Smoking In The Workplace Essay
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Smoking & Smoking Cessation in the Workplace
Table of Contents
Introduction p. 3
Purpose ... p. 3
The Effects of Smoke and Second-Hand Smoke ... p. 4
Do Non-smoking Policies Succeed? .. p. 5
Why do People Continue to Smoke? . p. 6
Promoting Smoking Cessation ... p. 9
Conclusion .. p. 15
Recommendations ... p. 15
References ... p. 17
Smoking & Smoking Cessation in the Workplace
Introduction
The single most preventable factor that contributes to the major health problems facing Canadians today is the use of tobacco. The very mention of the word smoking can evoke an argument from the calmest of people, whether they are smokers or non-smokers. The former feel threatened, while the latter feel they may have the chance to bring an end to an activity they have long disliked and disapproved of. Workplaces across the country are adopting smoke-free policies in order to provide clean air and to protect employees and the public alike from the harmful, if not life-threatening effects of smoking. According to the American Lung Association (1997), 94 per cent of smokers and non-smokers now believe companies should either ban smoking totally in the workplace or restrict it to separately ventilated areas.
Purpose
In response to an increased awareness of the dangers of smoking, there has been a growing interest in the introduction of smoking policies for the workplace. The purpose of this paper will be to outline some of the effects of smoking and the effectiveness of implementing smoking cessation programs. This paper also contains specific goals and strategic direction with which to achieve these goals and provides the groundwork for the formation of a committee to review the research and aid in implementing the recommendations. Well-designed and implemented programs and policies can aid in preventing the use and effects of tobacco and second-hand smoke.
The Effects of Smoking and Second Hand Smoke
The effects of the use of tobacco are well researched and well documented. Tobacco use poses a risk to both those who participate in the behavior, and to those who passively take in second-hand smoke. Stillman (1995) found that smoking is the leading cause of preventable death, and smoking related diseases are involved in more than one third of all hospital admissions. Fried (1994) reported that women who smoke are more often subject to infertility, miscarriage, spontaneous abortion, stillbirths, and underweight babies. Fried also found that crib death (sudden infant death syndrome, or SIDS) occurs 2.5 times more often in babies whose mothers smoke. Albrecht, Cassidy, Reynolds, Ketchem, and Abriola (1999) reported that more than 400,000 annual deaths are associated with tobacco use and the cost to health care and lost productivity is almost $100 billion per year. Moreover, maternal smoking in pregnancy has been linked to learning disabilities, hyperactivity, impulsivity, and soft neurological signs in school aged children. Albrecht et al (1999) also reported that maternal smoking and second hand smoke are associated with increased incidence of acute respiratory infections and more frequent hospitalization for severe bronchitis, pneumonia, asthma, and otitis media during the first year of infancy. Similarly, current estimates of the number of deaths attributed to smoking in Canada range as high as 38,000 per year (Albrecht et al, 1999). A large amount of deaths is also associated with involuntary exposure to the tobacco smoke.
According to Single, MacLennan and MacNeil (1994) in 1991, 46.8 billion cigarettes were sold legally in Canada. Thus, an estimated 35,717 deaths were attributed to smoking in Canada in 1990, a rate of 135.6 per 100,000. Single et al (1994) revealed that although Canadian men were once much more likely than women to smoke, men and women are now almost equally likely to be current smokers (31% vs. 28%). Also, men are more likely than women to be former smokers (39% vs. 31%). Meanwhile, smoking is highest among those aged 25 to 44 (35%) and lowest among those over 65 (15%).
The effects of smoking and second-hand smoke are many in number. Tobacco smoke represents the single most significant source of indoor air pollution. The smoke and second-hand smoke from tobacco contains over 4000 chemicals, both gas and particulate. The American Nurses' Association (ANA, 1998) researched and found that the gas phase of second-hand smoke contained such poisons and irritants as carbon monoxide, acrolein, ammonia, nitrogen oxides, benzene, pyridine, and hydrogen cyanide and the particulate phase contains nicotine and many known or probable carcinogens, which have no safe level for human exposure.
The seriously damaging health effects of tobacco smoke continue to be documented. ANA (1998) found that children and adults exposed to tobacco smoke experienced increased rates of respiratory illness, including lung cancer (approximately 3000 deaths per year in adults exposed to tobacco smoke), higher rates of respiratory tract infections (bronchitis and pneumonia), and exacerbation of asthma symptoms. The ANA (1998) also found that high exposure to tobacco smoke nearly doubles a woman's risk of heart attack, and also causes eye, nose, and throat irritation, leading to excess coughing, chest discomfort, and difficulty breathing.
Do Non-smoking Policies Succeed?
Joseph, Knapp, Nichol, and Pirie (1995) found that smoke-free hospital policies are designed to minimize patient, employee, and visitor exposure to secondhand smoke, encourage patients to quit smoking, and set an example for the community of institutional policies that reflect scientific knowledge about the health risks of smoking. David (1992) implemented a survey at a 38-bed hospice, where 119 staff is employed, as a preliminary way to introduce a no-smoking policy. The survey proved to be valuable in introducing staff to the concept of a policy, making them feel involved, and supplying the policy-makers with background information. Literature suggests that positive behavioral changes occur among employees after the introduction of a no-smoking policy. Shirres (1996) found in a study that the introduction of non-smoking policy and education programs induced positive behavioral and attitudinal changes in smoking. Martin (1998) states that providing a tobacco free environment that establishes nonuse of tobacco as a norm offers opportunities for positive role modeling. Joseph et al (1995) also found that having a person at the hospital dedicated to enforcing the no-smoking policy greatly improved the chances of success.
If a smoke-free work environment is to be achieved, greater efforts to assist smokers to quit will be necessary. Interventions to reduce smoking must become a priority for health care providers, as physicians and nurses come into contact and interact with a large number of smokers every year. Health promotion advocates must also communicate the cost savings and health benefits garnered from workplace smoking cessation programs.
Why do people continue to smoke?
Tobacco use, which occurs primarily through smoking, is a behavior influenced by pharmacological, psychological, social, and environmental factors (Fisher, Haire-Joshu, Morgan, Rehberg, & Rost, 1990). The U.S. Department of Health and Human Services (1988) state that nicotine, the major addictive agent in tobacco, provides both euphoric and sedating effects and serves as powerful pharmacological reinforcement for maintenance of the behavior. Christen and Christen (1994) suggested that recognizing tobacco use as an addiction is both critical for treating the tobacco user and for understanding why people continue to use tobacco despite the known health risks. Shiffman (1979) adds that in addition to its pharmacological effects, smoking involves a strong psychological dependence in that smokers report engaging in the behavior to soothe negative affective symptoms, such as tension, anxiety, boredom, and irritability. When these affective symptoms are reduced, it leads to an increased activity in the behavior.
Christen and Christen (1994) state that smoking is seldom a take-it-or-leave-it activity. Most smokers cannot choose to use tobacco one day and leave it alone the next. Most smokers admit that they would like to quit, but are unable to do so. Christen and Christen (1994) further argue that some individuals use nicotine as a tranquilizer: they believe that smoking keeps them on an even emotional keel and reduces their feelings of anger, fear, and frustration. In addition, Christen and Christen (1994) stated that smokers commonly reported smoking helps them to regulate their dysphoric moods or negative affect, and those who experience excessive stressors tend to increase their consumption. As mentioned, social and environmental conditions also influence tobacco use. McIntyre-Kingsolver, Lichenstein, & Mermelstein (1983) and Ockene, Benfari, Nuttall, Hurwitz, & Ockene (1983) state that a majority of smokers are surrounded by family members and friends who engage in the behavior, providing strong cues to continue smoking.
Albrecht et al (1999) found that adolescents are faced with lifestyle choices that are influenced by developmental level, cognitive understanding, decision-making skills, and social influences such as family values and peer pressure. Fried (1994) reported epidemiological data and study of psychological, biological, sociocultural, and physiological variables reveal a gender-related proclivity for females to initiate and maintain the tobacco habit. Young women appear to be more vulnerable to starting smoking and less amendable to stopping it. Fried (1994) reported a woman's fear of weight gain is a deterrent to cessation and an impetus to continue the tobacco habit. Women tend to report less confidence in their abilities to quit, perceive more barriers to abstinence, and anticipate negative consequences of quitting.
Fried (1994) suggested low income, poor housing, lack of education, single/divorced or separated marital status, unemployment, city dwelling, lack of independence, housewife, or single working parents are characteristics of a smoker. As mentioned, social and environmental conditions also influence tobacco use. These factors alone make it hard to resist and quit smoking, but when adolescents face smoking cessation, it can be even more difficult.
Christen and Christen (1994) state that smoking has both similarities to and differences from other addictions. Cigarette smoking, a special form of addiction with its own unique features, is incredibly resistant to long-term modification. Nicotine is addicting and smoking represents an addictive disorder, such as alcohol, cocaine, and heroin dependence. It is further argued that cigarette smoking is psychologically as well as physically addicting. Christen and Christen (1994) suggested that nicotine is now understood to be a strongly addictive mood-altering drug, with properties that clearly reinforce the continued use of tobacco products. They further argue that nicotine, as an ingestive disorder, compulsive nicotine intake causes physiological tolerance, tissue dependence, psychic dependence, and relatively well defined physical withdrawal symptoms.
Promotion Smoking Cessation
According to Blair (1995) one objective of wellness program activities is to foster employee health. However, workers whose health stands to gain the most from wellness programs are the least aware of their unhealthy lifestyles and the least motivated to change. According to Nagel, Mayton, and Walner (1995) since values are a central concept in understanding and predicting human behavior, health education aimed specifically at cigarette smoking or other habits treated singly rather than in relation to each other. Effective health promotion programs, that attempt to change negative behaviors while reinforcing existing positive behaviors must understand the attitudes and behavior of target audiences, are necessary. Mintz (1989) argued that for health promotion to be of any use in a practical sense, it must be put into the hands of those who can use it. Mintz (1989) suggested that the value of health information to society could only be fully realized if information is absorbed and acted upon to a significant degree by the audience that the information is intended to reach. According to Novelli (1997), successful utilization of health promotion is dependent upon understanding or identifying the target consumers' needs, expectations, satisfactions and dissatisfactions. Lefebvre and Rochlin (1997) and Wilson and Olds (1991) suggested that promotion of health products should consider the objectives of the promotion, the target audience, the desired effect, and the optimal reach and frequency.
Many serious public health and social problems of the day have their root in behaviors that begin in late childhood and adolescence. Nagel et al (1995) advised that drug education programs designed to keep adolescent from becoming daily users of tobacco (prevention) should be encouraged to focus on changing the value placed on health. According to Andreasen (1995), an extremely important task during the formative stages of the strategic planning process is to gain an understanding of the extent to which interpersonal influences are likely to be important for one or more target groups....
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