Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-28T16:30:19.252Z Has data issue: false hasContentIssue false
  • English
  • Français

Tobacco Use Among Healthcare Workers: Impact of a Worksite Policy Change at a US Military Community Hospital

Published online by Cambridge University Press:  27 July 2015

Margaret Ryan ,
Devan Romero ,
Jerlyn Tolentino ,
Ian Hammett ,
Danielle Robins ,
Jonathan Volden  and
Kim Pulvers
Margaret Ryan*
Affiliation:
Naval Hospital, Camp Pendleton, California University of California, San Diego, California
Devan Romero
Affiliation:
California State University, San Marcos, California
Jerlyn Tolentino
Affiliation:
Naval Hospital, Camp Pendleton, California
Ian Hammett
Affiliation:
Naval Hospital, Camp Pendleton, California
Danielle Robins
Affiliation:
Naval Hospital, Camp Pendleton, California
Jonathan Volden
Affiliation:
California State University, San Marcos, California
Kim Pulvers
Affiliation:
California State University, San Marcos, California
*
Address for correspondence: Dr. Margaret Ryan, Building H200, Naval Hospital, Camp Pendleton, CA 92055. Email: margaret.ryan.md@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introductions: Healthcare workers use less tobacco than other working populations. In contrast, US military members use more tobacco than civilians. Military healthcare workers, therefore, represent a unique group with regard to occupational factors that may influence tobacco use.

Aims/Methods: Records of workers at a military community hospital were reviewed to describe tobacco use. An anonymous survey assessed impressions of a worksite policy change that prohibited tobacco use anywhere on hospital grounds.

Results: Hospital staff included 2,074 professionals. Tobacco use was significantly associated with male sex and being a military enlisted worker. In fact, 37% of male enlisted members used tobacco; fewer than 10% of all other workers used tobacco. Among 232 survey respondents, 61% agreed with tobacco-restrictive worksite policies, but only 33% thought policies were effective. Nearly one-third of tobacco users reported decreasing use in the past year. In multivariable modelling, changing habits in response to worksite policy was the only factor significantly associated with decreased tobacco use.

Conclusions: Tobacco use among US military healthcare workers varies markedly by demographic characteristics. Male, military enlisted workers use tobacco at very high rates, paralleling the troops they serve. Implementation of tobacco-restrictive worksite policies is associated with decreased tobacco use in this population.

Type
Original Articles
Information
Journal of Smoking Cessation , Volume 12 , Issue 2 , June 2017 , pp. 113 - 121
Creative Commons
This is a work of the U.S. Government and is not subject to copyright protection in the United States.
Copyright
Copyright © The Author(s) 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agaku, I.T., King, B.A., & Dube, S.R. (2014a). Current cigarette smoking among adults - United States, 2005–2012. MMWR. Morbidity and Mortality Weekly Report, 63 (2), 29–34.Google ScholarPubMed
Agaku, I.T., King, B.A., Husten, C.G., Bunnell, R., Ambrose, B.K., Hu, S.S. et al. (2014b). Tobacco product use among adults–United States, 2012–2013. MMWR. Morbidity and Mortality Weekly Report, 63 (25), 542–547.Google Scholar
Alberg, A.J., Shopland, D.R., & Cummings, K.M. (2014). The 2014 surgeon general's report: Commemorating the 50th anniversary of the 1964 report of the advisory committee to the US surgeon general and updating the evidence on the health consequences of cigarette smoking. American Journal of Epidemiology, 179 (4), 403–412. doi: 10.1093/aje/kwt335.CrossRefGoogle Scholar
Asch, D.A., Muller, R.W., & Volpp, K.G. (2013). Conflicts and compromises in not hiring smokers. New England Journal of Medicine, 368 (15), 1371–1373. doi: 10.1056/NEJMp1303632.Google Scholar
Azagba, S., & Sharaf, M.F. (2012). The association between workplace smoking bans and self-perceived, work-related stress among smoking workers. BMC Public Health, 12, 123. doi: 10.1186/1471-2458-12-123.Google Scholar
Brownson, R.C., Haire-Joshu, D., & Luke, D.A. (2006). Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annual Review of Public Health, 27, 341–370. doi: 10.1146/annurev.publhealth.27.021405.102137.Google Scholar
Cheng, K.W., Glantz, S.A., & Lightwood, J.M. (2011). Association between smokefree laws and voluntary smokefree-home rules. American Journal of Preventive Medicine, 41 (6), 566–572. doi: 10.1016/j.amepre.2011.08.014.CrossRefGoogle ScholarPubMed
Cummings, K.M., Fong, G.T., & Borland, R. (2009). Environmental influences on tobacco use: Evidence from societal and community influences on tobacco use and dependence. Annual Review of Clinical Psychology, 5, 433–458. doi: 10.1146/annurev.clinpsy.032408.153607.Google Scholar
Curry, L.E., Richardson, A., Xiao, H., & Niaura, R.S. (2013). Nondisclosure of smoking status to health care providers among current and former smokers in the United States. Health Education and Behavior, 40 (3), 266–273. doi: 10.1177/1090198112454284.CrossRefGoogle ScholarPubMed
Ham, D.C., Przybeck, T., Strickland, J.R., Luke, D.A., Bierut, L.J., & Evanoff, B.A. (2011). Occupation and workplace policies predict smoking behaviors: Analysis of national data from the current population survey. Journal of Occupational and Environmental Medicine, 53 (11), 1337–1345. doi: 10.1097/JOM.0b013e3182337778.Google Scholar
Hehir, A.M., Indig, D., Prosser, S., & Archer, V.A. (2013). Implementation of a smoke-free policy in a high secure mental health inpatient facility: Staff survey to describe experience and attitudes. BMC Public Health, 13, 315. doi: 10.1186/1471-2458-13-315.CrossRefGoogle Scholar
Hermes, E.D., Wells, T.S., Smith, B., Boyko, E.J., Gackstetter, G.G., Miller, S.C. et al. (2012). Smokeless tobacco use related to military deployment, cigarettes and mental health symptoms in a large, prospective cohort study among US service members. Addiction, 107 (5), 983–994. doi: 10.1111/j.1360-0443.2011.03737.x.Google Scholar
Hoffman, G.J., & Mendez-Luck, C.A. (2011). Stressed and strapped: Caregivers in California. Policy Brief UCLA Cent Health Policy Res (Pb2011–11), 1–8.Google Scholar
Huang, J.Y., & Bargh, J.A. (2014). The Selfish Goal: Autonomously operating motivational structures as the proximate cause of human judgment and behavior. Behavioral and Brain Sciences, 37 (2), 121–135. doi: 10.1017/s0140525x13000290.Google Scholar
Huddle, T.S., Kertesz, S.G., & Nash, R.R. (2014). Health care institutions should not exclude smokers from employment. Academic Medicine, 89 (6), 843–847. doi: 10.1097/acm.0000000000000247.CrossRefGoogle Scholar
Hughes, M.C., Yette, E.M., Hannon, P.A., Harris, J.R., Tran, N.M., & Reid, T.R. (2011). Promoting tobacco cessation via the workplace: Opportunities for improvement. Tobacco Control, 20 (4), 305–308. doi: 10.1136/tc.2010.041038.CrossRefGoogle ScholarPubMed
Hyland, A., Barnoya, J., & Corral, J.E. (2012). Smoke-free air policies: Past, present and future. Tobacco Control, 21 (2), 154–161. doi: 10.1136/tobaccocontrol-2011-050389.Google Scholar
Jahnke, S.A., Haddock, C.K., Poston, W.S., Hyder, M.L., & Lando, H. (2011a). A national survey of cigarette prices at military retail outlets. JAMA, 306 (22), 2456–2457. doi: 10.1001/jama.2011.1774.Google Scholar
Jahnke, S.A., Hoffman, K.M., Haddock, C.K., Long, M.A., Williams, L.N., Lando, H.A. et al. (2011b). Military tobacco policies: The good, the bad, and the ugly. Military Medicine, 176 (12), 1382–1387.CrossRefGoogle ScholarPubMed
Kirst, M., Mecredy, G., Borland, T., & Chaiton, M. (2014). Predictors of substance use among young adults transitioning away from high school: A narrative review. Substance Use and Misuse, 49 (13), 1795–1807. doi: 10.3109/10826084.2014.933240.Google Scholar
La Torre, G. (2013). Is there an emergency of tobacco smoking among health professionals in the European region? European Journal of Public Health, 23 (2), 189–190. doi: 10.1093/eurpub/ckt002.CrossRefGoogle ScholarPubMed
Lee, J.G., Goldstein, A.O., Kramer, K.D., Steiner, J., Mathew, M., Ezzell, M.M. et al. (2010). Statewide diffusion of 100% tobacco-free college and university policies. Tobacco Control, 19 (4), 311–317. doi: 10.1136/tc.2009.032888.CrossRefGoogle ScholarPubMed
Lightwood, J., & Glantz, S.A. (2013). The effect of the California tobacco control program on smoking prevalence, cigarette consumption, and healthcare costs: 1989–2008. PLoS One, 8 (2), e47145. doi: 10.1371/journal.pone.0047145.CrossRefGoogle ScholarPubMed
Maguire, R.L., Brinkley, J., & Mansfield, C. (2010). Attitudes toward smoking restrictions in work sites, restaurants, and bars among North Carolinians. North Carolina Medical Journal, 71 (6), 511–518.CrossRefGoogle ScholarPubMed
Martinez-Sanchez, J.M., Blanch, C., Fu, M., Gallus, S., La Vecchia, C., & Fernandez, E. (2014). Do smoke-free policies in work and public places increase smoking in private venues? Tobacco Control, 23 (3), 204–207. doi: 10.1136/tobaccocontrol-2012-050877.Google Scholar
McGoldrick, D.E., & Boonn, A.V. (2010). Public policy to maximize tobacco cessation. American Journal of Preventive Medicine, 38 (3 Suppl), S327–S332. doi: 10.1016/j.amepre.2009.11.017.CrossRefGoogle ScholarPubMed
Nagelhout, G.E., Zhuang, Y.L., Gamst, A., & Zhu, S.H. (2014). Do smokers support smoke-free laws to help themselves quit smoking? Findings from a longitudinal study. Tobacco Control, 24 (3), 233–237. doi: 10.1136/tobaccocontrol-2013-051255.Google Scholar
O'Donnell, P.K. (2006). We were one: Shoulder to shoulder with the Marines who took fallujah. Cambridge: Da Capo Press.Google Scholar
Offen, N., Arvey, S.R., Smith, E.A., & Malone, R.E. (2011). Forcing the Navy to sell cigarettes on ships: How the tobacco industry and politicians torpedoed Navy tobacco control. American Journal of Public Health, 101 (3), 404–411. doi: 10.2105/ajph.2010.196329.Google Scholar
Offen, N., Smith, E.A., & Malone, R.E. (2013). ‘They're going to die anyway’: Smoking shelters at veterans’ facilities. American Journal of Public Health, 103 (4), 604–612. doi: 10.2105/ajph.2012.301022.Google Scholar
Olmsted, K.L., Bray, R.M., Reyes-Guzman, C.M., Williams, J., & Kruger, H. (2011). Overlap in use of different types of tobacco among active duty military personnel. Nicotine & Tobacco Research, 13 (8), 691–698. doi: 10.1093/ntr/ntr060.Google Scholar
Sarna, L., Bialous, S.A., Nandy, K., Antonio, A.L., & Yang, Q. (2014). Changes in smoking prevalences among health care professionals from 2003 to 2010–2011. JAMA, 311 (2), 197–199. doi: 10.1001/jama.2013.284871.CrossRefGoogle ScholarPubMed
Satterlund, T.D., Cassady, D., Treiber, J., & Lemp, C. (2011). Strategies implemented by 20 local tobacco control agencies to promote smoke-free recreation areas, California, 2004–2007. Preventing Chronic Disease, 8 (5), A111.Google Scholar
Schall, J.D. (2005). Decision making. Current Biology, 15 (1), R9–R11. doi: 10.1016/j.cub.2004.12.009.Google Scholar
Shahbazi, S., Arif, A.A., Portwood, S.G., & Thompson, M.E. (2014). Risk factors of smoking among health care professionals. Journal of Primary Care & Community Health, 5 (4), 228–233. doi: 10.1177/2150131914527618.Google Scholar
Smith, B., Ryan, M.A., Wingard, D.L., Patterson, T.L., Slymen, D.J., & Macera, C.A. (2008). Cigarette smoking and military deployment: A prospective evaluation. American Journal of Preventive Medicine, 35 (6), 539–546. doi: 10.1016/j.amepre.2008.07.009.CrossRefGoogle ScholarPubMed
Smith, E.A., Jahnke, S.A., Poston, W.S., Williams, L.N., Haddock, C.K., Schroeder, S.A. et al. (2014). Is it time for a tobacco-free military? New England Journal of Medicine, 371 (7), 589–591. doi: 10.1056/NEJMp1405976.Google Scholar
Smith, E.A., & Malone, R.E. (2012). Why strong tobacco control measures ‘can't’ be implemented in the U.S. Military: A qualitative analysis. Military Medicine, 177 (10), 1202–1207.Google Scholar
Smith, E.A., & Malone, R.E. (2013). Military exceptionalism or tobacco exceptionalism: How civilian health leaders’ beliefs may impede military tobacco control efforts. American Journal of Public Health, 103 (4), 599–604. doi: 10.2105/ajph.2012.301041.CrossRefGoogle ScholarPubMed
Song, A.V., Brown, P., & Glantz, S.A. (2014). When health policy and empirical evidence collide: The case of cigarette package warning labels and economic consumer surplus. American Journal of Public Health, 104 (2), e42–e51. doi: 10.2105/ajph.2013.301737.Google Scholar
Unrod, M., Oliver, J.A., Heckman, B.W., Simmons, V.N., & Brandon, T.H. (2012). Outdoor smoking ban at a cancer center: Attitudes and smoking behavior among employees and patients. Journal of Public Health Management and Practice, 18 (5), E24–E31. doi: 10.1097/PHH.0b013e31822d4bb5.Google Scholar
US Centers for Disease Control. (2011a). Current cigarette smoking prevalence among working adults–United States, 2004–2010. MMWR. Morbidity and Mortality Weekly Report, 60 (38), 1305–1309.Google Scholar
US Centers for Disease Control. (2011b). State smoke-free laws for worksites, restaurants, and bars–United States, 2000–2010. MMWR. Morbidity and Mortality Weekly Report, 60 (15), 472–475.Google Scholar
US Department of Defense. (2009). 2008 Health related behaviors survey of active duty military personnel. Falls Church: TRICARE Management Activity.Google Scholar
US Department of Defense. (2013). 2011 Health related behaviors survey of active duty military personnel. Falls Church, VA: TRICARE Management Activity.Google Scholar
US Department of Defense, & Office of the Chief of Naval Operations. (2010). OPNAVINST 1414.4c, ‘Navy enlisted fleet marine force warfare specialist qualification program’. Washington, DC.Google Scholar
US Department of Defense, & Office of the Navy Surgeon General. (2012). BUMEDINST 6200.12a ‘Comprehensive tobacco control for navy medicine’. Falls Church, VA.Google Scholar
US Department of Defense, & Secretary of the Navy. (2008). SECNAVINST 5100. 13E ‘Navy and marine corps tobacco policy’. Washington, DC.Google Scholar
US Institute of Medicine. (2009). Combating Tobacco use in Military and Veteran Populations. Washington, DC: The National Academies Press.Google Scholar
US Naval Hospital Camp Pendleton. (2011). NHCPINST 5100.1L, ‘Smoking and tobacco use regulations’. Camp Pendleton, CA.Google Scholar
Warner, K.E. (2011). Disparities in smoking are complicated and consequential. What to do about them? American Journal of Health Promotion, 25 (5 Suppl), S5–S7. doi: 10.4278/ajhp.25.5.c3.Google Scholar
Warner, K.E., & Mendez, D. (2010). Tobacco control policy in developed countries: Yesterday, today, and tomorrow. Nicotine & Tobacco Research, 12 (9), 876–887. doi: 10.1093/ntr/ntq125.Google Scholar
Zablocki, R.W., Edland, S.D., Myers, M.G., Strong, D.R., Hofstetter, C.R., & Al-Delaimy, W.K. (2014). Smoking ban policies and their influence on smoking behaviors among current California smokers: A population-based study. Preventive Medicine, 59, 73–78. doi: 10.1016/j.ypmed.2013.11.018.Google Scholar