Healthcare provider smoking cessation advice among US worker groups

Our plain-English summary of Healthcare provider smoking cessation advice among US worker groups, by D.J. Lee, L.E. Fleming, K.E. McCollister, et al (Tobacco Control, 2007).

The study

• Authors: D.J. Lee, L.E. Fleming, K.E. McCollister, A.J. Caban, K.L. Arheart, W.G. LeBlanc, K. Chung-Bridges, S.L. Christ, N. Dietz, J.D. Clark
• Journal: Tobacco Control
• Published: 2007;16(5):325-8
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: Among workers in dusty occupations, tobacco use is particularly detrimental to health because of the potential synergistic effects of occupational exposures (for example, asbestos) in causing disease. This study explored the prevalence of smoking and the reported smoking cessation discussion with a primary healthcare provider (HCP) among a representative sample of currently employed US worker groups.

Methods: Pooled data from the 1997-2003 National Health Interview Survey (NHIS) were used to estimate occupation specific smoking rates (n = 135,412). The 2000 NHIS Cancer Control Module was used to determine (among employed smokers with HCP visits) the prevalence of being advised to quit smoking by occupation (n = 3454).

Results: The average annual prevalence of current smoking was 25% in all workers. In 2000, 84% of smokers reported visiting an HCP during the past 12 months; 53% reported being advised by their physician to quit smoking (range 42%-66% among 30 occupations). However, an estimated 10.5 million smokers were not advised to quit smoking by their HCP. Workers with potentially increased occupational exposure to dusty work environments (including asbestos, silica, particulates, etc), at high risk for occupational lung disease and with high smoking prevalence, had relatively low reported discussions with an HCP about smoking cessation, including farm workers (30% overall smoking prevalence; 42% told to quit), construction and extractive trades (39%; 46%), and machine operators/tenderers (34%; 44%).

Conclusion: The relatively low reported prevalence of HCP initiated smoking cessation discussion, particularly among currently employed workers with potentially synergistic occupational exposures and high current smoking prevalence, needs to be addressed through educational campaigns targeting physicians and other HCPs.

In plain English

Using the US National Health Interview Survey, pooled 1997–2003 data (n = 135 412) gave smoking rates for 41 standard occupational categories. In 2000 (n = 3454), employed smokers with a healthcare provider visit in the past 12 months reported whether they were advised to quit. Exposures, including asbestos, were not measured; the authors flagged 13 of 41 occupations as known higher-risk for dust exposure and lung disease. About 25% of workers smoked. Of working smokers seen by a provider, 53% reported being told to quit (42% to 66% by occupation); an estimated 10.5 million did not report being advised. Dusty-work groups with high smoking often had below-average advice: farm workers (30% smoked; 42% told to quit), construction and extractive trades (39%; 46%), machine operators/tenderers (34%; 44%). Workers with more than high school education more often reported advice than those with less (odds ratio 1.30, 95% confidence interval 1.03 to 1.62). Occupation was generally not significant after adjusting for education. The authors called for educational campaigns targeting healthcare providers. They cautioned that occupation and education were correlated and that smokers may under-report advice.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional analysis of a national household survey (US National Health Interview Survey), with pooled 1997–2003 data for smoking rates and the 2000 Cancer Control Module for advice to quit; logistic regression adjusted for education
• Who was studied: Currently employed US workers in 41 standardised occupational categories. Smoking rates came from 1997–2003 pooled data (n = 135 412), representing an estimated 126.4 million US workers annually. Advice to quit came from employed smokers in the 2000 survey who reported a healthcare visit in the previous 12 months (n = 3454).
• Exposure: Occupation, in 41 standardised categories derived from US census occupational codes. The authors identified 13 of these occupations as having a known higher risk of occupational dust exposure (asbestos, silica, bio-aerosols and others) and lung disease, citing a NIOSH surveillance report. No exposures were measured.
• Main results:
  • Average annual prevalence of current smoking was 25% in all workers (24.8% in table 1), ranging from 39% in forestry and fishing occupations to 5% in health diagnosing workers
  • Among workers who were current smokers in the 2000 survey, 53% were told by their healthcare provider to stop smoking (range 42%–66% across occupations); 84% of all workers reported visiting a provider in the past 12 months
  • An estimated 10.5 million US workers who smoked and saw a provider in 2000 did not report being advised to quit
  • Farm workers: 30% smoking prevalence, 42% told to quit. Construction and extractive trades: 39% and 46%.
  • Machine operators/tenderers: 34% smoking prevalence, 44% told to quit
  • Of the 41 occupations, 13 were considered to have a known higher risk of occupational dust exposure and lung disease. All but one of these (farm operators and managers) were among the 13 occupations with the highest smoking rates.
  • Workers with more than a high school education were more likely to report receiving smoking cessation advice than workers with less education (odds ratio 1.30; 95% confidence interval 1.03 to 1.62). There was no difference between high school graduates and those with less than high school.
  • After adjustment for education, food service workers were less likely to report quit advice than all other workers (0.68 (0.49 to 0.94))
  • After adjustment for education, health service workers (1.78 (1.17 to 2.71)) and other administrative support workers (1.42 (1.07 to 1.88)) were more likely to report receiving advice
  • In multivariable models, occupational classification was generally not significant
  • Among smokers reporting only primary care physician and/or obstetrics/gynaecology contacts, 53% reported being advised to quit (worker group range 41%–66%)
• The authors' conclusion: The authors concluded that the relatively low reported prevalence of provider-initiated smoking cessation discussion needs to be addressed through educational campaigns targeting physicians and other healthcare providers. They said this applies particularly to workers with potentially synergistic occupational exposures and high smoking prevalence.
• Limitations the authors state:
  • The multivariable results should be interpreted with caution because occupation and education are correlated and sample sizes differ across occupation groups
  • Smokers may tend to under-report advice to quit smoking
  • Advice-to-quit estimates were not reported for some occupations because of small sample size

Topics

Medical terms in this study, explained in our Lexicon: Synergistic Effect, Occupational Exposure, Occupational Lung Disease.

Related studies

• Effectiveness of smoking cessation advice for asbestos workers — A. Johnson, P. Farrow, et al. (2006)
• Effectiveness of postal smoking cessation advice: a randomized controlled trial in young men with reduced FEV1 and asbestos exposure — S. Humerfelt, G.E. Eide, et al. (1998)
• A pilot study of telephone-based smoking cessation intervention in asbestos workers — O.Y. Osinubi, J. Moline, et al. (2003)
• Health promotion: Smoking control — (1983)
• Study of smoking behavior in asbestos workers — O.Y. Osinubi, A.A. Afilaka, et al. (2002)
• Protest and survive, the U.K. Construction Safety Campaign: a case study of workers' and victims' family action and legal and regulatory inaction on construction health and safety — M. Holder, T. O'Brien (2007)

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