Psychological Reports, 1991, 68, 1191-1194. O Psychological Reports 1991
SMOKING CONTROL AND SMOKING RATE: IMPLICATIONS FOR WORKSITE SMOKING CESSATION ' LINDA T. DAWLEY
HAROLD H . DAWLEY, JR.
Wellness Institute, Inc. New Orleans, Louisiana
Veterans Administration Medical Center Tuhne Uniuersity School of Medicine Louisiana Stute University Medical Center
RUSSELL E. GLASGOW
PELAYO CORREA
Oregon Kesearch Institute Eugene, Oregon
Pathology Department huisfana Sute University JANET RICE
Deparhnent of Biostutistics Tulane Universio School of Public Health Summary.-Amount of conml of smoking at three comparable chemical plants was associated with smoking rates. Using a self-report survey, smoking rates were assessed at the three plants. Company authorities were asked about smoking control policy and the extent to which smokmg was controlled at each of the three plants was observed. A judgment was made that one plant had a very strict smoking control policy while the other two had moderate policies of control. Smoking rate was then compared for each of the three companies. The company with the strongest smoking control policy had a significantly lower mean rate of smoking than the other two companies. Smoking control may serve to facilitate cessation on the worksite.
I n studying the problem behavior of tobacco smolung, it is important to recognize that there are several different approaches to the reduction of this problem. Some of these approaches provide specific treatment directly intended to help people stop smoking. There are other approaches, however, that are not treatment per se in that they d o not focus directly on helping people stop smoking but are instead intended to encourage indirectly people to stop smoking through the control and discouragement of smoking. Unfortunately, much of the literature does not differentiate these separate approaches and uses the terms smoking control, smolung discouragement, and smoking cessation interchangeably. An example of this point is evident in the report on smoking and cardiovascular disease of the Surgeon General (DHHR, 1783) which, in reviewing the literature on smoking cessation, identifies the area as "smoking cessation evaluation research" and five paragraphs later as "smoking control studies" (pp. 244-245). Seeking to establish consistent terminology, Dawley (1786) has proposed the differentiation of 'This research was supported by Research Grant 1 543 DA05545-01 from the National Institute of Drug Addiction of the National Institutes of Health, US Public Health Service. Direct reprint requests to Linda T. Dawley, Ph.D., Wellness Institute, Inc., Heritage Office Park, Gretna, LA 70053.
1192
L. T. DAWLEY, E T A L .
smoking control to refer to efforts to control where smoking may and may not occur, smoking discouragement as educational efforts designed to encourage nonsmoking behavior, and smoking cessation as formal treatment efforts designed to help people directly stop smoking. I n conceptualizing quitting smoking as a process of extinction, removing opportunity for reinforcement (smoking) is a key element. Removing or diminishing the effectiveness of the reinforcer of smoking is a key element in cessation strategies such a brand fading and aversive smoking (Orleans & Pinney, 1984). Orleans (1986) stated that a reduction in the range of settings in which individuals may smoke can reduce cues and stimulus-response patterns that help maintain smoking behavior and contribute to relapse. There is growing recognition that worksite smoking bans also cause the greatest inconvenience to smokers (DHHS, 1985), a consequence that can be thought of in terms from learning theory as negative reinforcement. Even though relatively little attention has been directed toward investigating smolung control as a way to facilitate cessation, the 1985 Surgeon General's report on smoking at the worksite (DHHS, 1985) stated that worksite smoking bans "convey potentially powerful messages about the role of cigarettes in society and help reinforce nonsmoking as normative behavior" (p. 304). This report went on to state that smoking control efforts "increase public knowledge of the health risks of smoking" as well as "alter attitudes about the social desirability of smoking and acceptability of smoking in public" (p. 304), factors that obviously increase the likelihood of stopping smoking. The present study describes the association of worksite smoking control and employees' rates of smoking. Three chemical companies located in the southcentral part of the United States served as the sites for this study. Assessment was on the Worksite Smoking Questionnaire (Dawley, 1986), an objective 15-item questionnaire designed to measure attitudes toward smoking and smoking behavior along with acceptance of the associated health risks. Smoking status was indicated by the number of cigarettes respondents smoke per day. Nonsmolung was indicated by writing O for the number of cigarettes smoked per day. O n five questions pertaining to health risks associated with smoking, i.e., "Tobacco smoking is the main cause of lung cancer," circling choices numbered from 1, "Do not at all agree" to 4, "Agree very much so" indicates agreement with each statement. The ratings are summed to form an index of the acceptance of health associated with smoking. All employees, including- nonsmokers, were asked to complete this questionnaire. Also, information was obtained from the managements about their past and present efforts to help employees stop smoking. How much smoking was controlled at the three sites was also assessed by evaluating the company policy on smoking control and observing how effectively the smoking control policies were enforced. The -
~
1193
WORKPLACE SMOKING: CONTROL, RATE
smoking policies were ranked on the extent to which each controlled smoking from "strong, moderate, to weak." Compliance was assessed with unobtrusive observations of behavior in four no-smoking areas during four 10min. times sampled over a two-day period. The three companies were comparable in terms of their histories of past efforts to help employees stop smoking and in management style. TABLE 1 SLIOKING CONTROL POLICY AND SMOKING RATE Company 1 Moderate Policy Total Employees 910 Respondents 401 (45%) Number of Smokers 119 Smoking Rate 34%
Company 2 Moderate Policy Total Employees 615 Respondents 281 (45%) Number of Smokers 401 Smoking Rate 32%
Company 3 Strong Policy Total Employees 1160 Respondents 483 (42%) Number of Smokers 85 Smoking Rate 18%
By comparing the number of areas in which smoking was permitted, a major difference was found in control of smoking at the three companies. One company had a strong policy on smoking control and prohibited smoking in virtually most of its worksite. The other two companies' smoking control policy permitted smoking in specified areas. A 100% compliance with the no-smoking policy was observed in all areas studied at the three sites. When the smoking rates at the three companies were associated with smoking control, the company with the strongest smoking control policy had the lowest rate of smoking (18% in comparison with rates of 32% and 34% at the other two companies). Related to this low rate of smoking was higher agreement with questions on the smoking questionnaire designed to assess acceptance of the health risks associated with smoking. The results are encouraging in that they indicate the value of smoking control as a way to facilitate no smoking. Many of the reasons given by people who stop smoking deal with becoming tired of the hassles and associated inconvenience. As an increasing number of smoking control ordinances are passed by local and state governments, smoking will become more of a hassle and inconvenience. Among smokers, it seems recognized that smoking control will fachtate their stopping smoking. I n 1986, 46% of the employees of the New York City Health Department stated that they would quit or reduce their smolung if smoking were controlled at the workplace (Morbidity and Mortality Weekly Report, 1986). Burtaine and Slade (1988) reported that 211 employees at two Pennsylvania hospitals reported that they- had quit smoking within one year after these hospitals decided to become smoke-free. Few smoking cessation programs can achieve comparable rates to those reported by Burtaine and Slade (1988). Efforts to increase the control of smoking at the worksite can be
1194
L. T. DAWLEY, ET AL
expected to continue. These efforts are generally made in conjunction with a provision for employees to participate in a smoking cessation program. There is growing agreement that, as the worksite changes to a setting where smoking is not only socially undesirable but unacceptable, increasing numbers of people can be expected to quit smoking in such settings. The value of smoking control as a way to facilitate smoking cessation is clear. Dawley (1986) has advocated that smoking control and discouragement, when coupled with efforts towards cessation, can increase their over-all effectiveness. Researchers have shown the effectiveness of one such program called SmokeFreea in two different government-funded studies at five petrochemical plants. These studies showed a significantly greater abstinence on 4-mo. follow-ups at companies in which the comprehensive program of smoking control, discouragement, and cessation was implemented in comparison with the companies using cessation alone. 2' ' REFERENCES BURTAINE, J., & SLADE,J. (1988) The smoke-free hospital. New Jersey Medicine, 85, 143-145. DAWLEY, H. H . (1786) SmokeFree-a comprehensive smoking control, discouragement, and cessation program. New Orleans, LA: Wellness Institute, Inc. M O R ~ ~ I TAND Y MORTALITYWEEKLYREPORT.(1986) Workplace smoking survey-New York City: perspectives in disease prevention and health promotion. Morbidity and Mortality Weekly Report, 35, 745-747. ORLEANS,C. T. (1786) Evaluation research design for worksite no-smoking policies and programs. Paper presented at the National Cancer Institute Conference, April, 1786. ORLEANS, C. T., & PINNEY,J. (1984) Non-smoking in the workphce: a guidefor employers. Washington, DC: Center for Corporate Public Involvement. OF HEALTHAND HUMANRESOLIRCES. (1983) The health conseauences of U.S. DEPARTMENT smoking: cardiovascular disease. A report of the Surgeon General, ~ e ~ & t m e noft Health and Human Services, Public Health Service, Office of Smoking and Health. D D H S Publ. No. (PHs) 84.502041 U.S. DWARTMENT OF HEALTHAND H L J A NSERVICES.(1985) The health consequences of smokin cancer and chronic lung disease i n the workplace. A re ort of the Surgeon ~ e n e r $ : De artment of Health and Human Services, Public ~ e a l t EService, Office on Smoking a n g ~ e a l t h .
Accepted June 4, 1771
'L. T. Dawley: Worksite smokin control, discouragement, and cessation. (Research grant f,unded by the National Institute o B ~ r u gAddiction, 1988) H . H . Dawley: Smoking control, discouragement, and cessation at the worksite. (Research grant funded by the Louisiana Lung and Cancer Trust Fund, 1987)
SMOKING CONTROL AND SMOKING RATE: IMPLICATIONS FOR WORKSITE SMOKING CESSATION ' LINDA T. DAWLEY
HAROLD H . DAWLEY, JR.
Wellness Institute, Inc. New Orleans, Louisiana
Veterans Administration Medical Center Tuhne Uniuersity School of Medicine Louisiana Stute University Medical Center
RUSSELL E. GLASGOW
PELAYO CORREA
Oregon Kesearch Institute Eugene, Oregon
Pathology Department huisfana Sute University JANET RICE
Deparhnent of Biostutistics Tulane Universio School of Public Health Summary.-Amount of conml of smoking at three comparable chemical plants was associated with smoking rates. Using a self-report survey, smoking rates were assessed at the three plants. Company authorities were asked about smoking control policy and the extent to which smokmg was controlled at each of the three plants was observed. A judgment was made that one plant had a very strict smoking control policy while the other two had moderate policies of control. Smoking rate was then compared for each of the three companies. The company with the strongest smoking control policy had a significantly lower mean rate of smoking than the other two companies. Smoking control may serve to facilitate cessation on the worksite.
I n studying the problem behavior of tobacco smolung, it is important to recognize that there are several different approaches to the reduction of this problem. Some of these approaches provide specific treatment directly intended to help people stop smoking. There are other approaches, however, that are not treatment per se in that they d o not focus directly on helping people stop smoking but are instead intended to encourage indirectly people to stop smoking through the control and discouragement of smoking. Unfortunately, much of the literature does not differentiate these separate approaches and uses the terms smoking control, smolung discouragement, and smoking cessation interchangeably. An example of this point is evident in the report on smoking and cardiovascular disease of the Surgeon General (DHHR, 1783) which, in reviewing the literature on smoking cessation, identifies the area as "smoking cessation evaluation research" and five paragraphs later as "smoking control studies" (pp. 244-245). Seeking to establish consistent terminology, Dawley (1786) has proposed the differentiation of 'This research was supported by Research Grant 1 543 DA05545-01 from the National Institute of Drug Addiction of the National Institutes of Health, US Public Health Service. Direct reprint requests to Linda T. Dawley, Ph.D., Wellness Institute, Inc., Heritage Office Park, Gretna, LA 70053.
1192
L. T. DAWLEY, E T A L .
smoking control to refer to efforts to control where smoking may and may not occur, smoking discouragement as educational efforts designed to encourage nonsmoking behavior, and smoking cessation as formal treatment efforts designed to help people directly stop smoking. I n conceptualizing quitting smoking as a process of extinction, removing opportunity for reinforcement (smoking) is a key element. Removing or diminishing the effectiveness of the reinforcer of smoking is a key element in cessation strategies such a brand fading and aversive smoking (Orleans & Pinney, 1984). Orleans (1986) stated that a reduction in the range of settings in which individuals may smoke can reduce cues and stimulus-response patterns that help maintain smoking behavior and contribute to relapse. There is growing recognition that worksite smoking bans also cause the greatest inconvenience to smokers (DHHS, 1985), a consequence that can be thought of in terms from learning theory as negative reinforcement. Even though relatively little attention has been directed toward investigating smolung control as a way to facilitate cessation, the 1985 Surgeon General's report on smoking at the worksite (DHHS, 1985) stated that worksite smoking bans "convey potentially powerful messages about the role of cigarettes in society and help reinforce nonsmoking as normative behavior" (p. 304). This report went on to state that smoking control efforts "increase public knowledge of the health risks of smoking" as well as "alter attitudes about the social desirability of smoking and acceptability of smoking in public" (p. 304), factors that obviously increase the likelihood of stopping smoking. The present study describes the association of worksite smoking control and employees' rates of smoking. Three chemical companies located in the southcentral part of the United States served as the sites for this study. Assessment was on the Worksite Smoking Questionnaire (Dawley, 1986), an objective 15-item questionnaire designed to measure attitudes toward smoking and smoking behavior along with acceptance of the associated health risks. Smoking status was indicated by the number of cigarettes respondents smoke per day. Nonsmolung was indicated by writing O for the number of cigarettes smoked per day. O n five questions pertaining to health risks associated with smoking, i.e., "Tobacco smoking is the main cause of lung cancer," circling choices numbered from 1, "Do not at all agree" to 4, "Agree very much so" indicates agreement with each statement. The ratings are summed to form an index of the acceptance of health associated with smoking. All employees, including- nonsmokers, were asked to complete this questionnaire. Also, information was obtained from the managements about their past and present efforts to help employees stop smoking. How much smoking was controlled at the three sites was also assessed by evaluating the company policy on smoking control and observing how effectively the smoking control policies were enforced. The -
~
1193
WORKPLACE SMOKING: CONTROL, RATE
smoking policies were ranked on the extent to which each controlled smoking from "strong, moderate, to weak." Compliance was assessed with unobtrusive observations of behavior in four no-smoking areas during four 10min. times sampled over a two-day period. The three companies were comparable in terms of their histories of past efforts to help employees stop smoking and in management style. TABLE 1 SLIOKING CONTROL POLICY AND SMOKING RATE Company 1 Moderate Policy Total Employees 910 Respondents 401 (45%) Number of Smokers 119 Smoking Rate 34%
Company 2 Moderate Policy Total Employees 615 Respondents 281 (45%) Number of Smokers 401 Smoking Rate 32%
Company 3 Strong Policy Total Employees 1160 Respondents 483 (42%) Number of Smokers 85 Smoking Rate 18%
By comparing the number of areas in which smoking was permitted, a major difference was found in control of smoking at the three companies. One company had a strong policy on smoking control and prohibited smoking in virtually most of its worksite. The other two companies' smoking control policy permitted smoking in specified areas. A 100% compliance with the no-smoking policy was observed in all areas studied at the three sites. When the smoking rates at the three companies were associated with smoking control, the company with the strongest smoking control policy had the lowest rate of smoking (18% in comparison with rates of 32% and 34% at the other two companies). Related to this low rate of smoking was higher agreement with questions on the smoking questionnaire designed to assess acceptance of the health risks associated with smoking. The results are encouraging in that they indicate the value of smoking control as a way to facilitate no smoking. Many of the reasons given by people who stop smoking deal with becoming tired of the hassles and associated inconvenience. As an increasing number of smoking control ordinances are passed by local and state governments, smoking will become more of a hassle and inconvenience. Among smokers, it seems recognized that smoking control will fachtate their stopping smoking. I n 1986, 46% of the employees of the New York City Health Department stated that they would quit or reduce their smolung if smoking were controlled at the workplace (Morbidity and Mortality Weekly Report, 1986). Burtaine and Slade (1988) reported that 211 employees at two Pennsylvania hospitals reported that they- had quit smoking within one year after these hospitals decided to become smoke-free. Few smoking cessation programs can achieve comparable rates to those reported by Burtaine and Slade (1988). Efforts to increase the control of smoking at the worksite can be
1194
L. T. DAWLEY, ET AL
expected to continue. These efforts are generally made in conjunction with a provision for employees to participate in a smoking cessation program. There is growing agreement that, as the worksite changes to a setting where smoking is not only socially undesirable but unacceptable, increasing numbers of people can be expected to quit smoking in such settings. The value of smoking control as a way to facilitate smoking cessation is clear. Dawley (1986) has advocated that smoking control and discouragement, when coupled with efforts towards cessation, can increase their over-all effectiveness. Researchers have shown the effectiveness of one such program called SmokeFreea in two different government-funded studies at five petrochemical plants. These studies showed a significantly greater abstinence on 4-mo. follow-ups at companies in which the comprehensive program of smoking control, discouragement, and cessation was implemented in comparison with the companies using cessation alone. 2' ' REFERENCES BURTAINE, J., & SLADE,J. (1988) The smoke-free hospital. New Jersey Medicine, 85, 143-145. DAWLEY, H. H . (1786) SmokeFree-a comprehensive smoking control, discouragement, and cessation program. New Orleans, LA: Wellness Institute, Inc. M O R ~ ~ I TAND Y MORTALITYWEEKLYREPORT.(1986) Workplace smoking survey-New York City: perspectives in disease prevention and health promotion. Morbidity and Mortality Weekly Report, 35, 745-747. ORLEANS,C. T. (1786) Evaluation research design for worksite no-smoking policies and programs. Paper presented at the National Cancer Institute Conference, April, 1786. ORLEANS, C. T., & PINNEY,J. (1984) Non-smoking in the workphce: a guidefor employers. Washington, DC: Center for Corporate Public Involvement. OF HEALTHAND HUMANRESOLIRCES. (1983) The health conseauences of U.S. DEPARTMENT smoking: cardiovascular disease. A report of the Surgeon General, ~ e ~ & t m e noft Health and Human Services, Public Health Service, Office of Smoking and Health. D D H S Publ. No. (PHs) 84.502041 U.S. DWARTMENT OF HEALTHAND H L J A NSERVICES.(1985) The health consequences of smokin cancer and chronic lung disease i n the workplace. A re ort of the Surgeon ~ e n e r $ : De artment of Health and Human Services, Public ~ e a l t EService, Office on Smoking a n g ~ e a l t h .
Accepted June 4, 1771
'L. T. Dawley: Worksite smokin control, discouragement, and cessation. (Research grant f,unded by the National Institute o B ~ r u gAddiction, 1988) H . H . Dawley: Smoking control, discouragement, and cessation at the worksite. (Research grant funded by the Louisiana Lung and Cancer Trust Fund, 1987)
