• Employee Advisory Boards
             WellWorks
  Organizational Level Intervention
• Labor-management approach
• Policies
   – Uniformly enforce worksite nonsmoking policies
   – Financial coverage for cessation treatment

• In HP/OHS condition: reduce occupational health
  risks
   – CO exposure
           WellWorks
 Interpersonal Level Intervention
• Promoting social support and social norms
  supportive of worker health
  – Group smoking cessation classes with
    integrated HP/OHS messages
              WellWorks
        Individual Interventions
• Reduce structural barriers for workers to
  participate in interventions
   – Allow workers to participate on work time
• Provide interventions by stage of readiness to
  change
   – Brochures, goal setting activities, trial behaviors
• Integrate tobacco and occupational health
  messages
   – CO analyzer
     Challenges to Delivering an
       Integrated Intervention
• Common challenges to worksite interventions
• Management resistance
• Resistance from health and safety personnel
• Forging the perspectives of two disciplines
 Recommended components to reduce
tobacco use among blue collar workers
• Let theoretical frameworks and evidenced-based
  research guide your programs
• Use participatory methods
• Address workers’ social context by integrating
  occupational health concerns with tobacco
  reduction strategies.
• Conduct interventions at the organizational,
  interpersonal, and individual levels