Original ResearchUnderstanding the needs of smokers who work as routine and manual workers on building sites: Results from a qualitative study on workplace smoking cessation
Introduction
Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in Western Europe, and is one of the most significant contributing factors to inequalities in health, life expectancy and ill health – especially cancer, coronary heart disease and respiratory disease.1, 2, 3 Moreover, there is now a substantial body of evidence demonstrating a socio-economic gradient between cigarette smoking and social disadvantage.4 Individuals in routine and manual (R/M) groupings (positions with a basic labour contract, in which employees are engaged in routine occupations). These groupings are characterized as having lower incomes than the national average, and usually living in areas of social deprivation are far more likely to smoke and less likely to become ex-smokers.3, 5, 6, 7 Smoking prevalence is twice as common in R/M households as it is in ‘managerial and professional’ households (28% vs 13%).4, 8 Furthermore, R/M smokers are more likely to have started smoking before 16 years of age (48% vs 33% for managerial and professional groups), and are more likely to be heavily addicted to smoking, with 37% of male R/M smokers having their first cigarette within 5 min of waking.2 Consequently, smoking plays a significant role in contributing to health inequalities between socio-economic groups both in the UK and internationally, and accounts for up to half of the entire mortality differential between manual and non-manual groups.2, 9
Given that most adults spend approximately one-third of their day in a workplace environment, the workplace can be a useful setting through which large groups of employees can be reached by public health and health promotion initiatives.10, 11, 12, 13, 14, 15 Indeed, since the World Health Organization's Ottawa Charter, settings such as workplaces, hospitals and schools have been used successfully to engage with specific target groups, including those deemed to be particularly ‘hard-to-reach’ such as R/M smokers, young people, injecting drug users, etc.16, 17, 18, 19 A systematic review of workplace interventions for smoking cessation by Cahill et al. draws attention to a number of potential benefits of initiatives based in such settings.6 These include attracting people less likely to seek advice (especially men)20, 21; encouraging peer group support and positive peer pressure; offering supportive structures such as the inclusion of occupational health staff in the workplace who may be on hand to give professional support; and provision of a convenient and accessible service (to a ‘captive audience’) as the employee is generally not required to travel to the programme.6 In addition to the benefits for employees, there are also a number of potential advantages from the employers' perspectives, mainly oriented around reducing loss of productivity.22, 23, 24
Despite the rationale and potential benefits for workplace-based smoking cessation programmes from a public health and/or health promotion perspective, there are few studies in the literature that are directly relevant to the contemporary UK context,25, 26 with most evidence stemming from the USA11, 12, 14, 15, 20, 23, 27, 28, 29, 30 or elsewhere.31, 32, 33, 34, 35, 36 Arguably, such US-based studies do not tend to reflect the contemporary trends and attitudes to smoking, nor the landmark legislative and public health policy changes that have occurred in the last decade in Europe and the UK. Furthermore, there is little evidence in the wider literature upon which to develop workplace strategies that are targeted specifically towards particular groups such as R/M workers and (in the case of the present study) construction workers. This has partly been a product of R/M construction workers presenting a ‘hard-to-reach’ sample, given their transient and often unsociable working hours, short-term contract arrangements and minimal spare time to participate in research.
In view of the above, the aims of this study were: (1) to gain insight into the beliefs, behaviours and cessation needs of R/M smokers to inform the development of a dedicated work-based smoking cessation service; and (2) to assess employers' perceptions and commitment towards such a service.
Section snippets
Design and sample
A qualitative research design was utilized including focus group discussions with R/M smokers working on two large construction sites in the London Borough of Tower Hamlets (Whitechapel and Canary Wharf), as well as individual interviews with the managers of the R/M smokers.
Given the ‘hard-to-reach’ sample, participants were recruited by diverse strategies in collaboration with National Health Service (NHS) Tower Hamlets, including working with the local authority and local cancer prevention
Motivations for smoking
Employees reported five main reasons for smoking continuance: enjoyment and the physical effects, habit and routine, boredom, opportunity to smoke and the social benefits including the influence of peers. These motivations are illustrated in turn.
Enjoyment of smoking, including the perceived physical benefits (e.g. ‘hit’ of nicotine, associated feelings of relaxation), as well as a positive adjunct to food or drinks including alcohol, was reported to be an important contributory factor in
Discussion
Although the rationale and potential benefits for targeted workplace-based smoking cessation services are well understood, this study is among the first in the UK context to explore how such work-based health promotion initiatives are perceived by ‘hard-to-reach’ R/M employees working on construction sites. It is likely to be the case that there are few equivalent studies outside of the USA, and thus the implications of this study may well extend to an international audience. A number of
Conclusion
This study showed that the development and implementation of work-based public health initiatives such as smoking cessation services are perceived positively by R/M employees working on construction sites and their employees. However, the milieu of construction work sites differs considerably, meaning tailored approaches to work-based smoking cessation programmes are likely to be needed to maximize potential benefits for employees and employers. Moreover, reconsideration of current Smokefree
Acknowledgements
The authors wish to thank the study participants and Paul Evans from the Roy Castle Lung Cancer Foundation. The authors also wish to thank Camille Gillmer, Rowena Merritt and Helen Spence for their support, expertise and guidance. Finally, the authors wish to thank the two reviewers for their helpful comments on an earlier version of this article.
References (52)
- et al.
Hypnosis and behavioral treatment in a worksite smoking cessation program
Addict Behav
(1986) - et al.
Randomized controlled trial of relapse prevention and a standard behavioural intervention with adult smokers
Addict Behav
(2006) - et al.
The effectiveness of NHS smoking cessation services: a systematic review
J Public Health
(2009) Tackling health inequalities: targeting routine and manual smokers in support of the public service agreement smoking prevalence and health inequality targets
(2009)- et al.
Barriers and motivators to gaining access to smoking cessation services amongst deprived smokers: a qualitative study
BMC Health Serv Res
(2006) General lifestyle survey overview: a report on the 2010 general lifestyle survey
(2012)- et al.
Leading the way: smoking cessation services in health action zones
(2000) - et al.
Workplace interventions for smoking cessation
Cochrane Database Syst Rev
(2008) - et al.
Explaining the social gradient in smoking cessation: it's not in the trying, but in the succeeding
Tob Control
(2009) Health survey for England 2009: health and lifestyles
(2010)