Assessing Tobacco Use Policies in the Workplace

1. Assessing Tobacco Use Policies in the Workplace Carol A. Riker, RN, MSN Associate Professor riker@email.uky.edu Grace Pasley, BS, AAS Data Management Coordinator glpasl0@email.uky.edu UK College of Nursing Tobacco Policy Research Program www.mc.uky.edu/tobaccopolicy/

2. Adult Smoking and Quitting in Kentucky and the U.S., 2004 Quitting Smoking State-Specific Prevalences of Cigarette Smoking and Quitting Among Adults, CDC (Nov. 11, 2005), MMWR, 54(44).

3. 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).

4. 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%.

5. 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)

6. (SHS) and Heart Disease • Short term exposure (5 min.-2 hrs.) can increase risk of heart attack and stroke. • SHS affects platelets, endothelium, and heart rate variability (narrowing of blood vessels and clot formation) • SHS exposure accounts for as many as 62,000 deaths per year from coronary heart disease (Wells, 1998)

7. (SHS) and Lung Cancer • Clear dose-response relationship between duration of exposure to SHS and increased lung cancer risk in never smokers. • Reducing exposure decreases opportunities to smoke, thus reducing active smoking levels (Brennan, et al., 2004)

8. Costs of Smoking in the Workplace • During a 1-year period of exposure, non-smoking employees are more likely than unexposed employees to take time off sick and require treatment for respiratory problems (McGhee, et al., 2000). • Smoking costs the U.S. $75.5 billion in direct health care costs and $81.9 billion in lost productivity costs annually (ALA, 2003).

9. Benefits of a Smoke-free Workplace • Disability and early retirement payments decrease by 75% (ASH) • Health and fire insurance premiums are reduced by over 25% (ASH) • Maintenance costs dramatically decrease (Nixon & West, 1989)

10. The Ventilation Lie • No feasible ventilation system can prevent harm from SHS exposure. • The toxins remain even when smoke and smell are gone • There is no safe level of exposure. • Simply separating smokers and nonsmokers is not effective • The current indoor air standard set by ASHRAE assumes no smoking

11. Worksite Smoking Bans Help Smokers Quit Smoke-free workplaces are associated with a 29% drop in cigarette consumption. Smokers are over 25% more likely to make serious quit attempts and achieve cessation (Glasgow, 1997).

12. Tobacco Policy in Kentucky Manufacturing Facilities, 2000-2004 Percent

13. Company Characteristics and Smoking Policies (2004) • 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.

14. 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

15. Elements of the Workplace Tobacco Policy Interview, 2006 • 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

16. 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 completed paper forms to UK • Send data forms to UK in mailer provided • Follow-up with interested manufacturers

17. 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

18. Conducting the Phone Interview • Verify that it is a convenient time (little potential for interruption) • Verify contact information and list name of person interviewed on Disposition Sheet (not on form) • Name • Phone/FAX/e-mail • Verify name of company and address

19. Conduct the Phone Interview • Get complete information…ask clarifying questions if needed. • Don’t suggest the “I don’t know” option • If person being interviewed is uncertain about an answer, complete the interview, 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.

20. 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.”

21. Proper Phone Etiquette • Be sensitive to time constraints • Be polite • Use nonjudgmental approach

22. Human Subjects Protections • Voluntary participation • Minimize barriers to participation • Understand the benefits of participation • Right to withdraw or refuse to answer • Confidentiality • No names or addresses of the interviewees on the actual interview form! TRAIN any helpers, emphasizing these protections.

23. Preparing for the Interview • Use one Disposition Sheet (pink form) for every company • Download the Interview Guide from website (www.mc.uky.edu/tobaccopolicy under Data Collection Forms. Your user name and password is on a label inside your manufacturer list folder. • Type in the Company Name and County on the first page of the interview Guide – one letter or number per box. These items will duplicate on all pages. • Print the Interview Guide. When you close the document, the company name and county will not be saved. • Please do not photocopy the form. If it gets skewed in copying, it cannot be read electronically.

24. Documentation Issues • Complete ALL questions • Use a PEN (blue or black)…DO NOT ERASE • Put an “X” through incorrect information, write “Error” next to it, and fill in the correct response • When filling out choice boxes, place a check mark or diagonal line (/) in the box. Do not circle the box or just place a dot in the box – Teleform cannot read it. • Please print or write legibly • Fill in only ONE box per question unless it says, “Fill in all that apply”

25. Documentation Issues • PRINT name of the workplace on every page. This can be done electronically (see Preparing for the Interview). • Pay attention to SKIP patterns. • Fill in the Box for “Other” in addition to PRINTING the information for “please specify.” • Write comments in the “Comments” box on the last page of the form. Please do not write comments anywhere else on the form – they cannot be read electronically. • Please print or write legibly. Otherwise, all your pages will have to be verified.

26. Submitting Forms Onlinewww.mc.uky.edu/tobaccopolicy(under Data Collection Forms) • Online version is similar to the print form. • Click on the correct boxes to answer and type in specifications (25 characters) • 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. • Any paper forms completed must be sent to UK in the mailer provided even if submitted online.

27. AFTER Each Interview • Check interview form for completeness • FAX forms to UK as you complete them (859-323-1033), unless you submit online. • If faxing several at a time be careful not to exceed your fax machine’s memory. • Best to use a high-speed FAX machine with memory, if available. • Contact Grace Pasley (859-323-8539) or glpasl0@email.uky.edu if you are having difficulty FAXing the forms or have questions

28. When ALL Interviews are Complete • When all interviews are completed, mail a copy of the 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; please shred any extra copies.

29. 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.

30. Helping Employers: Resources • http://www.cdc.gov/tobacco/ETS_Toolkit/worksites/Employer.htm (Guide)  • http://www.no-smoke.org/pdf/modelworkplacepolicy.pdf(Model Policy)   • http://www.cancer.org/docroot/PED/content/PED_10_2X_Smoking_In_The_Workplace.asp?sitearea=PED(Model Policy) • http://endsmoking.org/resources/employersguide/pdf/employersguide-2nd-edition.pdf (cessation resource) • http://www.surgeongeneral.gov/tobacco/tobaqrg.pdf(Clinical Practice Guidelines)