Smokers & Their Workplaces Opportunities for Research & Intervention Peggy Hannon, PhD, MPH
Collaborators Acknowledgements Jeff Harris, MD, MPH, MBA Courtney Hughes, PhD Emily Yette, MPHc This research is supported by a grant from the Tobacco Prevention & Control Program, Washington State Department of Health Julie Thompson
Project Goals Overview Methods Early Results Implications & Next Steps
Why This Project? WA Tobacco Prevention & Control Program Success in reducing overall tobacco use Significant disparities remain Characterize disparities Potential approaches to reaching these populations
Project Goals Explore feasibility of using workplaces to reach smokers, especially in disparity populations What % of smokers work? What are their demographic characteristics? Are they aware of & willing to use cessation tx? What are their worksites tobacco-related practices?
Methods WA 2006 Behavioral Risk Factor Surveillance System (BRFSS) Population survey of adults Focus for today WA 2006 Healthy Worksite Survey Random sample survey of worksites Preview for today
BRFSS Telephone survey, adults age 18+ CDC designs, conducts w/ state health depts. Survey includes core questions (all states) and state-added questions and modules WA has extensive state-added module on tobacco use and cessation
Analysis Strategy Participants categorized into 4 groups based on employment & insurance status Most analyses focus on employed smokers, split by insurance status Simple frequencies Multivariate regression (in progress) Additional analyses by workplace setting
Key Outcome Measures Smoking status Current smoker Attempt to quit in past year Interest in quitting Healthcare quit resources Healthcare provider advised to quit Use of cessation medications in past year State Quit Line Ever heard of Quit Line Ever called Quit Line Willing to call Quit Line
Current Smoking Rates by Employment and Insurance Status Employed* Unemployed* 15 15 32 33 Uninsured Insured 0 20 40 60 80 100 % Current Smokers Note. * indicates p <.01
Most Smokers Work Employed Unemployed 36% 64%
Most Working Smokers Insured Insured 26% Uninsured 74%
Employed Smokers Demographics Are Associated w/ Insurance Status Age <35* 41 34 61 % All Employed Smokers Uninsured Female 38 31 40 Insured Racial/ethnic minority* 16 21 34 Income<$25k* 17 25 50 No personal doctor* 27 38 70 0 20 40 60 80 100 Note. * indicates p <.01
Employed Smokers Quit Intentions Are Not Associated With Insurance Tried to quit past year 58 58 Like to quit Next 6 mos. 57 58 72 68 Uninsured Insured Next 30 days 26 35 0 20 40 60 80 % Reporting Quit Intentions
Insurance Predicts Employed Smokers Receipt of Medical Advice to Quit Ever advised to quit* 54 73 Advised to quit past year* 29 51 Uninsured Discussed cessation Rx* 12 28 Insured Discussed other strategies 13 21 0 20 40 60 80 100 % Reporting Physician Advice Note. * indicates p <.01. Discussed Rx/other strategies items were limited to the past year; uninsured smokers were much less likely to have visited a provider in the past year.
Insurance Does not Predict Employed Smokers Use of Cessation Medications 18 20 Uninsured Insured 0 20 40 60 80 100 % Used Medications in Past Year
Employed Smokers Cessation Insurance Coverage Yes 31 No 27 Don't Know 42 0 10 20 30 40 50 % Reporting Insurance Pays for Cessation Analysis restricted to employees with health insurance.
Insurance Does Not Predict Employed Smokers Awareness of & Willingness to Use WA Quit Line Ever heard of 43 54 Ever called 5 5 Uninsured Insured Willing to use 29 32 0 20 40 60 80 100 % Familiar with WA Quit Line
%Employed & %Uninsured Vary by Workplace Setting Car/Truck Classroom Home Hospital Office Outdoors Restaurant/Bar Store Warehouse/Factory 4 10 7 8 4 5 6 11 5 6 7 17 22 19 21 30 42 45 % Uninsured % of W orkforce 0 20 40 60 80 100 Data are based on 5267 employed BRFSS participants; 242 (5%) reported working in other workplace settings.
Smoking Prevalence Varies by Workplace Setting Car/Truck Classroom Home Hospital Office Outdoors Restaurant/Bar Store Warehouse/Factory 8 15 9 12 26 24 31 21 24 0 20 40 60 80 100 % Current Smokers Data are based on 5025 employed BRFSS participants.
Healthy Worksite Survey Random sample of WA worksites Multiple branches of one company Only those with 50+ employees eligible 731 completed the survey in 2006 39% response rate
Analyses Healthy Worksite respondents stratified by whether they insure the majority (75% or more) of employees Key outcomes Estimate of employees who smoke Presence & enforcement of tobacco policy Smoking cessation promotion Awareness & promotion of Quit Line
Worksites Insuring Fewer Employees Have More Smokers 24 >30% Smoke* 11 <75% Insured 75%+ Insured 0 20 40 60 80 100 % of Worksites Estimating >30% of Employees Currently Smoke * p <.01
Insurance Does Not Predict Tobacco Policies Tobacco Policy in Place 95 93 Tobacco Policy Always Enforced 79 81 <75% Insured 75%+ Insured Violators Referred to Cessation Services+ 27 36 0 20 40 60 80 100 + p <.05
Most Employers Do Not Promote Tobacco Cessation/Services Promote Cessation* 25 39 Aware of Quit Line 34 39 <75% Insured 75%+ Insured Promote Quit Line 4 8 0 20 40 60 80 100 * p <.01
Implications Workplaces can reach large proportion of smokers Different workplace settings may suggest different Tobacco cessation intervention strategies Priorities for tobacco interventions
Insured v. Uninsured Critical to reach out to both groups Majority of smokers insured, but Insurance often doesn t cover cessation Smokers don t know their cessation coverage Significant minority of smokers uninsured Quit Line best resource, especially now w/ NRT available
Quit Line Workplaces Workplaces aren t promoting Quit Line Many workplaces promote cessation &/or are aware of Quit Line Workplaces with more uninsured employees perceive higher smoking rates Employees About ½ aware of Quit Line, but only 5% have ever called About 1/3 willing to call Quit Line Need for more research on the barriers for the unwilling
Workplace Settings Settings with highest smoking rates not necessarily where to find most smokers Example: Office smoking rate=12% but 31% of employed smokers work in offices Settings w/ highest smoking rates employ small proportion of employed smokers Restaurants & bars (10%) Warehouses/Factories (10%) Cars/Trucks (7%) Highest proportion of smokers employed at offices (31%) & outdoors (15%)
Cessation Strategies by Setting Offices 94% employees have insurance! Enhance & promote cessation coverage Restaurants/Bars Outdoors Warehouses/Factories <80% of employees have insurance Formative work about Quit Line barriers Promote Quit Line
Next Steps Complete analyses for 2006 data Explore combining BRFSS datasets (2004-2007) for more robust analyses Identify needs for formative work re: Quit Line Search literature for effective strategies to promote insurance coverage for cessation medication
Summary Workplace = underused channel with potential to reach >60% of smokers in WA Insurance status = useful predictor of smoker characteristics & feasible cessation strategies Still much to learn about smokers barriers to using cessation medications and services
Questions & Discussion
Useful References Cahill K et al. Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews 2008;4:CD003440. Hammond D et al. Do smokers know how to quit? Knowledge and perceived effectiveness of cessation assistance as predictors of cessation behavior. Addition 2004;99:1042-8. McAfee T et al. Preventing premature death: tobacco treatment services for employees. Employee Benefits Journal 2004;29:18-23. McAfee TA. Quitlines: a tool for research and dissemination of evidencebased cessation practices. Am J Prev Med 2007;33(6S):S357-S367. McMenamin SB et al. Knowledge of Medicaid coverage and effectiveness of smoking treatments. Am J Prev Med 2006;31:369-74. Ringen K et al. Smoking cessation in a blue-collar population. Am J Ind Med 2002;42:367-377. Roddy E et al. Barriers and motivators to gaining access to smoking cessation services amongst deprived smokers a qualitative study. BMC Health Services Research 2006;6:147.
Contact Information Peggy Hannon Health Promotion Research Center peggyh@u.washington.edu 206-616-7859