Tobacco use is a public health problem worldwide, being a significant risk factor for cardiovascular disease and cancer which are the leading causes of death worldwide. According to the Centers for Disease Control and Prevention (CDC), tobacco smoking remains the largest preventable cause of disease, disability, and death in the United States. In addition to its health implications, tobacco smoking causes a substantial economic burden, costing the United States over $300 billion every year in direct medical expenses and productivity loss.
Tobacco use in the workplace has been a significant cause of concern over the years, as many workers exposed to tobacco smoke are susceptible to its various health risks and attendant productivity decline. There has been more than a 50% decline in cigarette smoking among US adults since the first Surgeon-General’s Report on health risks of smoking over 50 years ago. However, about 20 percent of the workforce still smoke cigarettes, exposing non-smokers to second-hand smoke.
According to the CDC Foundation, productivity loss resulting from of second-hand smoking-related illnesses costs about $5.6 billion every year with a total of $156 billion recorded yearly in productivity loss from all smoking-related illnesses.
CDC Foundation also notes that workplaces, where smoking is allowed, spend an average of $728 more per 1,000 square feet each year in maintenance costs than smoke-free workplaces. This translates to a total cost of $9,000 to $14,000 annually since most US commercial buildings average between 12,000 to 19,000 square feet. Cigarette smoking increases the incidence of workplace fire hazards and breakdown of work equipment.
The CDC reports that the percentage of workers who smoke vary with the occupation and industry. The industries with the highest rates of worksite tobacco smoking are mining (30%), hospitality and food services (30%), and construction (29.7%). Similarly, the rates of e-cigarettes or smokeless tobacco use are still relatively higher in these industries. In addition, the CDC notes that the incidence of cigarette smoking is highest among workers with less than high school certificate (28.4%), those without a health insurance plan (28.6%), and workers living below the federal poverty level (27.7%).
Benefits of a Tobacco-free Workplace
This public health issue has begun to draw attention in the workplace as proactive steps are being taken to mitigate workplace cigarette smoking and its attendant risks. Employers are beginning to enact policies to prohibit tobacco use, in addition to legislation banning the use of tobacco in the workplace which has been adopted by 27 states and the District of Columbia.
The main purposes of worksite tobacco cessation programs are to encourage users to quit and reduce second-hand smoke exposure to other employees. Furthermore, these workplace policies and encouraging tobacco cessation have a ripple effect, preventing tobacco use initiation among other employees and influencing tobacco-use behavior in families of employees.
Tobacco-free worksite creates a safer and healthier work environment which, in turn, reduces the risk of deleterious health complications. Therefore, direct health cost to the employer is reduced, and employee productivity is promoted. In the long term, employers save a lot of money on maintenance costs when tobacco, matches, and cigarette butts are eliminated from the workplace. Office equipment and furniture also last longer in a tobacco-free environment.
Strategies to Curb Workplace Tobacco Use
Curbing tobacco use in the workplace is beyond expressly prohibiting it while providing effective programs for smoke cessation. The first step in implementing a successful worksite smoke cessation program is developing an evaluation plan. This involves a careful assessment of the potential baseline process, as well as the possible health outcomes and the organizational restructuring needed to implement those programs.
In creating a workplace tobacco cessation policy, the evaluation process should determine the following:
- Structural formats necessary for implementing the policy
- The approaches that are appropriate for the employees
- The qualifications of the instructors or trainers
- What programs will be most effective for the employees: off-site or on-site programs
- Availability of relapse prevention strategies
- If the program is culturally, ethnically, and educationally appropriate for the employees
- A six-month to one-year prediction of the success of the programs.
In implementing these strategies, employers should set up policy effective dates when the program will take effect and conduct regular training sessions for employees and managers.
Some of the recommendations by the National Institute for Occupational Safety and Health (NIOSH) for employers in ensuring a tobacco-free worksite include the following:
- Establish smoke-free zones to protect employees from exposure to second-hand smoke and emissions from e-cigarettes and other electronic nicotine devices. This would involve installing “No Smoking” or “Tobacco-Free Area” signs on strategic locations including entrances and walkways.
Smoke-free zones should include:
- All indoor areas with no exceptions, even if it is separately enclosed or ventilated.
- All areas outside office building entrances
- All work vehicles
Additionally, all ashtray and place receptacles for smoking materials should be removed from building entrances, windows, and ventilation units.
- Install “No Smoking” or “Tobacco-Free Area” signs on strategic locations including entrances and walkways.
- E-cigarette smoking should also be prohibited in the workplace, given the growing body of evidence suggesting its low safety levels.
- Comply with the available federal, state, and local regulations which prohibit smoking, smoking materials, and use of tobacco products in the areas of the worksite where high-risk occupational hazards are, such as, areas with explosive or highly inflammable substances.
- Educate employees on tobacco-related health risks (including risks of second-hand smoking), as well as the benefits of smoke-cessation. Employers can leverage technology here by providing web-based cessation initiatives or mobile device messaging methods.
- Provide comprehensive tobacco cessation programs and support systems for employees and their dependents who use tobacco at no cost or subsidized cost for workers who earn lower with a primary purpose to improve employee health.
- Provide active tobacco-cessation policies and interventions that promote employee participation. Ensure employees are involved in these programs in a step-wise manner and at levels corresponding to their progress, as cigarette cessation itself is a gradual process.
- Educate employees on occupational safety risks of cigarette smoking and strategies to limit those risks.
- Provide incentives for employees who are in the tobacco-cessation program, for instance, by providing health insurance coverage for smoking cessation therapies. This has been shown to increase the number of smokers who put efforts at quitting and those who eventually succeed in quitting.
Although some employers have already implemented these strategies, they are not yet widely spread across the United States, and some more work needs to be done. Effective smoke-cessation policies not only improve workforce performance, but they also improve the health and quality of life of all employees.
Learn more about Strategies to Tackle Workplace Tobacco Use in our Healthy Workplace Design Summit in the 11th edition of the Healthcare Revolution Conference holding between October 28th and 30th, 2018.