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					  Smoke-Free
Workplace Policies

Their Role in Reducing Harm
  Caused by Tobacco Use
              Janis M. Dauer
        Chronic Disease Conference
               Roanoke, VA
               April 5, 2005
         Secondhand Smoke (SHS)

       1986 Surgeon General’s Report: SHS
        identified as a cause of disease in non-
        smokers
       1993 EPA Report: SHS designated as a
        Class A (known human) carcinogen
   Contains over 4,000
    substances, more than
    40 are known carcinogens
          Secondhand Smoke (SHS)

   Health effects in nonsmoking adults:
       lung cancer
       heart disease
   Health effects in children:
       Asthma
       Ear infections
       Bronchitis and pneumonia
       Sudden Infant Death Syndrome (SIDS)
          Secondhand Smoke (SHS)

   Latest Cal EPA “causal effects” data:
       Low birthweight
       Pre-term delivery
       Nasal sinus cancer
       Breast cancer
       Altered vascular properties

California EPA draft report:
http://www.arb.ca.gov/toxics/ets/dreport/dreport.htm
        Workplace Restrictions

Significant increases since 1985 -
 Immediate work area bans (allowed in
  designated common areas indoors):
       38% (1985)
       67% (1993)
   Total indoor bans:
       3% (1986)
       71% (2002)!

               Even in Virginia…
        Trends in smoke-free policy protection among indoor workers,
                           Virginia workforce vs U.S. workforce
               % of workers 15 y.o.a. and older reporting a smoke-free place of employment

     Percent
80

           VA workers
                                                    70.6     69
                                                                        71.2    70.9
           US workers
60                              62.2    63.4


                    46.2
40       43.7



20



 0
           1992-93                 1995-96            1998-99             2001-02
          Smoke-free worksite trends in Virginia
                by race and ethnicity *
               Percent


                     71.7                70.4                                  72.7
                  70.8                72.3                 66.5          78
80
                                                                           64.7
                                                        61.4
                                 63.4                 65
               61
60

                                                  49.2
40         45.6
                               36.9                                  35.9

20
                     1992-93      1995-96        1998-99       2001-02

 0
         White              Black               Hispanic          All others

 * Sample size for Hispanic and All other race workers very small (< 100 per year)
          Smoke-free policy trends among Virginia
                      MALES by age
                                 1992-93       2001-02


15-24                     38.3                            51.9



25-39                     38.3                                   69.3



40-54                44.4                                        67



 55 +                     38.8                                          81.3


    100    80   60   40          20        0    20       40      60       80   100
           Changes in smoke-free workplace policy
          coverage among Virginia FEMALES by age
                                  1992-93       2001-02


15-24                      40.5                                63.2



25-39                47.2                                             75.4



40-54               51.5                                              76.8



 55+                  45.2                                            74.8


    100   80   60     40          20        0     20      40     60          80   100
     Trends in smoke-free policies among Virginia
              workers by type of worker
        Percent


                                                           77.6                  77
80                                    70.4

                                                                          63.8
60             50.5                                    57.4

                                 43                51.6               49.7
40        33.6            40.8


20     24.8

                      Blue collar            Service       White collar

 0
     1992-93            1995-96                  1998-99            2001-02
        Trends in smoke-free employment in VA, by
           gender and major occupational group
        Percent




100
                                        76.5          76                                  78.4       77.6
                                                                                  72.2
                        67.8
80
                                                                                                 68.2
                                                                      52.4            61.5
              47.9                                                                65.6
60                                 52          53.9
                     46.2
                                        52.8                           50.841.1
                            47.1                                35.9
40        30.2                                                                               39.6
                 36.7
                                                            27.9
20    23.4
                            Blue collar               Service      White collar

 0
      92-93   95-96     98-99           01-02               92-93      95-96      98-99      01-02

                        MEN                                           WOMEN
         Trends in smoke-free worksite coverage among indoor
           workers in the U.S. by gender and type of worker
                  Percent


                                                                                            77.8      78.8
                                      73.7          75                           73.4
                            68.6
80
                                                                       56.5
                                                                                        59.3       61.4
                 50.2                        56.7
60                                 53.6                                        53 59.3         61.5
                        47.4
                                          52.9                          52.6
                               49.8
                                                                 38.1
40                 43
            30
                                                              32.3
       27
20

                               Blue collar          Service          White collar
 0
     1992-93     1995-96    1998-99   2001-02             1992-93      1995-96   1998-99   2001-02

                     MEN                                                 WOMEN
               Trends in smoke-free worksite coverage among
                     various Food Service Occupations
                             Percent


                             72.6
                                                                      67.3            67.2
                      70.8
                                                                               68.3                  60

               65.3                                       53.2 60.1
                                                                                              57.5
                                                                                                                                                        48.8
                                                   50.3                                                                               44.1
60                                                                      53.1
                                                                                       50.3                                                      45.2
                                                            49                                                                            47.1
          48                                42.2                                                                          29.8 37.7

40                                                                               40                                    27.7 35.6
                                                                 34.8                                                                                                 17

                                       27                                                                         21
                                                    25.4                                                                                                       12.9
20                                                                                                                      22.6
                                                                                                                                   18.6
                                                                                                                                                         6.3
                                                                                                            7.9
                                                                                                                                                   4
 0
     US workers                          Food counter    Msc. food prep                                          Waiter Asst       BARTENDERS
                                    Cooks           Kitchen                                               Waiters         Supervisors

                                        1992-93                   1995-96                      1998-99                 2001-02
                  State of Virginia employment trends for
                  bar and restaurant workers, 1990-2004
       Number in thousands

 230
                                                                                                          

                                                                                                  
                                                                                          
 210                                                                               
                                                                            
                                                                     
                                                        
 190                                            
                                         
                                  
 170
                           
         
 150
    1990   1991    1992   1993   1994   1995   1996   1997   1998   1999   2000   2001   2002   2003    2004


Source: Bureau of Labor Statistics www.bls.gov                                      * Data for 2004 preliminary
 Non-compliance with smoke-free workplace policies
     % of VA workers who reported someone smoked in work area in last two weeks

               Percent

         5


         4


         3


         2


         1
                                       U.S. workers
                                       VA workers
          0
U.S. workers               5                3.9                    3.2
 VA workers              4.1                4.3                    2.1

                     1995-96           1998-99                2001-02
   Public support for workplace smoking restrictions
       % VA residents favoring smoking restrictions for indoor work areas




100%          55.4            61.9             67.1            75


80%                            Smoke-free
                               Allow only in certain areas
60%                            Allow everywhere


40%
              42.7
                              36.3             31.5
20%                                                            24.4

               1.9            1.8              1.3             0.7
 0%
             1992-93        1995-96         1998-99          2001-02
                        Workplace Policies

    NO SMOKING                       NO TOBACCO USE
       No lit cigarettes, cigars       No smoking of tobacco or
        or pipes allowed but             use of any smokeless
        snuff and chewing                tobacco product allowed.
        tobacco can be used.



SMOKING “ROOM”                       OUTDOORS ONLY
   Tobacco use/smoking is              Tobacco use/smoking is
    limited to an indoor area that       prohibited completely
    is designated as the “smoking        indoors but allowed outside
    room.”                               the building.
                        Workplace Policies

OUTDOORS, but…                      OUTDOOR AREAS
   Tobacco use/smoking not            Tobacco use/smoking
    allowed within a specific           allowed outdoors but only in
    distance of entry/exit doors.       specific areas/kiosks.




INSIDE CARS                         NOT ON PROPERTY
   Tobacco use/smoking only           Tobacco use/smoking
    allowed on workplace                prohibited anywhere on
    property inside a vehicle.          company property.
                        Workplace Policies

ON COMPANY TIME                        NONSMOKERS ONLY
   Tobacco use/smoking not                Only nonsmokers will be
    allowed on company property             allowed to work for the
    or anywhere else while                  company
    employee is on company time.                New hires must be
   No evidence of tobacco                       nonsmokers
    use/smoking is permitted while              Current employees must
    on company time, including:                  quit
        Seeing tobacco use, tobacco            Employees who start, do not
         products or paraphernalia               quit, or relapse will be fired.
        Smelling tobacco smoke or         Same as above for smokeless
         snuff/chewing tobacco.             tobacco users.
         Why Restrict Smoking?


   Reduce exposure to SHS (air pollution)

   Reduce amount smoked

   Increase quit attempts

   Support those trying to quit
        Why Restrict Smoking?

   Reduce craving & withdrawal

   Increase successful quitting

   Lower healthcare and/or
    insurance costs

   Reduce youth initiation
             Why Restrict Smoking?

   Increase community smoking restrictions
   Promote pro-health message
   Demonstrate caring/concern,
    sincere commitment
       Customers’ (patients’) well-being
        comes first
       Staff enjoyment of break areas
         Why Restrict Smoking?


   Eliminate tacit approval/indifference

   Improve company image

   Increase productivity

   Lower clean-up costs
                              WORKPLACE POLICY ASSESSMENT
                  NO  NO TO- SMOK-  OUT-  OUT-  OUT-   INSIDE    NOT     ON     NON-
                SMOK- BACCO   ING  DOORS DOORS DOOR     CARS     ON     COM-   SMOK-
                 ING   USE   ROOM   ONLY  but… AREAS            PROP-   PANY    ERS
                                                                ERTY    TIME   ONLY
Reduce
exposure to
SHS
                                                                        
Reduce
amount
smoked
                                                                            
Increase quit
attempts                                                                    
Support
those trying
to quit
                                                                           
Reduce
craving &
withdrawal
                                                                        
Increase
successful
quitting
                                                                            
Lower

                                                                      
healthcare,
insurance                                                                       
costs

                                                          
Reduce youth
initiation                                                                
                               WORKPLACE POLICY ASSESSMENT
                   NO  NO TO- SMOK-  OUT-  OUT-  OUT-   INSIDE    NOT     ON     NON-
                 SMOK- BACCO   ING  DOORS DOORS DOOR     CARS     ON     COM-   SMOK-
                  ING   USE   ROOM   ONLY  but… AREAS            PROP-   PANY    ERS
                                                                 ERTY    TIME   ONLY
Increase

                                                          
community
smoking                                                                      
restrictions
Promote pro-
health
message
                                                                        
Demonstrate:
patients
come first
                                                                             
Demonstrate:

                       
staff enjoy-
ment of break                                                              
areas

                        
Eliminate
tacit approval                                                              
Improve
company
image
                                                                            
                  
Increase
productivity                                                                   
Lower clean-
up costs                                                                    
                                                WORKPLACE POLICY ASSESSMENT
                        NO         NO     SMOKING    OUT-    OUT-     OUT-    INSIDE   NOT ON      ON       NON-
                      SMOKING   TOBACCO   “ROOM”    DOORS   DOORS,   DOOR      CARS    PROP-    COMPANY   SMOKERS
                                  USE                ONLY    but…    AREAS              ERTY      TIME      ONLY
Reduce exposure
to SHS                                                                                              
                        
Reduce amount
smoked                                                                                                   
Increase quit
attempts                                                                                                
                        
Support those
trying to quit                                                                                          
                                  
Reduce craving &
withdrawal                                                                                           
Increase
successful quitting                                                                                     
                                                                                               
Lower healthcare,
insurance costs                                                                                             
                                                                              
Reduce youth
initiation                                                                                            
Increase commun-
ity smoking                                                                                         
restrictions
Promote pro-
health message                                                                                     
Demonstrate:
patients come first                                                                                     
Demonstrate: staff
enjoyment - break                                                                                   
areas

                                  
Eliminate tacit
approval                                                                                               
                                  
Improve company
image                                                                                                   
                        
Increase
productivity                                                                                              
Lower clean-up
costs                                                                                                  
            Common Issues

   PLANNING
       Essential
       Top level support
       Team approach
       Timeline
       Written policy
       Educate
             Common Issues


   ENFORCEMENT
       Clearly defined
        consequences
       Identify responsible
        person(s)
       Educate and promote
       Follow through
              Common Issues

   HELPING USERS
       Customers/Patients
            Duration of visit
            Company mission
       Employees
            Duty to assist
            Cost-effective
       Visitors/guests
            Inform
              Common Issues

   HELPING USERS
       Withdrawal
            Medications
            Coping “tips”
       Cessation
            Provide service
            Refer out
       Support
            Positive attitude
              Resources - Worksites

   CDC Taking Action Against Secondhand Smoke
    www.cdc.gov/tobacco/ETS_Toolkit/worksites/intro.htm
   Americans for Nonsmokers’ Rights
    www.no-smoke.org/goingsmokefree.php?dp=d12
   Secondhand Smoke: Clearing the Air in
    Enclosed and Public Work Places (ANR)
    www.ama-assn.org/ama/upload/mm/375/
    2ndhand_smoke_manual.doc
   Tobacco Technical Assistance Consortium
    www.ttac.org/products/health_policy/index.html
                Resources - Worksites

   Tobacco Cessation at the Worksite
    www.coloradohealthonline.com/tobacco/tobacco.htm
   Secondhand Smoke: What You Can Do About Second-
    hand Smoke As Parents, Decisionmakers and Building Occupants
    www.epa.gov/smokefree/pubs/etsbro.html
   Center for Tobacco Cessation
       www.ctcinfo.org/resources/toolkits.asp#
        Guides_&_Toolkits_for_Employers
       www.ctcinfo.org/resources/toolkits.asp#
        Resources_on_Smoking_Bans
               Resources - Hospitals

   The Michigan Smoke-Free Hospitals project
       Smoke-Free Environment Implementation Plan
      “How-to” manual on CD for developing and
       implementing a smoke-free hospital campus
      Tom Peterson, M.D., Medical Director, MMPC

       Ph (616) 974-4455, tpeterson@mmpc.com
   Smoke-Free Baltimore County
      Smoke-Free Hospital Grounds

      Smoke-Free Psychiatric Hospital Grounds

      http://smokefreebc.org/content.php?ci=35
         Resources – Healthcare Providers

   Becoming Tobacco-Free, A Guide for Healthcare
    Organizations
    www.mainehealth.com/mh_media/Tobacco8-Final.pdf
   Treating Tobacco Use and Dependence: Practical
    Strategies to Help Your Patient Quit (with video) and
   Treating Tobacco Use and Dependence
    in Hospitalized Smokers
       Contact Sandy Keller
        608-265-4869
        slk@ctri.medicine.wisc.edu
       Download:
        www.ctri.wisc.edu/main_dept/guide/guide_main.html#
        GuidelineTraining
         Resources – Healthcare Providers

   USPHS clinical practice guideline: Treating
    Tobacco Use and Dependence
    www.surgeongeneral.gov/tobacco
    www.ahrq.gov/clinic/tobacco/order.pdf
   Alliance for the Prevention and Treatment
    of Nicotine Addiction
    www.aptna.org/Related_Links.html
       Online training courses
       Sources of materials
       Special populations resources
       Links to other resources
          Resources – Cessation: Print

   Employers’ Smoking Cessation Guide: Practical
    Approaches to a Costly Workplace Problem
    www.endsmoking.org/resources/employersguide/pdf/
    employersguide-2nd-edition.pdf
   Cessation Fact Sheets
    http://tobaccofreekids.org/research/
    factsheets/index.php?CategoryID=25
   Free USPHS materials
    www.surgeongeneral.gov/tobacco
    www.ahrq.gov/clinic/tobacco/order.pdf
      Resources – Cessation: Online

   ALA’s Freedom From Smoking® Online
    www.lungusa.org (scroll down to link)
   Federal online program (NIH/CDC/NCI)
    www.smokefree.gov
   Smokeless tobacco resource
    www.chewfree.com
   Smoke-Free Virginia website
    www.smokefreevirginia.org
      Directory of local programs

      Links to other resources
     Resources – Cessation: Phone

    National Toll-Free Phone Assistance
   National Network of Quitlines 1-800-QUIT NOW
   NCI Smoking Cessation Quitline 1-877-44U QUIT
   ALA Call Center 1-800-548-8252
   American Cancer Society 1-800-227-2345
   Great Start 1-866-66 START
    (pregnant women)
       Resources – Cessation: Phone

     Virginia Toll-Free Phone Assistance

   Coming soon… VIRGINIA QUITLINE
    (via National Network number 1-800-QUIT NOW)
   Smoke-Free Virginia Helpline 1-877-856-5177
      Recorded message

      Free Quit Kit mailed


   American Lung Assoc. 1-800-LUNG USA
    (local program information provided)
   ALF Washington DC Quitline 1-800-399-5589
          Smoking Policies - Hospitals
           (National data provided by Tom Peterson, MMPC)
   By the late 70’s-early 80’s:
       Sales of tobacco products in hospitals eliminated
       Smoke-free wards/areas introduced
   By 1978, only:
       42% had any anti-smoking regulations
       1.2% had total indoor bans
   1988 survey:
       90% had some form of internal restrictions
       8% were smoke-free indoors
   1991: JCAHO standards issued, and…
   1993 inspections: 95.6% found compliant
            Smoke-Free Grounds
   Over 80 hospitals in the USA have
    implemented smoke-free campus policies
   In Virginia:
       Major hospital in Southwest Virginia (5/05)
       Danville Regional Medical Center (7/05)
       Potomac Hospital
       UVA Health System
       Mary Washington Hospital
       Major private university
       Major health insurance company
       Indian Creek Correctional Center
       St. Bride’s Correctional Center
       Botetourt Correctional Center
          Taking Action – At Work

   Program integration – chronic diseases
       Increase awareness of cessation resources
       Promote cessation (staff, patients, community)
       Incorporate brief intervention into system
       Integrate – continuity of care
   Other actions
       Role model
       Advocate for smoke-free grounds
       Advocate for reimbursement/coverage
       Advocate for funding/resources
          Taking Action – At Home

   Prohibit smoking in your home and vehicle
   Patronize smokefree establishments
   Complain about secondhand smoke
   Participate in advocacy activities
   Join (or start) a local coalition
   Support cessation
               Taking Action - Resources

   Advocacy organizations
       Virginians For a Healthy Future
       Americans for Nonsmokers’ Rights
       SmokeFree Action Network
            Action alerts, national and for each state
            E-mail lists with variety of topics
             (e.g., smokefree hospitals)
    www.smokefreevirginia.org/Additional-Resources.html
   Cessation information
       Association for the Treatment of Tobacco Use and
        Dependence: www.attud.org
       Center for Tobacco Cessation e-newsletter:
        www.ctcinfo.org/enewsletter/default.asp
      The Tobacco Use Control Puzzle

      Preventing              Promoting
  youth initiation            cessation




                            Increasing
                            excise taxes
 Clean indoor
air regulations
The Chronic Disease Puzzle




         TOBACCO
           USE
         CONTROL
           Questions?

           Janis M. Dauer, MS, CAC
               Program Manager
Alliance for the Prevention and Treatment of
                 Nicotine Addiction
          3557 Chesapeake Blvd, #1
               Norfolk, VA 23513
                (757) 858-9934
               jdauer@aptna.org

				
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