Benefit in Stop-Smoking Programs Targeted for Working-Class Groups

Newswise — A study by researchers at Dana-Farber Cancer Institute suggests that a person's occupation is a distinct and significant factor - in addition to education, income, race/ethnicity, and gender - in determining which groups of adults bear the greatest burden of smoking, and which may especially benefit from smoking-cessation efforts. The findings are published in today's issue of the American Journal of Public Health.

In a companion study in the same issue, a Dana-Farber team describes one of the first worksite programs to successfully reduce smoking rates among blue-collar workers.

The first study used data from the 2000 National Health Interview Survey (NHIS), which collected health information from more than 100,000 people, to compare smoking rates in different population groups. The researchers found that among both whites and blacks, smoking rates are highest among those in working-class, non-supervisory occupations, including blue-collar and service jobs, and those with less education and lower income. A similar socioeconomic pattern occurred among Hispanic and Asian groups, and less so among American Indian/Alaska Natives, though the small numbers of these groups in the study may limit interpretation of the findings. In all socioeconomic groups, men were more likely to smoke than women.

"Among adults, occupation is a useful category for understanding where the risk of smoking falls heaviest," says the study's lead author, Elizabeth Barbeau, ScD, MPH, of Dana-Farber. "It's clear that smoking is more prevalent among working-class compared to supervisory and professional occupations in all racial and ethnic groups. This finding underscores the need to consider occupational class along with race/ethnicity, gender, education, and income in setting priorities for smoking-cessation programs."

Moreover, the researchers found, while smokers in all socioeconomic groups try to quit the habit at about the same rate, people in supervisory and professional occupations, and those with more education and higher incomes, tended to be more able to quit than those with fewer socioeconomic resources. This was true across all racial/ethnic groups and both genders.

"These results suggest that stop-smoking programs should increase efforts to reach out to people in the working class, including those in blue-collar and service jobs," Barbeau remarks. The group she and her colleagues have identified as being most likely to smoke is significant. Working-class adults, both white and of color, who have less than a college degree, and are poor or near-poor comprise nearly three-quarters of the entire U.S. population.

"Our aim is to draw attention to groups who continue to be unduly burdened by smoking and who could benefit from programs geared to their needs," Barbeau says. "Failing to do so will result in widening gaps in smoking among socioeocnomic groups."

One program that has identified ways to reduce the gap between smoking among white- and blue-collar workers is the subject of the second Dana-Farber-led study in the new issue of the AJPH.

The program, which was tested among workers at 15 manufacturing firms in Eastern Massachusetts, differed from previous smoking-cessation efforts in that it ran in tandem with a broader initiative in occupational health and safety. The combination may have made the critical difference in the program's effectiveness, researchers say.

In the study, investigators randomly assigned the participating companies to one of two groups: those where health-promotion activities such as smoking cessation and healthy eating would be offered on a stand-alone basis, and those where such activities would be integrated into occupational health and safety efforts.

At the end of two years, investigators found that smoking quit rates among blue-collar workers in the second group of companies were more than twice that of their counterparts in the first group " and essentially the same as the quit rates of white-collar workers.

"To our knowledge, this is the first smoking-cessation program that has produced markedly high rates of quitting smoking among blue-collar workers when tested in the workplace," says lead author Glorian Sorensen, PhD, MPH. "It offers real encouragement that similar programs could be effective on a broad scale."

Investigators point to several possible reasons why the combined approach was successful. One is that blue-collar workers may see job-related hazards as a greater threat to their health than smoking or bad nutrition. As a result, tying stop-smoking and healthy-eating programs into occupational safety efforts may help motivate workers to take action on both fronts, Sorensen suggests.

In addition, the combined approach "conveys a sense that company management shares workers' concerns about their health and is willing to do its part to help workers lead healthier lives," Sorensen states. "It addresses the broader priorities and concerns that workers have about their health."

Dana-Farber Cancer Institute is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.